Caries-inhibitory effect of titanium tetrafluoride in rats

What is the effectiveness of titanium tetrafluoride to prevent or treat dental caries and tooth erosion? A systematic review

OBJECTIVES

Answer the question: What is the effectiveness of titanium tetrafluoride (TiF₄) when compared to other fluorides, placebo solution or a negative control to prevent or treat dental caries and tooth erosion?

MATERIALS AND METHODS

This review is in accordance with PRISMA guidelines. In vivo and in situ studies that used TiF₄ over enamel or dentine were included. Electronic searches were conducted on MEDLINE, Scopus, Embase, WOS, Cochrane Library, VLH, Clinical Trials and OpenGrey. Risk of bias (ROB) assessments used RoB2 and ROBINS-I for randomized and non-randomized controlled trials (RCTs and on-RCTs); Syrcle's ROB tool for animal studies; and a modified tool proposed by Hollanders for in situ studies.

RESULTS

A total of 28 studies met the eligibility criteria. From these, 6 were in humans (3 RCT and 3 Non-RCT); 4 were in animals and 18 were in situ. For in vivo studies, all RCTs have some concerns related to ROB and all of the non-RCT studies were classified as with serious risk. One animal study had a low and three a high ROB. Regarding in situ studies, seven had a low, ten had an average and only one had a high ROB. The certainty of the evidence (GRADE) ranged from moderate to very low.

CONCLUSIONS

Although most of the results suggest a positive effect of TiF4 on the prevention and treatment of caries and dental erosion, it is not possible to have definitive conclusions due to the high studies' methodological heterogeneity, and the low quality of evidence for most outcomes.

REGISTRATION

The protocol of this syste. atic review was registered in the OPEN SCIENCE FRAMEWORK database (osf.io/6dgs9) DOI:10.17605/OSF.IO/KUZA7 on 6 August 2020.

Microshear Bond Strength of Composite Resin to Enamel Treated With Titanium Tetrafluoride and the Carbon Dioxide Laser (10.6 µm): An In Vitro Study

Introduction: The present study aims to assess the microshear bond strength (µSBS) of composite to enamel treated with titanium tetrafluoride (TiF4 ) and CO₂ laser irradiation. Methods: Fifteen human molars were sectioned and their enamel surfaces were abraded. The sections were randomly assigned to 5 groups (n=15): (CO); control group, (AP); treated with 1.23% acidulated phosphate fluoride (APF) for 4 minutes, (Ti); 4% TiF₄ for 1 minute, (L+AP); CO₂ laser irradiation (10.6 µm wavelength, 1 W peak power, 10 ms pulse duration, 500 ms repetition time, 0.2 mm beam spot size at the tissue level, 2 cm distance of handpiece tip to tissue surface (DSE, South Cores) followed by 1.23% APF, and (L+ Ti); 10.6μm CO₂ laser irradiation followed by 4% TiF₄ for one minute. Using Tygon tubes, Z250 (3M/ESPE) composite was bonded to the surface of the samples. The µSBS of composite to enamel was measured using a microtensile testing machine after 500 thermal cycles. The data were analyzed by one-way ANOVA and the Tukey HSD test (P <0.05). Results: The mean µSBS was 20.66, 20.21, 13.44, 23.01, and 10.16 MPa in CO, AP, Ti, L+AP, and L+Ti groups respectively. Significant differences were observed between CO and Ti (P =0.026) and also CO and L+ Ti (P <0.0001). Conclusion: The application of TiF₄ per se and after CO₂ laser irradiation on enamel decreased the µSBS of composite to enamel; on the other hand, APF alone and after laser irradiation did not have any adverse effect on the µSBS of composite to enamel.

Comparison of antimicrobial effects of titanium tetrafluoride, chlorhexidine, xylitol and sodium fluoride on streptococcus mutans: An in-vitro study

Introduction

No studies have yet documented the bactericidal effects of TiF4, and its role in the treatment of dental caries, and no definite protocol has been introduced to regulate its use. The aim of this study was to determine the antimicrobial/bactericidal effects of TiF4 on Streptococcus Mutans (S. Mutans) and to compare it with chlorhexidine (Chx), sodium fluoride (NaF) and xylitol.

Methods

This study was conducted at the Shiraz University of Medical Sciences microbiology laboratory during March 2015 to September 2015. In this in-vitro study, first a bacterial suspension was prepared and adjusted to a 0.5 McFarland standard (equivalent to 1×10⁸ CFU/ml). The minimal inhibitory concentration (MIC) and minimal bactericidal concentrations (MBC) of TiF4, Chx, NaF and xylitol were assessed using broth microdilution assay and disk diffusion methods. In order to neutralize the acidic nature of TiF4, we used a sodium hydroxide preparation to obtain a pH of 7.2 and repeated all of the previous tests with the neutralized TiF4 solution. We reported the final results as percentages where appropriate.

Results

The MIC of TiF4, NaF and Chx for S. Mutans were 12.5%, 12.5% and 6.25%, respectively. At a concentration of 12.5% the inhibition zone diameters were 9 mm, 15mm and 14mm for TiF4, NaF and Chx, respectively. The MBC was 25%, 12.5% and 12.5% for TiF4, NaF and Chx, respectively. Xylitol failed to show any bactericidal or growth inhibitory effect in all of its concentrations. When we repeated the tests with an adjusted pH, identical results were obtained.

Conclusion

TiF4 solutions have anti-growth and bactericidal effects on S. Mutans at a concentration of 12.5% which is comparable with chlorhexidine and NaF, indicating the possible use of this solution in dental practice as an anti-cariogenic agent, furthermore the antimicrobial activity is unaffected by pH of the environment.

Role of titanium tetrafluoride (TiF(4)) in conservative dentistry: A systematic review

The role of fluoride to reduce demineralization and enhance remineralization of dental hard tissue has been well documented. Different forms of fluoride solutions have been topically used in dentistry as prophylactic agents against tooth decay. In the recent past, metal fluorides, especially titanium tetrafluoride, have become popular in the fraternity of dental research due to their unique interaction with dental hard tissue. Many studies on titanium tetrafluoride, with positive and negative conclusions, have been published in many research journals. This gives the reader a plethora of inconclusive results with one study neutralizing the outcome of other, which confuses us regarding the present status of titanium tetrafluoride in the field of dentistry. This is an endeavor to organize and present the various studies of this unique compound, to provide us with a lucid overall review of its versatile potential application in dentistry, along with its fallacy/drawbacks. We have discussed its role as a cariostatic agent, pit and fissure sealant, tooth desensitizer, against dental erosion, as a root canal irrigant and others.

Effect of 4% titanium tetrafluoride application on shear bond strength of composite resin: An in vitro study

AIMS

The objective of thisstudy is to evaluate and compare 4% titanium tetrafluoride with 2% Sodium fluoride, and the bond strength of composite resin with dentin and their effects on the smear layer.

MATERIALS AND METHODS

Fifty freshly extracted non-carious molar and premolar teeth were selected. The occlusal surfaces of the teeth were ground, to prepare flat dentin surfaces at a depth of 2 mm and were randomly grouped with 10 specimens in each. Group I (Etching + Adhesive + Composite resin) was taken as a control group. In Group II, 4% titanium tetrafluoride was applied before etching and in Group III, 4% titanium tetrafluoride was applied after etching. In Group IV, 2% Sodium fluoride was applied before etching and in Group V, 2% Sodium fluoride was applied after etching. Shear bond strength was tested using the Lloyds Universal testing machine and was recorded in MPa.

RESULTS

The results were statistically analyzed using the one-way Anova test. Group III showed the highest bond strength among the experimental groups, but less than the control group.

CONCLUSIONS

Under the conditions of this in vitro study, titanium tetrafluoride did not significantly affect the bond strength of the composite. Sodium fluoride was found to deleteriously affect the bond strength of the composite.

Titanium tetrafluoride and dental caries: a systematic review

The aim of this systematic review was to evaluate the effectiveness of titanium tetrafluoride as a preventive or cariostatic agent against caries. The databases used to find the articles analyzed were MEDLINE LILACS, and BBO. In MEDLINE and LILACS the search strategy utilized was "titanium" [Words] and "tetrafluoride" [Words] and Spanish or English or Portuguese [Language], whereas In BBO "titânio" [Words] and "tetrafluoreto" [Words] and Espanhol or Inglês or Português [Language]. Out of a total of 42 studies found, which assessed possible preventive/cariostatic effects of titanium tetrafluoride against caries in vivo, only 2 were selected. In both studies, titanium tetrafluoride was shown to be effective against caries. However, given that the quality and consequently the validity of these two clinical studies are questionable, their results do not allow to conclude that titanium tetrafluoride is effective against caries clinically.

Effects of a new titanium fluoride derivative on enamel de- and remineralization

The potential of a new titanium fluoride (TiF) derivative for caries prevention was tested in a pH-cycling model. Daily treatments with various concentrations (100, 250, and 500 p.p.m.) of TiF were compared with similar sodium fluoride (NaF) treatments given at the same pH. Bovine enamel lesions were subjected to 3 wk of pH cycling. The effects were assessed by analyzing calcium uptake and loss in the re- and demineralizing solutions, respectively, and by post pH cycling microradiographic analysis of the lesions. Treatments with NaF reduced calcium loss, enhanced calcium uptake, and induced overall lesion remineralization. Treatments with TiF derivative gradually caused almost complete inhibition of calcium loss and uptake (lesion 'arrestment'), irrespective of the concentration of the TiF derivative. To test the permanence of protection, sound enamel was pretreated with either TiF derivative or NaF, and demineralized for 14 d at pH 4.4 and 4.6. Calcium loss data show that up to 80% inhibition of demineralization could be achieved for the TiF derivative, which was not possible for NaF treatments. This inhibition was obtained through a combination of concentration and number of treatments. The TiF derivative is a promising agent for the prevention of dental caries, especially when aimed at preventing the onset of caries.

Effect of titanium tetrafluoride and sodium fluoride on erosion progression in enamel and dentine in vitro

Our aim was to investigate the effect of TiF4 solutions on mineral loss on enamel and dentine in vitro. Samples were fluoridated 1 x 5 min per day with 1.64% w/v TiF4 or 2.2% w/v NaF solutions, each with a pH of 1.2, and then subjected to a cyclic de- and remineralization procedure for 5 days. Demineralization was performed for 6 x 10 min per day with citric acid (pH 2.3). In controls no fluoridation was performed. Mineral content was determined by longitudinal microradiography. Enamel mineral loss was markedly reduced by both fluoride solutions, but TiF4 was significantly more effective than NaF: cumulative mineral loss on day 3 was 61.7 +/- 15.0 microm in the NaF and 34.2 +/- 13.1 microm in the TiF4 group (p < or = 0.001) compared with 121.0 +/- 27.0 microm in the control group. Dentine mineral loss ceased after both TiF4 and NaF applications (cumulative mineral loss on day 5 in controls: 61.0 +/- 17.0 microm, in the TiF4 group: 15.4 +/- 13.4 microm and in the NaF group: 21.8 +/- 11.8 microm). Both TiF4 and NaF application reduced mineral loss both on enamel and dentine, which could open new possibilities for a symptomatic therapy of erosions.

The effects of fluorides and/or trace elements on the solubilities of enamel and cementum

The purpose of this study is to determine the effects of fluorides and trace elements applied alone or in combination at different concentrations on the solubilities of enamel and cementum surfaces of the same teeth. The study has been performed on enamel and cementum surfaces of the impacted third molars extracted by surgical operation. Aqueous solutions of sodium fluoride, aluminum potassium phosphate, strontium chloride and titanium tetrachloride at different concentrations were applied to the surfaces. The solubilities of enamel and cementum and the depth of etchings have been calculated by means of the inorganic phosphorus in these etching solutions. According to the results, higher concentrations of fluoride and lower concentrations of strontium and titanium led to a significant reduction into solubilities of enamel and cementum. As certain combined applications of fluorides and trace elements decreased both of the enamel and cementum solubilities, it may be assumed that if such a treatment is beneficial during the adolescence of an individual, it may also be used when he is older.

Influence of tooth surface conditions on enamel fluoride uptake after topical application of TiF4 in vitro

Three groups of extracted human teeth were sectioned longitudinally into experimental and control halves. The enamel surfaces of the three groups of teeth were pretreated with 37% H3PO4 for 1 min, 0.5 M NaClO3 for 2 h, or water rinsing for 10 min. The experimental halves of the three groups received an application of 1% TiF4 for 1 min and were washed with deionized water. The tooth specimens were then immersed in synthetic saliva for 24 h at 37 degrees C before sampling for measurement of fluoride uptake. An acid etching technique was used to determine the uptake of fluoride by measuring both fluoride and calcium concentrations in the solution collected from each etched sample. A significantly higher uptake of fluoride was found in teeth rinsed in water and etched with 37% H3PO4 than in teeth pretreated in 0.5 M NaClO3. It seems that the organic components in enamel play an important role in the fluoride uptake after the topical application of TiF4.

Root surface reactions to TiF4 and SnF2 solutions in vitro. An ultrastructural study

Previous studies have indicated that TiF4 and SnF2 differ in their demineralizing effect when applied topically to root surfaces at the same acidity. The aim of this study was to examine in more detail the outermost layer of root surface specimens by transmission electron microscopy (TEM) after short-term exposure to these acidic fluoride solutions. Root surface specimens were exposed for 1 min and 4 min to equimolar (1.1 M F) solutions of a) TiF4, native pH 1.0; b) SnF2, acidified to pH 1.0; and c) SnF2, native pH 2.5. The specimens were then rinsed in saline and processed for TEM. Exposure to TiF4 resulted in a partly demineralized zone 8-10 microns deep after 1 min and 5-27 microns deep after 4 min of application. A 0.1-micron-thick, electron-dense coating was present in all TiF4-treated specimens. Acidified SnF2 resulted in a completely demineralized zone, 4-7 microns deep, when applied for 1 min and 4 min, whereas SnF2 at native pH produced a 0.5- to 1.0-micron-wide partially demineralized zone. Unevenly distributed crystalline deposits were a frequent finding on SnF2-treated surfaces. The results indicate that solutions of TiF4 and SnF2 at native pH will cause only slight demineralization when applied topically to root surfaces.