SMART: Silver diamine fluoride reduces microtensile bond strength of glass ionomer cement to sound and artificial caries-affected dentin

Silver-modified atraumatic restorative technique (SMART) is an emerging restorative technique; however, the effect of silver diamine fluoride (SDF) application on the bond strength of glass ionomer cement (GIC) is unknown. This study aimed to determine if SDF application to sound and artificial caries-affected dentin (ACAD) immediately prior to GIC restoration affected microtensile bond strength (mu TBS). Caries was induced on extracted molars using a pH-cycling protocol that was validated against natural caries (similar mu TBS). Dentin surfaces were treated with 38% SDF, control groups with de-ionized water and immediately restored. Beam-shaped specimens were sectioned and subjected to tensile forces for mu TBS determination. Two hundred and eighty-seven specimens from 40 teeth were tested. SDF application significantly (p<0.001) reduced mu TBS in sound dentin (19.00 +/- 8.20 MPa vs. 14.60 +/- 6.68 MPa), while no difference was found in ACAD. No difference was found in failure mode among groups. For SMART, SDF application on sound dentin before immediate GIC restoration may decrease bond strength.