Non-Cochrane · other · PM42780665
The cytotoxic and biological effects of silver diamine fluoride on human dental pulp cells: A systematic review and meta-analysis.
Kumari Chanchal, Singhal Ruchi, Namdev Ritu, et al. · Journal of oral biology and craniofacial research · 2026 · PubMed · doi:10.1016/j.jobcr.2026.101548
Findings
Population Human dental pulp cells
12 findings
| Silver diamine fluoride 0.00001–0.0005% | None | Cell viability Laboratory · SDF concentration 0.00001–0.0005% | Pooled cell viability proportion 0.99 [0.97, 1.00] GRADE not reported 3 studies |
| Silver diamine fluoride 0.00001% | None | Cell viability Laboratory · SDF concentration 0.00001% | Pooled cell viability proportion 0.98 [0.88, 1.00] GRADE not reported 2 studies |
| Silver diamine fluoride 0.0001% | None | Cell viability Laboratory · SDF concentration 0.0001% | Pooled cell viability proportion 1.00 [0.99, 1.00] GRADE not reported 3 studies |
| Silver diamine fluoride 0.0005% | None | Cell viability Laboratory · SDF concentration 0.0005% | Pooled cell viability proportion 0.96 [0.91, 0.99] GRADE not reported 2 studies |
| Silver diamine fluoride 0.001–0.005% | None | Cell viability Laboratory · SDF concentration 0.001–0.005% | Pooled cell viability proportion 0.73 [0.46, 0.93] GRADE not reported 5 studies |
| Silver diamine fluoride 0.001% | None | Cell viability Laboratory · SDF concentration 0.001% | Pooled cell viability proportion 0.60 [0.11, 0.98] GRADE not reported 4 studies |
| Silver diamine fluoride 0.003% | None | Cell viability Laboratory · SDF concentration 0.003% | Pooled cell viability proportion 0.92 [0.65, 1.00] GRADE not reported 3 studies |
| Silver diamine fluoride 0.005% | None | Cell viability Laboratory · SDF concentration 0.005% | Pooled cell viability proportion 0.61 [0.18, 0.96] GRADE not reported 2 studies |
| Silver diamine fluoride ≥0.008% | None | Cell viability Laboratory · SDF concentration ≥0.008% | Pooled cell viability proportion 0.14 [0.00, 0.41] GRADE not reported 3 studies |
| Silver diamine fluoride 0.008% | None | Cell viability Laboratory · SDF concentration 0.008% | Pooled cell viability proportion 0.03 [0.01, 0.06] GRADE not reported 1 study |
| Silver diamine fluoride 0.01% | None | Cell viability Laboratory · SDF concentration 0.01% | Pooled cell viability proportion 0.06 [0.01, 0.15] GRADE not reported 2 studies |
| Silver diamine fluoride 0.03% | None | Cell viability Laboratory · SDF concentration 0.03% | Pooled cell viability proportion 0.45 [0.00, 1.00] GRADE not reported 2 studies |
Included primary studies 7
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Garcia-Bernal 2022 The Cytocompatibility of Silver Diamine Fluoride on Mesenchymal Stromal Cells from Human Exfoliated Deciduous Teeth: An In Vitro Study. PMID:35329556 | 2022 | this review only | Cell viability | not extracted yet |
| Hu 2022 Characterization of silver diamine fluoride cytotoxicity using microfluidic tooth-on-a-chip and gingival equivalents. PMID:35778310 | 2022 | this review only | Cell viability | not extracted yet |
| Khalil 2024 Silver diamine fluoride: A stem cell cytotoxicity and dentin growth factor release in-vitro study. PMID:37691596 | 2024 | this review only | Cell viability | not extracted yet |
| Lopez-Garcia 2024 In vitro biocompatibility of ammonia-free silver fluoride products on human dental pulp stem cells. PMID:38113650 | 2024 | this review only | Cell viability | not extracted yet |
| Maru 2024 Evaluation of cytotoxicity of 3.8 % SDF and BioAKT solutions on the viability of dental pulp stem cells. PMID:38293570 | 2024 | this review only | not stated | not extracted yet |
| Oropeza 2022 Cytotoxicity Analysis of Human Dental Pulp Stem Cells After Silver Diamine Fluoride Application. PMID:36947755 | 2022 | this review only | Cell viability | not extracted yet |
| Srisomboon 2022 Effects of Silver Diamine Nitrate and Silver Diamine Fluoride on Dentin Remineralization and Cytotoxicity to Dental Pulp Cells: An In… PMID:35225979 | 2022 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Human dental pulp cells: dental pulp stem cells (DPSCs), stem cells from human exfoliated deciduous teeth (SHEDs), odontoblast-like cells, pulp fibroblasts and other human-derived pulp cell lines | Human DPSCs (n=5); SHEDs (n=2) |
| Intervention | Silver diamine fluoride (SDF) at any concentration or formulation | SDF from 0.0001% to 38% (conventional SDF, Riva Star, e-SDF, ammonia-free silver fluoride, KI-containing systems) (n=7); meta-analysis limited to conventional SDF with MTT viability (n=5) |
| Comparison | Corresponding control conditions where available; studies reporting cell viability included in the meta-analysis irrespective of comparator | Negative (untreated) controls (n=7); other agents in some studies: silver diamine nitrate, silver fluoride, potassium iodide, BioAKT, sodium hypochlorite |
| Outcomes | Primary: cytotoxicity assessed through cell viability assays. Secondary: apoptosis or necrosis, cell proliferation, morphological changes, odontogenic differentiation markers | Cell viability (MTT, CyQuant, colorimetric) (n=7); IC50; cell migration; apoptosis/necrosis; cytoskeleton staining; ROS; ALP activity; growth factor release |
| Study designs | In vitro or ex vivo experimental studies (randomized or non-randomized); English language; animal studies excluded | 7 in vitro studies (2022 to 2024); no ex vivo studies; ToxRTool scores 15 to 16 |
| Timing | Not specified | Exposure durations 30 s to 7 days |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | NR | Yes | no |
| 2Protocol established before the reviewcritical | NR | Partial Yes | no |
| 3Choice of study designs explained | NR | No | no |
| 4Comprehensive literature searchcritical | NR | Partial Yes | no |
| 5Study selection in duplicate | NR | Yes | no |
| 6Data extraction in duplicate | NR | Yes | no |
| 7List of excluded studies with reasonscritical | NR | No | no |
| 8Included studies described in detail | NR | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | NR | NRSI: N/A · RCT: N/A | no |
| 10Funding of included studies reported | NR | No | no |
| 11Appropriate meta-analysis methodscritical | NR | NRSI: N/A · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | NR | No | no |
| 13Risk of bias accounted for in interpretationcritical | NR | No | no |
| 14Heterogeneity explained | NR | Yes | no |
| 15Publication bias investigatedcritical | NR | No | no |
| 16Conflicts of interest reported | NR | Yes | no |
| Overall | NR | Critically Low | no |