Cu#ng the Cu#ng Edge Silver Diamine Fluoride. Jeremy Horst UCSF

Transcription

1 Cu#ng the Cu#ng Edge Silver Diamine Fluoride Jeremy Horst UCSF

2 disclosure I have no financial interests in any product discussed here.

3 Outline 1. US short term RCT 2. Case _ 3. Following by Xrays 4. SDF + GIC/ART = SMART

4 1 st US study of SDF... 2 week outcome n arrested (SD) 95% CI adverse events SDF (.38).55 to.85 placebo (.18).00 to.16 flu, nausea, redness, spot diarrhea x 2, tummy ache, toothache + diarrhea microbiology... Peter Milgrom Sharity Ludwig Lloyd Mancl Marilyn Rothen

5 Caries Arrest in kids arrested caries 100%# 50%# 100%# 0%# 50%# 100%# 0%# 50%# 100%# 0%# 50%# 100%# 0%# 50%# 100%# 0%# 50%# 100%# 0%# 50%# 0%# 0.5# 1# 1.5# 2# 2.5# 3# time (years) SDF#q6mon# control## SDF#q6mon# SDF#q1year# SDF#q1year# SDF#q6mon# 12%#SDF#q1year# 12%#SDF#q6mon# SDF#q1year# exc#sdf#q1year# exc#naf#q3mon# NaF#q3mon# SDF#once# SDF,#tannate## 12%#SDF#once# 30%#SDF#once# GIC#once# Llodra et al., year olds 3.2 lesions at start Zhi et al., year olds 3.4 surfaces at start Fung et al., year olds 4.7 lesions at start Chu et al., year olds 6 lesions at start 30%#SDF#q1year# Duangthip et al., %#SDF#3x/2weeks# year olds NaF#3x/2weeks# 6.7 lesions at start Yee et al., year olds 6.8 lesions at start Santos et al., year olds 3.8 lesions at start

6 3 year outcome severely fragile 4-7 year old 1.5 years 3+ years

7 pre/post SDF Xray analysis 333 pa_ents treated 4.7 (± 2.0, 1-12) start Xrays before & acer. 17 pa_ents. 3.6 (± 2.0) lesions 2.6 (± 1.3) applica_ons pa_ents 8.8 (± 4.5, 6-20) month Xrays f/u applica_ons 30% of lesions progressed.28 (±.57) new lesions, vs 2.1 (±1.3) in matched controls

8 4y9m 2 treatments +6 1year: 0 new cavi_es

9 start: 2y11m 2 treatments +6 months 2 treatments +7 1y4m: 0 new cavi_es

10 3y8m lesions: A,B,I,J,S,F,H,C 2 treatments +6 months 2 treatments +8 months A disappeared M,R 1y2m: 2 new cavi_es

11 3y10m Topical 2years: 0 new cavi_es 3 treatments +9 months +2 treatments +6 months +1 treatment +6 months 5y10m

12 3y10m Topical 2years: 0 new cavi_es 3 treatments +9 months +2 treatments +6 months +1 treatment +6 months 5y10m

13 Topical arrest 2years: 0 new cavi_es 3 treatments +9 months +2 treatments +6 months 5y10m

14 Topical arrest 2years: 0 new cavi_es 3 treatments +9 months +2 treatments +6 months 5y10m

15 Synthesis: what to do clinically Offer op_ons Monitor with more Xrays Disking Consider sealing with GIC

16 SDF + GIC: silver modified ART SMART Glass Ionomer Cements (GICs) add the benefit of sustained fluoride release and a seal! Protocol: SDF, then standard ART protocol. (they darken over _me) Drs. John Frachella & Cate Quas

17 SMART armamentarium

18 GIC stain by SDF SDF + GIC Fuji 2LC 1 month SDF + GIC Fuji 9 1 month 3x SDF no- prep GIC Shofu Beau_fil 2 weeks

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20 Pre- op SDF Post- op

21 100 microns

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24 25 microns

25 Confirma_on of silver in the den_nal tubules by SEM- EDX

26 The paradox of covering Lesion (GIC) seal stops progression seal may seal in SDF GIC prevents lesions nearby GIC needs less frequent reapplica_on Small lesions may not retain GIC Mouth (SDF) - SDF prevents lesions throughout mouth - SDF needs more applica_ons - SDF is cheaper - SDF is less technique sensi_ve - Deep lesions may progress

27 THANK YOU

28 Arrest Gao et al., 2016

29 Authors, Year of Publication Random Sequence Generation (Selection Bias) Allocation Concealment (Selection Bias) Blinding of Outcome Assessment (Detection Bias) Incomplete Outcome Data (Attrition Bias) Selective Reporting (Reporting Bias) Other Bias Duangthip et al., 2016 dos Santos et al., 2012 Zhi et al., 2012 Yee et al., 2009 Braga et al., 2009 Huang et al., 2005 Llodra et al., 2005 Mauro et al., 2004 Chu et al., 2002 Yang et al., 2002 Fukumoto et al., 1997 Miasato et al., 1996 Ye, 1994 Maciel, 1988 Oliveira, 1985 Wang, 1984 Tsutsumi et al., 1981 Yoshida et al., 1976 Nishino et al., 1969, low risk;, high risk;, unclear risk. Gao et al., 2016

30 Caries Preven_on in kids prevented caries 100%# 50%# 100%# 0%# 50%# 100%# 0%# 50%# 100%# 0%# 50%# 0%# 0.5# 1# 1.5# 2# 2.5# 3# time (years) SDF#q6mon# SDF#q1year# Sealant#once# NaF#q6mon# SDF#q1year# exc#sdf#q1year# exc#naf#q3mon# NaF#q3mon# SDF#once# GIC#sealant#once# Llodra et al., year olds control: 2.5 new lesions (only applied to lesions) Liu et al., year olds control: 4.6 new lesions Chu et al., year olds control: 1.6 new lesions (only applied to lesions) Monse et al., year olds control: 0.44 new lesions

31 GIC sealants > Resin sealants??? 2 years 3 years Beiru_ 2006 n=315 Chen 2012 n=867 Liu 2014 n=357 Hilgert 2015 n=203 Beiru_ 2006 n=292 Oba 2009 n=137 Hilgert 2015 n=171 4 years Beiru_ 2006 n=266 Zhang 2014 n=741 5 years Beiru_ 2006 n=156 Barja 2009 n=49 Mickenautsch and Yengopal PLoS One 2016

32 Does a sealant here prevent caries here? 2,557 7yo, 2.5 years in Italy New caries on distal of 2nd primaries * 0.94 * GIC Fluoride Resin Resin Cage# et al., J Dent Res 2014

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