Cytotoxicity of Silver-Containing Coatings Used in Dentistry, a Systematic Review

Silver is an element that has been widely used in medicine. As a result of its remarkable properties, this metal is now extensively used in virtually all areas of dentistry. Its anti-caries and antibacterial properties are used in (but not limited to) periodontal therapy or during endodontic treatment. The addition of silver ions to materials, such as cements and substances used for fillings, proved to increase their flexural strength and surface microhardness. This element has also found use in orthodontics, e.g., as a material covering components of fixed braces or in implantology as one of the components of coatings applied to dental implants. The following systematic review aims to find and analyze available studies that evaluate silver according to cytotoxicity. For this purpose, information was gathered from three databases: PubMed, Web of Science, and Scopus. This was followed by the Risk of Bias (RoB) analysis and the GRADE analysis of selected articles in which cytotoxicity was tested on human gingival fibroblasts (HGFs). A total of 387 articles were evaluated using required criteria, and, 13 papers were selected for final review. As all studies were evaluated to be of relatively good quality, it may be concluded that silver used in dentistry in low concentrations is free of significant cytotoxicity, and its use helps to improve the properties of the materials used.