The efficacy of 38% silver diamine fluoride in preventing orthodontic white spots: a split-mouth randomized controlled trial

AIM. White spot lesions represent a negative and common adverse effect of fixed orthodontics. The research tried to establish the effectiveness of isolated use of 38% silver diamine fluoride in prevention of active white spot lesions during debonding of orthodontic appliances. The study was a randomized, split-mouth controlled, placebo-controlled, and a double-blind study.

MATERIALS AND METHODS. Split-mouthed randomized, double-blind, placebo-controlled trial was applied. Thirty teenagers (mean age 15.2 ± 1.8 years), whose bilateral active lesions on the anterior teeth occurred after debonding and had a minimum of two active white spots lesions on the anterior teeth were enrolled. Randomly, the lesions were divided in regards to treatment, whereby one time use was done with 38% silver diamine fluoride (experimental), or placebo solution (control).

RESULTS. The general finding was the stabilization of the lesions with a hard and smooth feel with a sense of touch upon examination after the assessment period, one- and three-months follow-ups. The alteration in the laser fluorescence (DIAGNOdent) scores and aesthetical satisfaction with patients were secondary outcomes. Silver diamine fluoride group had considerably variable arrestment rates than the placebo group at the three months follow-ups (93.3 and 16.7 respectively, p < 0.001). The mean scores (DIAGNOdent) in the silver diamine fluoride group were very low (32.1–18.4) than in the placebo group (30.8–36.9) (p = 0.001). It was determined that the patient satisfaction in reference to the black stain after the usage of SDF was insignificant; its mean value was 2.8 out of 10.

CONCLUSIONS. 38% silver diamine fluoride used as a single application on an individual patient is fairly effective in the prevention of white spots lesions associated with orthodontics, although its acceptance is low due to its staining effect. Silver diamine fluoride is an aesthetically problematic good solution that can be applied to treat the post-orthodontic white space lesions especially in patients with a high risk of caries.

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