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.

The effect of CO2 9.3 μm short-pulsed laser irradiation in enamel erosion reduction with and without fluoride applications-a randomized, controlled in vitro study

The aim of this in vitro study was to evaluate the protective effect of short-pulsed CO₂ 9.3 μm laser irradiation against erosion in human enamel without and combined with TiF₄ and AmF/NaF/SnCl₂ applications, respectively, as well as compared to the protective effect of these fluoride treatments alone. After polishing, ninety enamel samples (3 × 3mm) were used for 9 different treatment groups: 4% TiF₄ gel (pH 1.5, 24,533 ppm F^-); AmF/NaF/SnCl₂ rinse (pH 4.5; 500 ppm F^-, 800 ppm Sn²); CO₂ laser (average power 0.58 W); CO₂ laser (0.58 W) + TiF₄; CO₂ laser (0.58 W) + AmF/NaF/SnCl₂; CO₂ laser (0.69 W); CO₂ laser (0.69 W) + TiF₄; CO₂ laser (0.69 W) + AmF/NaF/SnCl₂; negative control (deionized water). TiF₄ gel was brushed on only once before the first erosive cycling, while samples treated with AmF/NaF/SnCl₂ were daily immersed in 5 ml of the solution before cycling. Laser treatment occurred with a CO₂ laser (wavelength 9.3 μm, pulse repetition rate 100 Hz, pulse duration 14.6 μs/18 μs, average power 0.58 W/0.69 W, fluence 1.9 J/cm²/2.2 J/cm², beam diameter 0.63 mm, irradiation time 10 s, air cooling). TiF₄ was applied only once, while AmF/NaF/SnCl₂ was applied once daily before the erosive challenge. Surface loss (in μm) was measured with optical profilometry immediately after treatment, and after 5 and 10 days of erosive cycling (0.5% citric acid, pH 2.3, 6 × 2 min/day). Additionally, scanning electron microscopy investigations were performed. All application measures resulted in loss of surface height immediately after treatment. After 5 days, significantly reduced surface loss was observed after applying laser irradiation (both power settings) followed by applications of TiF₄ or AmF/NaF/SnCl₂ solution (p < 0.05; 2-way ANOVA and Tukey test) compared to fluoride application alone. After 10 days, compared to after 5 days, a reduced tissue loss was observed in all groups treated with AmF/NaF/SnCl₂ solution. This tissue gain occurred with the AmF/NaF/SnCl₂ application alone and was significantly higher when the application was combined with the laser use (p < 0.05). Short-pulsed CO₂ 9.3 μm laser irradiation followed by additional application of AmF/NaF/SnCl₂ solution significantly reduces the progression of dental enamel erosion in vitro.

The Effect of Titanium Tetrafluoride and Sodium Hypochlorite on the Shear Bond Strength of Methacrylate and Silorane Based Composite Resins: an In-Vitro Study

STATEMENT OF THE PROBLEM

The bond strength of composites with different adhesive systems with dentin is an important factor in long term durability of composite restorations. The effect of titanium tetrafluoride (TiF₄) as anti caries agent and sodium hypochlorite (NaOCl) as disinfectant on the shear bond of nanofilled and silorane based composite resins have not been investigated in previous studies.

PURPOSE

This study was conducted to determine bond strength between dentin and two composite systems, by means of shear bond test using TiF₄ and NaOCl.

MATERIALS AND METHOD

Middle dentin of 60 intact extracted maxillary premolar teeth were exposed by sectioning the crowns at a depth of 2mm from central groove and parallel to the occlusal surface. Standardized smear layer was created using a 600-grit silicon carbide paper and then samples were embedded in acrylic resin blocks. Then the samples were randomly divided into 6 \groups summarized as Group I: Z350, Group II: Z350+ NaOCl, Group III: Z350+ TiF₄, Group IV: P90, Group V: P90+ NaOCl, Group VI: P90+ TiF₄ according to manufacturer's instruction. Then samples were subjected to shear bond strength (SBS) test using universal testing machine and data were analyzed using ANOVA and Tukey tests (p< 0.05).

RESULTS

Application of 5% NaOCl caused a significant decrease in SBS of nanofilled composite resin (p= 0.004), and also silorane based composite resin (p= 0.006). Application of 4% TiF₄ caused a significant increase in SBS of silorane based composite resin (p= 0.001). The effect of TiF₄ on nanofilled composite was not statistically significant.

CONCLUSION

Using TiF₄ has a positive effect on increasing the shear bond while NaOCl has negative effect on bond strength.

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.