This in vitro study aimed to evaluate the action of TiF4 on sound and carious bovine and human enamel. Sound (S) and pre-demineralised (DE) bovine and human (primary and permanent) enamel samples were treated with TiF4 (pH 1.0) or NaF varnishes (pH 5.0), containing 0.95, 1.95, or 2.45% F for 12 h. The enamel surfaces were analysed using SEM-EDX (scanning electron microscopy/energy-dispersive X-ray spectroscopy) (n = 10, 5 S and 5 DE) and KOH-soluble fluoride was quantified (n = 20, 10 S and 10 DE). Hydroxyapatite powder produced by precipitation method was treated with the corresponding fluoride solutions for 1 min (n = 2). The formed compounds were detected using X-ray diffraction (XRD). All TiF4 varnishes produced a coating layer rich in Ti and F on all types of enamel surface, with micro-cracks in its extension. TiF4 (1.95 and 2.45% F) provided higher fluoride deposition than NaF, especially for bovine enamel (p < 0.0001). It also induced a higher fluoride deposition on DE samples compared to S samples (p < 0.0001), except for primary enamel. The Ti content was higher for bovine and human primary enamel than human permanent enamel, with some differences between S and DE. The XRD analysis showed that TiF4 induced the formation of new compounds such as CaF2, TiO2, and Ti(HPO4)2·H2O. In conclusion, TiF4 (>0.95% F) interacts better, when compared to NaF, with bovine and human primary enamel than with human permanent enamel. TiF4 provoked higher F deposition compared to NaF. Carious enamel showed higher F uptake than sound enamel by TiF4 application, while Ti uptake was dependent on the enamel condition and origin.

Antonakos A, Liarokapis E, Leventouri T: Micro-Raman and FTIR studies of synthetic and natural apatites. Biomaterials 2007;28:3043-3054.
Attin T, Hartmann O, Hilgers RD, Hellwig E: Fluoride retention of incipient enamel lesions after treatment with a calcium fluoride varnish in vivo. Arch Oral Biol 1995;40:169-174.
Attin T, Lennon AM, Yakin M, Becker K, Buchalla W, Attin R, Wiegand A: Deposition of fluoride on enamel surfaces released from varnishes is limited to vicinity of fluoridation site. Clin Oral Investig 2007;11:83-88.
Bruun C, Givskov H: Calcium fluoride formation in enamel from semi- or low-concentrated F agents in vitro. Caries Res 1993;27:96-99.
Buskes JA, Christoffersen J, Arends J: Lesion formation and lesion remineralization in enamel under constant composition conditions. A new technique with applications. Caries Res 1985;19:490-496.
Büyükyilmaz T, Ogaard B, Rølla G: The resistance of titanium tetrafluoride-treated human enamel to strong hydrochloric acid. Eur J Oral Sci 1997;105:473-477.
Buzalaf MA, Pessan JP, Honório HM, ten Cate JM: Mechanisms of action of fluoride for caries control. Monogr Oral Sci 2011;22:97-114.
Carey CM: Focus on fluorides: update on the use of fluoride for the prevention of dental caries. J Evid Based Dent Pract 2014;14(suppl): 95-102.
Caslavska V, Moreno EC, Brudevold F: Determination of the calcium fluoride formed from in vitro exposure of human enamel to fluoride solutions. Arch Oral Biol 1975;20:333-339.
Castilho AR, Salomão PM, Buzalaf MA, Magalhães AC: Protective effect of experimental mouthrinses containing NaF and TiF4 on dentin erosive loss in vitro. J Appl Oral Sci 2015;23:486-490.
Chevitarese AB, Chevitarese O, Chevitarese LM, Dutra PB: Titanium penetration in human enamel after TiF4 application. J Clin Pediatr Dent 2004;28:253-256.
Comar LP, Cardoso Cde A, Charone S, Grizzo LT, Buzalaf MA, Magalhães AC: TiF4 and NaF varnishes as anti-erosive agents on enamel and dentin erosion progression in vitro. J Appl Oral Sci 2015;23:14-18.
Comar LP, Souza BM, Grizzo LT, Buzalaf MA, Magalhães AC: Evaluation of fluoride release from experimental TiF4 and NaF varnishes in vitro. J Appl Oral Sci 2014;22:138-143.
Comar LP, Wiegand A, Moron BM, Rios D, Buzalaf MA, Buchalla W, Magalhães AC: In situ effect of sodium fluoride or titanium tetrafluoride varnish and solution on carious demineralization of enamel. Eur J Oral Sci 2012;120:342-348.
Delbem AC, Alves KM, Sassaki KT, Moraes JC: Effect of iron II on hydroxyapatite dissolution and precipitation in vitro. Caries Res 2012;46:481-487.
Divaris K, Preisser JS, Slade GD: Surface-specific efficacy of fluoride varnish in caries prevention in the primary dentition: results of a community randomized clinical trial. Caries Res 2013;47:78-87.
Gu Z, Li J, Söremark R: Influence of tooth surface conditions on enamel fluoride uptake after topical application of TiF4 in vitro. Acta Odontol Scand 1996;54:279-281.
Hove LH, Holme B, Stenhagen KR, Tveit AB: Protective effect of TiF4 solutions with different concentrations and pH on development of erosion-like lesions. Caries Res 2011;45:64-68.
Hove LH, Holme B, Young A, Tveit AB: The protective effect of TiF4, SnF2 and NaF against erosion-like lesions in situ. Caries Res 2008;42:68-72.
Hove LH, Young A, Tveit AB: An in vitro study on the effect of TiF4 treatment against erosion by hydrochloric acid on pellicle-covered enamel. Caries Res 2007;41:80-84.
Klimek J, Hellwig E, Ahrens G: Fluoride taken up by plaque, by the underlying enamel and by clean enamel from three fluoride compounds in vitro. Caries Res 1982;16:156-161.
Levy FM, Magalhães AC, Gomes MF, Comar LP, Rios D, Buzalaf MA: The erosion and abrasion-inhibiting effect of TiF4 and NaF varnishes and solutions on enamel in vitro. Int J Paediatr Dent 2012;22:11-16.
Lippert F, Hara AT, Martinez-Mier EA, Zero DT: In vitro caries lesion rehardening and enamel fluoride uptake from fluoride varnishes as a function of application mode. Am J Dent 2013;26:81-85.
Lippert F, Hara AT, Martinez-Mier EA, Zero DT: Laboratory investigations into the potential anticaries efficacy of fluoride varnishes. Pediatr Dent 2014;36:291-295.
Lussi A, Carvalho TS: The future of fluorides and other protective agents in erosion prevention. Caries Res 2015;49(suppl 1):18-29.
Magalhães AC, Comar LP, Rios D, Delbem AC, Buzalaf MA: Effect of a 4% titanium tetrafluoride (TiF4) varnish on demineralisation and remineralisation of bovine enamel in vitro. J Dent 2008a;36:158-162.
Magalhães AC, Kato MT, Rios D, Wiegand A, Attin T, Buzalaf MAR: The effect of an experimental 4% TiF4 varnish compared to NaF varnishes and 4% TiF4 solution on dental erosion in vitro. Caries Res 2008b;42:269-274.
Magalhães AC, Wiegand A, Rios D, Buzalaf MA, Lussi A: Fluoride in dental erosion. Monogr Oral Sci 2011;22:158-170.
Marinho VC, Chong LY, Worthington HV, Walsh T: Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2016;29: CD002284.
Marinho VC, Worthington HV, Walsh T, Clarkson JE: Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2013;11:CD002279.
Olympio KP, Cardoso VE, Bijella MF, Pessan JP, Delbem AC, Buzalaf MA: Urinary fluoride output in children following the use of a dual-fluoride varnish formulation. J Appl Oral Sci 2009;17:179-183.
Qu H, Wei M: Synthesis and characterization of fluorine-containing hydroxyapatite by a pH-cycling method. J Mater Sci Mater Med 2005;16:129-133.
Ribeiro CC, Gibson I, Barbosa MA: The uptake of titanium ions by hydroxyapatite particles - structural changes and possible mechanisms. Biomaterials 2006;27:1749-1761.
Rintoul L, Wentrup-Byrne E, Suzuki S, Grøndahl L: FT-IR spectroscopy of fluoro-substituted hydroxyapatite: strengths and limitations. J Mater Sci Mater Med 2007;18:1701-1709.
Rošin-Grget K, Peroš K, Sutej I, Bašić K: The cariostatic mechanisms of fluoride. Acta Med Acad 2013;42:179-188.
Saxegaard E, Rölla G: Fluoride acquisition on and in human enamel during topical application in vitro. Scand J Dent Res 1988;96:523-535.
Seppä L: Fluoride varnishes in caries prevention. Med Princ Pract 2004;13:307-311.
Souza BM, Lima LL, Comar LP, Buzalaf MA, Magalhães AC: Effect of experimental mouthrinses containing the combination of NaF and TiF4 on enamel erosive wear in vitro. Arch Oral Biol 2014;59:621-624.
Stenhagen KR, Hove LH, Holme B, Tveit AB: The effect of daily fluoride mouth rinsing on enamel erosive/abrasive wear in situ. Caries Res 2013;47:2-8.
Sundaram CS, Viswanathan N, Meenakshi S: Defluoridation chemistry of synthetic hydroxyapatite at nano scale: equilibrium and kinetic studies. J Hazard Mater 2008;155:206-215.
ten Cate JM: Contemporary perspective on the use of fluoride products in caries prevention. Br Dent J 2013;214:161-167.
Twetman S: The evidence base for professional and self-care prevention - caries, erosion and sensitivity. BMC Oral Health 2015;15(suppl 1):S4.
Vieira AM, Ruben JL, Bronkhorst EM, Huysmans MC: In vitro reduction of dental erosion by low-concentration TiF4 solutions. Caries Res 2011;45:142-147.
Wiegand A, Magalhães AC, Attin T: Is titanium tetrafluoride (TiF4) effective to prevent carious and erosive lesions? A review of the literature. Oral Health Prev Dent 2010a;8:159-164.
Wiegand A, Magalhães AC, Navarro RS, Schmidlin PR, Rios D, Buzalaf MA, Attin T: Effect of titanium tetrafluoride and amine fluoride treatment combined with carbon dioxide laser irradiation on enamel and dentin erosion. Photomed Laser Surg 2010b;28:219-226.
Wiegand A, Waldheim E, Sener B, Magalhães AC, Attin T: Comparison of the effects of TiF4 and NaF solutions at pH 1.2 and 3.5 on enamel erosion in vitro. Caries Res 2009;43:269-277.
Yu H, Attin T, Wiegand A, Buchalla W: Effects of various fluoride solutions on enamel erosion in vitro. Caries Res 2010;44:390-401.
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