Effect of TiF4 varnish on microbiological changes and caries prevention: in situ and in vivo models

Abstract

Objective: The aim of this study was to evaluate microbiological changes, oral soft tissue toxicity, and caries-preventive effect of an experimental titanium tetrafluoride (TiF₄) varnish compared with a commercially available fluoride varnish (NaF), using in situ and in vivo models.

Materials and methods: The treatment groups were the following: TiF₄ varnish (experimental varnish), Duraphat® (fluoride positive control), placebo varnish (no fluoride), and no treatment (negative control). The varnishes were applied once over the enamel surface using a microbrush. For the in vivo study, 48 Wistar rats were infected with Streptococcus sobrinus 6715, received a treatment, and were submitted to a cariogenic challenge. After 4 weeks, S. sobrinus, oral soft tissue toxicity, presence, and severity of caries were evaluated. For the in situ study, 12 volunteers took part in this randomized crossover, double-blind study performed in four phases of 14 days each. They used intraoral appliances containing four enamel specimens that received the varnish according treatment group. After 24 h, the varnish was removed and plaque accumulation was allowed. A 20% sucrose solution was dripped over the enamel blocks (10×/day for 5 min each). Total streptococci, S. mutans, Lactobacillus, Candida spp. counts, and presence of white spot lesions were evaluated. Lesion depth was also quantified by micro-CT.

Results: For the in vivo study, the fluoride (F-varnishes) showed a statistically significant reduction in the percentage of S. sobrinus compared to the negative control (p < 0.05). Toxicological analysis revealed no abnormalities in oral tissues of rats from all groups, and both F-varnishes reduced the number and severity of caries lesions, without significant differences (p < 0.05). No statistical differences in microbiological counts were seen for the in situ experiment (p > 0.05). However, the specimens treated with TiF₄ exhibited lower percentage of white spot lesions and the lesion depth was significantly reduced by F-varnishes (p < 0.05).

Conclusions: F-varnishes showed reduction in the percentage of S. sobrinus in vivo, no oral soft tissue toxicity, and a caries-preventive effect in vivo and in situ.

Clinical relevance: NaF varnish is largely used due its capacity to form CaF₂-like layer on enamel. Therefore, development of studies focused on other fluoride compounds such as a TiF₄ varnish, which may have greater efficacy than NaF against tooth demineralization, is important.

Keywords: Caries; Fluoride varnish; Mutans streptococci; Oral biofilm; Titanium tetrafluoride.