Effect of an aqueous 4% titanium tetrafluoride solution on preventing caries in orthodontic patients: a controlled clinical trial

ABSTRACT Introduction: Titanium tetrafluoride (TiF4) is a fluoride compound that, when is applied over enamel, promotes a protection against demineralization through a titanium dioxide (TiO2) acid-resistant coat. Objectives: This study sought to verify the hypothesis that a single application of 4% TiF4 increases the resistance of enamel to dental demineralization in orthodontic patients. Materials and Methods: This controlled clinical trial followed CONSORT guidelines and investigated the prevention of enamel demineralization, fluoride retention, and the presence of a Ti layer after TiF4 application on banded teeth exposed to clinical cariogenic biofilm. Forty premolars were divided into a control group (CG; n = 20) and a test group (TG; n = 20). Teeth from both groups received prophylaxis and orthodontic bands with a cariogenic locus. In the TG, all teeth additionally underwent aqueous 4% TiF4 solution application after prophylaxis before being banded. After one month, teeth from both groups were extracted and prepared to assess the microhardness, fluoride retention, and evaluation of the Ti coating over the enamel surface. All data were analyzed with a paired Student's t-test (p<0.05). Results: Enamel microhardness and fluoride uptake were higher in TG than in CG, while the Ti layer could be seen over TG teeth that received TiF4 application. Conclusion: Under clinical circumstances, the 4% aqueous TiF4 solution was effective in preventing enamel mineral loss through increasing the enamel resistance to dental demineralization, enhancing its microhardness and fluoride uptake, and forming a Ti coat.

RESUMO Introdução: O tetrafluoreto de titânio (TiF4) é um composto fluoretado que, quando aplicado sobre o esmalte dentário, promove uma proteção contra desmineralização, por meio da formação de uma camada ácido-resistente de dióxido de titânio (TiO2). Objetivos: O presente estudo buscou verificar a hipótese de que uma única aplicação de TiF4 a 4% aumenta a resistência do esmalte dentário à desmineralização, em pacientes ortodônticos. Material e Métodos: Esse ensaio clínico controlado seguiu as diretrizes do CONSORT e investigou a prevenção da desmineralização do esmalte, retenção de flúor e a presença de uma camada de titânio após a aplicação do TiF4 em dentes bandados expostos ao biofilme cariogênico clínico. Quarenta pré-molares foram divididos em dois grupos: controle (GC; n = 20) e teste (GT; n = 20). Dentes de ambos os grupos receberam profilaxia e bandas ortodônticas com nicho cariogênico. No GT, todos os dentes também foram submetidos a aplicação de solução aquosa de TiF4 4 após profilaxia, antes de serem bandados. Após um mês, os dentes de ambos os grupos foram extraídos e preparados para avaliar a microdureza, retenção de flúor e avaliação da camada de titânio sobre a superfície do esmalte. Todos os dados foram analisados pelo teste t pareado (p<0,05). Resultados: A microdureza do esmalte e a absorção de flúor foram mais elevadas no GT do que no GC, enquanto uma camada de titânio pôde ser observada sobre os dentes do GT, que receberam aplicação TiF4. Conclusão: Em circunstâncias clínicas, a solução de TiF4 a 4% foi eficaz na prevenção da perda mineral do esmalte, por meio do aumento da resistência à desmineralização dentária, aumentando sua microdureza e absorção de flúor, e formando uma camada protetora de titânio.

Research Trends on Preventive and Therapeutic Use of TIF4 for Dental Caries and Erosion

Abstract Objective: To evaluate TIF4 preventive and therapeutic use in caries and erosive lesions. Material and Methods: Searches were performed in six databases. Studies evaluating TiF4 use in vitro, in situ, and in vivo in caries and erosive lesions were included and imported into VantagePoint™ (VP). Data about publication year, authors, country, journal, study design, outcomes, TIF4 vehicles, application and intervention time, cariogenic challenge, erosive cycles, effects (positive/ negative /null) and approach (preventive/therapeutic) were analyzed through VP and Excel. Results: 93 published studies were included and an increase in publications was observed between 2010 and 2021. Forty-three authors published three or more articles, of which 67.4% were developed in Brazil and published in Caries Research (22.6%). 69.9% were in vitro studies with erosion assays (59.1%) and with preventive approaches (67.4%). The principal vehicle was a solution (69.9%) with a 1-min single application (58.0%) and with an intervention time of 5-7 days (22.6%). The principal cariogenic challenge in vitro was pH cycling (11.8%); in situ was sucrose + biofilm (6.2%); and in vivo, biofilm (6.2%). The most used erosive cycle was 4× per day in in vitro studies (20.4%) and 1× in vivo (2.1%). A positive effect was observed in prevention (41.9%) and treatment (24.7%) studies. Conclusion: TIF4 has shown a positive effect in prevention and therapeutic treatments for dental caries and erosion (AU).

Teria o tetrafluoreto de titânio um efeito preventivo contra a doença cárie? / Would titanium tetrafluoride have a preventive effect against dental caries?

A solução aquosa de tetrafluoreto de titânio (TIF4), quando aplicada sobre o esmalte dentário, forma uma cobertura rica em titânio que o protege contra os ácidos presentes durante o desafio cariogênico. Assim, o objetivo deste trabalho é discutir o efeito preventivo de TIF4, comparado aos demais métodos de prevenção descritos na literatura, tais como os selantes resinosos ou ionoméricos e os demais veículos de fluoreto.