{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T22:42:18Z","timestamp":1776465738381,"version":"3.51.2"},"reference-count":54,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical University\u2014Plovdiv, Bulgaria","award":["18\/2023"],"award-info":[{"award-number":["18\/2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: Early caries management is essential to enable reversal of white spot lesions without the further need for operative interventions, especially in primary dentition. Silver-based compounds can be quite effective in arresting caries lesions; however, a major drawback is teeth staining. This study aimed to evaluate the remineralization potential and aesthetic effects of novel, green-synthesized nano-silver fluoride (NSF) on artificial white spot lesions in primary teeth in comparison to 38% silver diamine fluoride (SDF) and silver diamine fluoride\/potassium iodide (SDF\/KI). Materials and Methods: NSF was synthesized using green tea extract. Sixty primary teeth specimens with artificial enamel lesions were randomly divided into five groups depending on the applied material: 38% SDF, 38% SDF\/KI, single and double application of NSF, and control group. Treatments were followed by pH cycling. Surface microhardness and photographic analysis were conducted to assess remineralization and staining. Statistical analysis was conducted using non-parametric tests including Kruskal\u2013Wallis and Mann\u2013Whitney U tests with Bonferroni correction. Results: The greatest increase in microhardness was observed in the group receiving double NSF application. Its remineralizing potential was comparable to that of 38% SDF\/KI, with no statistically significant difference (p = 1.000). Importantly, NSF-treated samples exhibited no teeth discoloration, unlike the black staining observed in SDF and SDF\/KI groups. Conclusions: Green-synthesized NSF is a promising alternative to conventional SDF and SDF\/KI, offering remineralization benefits without compromising aesthetics. The eco-friendly formulation and non-staining properties support its potential for clinical use in pediatric dentistry.<\/jats:p>","DOI":"10.3390\/dj13070331","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T08:47:14Z","timestamp":1753087634000},"page":"331","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Green-Synthesized Nano-Silver Fluoride for Remineralization of Enamel Lesions in Primary Teeth: A Comparative In Vitro Study with SDF and SDF\/KI"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3525-7733","authenticated-orcid":false,"given":"Antonia","family":"Palankalieva","sequence":"first","affiliation":[{"name":"Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical University of Plovdiv, 3 Hristo Botev Blvd, 4000 Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9158-6208","authenticated-orcid":false,"given":"Plamen","family":"Katsarov","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, Medical University of Plovdiv, 15A Vassil Aprilov Blvd, 4002 Plovdiv, Bulgaria"},{"name":"Research Institute at Medical University of Plovdiv (RIMU), 4002 Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ani","family":"Belcheva","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical University of Plovdiv, 3 Hristo Botev Blvd, 4000 Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1038\/s41368-022-00186-0","article-title":"Expert consensus on early childhood caries management","volume":"14","author":"Zou","year":"2022","journal-title":"Int. J. Oral Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1177\/0022034515573272","article-title":"Global burden of untreated caries: A systematic review and metaregression","volume":"94","author":"Kassebaum","year":"2015","journal-title":"J. Dent. Res."},{"key":"ref_3","first-page":"6","article-title":"Contemporary technologies for remineralisation therapies: A review","volume":"11","author":"Walsh","year":"2009","journal-title":"Int. Dent. SA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jare.2015.02.007","article-title":"A review on plants extract mediated synthesis of silver nanoparticles for antimicrobial applications: A green expertise","volume":"7","author":"Ahmed","year":"2016","journal-title":"J. Adv. Res."},{"key":"ref_5","first-page":"84","article-title":"Delivery Methods of Silver Diammine Fluoride to Contacting Proximal Tooth Surfaces and History of Silver in Dentistry","volume":"41","author":"Croll","year":"2020","journal-title":"Compend. Contin. Educ. Dent."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jdent.2012.03.009","article-title":"Silver compounds used in dentistry for caries management: A review","volume":"40","author":"Peng","year":"2012","journal-title":"J. Dent."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1038\/s41415-020-1641-4","article-title":"Silver diamine fluoride\u2014An overview of the literature and current clinical techniques","volume":"228","author":"Greenwall","year":"2020","journal-title":"Br. Dent. J."},{"key":"ref_8","first-page":"149","article-title":"Effect of topically applied ammoniacal silver fluoride on dental caries in children","volume":"9","author":"Nishino","year":"1969","journal-title":"J. Osaka Univ. Dent. Sch."},{"key":"ref_9","first-page":"93","article-title":"Effects of diamine silver fluoride on arrestment and prevention of caries in primary tooth","volume":"31","author":"Hihara","year":"1994","journal-title":"Dent. Jpn."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1177\/0022034509338671","article-title":"Efficacy of Silver Diamine Fluoride for Ar-resting Caries Treatment","volume":"88","author":"Yee","year":"2009","journal-title":"J. Dent. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1177\/154405910508400807","article-title":"Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial","volume":"84","author":"Llodra","year":"2005","journal-title":"J. Dent. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1177\/00220345010800120901","article-title":"A Community-based Caries Control Program for Pre-school Children Using Topical Fluorides: 18-month Results","volume":"80","author":"Lo","year":"2001","journal-title":"J. Dent. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103375","DOI":"10.1016\/j.jdent.2020.103375","article-title":"A randomized clinical trial to arrest dentin caries in young children using silver diamine fluoride","volume":"99","author":"Mabangkhru","year":"2020","journal-title":"J. Dent."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1016\/j.dental.2018.10.007","article-title":"Remineralisation of enamel with silver diamine fluoride and sodium fluoride","volume":"34","author":"Yu","year":"2018","journal-title":"Dent. Mater."},{"key":"ref_15","first-page":"b871057","article-title":"Commercial Silver Diamine Fluoride (SDF) Products on Caries Lesion Progression in Primary Enamel: An In Vitro Study","volume":"18","year":"2020","journal-title":"Oral Health Prev. Dent."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Lee, K.E., Erdenebulgan, M., Kang, C.M., Jung, H.I., and Song, J.S. (2022). Effect of Silver Diamine Fluoride and Potassium Iodide Solution on Enamel Remineralization and Discoloration in Artificial Caries. Materials, 15.","DOI":"10.3390\/ma15134523"},{"key":"ref_17","first-page":"555655","article-title":"Potassium Iodide. The Solution to Silver Diamine Fluoride Discoloration?","volume":"5","author":"Nguyen","year":"2017","journal-title":"Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"752","DOI":"10.5005\/jp-journals-10005-2076","article-title":"Comparative Evaluation of Effect of Potassium Iodide and Glutathione on Tooth Discoloration after Application of 38% Silver Diamine Fluoride in Primary Molars: An In Vitro Study","volume":"14","author":"Kamble","year":"2021","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1177\/0022034517740123","article-title":"Silver diamine fluoride: A successful anticarious solution with limits","volume":"29","author":"Burgess","year":"2018","journal-title":"Adv. Dent. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.identj.2023.07.006","article-title":"Silver diamine fluoride staining with potassium iodide: A prospective cohort study","volume":"74","author":"Patel","year":"2024","journal-title":"Int. Dent. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.3762\/bjnano.9.98","article-title":"Review on nanoparticles and nanostructured materials: History, sources, toxicity and regulations","volume":"9","author":"Jeevanandam","year":"2018","journal-title":"Beilstein J. Nanotechnol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2555","DOI":"10.2147\/IJN.S246764","article-title":"The Antibacterial Mechanism of Silver Nanoparticles and Its Application in Dentistry","volume":"15","author":"Yin","year":"2020","journal-title":"Int. J. Nanomed."},{"key":"ref_23","first-page":"e26956","article-title":"Applications of silver nanoparticles in pediatric dentistry: An overview","volume":"14","author":"Khubchandani","year":"2022","journal-title":"Cureus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1007\/s10856-014-5221-5","article-title":"An innovative approach to treating dental decay in children. A new anti-caries agent","volume":"25","author":"Targino","year":"2014","journal-title":"J. Mater. Sci. Mater. Med."},{"key":"ref_25","first-page":"ZC97","article-title":"Impact of Nano Hydroxyapatite, Nano Silver Fluoride and Sodium Fluoride Varnish on Primary Teeth Enamel Remineralization: An In Vitro Study","volume":"11","author":"Nozari","year":"2017","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3207","DOI":"10.2147\/IJN.S243202","article-title":"Synthesis and Characterization of Fluoridated Silver Nanoparticles and Their Potential as a Non-Staining Anti-Caries Agent","volume":"15","author":"Yin","year":"2020","journal-title":"Int. J. Nanomed."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.biotechadv.2013.01.003","article-title":"Synthesis of metallic nanoparticles using plant extracts","volume":"31","author":"Mittal","year":"2013","journal-title":"Biotechnol. Adv."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"5087","DOI":"10.2147\/IJN.S200254","article-title":"Green nanotechnology: A review on green synthesis of silver nanoparticles\u2014An ecofriendly approach","volume":"14","author":"Ahmad","year":"2019","journal-title":"Int. J. Nanomed."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"350","DOI":"10.4028\/www.scientific.net\/AMR.832.350","article-title":"Plant Extract as Reducing Agent in Synthesis of Metallic Nanoparticles: A Review","volume":"832","author":"Mohamad","year":"2013","journal-title":"Adv. Mater. Res."},{"key":"ref_30","first-page":"89","article-title":"Anticariogenic effect of tea: A review of literature","volume":"5","author":"Moezizadeh","year":"2013","journal-title":"J. Dent. Oral Hyg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.apsusc.2018.08.203","article-title":"Green tea extract mediated biogenic synthesis of silver nanoparticles: Characterization, cytotoxicity evaluation and antibacterial activity","volume":"463","author":"Rolim","year":"2019","journal-title":"Appl. Surf. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"43","DOI":"10.4103\/0970-9290.99037","article-title":"Effect of different types of tea on Streptococcus mutans: An in vitro study","volume":"23","author":"Subramaniam","year":"2012","journal-title":"Indian J. Dent. Res."},{"key":"ref_33","first-page":"753","article-title":"Effectiveness of a novel nano-silver fluoride with green tea extract compared with silver diamine fluoride: A randomized, controlled, non-inferiority trial","volume":"7","author":"Arrag","year":"2020","journal-title":"Int. J. Dent. Oral Sci."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Huang, S.B., Gao, S.S., and Yu, H.Y. (2009). Effect of nano-hydroxyapatite concentration on remineralization of initial enamel lesion in vitro. Biomed. Mater., 4.","DOI":"10.1088\/1748-6041\/4\/3\/034104"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Cohen, J. (2013). Statistical Power Analysis for the Behavioral Sciences, Routledge. [2nd ed.].","DOI":"10.4324\/9780203771587"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"231","DOI":"10.5395\/rde.2016.41.3.231","article-title":"Statistical notes for clinical researchers: Sample size calculation 3. Comparison of several means using one-way ANOVA","volume":"41","author":"Kim","year":"2016","journal-title":"Restor. Dent. Endod."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1159\/000348589","article-title":"Remineralization of artificial enamel lesions by theobromine","volume":"47","author":"Amaechi","year":"2013","journal-title":"Caries Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"7958","DOI":"10.1016\/j.biortech.2010.05.051","article-title":"Immobilization of silver nanoparticles synthesized using Curcuma longa tuber powder and extract on cotton cloth for bactericidal activity","volume":"101","author":"Sathishkumar","year":"2010","journal-title":"Bioresour. Technol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2694","DOI":"10.1021\/la0613124","article-title":"Biosynthesis of silver nanoparticles by filamentous cyanobacteria from a silver (I) nitrate complex","volume":"23","author":"Lengke","year":"2007","journal-title":"Langmuir"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1007\/s10904-019-01313-x","article-title":"Biological and Environmental Applications of Silver Nanoparticles Synthesized Using the Aqueous Extract of Ginkgo biloba Leaf","volume":"30","author":"Huang","year":"2020","journal-title":"J. Inorg. Organomet. Polym."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/j.procbio.2010.03.024","article-title":"Tansy fruit mediated greener synthesis of silver and gold nanoparticles","volume":"45","author":"Dubey","year":"2010","journal-title":"Process Biochem."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1159\/000260599","article-title":"Alternating demineralization and remineralization of artificial enamel lesions","volume":"16","author":"Duijsters","year":"1982","journal-title":"Caries Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1159\/000261262","article-title":"Effect of fluoride concentration on remineralization of carious enamel an in vitro pH-cycling study","volume":"24","author":"Damato","year":"1990","journal-title":"Caries Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/S0011-8532(22)00816-3","article-title":"Microbiologic aspects of dental plaque and dental caries","volume":"43","author":"Marsh","year":"1999","journal-title":"Dent. Clin. North Am."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1590\/S1678-77572010000400002","article-title":"pH-cycling models for in vitro evaluation of the efficacy of fluoridated dentifrices for caries control: Strengths and limitations","volume":"18","author":"Buzalaf","year":"2010","journal-title":"J. Appl. Oral Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e17897","DOI":"10.7717\/peerj.17897","article-title":"The use of silver diamine fluoride to prevent\/treat enamel carious lesions: A narrative review","volume":"12","author":"AlSheikh","year":"2024","journal-title":"Peer J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"309","DOI":"10.2341\/20-237-L","article-title":"Longitudinal in vitro effects of silver diamine fluoride on early enamel caries lesions","volume":"47","author":"Alcorn","year":"2022","journal-title":"Oper. Dent."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e653","DOI":"10.4317\/jced.58318","article-title":"Effect of application time and concentration of silver diamine fluoride on the enamel remineralization","volume":"13","author":"Punhagui","year":"2021","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1515\/ntrev-2018-0083","article-title":"In Vitro morphological, optical and microbiological evaluation of nanosilver fluoride in the remineralization of deciduous teeth enamel","volume":"7","author":"Teixeira","year":"2018","journal-title":"Nanotechnol. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Albahoth, A.S., Jeon, M.J., and Park, J.W. (2025). Synergistic effect of nanosilver fluoride with L-arginine on remineralization of early carious lesions. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-89881-6"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Quritum, M., Abdella, A., Amer, H., El Desouky, L.M., and El Tantawi, M. (2024). Effectiveness of nanosilver fluoride and silver diamine fluoride in arresting early childhood caries: A randomized controlled clinical trial. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04406-3"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Atteya, S.M., Amer, H.A., Saleh, S.M., and Safwat, Y. (2023). Self-assembling peptide and nano-silver fluoride in remineralizing early enamel carious lesions: Randomized controlled clinical trial. BMC Oral Health, 23.","DOI":"10.1186\/s12903-023-03269-4"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"173","DOI":"10.22514\/jocpd.2024.137","article-title":"Remineralization potential of a novel varnish: An in vitro comparative evaluation","volume":"48","author":"Gokce","year":"2024","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Butera, A., Maiorani, C., Gallo, S., Pascadopoli, M., Quintini, M., Lelli, M., Tarterini, F., Foltran, I., and Scribante, A. (2023). Biomimetic action of zinc hydroxyapatite on remineralization of enamel and dentin: A review. Biomimetics, 8.","DOI":"10.3390\/biomimetics8010071"}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/7\/331\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:13:07Z","timestamp":1760033587000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/7\/331"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,21]]},"references-count":54,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["dj13070331"],"URL":"https:\/\/doi.org\/10.3390\/dj13070331","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,21]]}}}