Abstract
Objectives: selective caries excavation (SE) is recommended for deep carious lesions. Bulk fill composites (BF) may be considered to restore SE-cavities. We compared the susceptibility for secondary caries adjacent to BF versus incrementally filled composites (IF) in SE and non-selectively excavated teeth (NS) in vitro. Methods: in 72 extracted human premolars, artificial caries lesions were induced on pulpo-axial walls of standardized cavities. The lesions were left (SE) or removed (NS), and teeth were restored using two BF, GrandioSO x-tra/Voco (BF-Gra) and SDR/Dentsply (BF-SDR), and an IF, GrandioSO/Voco (IF-Gra) (n = 12/group for SE and NS). After thermo-mechanical cycling (5–55 °C, 8 days), teeth were submitted to a continuous-culture Lactobacillus rhamnosus biofilm model with cyclic loading for 10 days. Mineral loss (ΔZ) of enamel surface lesions (ESL), dentin surface lesions (DSL), and dentin wall lesions (DWL) was analyzed using transversal microradiography. Results: ΔZ was the highest in DSL, followed by ESL, and it was significantly lower in DWL. There were no significant differences in ΔZ between groups in DSL, ESL, and DWL (p > 0.05). Regardless of lesion location, ΔZ did not differ between SE and NS (p > 0.05). Conclusions: BF and IF both showed low risks for DWL (i.e., true secondary caries) after SE in vitro, and surface lesion risk was also not significantly different between materials. SE did not increase secondary caries risk as compared with NS. Clinical Significance: the risk of secondary caries was low after selective excavation in this study, regardless of whether bulk or incrementally filled composites were used
Highlights
Selective caries excavation (SE) has been recommended, with soft or leathery carious tissue being intentionally left close to the pulp, while, in the periphery, only hard or firm dentin remains after excavation
Our second hypothesis was that the carious tissue removal strategy, i.e., selective caries excavation (SE) versus non-selective removal, was not significantly associated with ∆Z
Seventy-two standardized proximal cavities were prepared in extracted human premolars to compare the risk of secondary caries adjacent to different bulk filling materials in association with SE
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. It has been argued that, during SE, the amount of remaining carious tissue should be limited, with soft dentin only remaining in areas where pulp exposure is otherwise likely because the bond strength of dental adhesives to carious dentin are lower than to sound dentin, and, as carious hard tissues, come with a detrimental elastic modulus and impaired physical support for the restoration against masticatory forces [4,5] In such circumstances, SE has not been found to come with higher risk of secondary caries or fracture than conventional, non-selective removal. The clinical evidence supporting bulk fills is limited [6,7,8], which is why in vitro studies are a useful means to compare the different material classes under controlled environments Such environments allow for studying specific restorative failures, like secondary caries ( termed caries adjacent/next to restorations, CAR). Our second hypothesis was that the carious tissue removal strategy, i.e., SE versus non-selective removal, was not significantly associated with ∆Z
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