Remineralization potential after a single application of silver diamine fluoride and casein phosphopeptide-amorphous calcium phosphate fluoride on demineralized dentin

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• Picked for Histology (top studies of the week, 30 August 2026): Remineralization of demineralized dentin, SEM analysis
• Picked for Medical Physics (top studies of the week, 30 August 2026).

Abstract

BACKGROUND: Non-invasive treatment involves the use of various remineralizing and cariostatic agents, including sodium fluoride, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), silver nitrate, and silver diamine fluoride (SDF). OBJECTIVES: The purpose of the present study was to evaluate the surface morphology and mineral uptake of demineralized dentin following a single application of SDF and CPP-ACPF. MATERIAL AND METHODS: Twenty-four caries-free premolar sections with marked areas of specific dimensions on the dentin surface were exposed to a demineralizing solution for 96 h and randomly allocated to 2 groups: group 1 (SDF); and group 2 (CPP-ACPF). Surface morphology was analyzed using scanning electron microscopy (SEM), while mineral uptake was assessed using energy-dispersive X-ray spectroscopy (EDX) following demineralization and the application of the test agents. Paired and unpaired t tests were used to analyze the continuous data. RESULTS: The EDX revealed a difference in the mean increase in the calcium(Ca)/phosphorus (P) ratio between the SDF group (0.34 ±0.92) and the CPP-ACPF group (0.01 ±0.22); however, this difference was not statistically significant (p = 0.400). In contrast, the mean increase in fluoride uptake was significantly higher in the SDF group (2.07 ±0.66 at%) than in the CPP-ACPF group (0.37 ±0.38 at%) (p = 0.001). The SEM images showed dense, granular structures in the intertubular areas, with partial occlusion of the dentinal tubules in the SDF group, whereas the CPP-ACPF group exhibited mineral deposits partially occluding the dentinal tubules, with non-homogeneous sediment formation. CONCLUSIONS: A single application of both SDF and CPP-ACPF demonstrated potential to promote mineral uptake in demineralized dentin, with comparable effects on calcium and phosphate incorporation. However, SDF showed a greater capacity for fluoride uptake and produced a denser, more compact surface morphology, whereas CPP-ACPF resulted in a more porous mineral deposition pattern. Overall, both agents demonstrated remineralization potential, although their effects on the mineral composition and surface characteristics of demineralized dentin differed.

Abstract as published, via PubMed.