Journal of South Asian Association of Pediatric Dentistry
Volume 5 | Issue 3 | Year 2022

A Comparative Evaluation of Shear Bond Strength of Type IX GIC to Demineralized Dentin in Primary Teeth with and without Application of SDF: An In Vitro Study

Swapnaja V Gadekar1https://orcid.org/0000-0002-1359-0455, Amey M Panse2, Prasad Jathar3, Pradyumna S Khairnar4, Abhijeet V Gadekar5, Apurva Pawar6

1-3,6Department of Pedodontics and Preventive Dentistry, Sinhgad Dental College & Hospital, Pune, Maharashtra, India

4Department of Oral and Maxillofacial, Surgery and General Dentistry, Hinduhridaysamrat Balasaheb Thakeray, Trauma Care Hospital, Mumbai, Maharashtra, India

5Smt. Mathurabai Bhausaheb Thorat Sevabhavi Trust Dental College and Hospital, Sangamner, Maharashtra, India

Corresponding Author: Swapnaja V Gadekar, Department of Pedodontics and Preventive Dentistry, Sinhgad Dental College & Hospital, Pune, Maharashtra, India, Phone: +91 8169583639, e-mail: swapnajavgadekar93@gmail.com

Received on: 28 October 2022; Accepted on: 01 December 2022; Published on: 26 December 2022


Background: Both deciduous and permanent teeth with single surface cavities have been demonstrated to respond well to the atraumatic restorative technique (ART) combined with glass ionomer cement (GIC). However, ART is not widely accepted due to the prevalence of secondary caries. The silver-modified ART (SMART) technique was proposed to address the drawback of ART.

Materials and methods: The ultrasonic scaler was used to clean and debride 65 healthy, noncarious primary molars. The enamel was removed initially from each sample, exposing the dentin. The samples were placed in a 40 mL solution containing 2.2 mM each of potassium dihydrogen phosphate (KH2PO4) and calcium chloride (Cacl2) (pH 4.5) for 3 days to demineralize the dentin. The specimens were then randomly and equally divided into five groups (n = 13) as follows: group I has no application of silver diamine fluoride (SDF) + GIC; group II has SDF air-dried + GIC right away; group III has SDF light-cured + GIC right away; group IV has SDF air-dried + GIC after 24 hours, and group V has SDF light-cured + GIC right away.

Result: Except for SDF air-dried + immediate GIC vs SDF air-dried + GIC after 24 hours, where there was an insignificant difference noticed, there was a remarkable difference noted for the values between the groups (p-value, 0.01, 0.05).

Conclusion: This study looked at all four treatment groups and found enhanced shear bond strength, which suggests that SDF does improve the durability of the restorations.

How to cite this article: Gadekar SV, Panse AM, Jathar P, et al. A Comparative Evaluation of Shear Bond Strength of Type IX GIC to Demineralized Dentin in Primary Teeth with and without Application of SDF: An In Vitro Study. J South Asian Assoc Pediatr Dent 2022;5(3):157-163.

Source of support: Nil

Conflict of interest: None

Keywords: Primary teeth, Shear strength, Silver diamine fluoride, Type IX GIC


Dental caries is a chronic, stereotypically widespread illness that affects all populations to variable degrees of severity. ART, which was introduced in the 1980s as a component of a primary oral health care program of the Dental School in Tanzania, was vigorously pushed by the World Health Organization as a viable technique to address the demand for the treatment of dental caries.1 In ART, the cavity is sufficiently opened up so that soft, demineralized carious tooth tissues can be manually removed, and this is prevented by filling the cavity with an adhesive dental substance that also closes any leftover pits and cracks that are still vulnerable.1 However, because of the incidence of secondary dental caries, which are linked to the tiny quantity of soft caries that remains after hand excavation, ART is considerably less acceptable.2 Since the early 1970s, SDF has been used to prevent dental cavities worldwide. It gained popularity in 2014, mostly among pediatric populations.2 Along with fluoride ions, which have the power to mineralize the demineralized tissue, silver ions which have the ability to limit bacterial development and prevent collagen degradation, and also contribute to the caries-arresting action of SDF.2 The structure of existing lesions is hardened when SDF combines with hydroxyapatite to produce calcium fluoride and silver phosphate. Additionally, sodium fluoride or silver nitrate alone is not as effective at preventing the development of carious lesions as fluoride ions combined with silver are. SDF may be an effective anticariogenic pretreatment substance for dental tissue healing that helps to avoid the development of recurrent caries.3 The prognosis of the tooth restored with ART is significantly improved by SDF, which creates a biological seal at the restorative interface.4 So, the SMART technique was proposed to get around ART’s drawbacks. In order to completely stop the caries process and harden the dentin matrix, soft caries must first be removed from the affected area before the cavity is filled with GIC.4 The ionic transition of silver to metallic silver or silver dioxide, which produces a slightly rough surface, has been reported to be stimulated by light exposure.5 In modern restorative treatment, the material’s ability to adhere to tooth structure is crucial.5 SDF treatment has been promoted as a way to enhance the bonding power of adhesive cement. However, there isn’t enough proof to support this claim, especially in the case of primary teeth, where decay is more common, and cooperation is lower.


We gathered 65 deciduous teeth that were healthy and free of decay. Following cleaning, the samples were kept in 10% aqueous formalin until use. The enamel was initially removed from each specimen, exposing the dentin, using a micromotor and a diamond disc operated at a low speed. The specimens were then placed in self-curing acrylic resin. To ensure that the tooth is free of enamel, the dentine surface will be examined with a 40× light microscope. The specimen’s dentin surface was ground with 220-grit silicon carbide paper on a manual polisher under running water for 60 seconds. By soaking the samples in 40 mL of 2.2 mM each of KH2PO4 and Cacl2 (pH 4.5) at 370°C for 3 days,4 dentin demineralization was accomplished. After demineralization, the specimens were flushed with deionized water for 5 minutes, and specimens were randomly and equally split into five groups (n = 13):

Figs 1A to D: Samples after SDF application: (A) SDF air-dried + immediate GIC; (B) SDF light-cured + immediate GIC; (C) SDF air-dried + GIC after 24 hours; (D) SDF light-cured + GIC after 24 hours

Figs 2A to E: Samples after GIC restoration: (A) No SDF + GIC; (B) SDF air-dried + immediate GIC; (C) SDF light-cured + immediate GIC; (D) SDF air-dried + GIC after 24 hours; (E) SDF light-cured + GIC after 24 hours

Samples were prepared for shear bond strength testing on universal testing equipment after GIC restoration (Instron, an ITW company, Massachusetts, United Kingdom). At the interface, the load was applied parallel to the occlusal plane at a set crosshead speed of 1 mm/minute.


Intercomparison of mean, standard deviation (SD), F, and p-value of shear bond strength of different study groups using one-way analysis of variance (ANOVA) test (Table 1 and Fig. 3).

Table 1: Intercomparison of mean, SD, F, and p-value of shear bond strength of different study groups using one-way ANOVA test
Groups Mean SD F- value p-value
A Control group (no SDF + GIC) 1.01 0.17 66.816 0.001*
B SDF air-dried + immediate GIC 2.05 0.67
C SDF light-cured + immediate GIC 3.23 0.67
D SDF air-dried + GIC after 24 hours 2.50 0.60
E SDF light-cured + GIC after 24 hours 4.70 0.52

One-way ANOVA test; *indicates significant difference at p ≤ 0.05

Fig. 3: Intercomparison of the mean value of shear bond strength of different study groups: x-axis, study groups; y-axis, mean value of shear bond strength

A one-way ANOVA test was used.

The obtained results were reported as mean SD noted in Table 1 and Figure 3. For the values between groups, a statistically significant difference (p = 0.001) was observed. SDF light-cured + GIC after 24 hours (group V) had the greatest mean shear strength (MPa) of any group, followed by SDF light-cured + immediate GIC (group III) (3.23 MPa), SDF air-dried + GIC after 24 hours (group IV) (2.50 MPa), and SDF air-dried + instant GIC (group II) (2.05 MPa). Control had the lowest shear bond strength (1.01 MPa) (group I). Significant shear bond strength differences existed between the study groups (p = 0.001).

Pairwise Comparison of the Difference between the Mean Value of Shear Bond Strength of Study Groups (Table 2 and Fig. 4)

Table 2: Pairwise comparison of difference between mean value of shear bond strength of study groups using post hoc test
Pair Difference p-value
Control group vs SDF air-dried + immediate GIC −1.04 0.001*
Control group vs SDF light-cured + immediate GIC −2.22 0.001*
Control group vs SDF air-dried + GIC after 24 hours −1.49 0.001*
Control group vs SDF light-cured + GIC after 24 hours −3.69 0.001*
SDF air-dried + immediate GIC vs SDF light-cured + immediate GIC −2.18 0.001*
SDF air-dried + immediate GIC vs SDF air-dried + GIC after 24 hours −0.45 0.347 (NS)
SDF air-dried + immediate GIC vs SDF light-cured + GIC after 24 hours −2.65 0.001*
SDF light-cured + immediate GIC vs SDF air-dried + GIC after 24 hours 0.73 0.027*
SDF light-cured + immediate GIC vs SDF light-cured + GIC after 24 hours −1.47 0.001*
SDF air-dried + GIC after 24 hours vs SDF light-cured + GIC after 24 hours −2.20 0.001*

Post hoc Tukey test; * indicates significant difference at p ≤ 0.05; NS, nonsignificant

Fig. 4: Pairwise comparison of the difference in between the mean value of shear bond strength of study groups: x-axis, study groups comparison; y-axis, mean difference value of shear bond strengths

The post hoc Tukey test was used.

Except for SDF air-dried + immediate GIC vs SDF air-dried + GIC after 24 hours, where there was a statistically nonsignificant difference noticed, there was a statistically significant/highly significant difference noted for the values between the groups (p-value, 0.01, 0.05) noted in Figure 4.

Group I demonstrated the least bond strength values when compared to the other groups, and the intergroup comparison of group I with other groups showed a statistical difference. Among all groups, group V showed the highest bond strength value and showed significant statistical differences in intergroup comparison with all the other groups. Group II showed less bond strength value among all the treated groups (groups III, IV, and V), and intergroup comparison of group II with group III and group V showed a statistical difference, but there was no significant statistical difference when compared with group IV. Group IV showed less bond strength when compared to group III, and group V, intergroup comparison of group IV with group III and V showed statistically significant difference. Group III showed less bond strength as compared to Group V and showed a statistical difference.

Two-way ANOVA Test

Using a two-way ANOVA, the shear strength was evaluated in relation to the conditions (without SDF, with SDF and air drying, and with SDF and light illumination) (immediate and 24 hours). The results of the two-way ANOVA test demonstrated that different treatment modalities—without SDF, SDF with air drying, and SDF with light illumination—as well as different time spans (immediate and 24 hours), have a significant impact on the shear bond strength, that is, different treatment modalities and different time spans were linked to different strengths. The p-value for the interaction between treatment and time is 0.004, which indicates that the shear bond strength varies for different treatments depending upon the time interval.


A dental illness known as dental caries is an infectious microbiologic condition that affects the teeth and causes localized calcified tissue damage and breakdown. As part of “A traumatic Restorative Treatment,” carious cavities are physically cleaned using hand tools and then restored with an adhesive fluoride-releasing substance.6 Early on in the development of ART, it was frequently seen as a drawback that a large percentage of restorations failed because secondary caries occasionally formed as a result of disintegrated dentine remaining in the cavity.7 As part of a thorough caries treatment program, it is possible to recommend 38% SDF to stop the carious lesions in primary teeth in order to prevent subsequent caries. The arrested lesion is marked by a black stain or scar, which is the distinguishing feature of SDF.8 The two materials are combined using the SMART process. The carious lesion is first treated with SDF and then restored using GIC. This effectively stops cavities, and after that, a glass ionomer is used to restore the tooth’s shape. No extra tooth structure is removed in the process.9

The antibacterial properties of silver and the remineralizing properties of fluoride are combined in the transparent liquid known as SDF.10 It is a treatment tool that is both secure and efficient for treating caries lesions in the pediatric population.10 SMARTs have recently gained popularity due to their excellent biological compatibility and the favorable biological response observed in laboratory studies and clinical applications.11 According to the SDF protocol and adhesive system, Lutgen et al. prior study showed that SDF had a substantial impact on the micro shear strength of dentin.11 In a different study, Knight et al. reported that dentine samples that had been etched with 37% phosphoric acid for 5 seconds before being treated with silver fluoride and potassium iodide produced bond strengths that were not materially different from samples that had been treated with 10% polyacrylic acid conditioner for 10 seconds after being washed off the precipitate and allowed to air dry.12 SDF use in carious cavities prior to ART restorations was clinically safe, according to a stated by Horst et al.13 Also came to the conclusion that using the ART approach in conjunction with the application of SDF to the dentine surface had no effect on the strength of the dentine bond.13 According to Quock et al., SDF improved the bond strength of resin composite to noncarious dentin.14

The greater shear bond strength values obtained for SDF light-cured followed by GIC restoration after 24 hours in the current study can be because of the following properties:

Caries Arrest

Around 38% SDF solution is commonly used to arrest caries in young children, and the application of SDF is a noninvasive procedure that is quick and simple to use. However, it stains the carious teeth and turns the arrested caries black.15 Annual application of SDF is effective in arresting caries in primary teeth stated by Chu et al.16

Caries Prevention

Silver diamine fluoride (SDF) prevents the demineralization of dentin and enamel, as well as the development of cariogenic bacteria. In both primary and permanent dentition, it also has a preventative impact.16 In comparison to fluoride varnish and acidulated phosphate fluoride gel, SDF significantly lowered the Streptococcus mutans levels in saliva, according to Shah et al. said that SDF might be used effectively as a topical fluoride agent.17 Llodra et al. came to the conclusion that using a 38% SDF solution twice a year is effective in preventing caries in primary teeth.18


The levels of salivary mutans significantly decrease after SDF administration. SDF applications are highly effective at preventing new caries and slowing the spread of existing lesions.19 Calcium sucrose phosphate and casein phosphopeptide-amorphous calcium phosphate were shown to have the next-highest remineralizing efficacy, according to Vinod et al.20 Gupta et al. reported that 3.8% SDF has similar antimicrobial activity as 2% chlorhexidine.21 Both GIC type VII and SDF have significantly higher mineral contents and remineralization capability than calcium hydroxide, according to Gupta et al.,21 Shah et al. stated that 38% SDF could be used as an effective remineralizing agent as it shows a significant increase in fluoride content in enamel.22 Use of 38% SDF elevates the remineralization of early caries, according to research by Pinyanirun et al.23


Fluoride is released by SDF, which also aids in the deposition of silver phosphate to replenish the mineral content and reharden the tooth structure. According to the study, SDF increases and remineralizes the microhardness of carious dentin.24 Uzel et al. claim that using SDF under resin restoration is unsuccessful at preventing restorative microleakage.24 According to Perez-Hernaandez et al., samples that weren’t treated with SDF showed more microleakage.25

The late 1990s saw the introduction of type IX GIC, a very viscous condensable or packable substance intended for geriatric and pediatric patients. The silica particle and polyacrylic acid reaction are sped up by the smaller glass particles and higher powder: liquid ratio.26 In comparison to traditional GICs, there have been documented increases in strength, wear resistance, and flexural strength. Additionally, it is less sensitive to moisture and has higher dissolving resistance than traditional GIC.27 To counteract many dislodging pressures, including compressive strength, tensile strength, and shear strength, effective restorative materials must have stronger adhesive capabilities with the dentinal surface.28

In the current study, the effectiveness of SDF on shear bond strength between type IX GIC and demineralized dentin was compared and evaluated. The result showed that:

  • The control group had the minimal shear strength value among all the groups, suggesting that SDF application does increase the shear strength.

  • Among the various SDF application protocol groups-SDF, light-cured and restored after 24 hours showed the highest bond strength (p < 0.001).

  • SDF air-dried and GIC restoration after 24 hours (group IV) displayed higher values than SDF air-dried and immediate GIC restoration (group II), but the statistical difference was barely noticeable.

  • SDF light-cured and GIC restoration after 24 hours (group V) showed higher bond strength value than SDF light-cured and immediate GIC restoration (group III), and the statistical difference was significant.

Noncarious primary molars with preshedding mobility were selected for study, as they are easily available.

Demineralization of Samples

In the current study, the demineralization of samples was achieved by immersing them in an artificial demineralizing solution made by using KH2 PO4 and Cacl2, pH 4.5, at a temperature of 37°C for 3 days. After demineralization, exposed dentin became rough due to loss of mineral content which allows more penetration of SDF into dentinal tubules. Sabel et al. used a demineralizing solution of 0.1 mol/L lactic acid, pH 5.3, at a temperature of 37°C for 3 days.29 Moron et al., in their study, compared four artificial demineralization solutions and reported that the artificial dentin carious lesion induced by different models differed significantly.30 Silver ions totally permeate demineralized dentin, and they also enter into the sound dentin underneath, according to a paper by Sayed et al.31 They also noted that the higher the degree of dentin demineralization, the faster the rate of silver accumulation with deeper penetration.31

Silver Diamine Fluoride (SDF) Application

Due to its financial advantages and simplicity of usage in juvenile or geriatric populations in underprivileged communities with restricted access to dental care, SDF has recently won praise. Commercially available in solution form, SDF, also known as Ag(NH3)2F, ranges in concentration from 10 to 38 wt%, with the 38 wt% concentration of SDF having been clinically proven to be successful in halting caries.32 According to Yee et al., 12% of SDF proved ineffective in stopping caries in the pediatric population.32 Mei et al. found that SDF increases the microhardness of softened dentine by depositing silver, which prevents the demineralization process and remineralizes the carious dentine by fluoride, which enhances micromechanical interlocking and hence raises the bond strength.33 Based on a systemic assessment, Tolba et al. showed that a 38% SDF solution was more effective than a 12% SDF solution in halting caries of deciduous teeth.34 Fung et al. discovered that twice-yearly application of a 38% SDF solution, as opposed to a 12% SDF solution, is more effective at stopping dental caries.35 Dos Santos et al. reported caries arresting rate is more in 30% of SDF applications than in glass ionomer applications. So, 38% SDF solution was used in this study.36 When SDF was applied, a demineralization reaction was triggered, exposing enough microporous collagen, enhancing the micromechanical interlocking, and enhancing the subsequent infiltrations by hybridization.37 In addition, the interactions between polyacrylic acid and calcium ions mostly produced the ionomer calcium polycarboxylate, which results in a chemical chelation that is reasonably persistent. In addition, the binding strength would be enhanced by hydrogen bonds formed between different collagen free radicals and cement carboxyl radicals.37 Thus, it has been found in the current investigation that the application of SDF results in the creation of silver and silver oxide, which may strengthen the binding between glass ionomer and dentin.


In the present study, SDF solution was applied for 1–3 minutes and then air-dried using a three-way syringe to remove the excess SDF solution from the dentin surface. After air-drying, yellowish discoloration was seen on the dentin surface, which changed into black discoloration within 24 hours. Results of the current study showed that samples that were air-dried showed significantly lower bond strength than samples that were light-cured.

Light Illumination

A little rough surface is produced when the ionic conversion of silver to metallic silver or silver oxide to become black accelerates.38 In the current investigation, 100% light-cured samples showed an immediate change in color and much higher binding strength, while nonlight-cured samples darkened after 24 hours. According to McDonald, silver ions can impale themselves into demineralized dentin without being affected by light curing.39 Light curing, according to Crystal and Niederman, speeds up precipitation onto dentin.40

Application of Force

With a 5 KN load and a crosshead speed of 0.05 mm/minute, Al-Manei et al. examined the shear bond strength in a universal testing machine.41 A UTM moving at 1 mm/minute with a maximum loading of 500 N was used in numerous other investigations, including those by Verma et al., to evaluate the shear bonds of each sample.42 According to Zhao et al., the specimens were glued with cyanoacrylate to the universal testing machine’s jig and put through a series of tests until they failed under a 100 N force, which is calculated under Newton at 1 mm/minute crosshead speed.43 At a crosshead speed of 1 mm/minute, Hegade et al. evaluated the shear bond strength.44 Similar to previous studies, the force was applied to each specimen in the current investigation using a knife-edged blade parallel to the interface between dentin and restorative material at a crosshead speed of 1 mm/minute until the link between the two was broken.


Limitations to this study include the inherent difference in shear bond strength between in vitro artificial carious lesions and clinical caries. Shear bond strength testing also has limited generalizability to ART restorations’ clinical longevity. Ideally, the longevity of SDF and ART restorations would be tested clinically. Study results are not relatable to permanent dentition due to different dentinal tubule structures. A flat surface is necessary for reproducible shear bond strength measurements. Given the limitations and subjectivity of using clinical noncarious lesions that have been ground down to a flat surface into dentin surface area available on primary dentition for creating artificial carious lesions, the decision was made to use primary molars. There is a lack of previous research literature of review, so the decision was made to discuss this topic as a study.

Lastly, the researchers did not examine the fracture surface under microscopy. Previous studies suggest that fractures in GIC may occur in the cohesive interface, resulting in a bond strength measurement that does not reflect true adhesive failure.


The following conclusions can be drawn from the study’s findings:


Swapnaja V Gadekar https://orcid.org/0000-0002-1359-0455


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