Health scinces bangalore, karnataka. Master of dental surgery



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RAJIV GANDHI UNIVERSITY OF

HEALTH SCINCES

BANGALORE, KARNATAKA.

MASTER OF DENTAL SURGERY (M.D.S.)

DEPARTMENT OF PEDODONTICS AND

PREVENTIVE DENTISTRY
2012-2015

A.E.C.S. MAARUTI COLLEGE OF DENTAL

SCIENCES & RESEARCH CENTRE,

BANGALORE.

RAJIV GANDHI UNIVERSITY OF HEALTH SCINCES

BANGALORE, KARNATAKA.

ANNEXURE-II


SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION



NAME OF THE CANDIDATE AND ADDRESS


DR.GEETHA C P
POST GRADUATE STUDENT

DEPT. OF PEDODONTICS AND PREVENTIVE DENTISTRY

A.E.C.S. MAARUTI COLLEGE OF DENTAL SCIENCES

& RESEARCH CENTRE,

NO. 108, TANK BUND ROAD, HULIMAVU, BANGALORE-

560 076.

NAME OF THE INSTITUTION


A.E.C.S. MAARUTI COLLEGE OF DENTAL SCIENCES

& RESEARCH CENTRE, BANGALORE.

COURSE OF THE STUDY AND SUBJECT


MASTER OF DENTAL SURGERY (MDS)

PEDODONTICS AND PREVENTIVE DENTISTRY

DATE OF ADMISSION TO THE COURSE



31st May 2012

TITLE OF THE TOPIC


CLINICAL EVALUATION AND COMPARISON OF SILVER DIAMINE FLUORIDE AS A CARIES ARRESTING AGENT IN PRIMARY TEETH


  1. BRIEF RESUME OF THE INTENDED WORK



6.1 NEED FOR STUDY

Dental caries is one of the most prevalent chronic diseases affecting children and adults across the globe that can be both treated and prevented1. There is a transition towards minimally invasive restorative techniques in restorative dentistry based upon reducing bacterial viability and encouraging remineralization of caries infected tissue. Glass ionomer cements,varnishes, resin modified glass ionomer cements and compomers are available with varying quantities of fluoride and fluoride release rates as well as different

clinical success values2
Silver diamine fluoride (SDF) has also been used as a cariostatic agent3. Application of silver diamine fluoride is simple and non invasive. SDF helps in the deposition of silver phosphate to restore mineral content, resulting in rehardening of tooth structure. It also releases fluoride. Cariostatic action is obtained by the stimulation of dentin sclerosis, not allowing the progress of dental decay 4,5. Antimicrobial action is due to its action over Streptococcus Mutans6.
Glass ionomer has also been used as a material for placement of dental restorations and is known to release fluoride, which can help to remineralize the carious lesion7. There are not many invivo studies to compare the caries arresting property of different concentrations of silver diamine fluoride and glass ionomer. This study aims to compare the effect of silver diamine fluoride (at different concentrations) and glass ionomer in arresting dentine caries in primary teeth.
6.2 REVIEW OF LITERATURE

1. A prospective controlled clinical trial was conducted on the efficacy of 38% SDF solution for caries reduction. Four hundred and twenty-five six-year-old children were divided into two groups: One group received SDF solution in primary canines and molars and first permanent molars every 6 months for 36 months. The second group served as controls. The 36-month follow-up was done on 373 children. The mean number of new decayed surfaces appearing in primary teeth during the study was 0.29 in the SDF group vs. 1.43 in controls. The mean of new decayed surfaces in first permanent molars was 0.37 in the SDF group vs. 1.06 in controls. The study concluded that SDF solution is effective for caries reduction in primary teeth and first permanent molars 3.


2. Randomized clinical trial was done on 976 Nepalese schoolchildren to investigate the caries-arresting effectiveness of a

(1) 38% silver diamine fluoride (SDF) with tannic acid as a reducing agent

(2) 38% SDF alone

(3) 12% SDF alone and

(4) Control group with no application

At 6, 12, and 24 months, the mean number of arrested carious surfaces was significantly higher in the two groups treated with 38% SDF than in the 12% SDF and control groups. The difference observed at 6 months decreased over 24 months, but remained statistically significant. There was no significant difference in the mean number of arrested carious surfaces between the 38% SDF and the 38% SDF + tannic acid groups, or between the 12% SDF and the control groups throughout the 24-month study period. There was also no significant difference between the groups in the mean number of non-vital teeth and the mean number of exfoliated surfaces at any time.4


3. Glass ionomer and silver diamine fluoride were evaluated and compared to calcium hydroxide for their anti microbial efficacy and re-mineralizing potential. Dentin disks prepared from 45 freshly extracted first premolars were divided into three groups (n = 15). Each disk was cut into two equal parts, in which one half formed the control. Thirty dentin samples were used for ion estimation and the other 15 for microhardness testing. Atomic absorption spectrophotometry, colorimetric and potentiometric titration analyses were performed for calcium, phosphate and fluoride ion detection, respectively. The antimicrobial efficacy was analyzed using pure culture of Streptococcus mutans and mixed flora.The results of mineral content analysis in this study indicate that almost equivalent rise in the percentage of calcium ions was seen in GC VII and Ca(OH)2 group, followed by SDF group. Highest percentage of rise in phosphate ions was seen in GC VII group followed by SDF and Ca(OH)2 groups. Highest increase in fluoride ions was seen in GC VII, followed by SDF and Ca(OH)2 groups. The results indicated that both GC VII and SDF can be used as potential substitutes to Ca(OH)2 for indirect pulp capping. 5
4. Thirty-two artificially demineralized human dentine blocks were equally divided with S. mutans and A. naeslundii. Either SDF or water was applied to eight blocks in each group. Biofilm morphology, microbial kinetics and viability were evaluated by scanning electron microscopy, colony forming units, and confocal microscopy. The cross section of the dentine carious lesions were assessed by microhardness testing, scanning electron microscopy with energy-dispersive x-ray spectroscopy and Fourier transform infrared spectroscopy. Biofilm counts were reduced in SDF group than control. Surfaces of carious lesions were harder after SDF application than after water application, in S. mutans group, Ca and P weight percentage after SDF application than after water application. Lesions showed a significantly reduced level of matrix to phosphate after SDF treatment. Study showed that SDF posses an anti-microbial activity against cariogenic biofilm of S. mutans or A. naeslundii formed on dentine surfaces. SDF slowed down demineralization of dentin6.
5. A study was done to compare the effectiveness of annual topical application of silver diamine fluoride (SDF) solution, semi-annual topical application of SDF solution, and annual applicationof a flowable high fluoride-releasing glass ionomer in arresting active dentine caries in primary teeth. A total of 212 children, aged 3–4 years, were randomly allocated to one of three groups for treatment of carious dentine cavities in their primary teeth: Gp1-annual application of SDF, Gp2-semi-annual application of SDF, and Gp3-annual application of glass ionomer. Follow-up examinations were carried out every six months to assess whether the treated caries lesions had become arrested. After 24 months, 181 (85%) children remained in the study. The caries arrest rates were 79%, 91% and 82% for Gp1, Gp2 and Gp3, respectively ( p =0.007).Annual application of either SDF solution or high fluoride-releasing glass ionomer can arrest active dentine caries. Increasing the frequency of application to every 6 months can increase the caries arrest rate of SDF application7.
6.3 OBJECTIVES OF THE STUDY

Clinical and microbiological evaluation of 38% silver diamine fluoride as a caries arresting agent in primary teeth.

Clinical and microbiological evaluation of 12% silver diamine fluoride as a caries arresting agent in primary teeth.

Clinical and microbiological evaluation of low viscosity high fluoride releasing glass ionomer as a caries arresting agent in primary teeth.

Clinical and microbiological evaluation & comparison of 38% and 12% of silver diamine fluoride and low viscosity high fluoride releasing glass ionomer as a caries arresting agent in primary teeth.

  1. MATERIALS AND METHODS




7.1 SOURCE OF DATA

The study will be conducted on 75 primary molar teeth in patients aged between 5-9 years of age visiting the Department of Pedodontics and Preventive Dentistry at A.E.C.S Maaruti College of Dental Sciences and Research Center, Bangalore.

A study performa will be designed which will include demographic details, chief complaint and recording of all the subjective and objective symptoms, radiographic findings and the follow-up recordings.
INCLUSION CRITERIA

1. Healthy cooperative children of 5-9 years

2. No history of spontaneous pain

3. Distinct occlusal cavity with visible dentin (ICDAS II code 5)

4. Children with prior parent consent.

5. Teeth with atleast 2/3rd root present.


EXCLUSION CRITERIA

1. History of pain

2. Pain on percussion or palpation

3. Presence of swelling/fistula near the carious tooth

4. Radiographic evidence of any pathology.

5. Premature hyper mobility of teeth.

6.Inter radicular bone loss.
MATERIALS REQUIRED

1. Silver Diamine fluoride 38% (Saforide , J. Morita Corporation. Osaka, Japan)

2. Silver Diamine Fluorde 12% (Cariestop – Biodinamica)

3. Low viscosity high fluoride releasing glass ionomer cement (fuji VII)

4. Reinforced zinc oxide-eugenol(IRM® DENTSPLY)

5. Highly viscous, condensable glass ionomer ( Fuji IX)

6. Mouth mirror

7. Explorer and Tweezers

8. Suction tips

9. Gloves

10. Mouth mask

11. Dapen dish

12. Cotton rolls and pellets

13. Spoon Excavators (No.5 &18)

14. GC Dentin Conditioner

15. Plastic/Agate spatula

16. Plastic filling instrument

17. Viva brush applicator (Ivoclar Vivadent)

18. Articulating paper

19. Aerotor and Contra angled Micromotor hand piece

20. Finishing burs
7.2 METHODOLOGY

Ninety (90) primary molar teeth will be selected by using the inclusion and exclusion criteria. Only occlusal surface of the primary molar teeth will be considered for the study. Status of the dentinal caries lesions will be assessed by visual inspection and aided by tactile detection using a sharp probe. Cavities with yellowish /brown rough wall or floor which can be easily penetrated by probe using a light force will be diagnosed as active.

Those with smooth hard surfaces which can not be penetrated will be classified as arrested. After thorough oral prophylaxis of both upper and lower arches isolation will be done using cotton roll .The first sample for microbial analysis will be collected with a sterile excavator from the center of demineralized lesion before starting the removal of caries and will be immediately transfer to the lab for culture.

The samples taken will be inoculated on to MS agar and Rogosa SL agar for selective isolation of Streptococcus mutans and Lactobacilli respectively. Total Viable Count (TVC) for all cultivable bacteria will be done. Microbial culture will be done aerobically and anaerobically and Colony Forming Unit counting will be calculated


Dentin excavation will be accomplished in circular scratching movements from the dentinoenamel junction to the cavity floor, using #5 or #18 spoon excavators according to the lesion size. Excavation will be completed when dentin at the cavity floor become resistant to probing, following the clinical criteria of hard texture.

Teeth selected will be randomly divided into 3 groups of 25 each.


GROUP 1: After drying the teeth with a cotton pellet, one drop of 38 % silver diamine fluoride will be taken in a plastic dappen dish and will be applied with a Viva brush applicator for 2 minutes
GROUP 2: Teeth that will be painted with silver diamine fluoride 12% following the same procedure of group 1.
GROUP 3: The cavity surfaces will be pre conditioned with the Fuji VII GC conditioner, and then it will be washed with a wet cotton pellet and will be allowed for drying. Then it will be painted with a low viscosity high fluoride releasing glass ionomer material (Fuji VII,GC corporation Japan) with vivabrush applicator. GC varnish will be applied as a protective coating.
All the three groups will be restored with reinforced zinc oxide eugenol (IRM® Dentsply). The children will be instructed not to eat or drink for atleast 1 hour.
The patients will be recalled after a period of 6 months for evaluation of the caries arresting property of different materials.
The restorative material will be removed first using smooth round burs at low speed and then using sterile excavator. A sample of dentin from the pulpal wall of the cavity just below the restoration will be taken under sterile conditions and will be immediately transferred to the laboratory for the microbiological evaluation for streptococcus mutans and lactobacilli.
Arrested caries will be restored with highly viscous condensable glass ionomer cement (Fuji IX). In case of caries progression the necessary treatment will be done accordingly.
The results will be tabulated and subjected to statistical analysis.
7.3 Does the study require any investigation or interventions to be conducted on patients or other human or animals? If so, please describe briefly.

Radiograph will be taken during the study.


7.4 Has the ethical clearance been obtained from your institution?

YES



8. LIST OF REFERENCES



8.1 JOURNAL REFERENCES

1. Alice Chen, Mary Cho, Sari Kichler, Jeffrey Lam, Anum Liaque, Sobia Sultan. Silver diamine fluoride: An alternative to topical fluorides. JCDA 2012 April;XX(X):1-14.
2. Arends J, Dijkman GE and Dijkman AG . Review of  fluoride release and secondary caries reduction by fluoridating composites. Adv Dent Res 1995 9: 367 – 370.
3. Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molar of schoolchildren:36-month clinical trial J Dent Res 2005 84(8):721-724.
4. Yee R, Holmgren C, Mulder J, Lama D, Walker D, Palenstein Helderman W. Efficacy of silver diamine fluoride for arresting caries treatment. J Dent Res 2009 88(7):644-647.
5. Gupta A, Sinha N, Logani A, Shah N. An ex vivo study to evaluate the remineralizing and antimicrobial efficacy of silver diamine fluoride and glass ionomer cement type VII for their proposed use as indirect pulp capping materials – Part I. J Conserv Dent. 2011 Apr-Jun;14(2): 113–116
6. Chun Hung Chu,Lei Mei, Seneviratne CJ, Man Lo EC. Effects of silver diamine fluoride on dentin carious lesions induced by streptococcus mutans and actinomyces naeslundii biofilm. International Journal of Paediatric Dentistry 2012 Jan;22(1):2–10.
7. Zhi QH, Chin Man Lo E , Lin HC. Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children Journal Of Dentistry.2012:(40):962-967.



9. SIGNATURE OF THE CANDIDATE






10. REMARKS OF THE GUIDE



This study is suitable for dissertation


11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)



11.1 GUIDE

11.2 SIGNATURE




DR. SAPNA KONDE, M.D.S.,

PROFESSOR AND HEAD,
DEPARTMENT OF PEDODONTIA & PREVENTIVE DENTISTRY

A.E.C.S. MAARUTI COLLEGE OF DENTAL SCIENCES & RESEARCH CENTRE.


11.3 CO-GUIDE IF ANY:

11.4 SIGNATURE


DR. KUMAR N C, M.D.S.,

ASSOCIATE PROFESSOR,
DEPARTMENT OF PEDODONTIA & PREVENTIVE DENTISTRY

A.E.C.S. MAARUTI COLLEGE OF DENTAL SCIENCES & RESEARCH CENTRE.


11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE


DR. SAPNA KONDE, M.D.S.,

PROFESSOR AND HEAD,
DEPARTMENT OF PEDODONTIA & PREVENTIVE DENTISTRY

A.E.C.S. MAARUTI COLLEGE OF DENTAL SCIENCES & RESEARCH CENTRE.


12. REMARKS OF THE CHAIRMAN AND PRINCIPAL

12.1 SIGNATURE OF THE CHAIRMAN AND PRINCIPAL











A.E.C.S. Maaruti College of Dental Sciences

and Research Center, Bangalore.

Department of Pedodontics and Preventive Dentistry
CONSENT FORM
I -------------------------------------- (name of the parent) hereby give my consent

to include my child ----------------------------------------------for the study being



conducted by Dr .Geetha C P, PG Student, Department Of Pedodontics and Preventive Dentistry, AECS Maaruti College of Dental Sciences and Research Center, Bangalore.
The above treatment procedure performed in the 6 months study has been explained to me.
Signature of Parent: Staff Signature:
Address:

Place:






ANNEXURE 1
PROFORMA

Patient’s name : Case No:
Age : Date :
Sex : O.P.No:
Father’s Name :
Occupation :
Address :
Telephone No. :
Significant Medical History :
Past Dental History :
Personal History :
Chief Compliant :
History of Presenting Illness:


HARD TISSUE EXAMINATION

1. Teeth Present: (FDI system):
2. DMFT/S or deft/s Index:
Score DMFT/S: Score deft/s:


OHIS Index

Debris Index (DI-S)











6

1

6











Score =





Calculus Index (CI-S)











6

1

6











Score =





OHI-S = DI-S +CI-S

Total score =





PROFORMA (CONTD)

Oral Hygiene Assessment :

Provisional diagnosis:

Investigations:


  1. Radiograph




  1. Vitality test




  1. Microbiological Evaluation


Final Diagnosis:

Treatment plan:

PROFORMA (CONTD)


ICDAS II codes and criteria


Code

Criterion


0

Sound tooth surface: no evidence of caries after 5 s air drying

1

First visual change in enamel: opacity or discoloration

(white or brown) is visible at the entrance to the pit or fissure

seen after prolonged air drying


2

Distinct visual change in enamel visible when wet, lesion

must be visible when dry




3

Localized enamel breakdown (without clinical visual

signs of dentinal involvement) seen when wet and after



prolonged drying


4

Underlying dark shadow from dentine

5

Distinct cavity with visible dentine

6

Extensive (more than half the surface) distinct cavity with visible dentine





Follow up evaluation:
6th Month:

Clinical:

Microbiological:



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