Caries Removal In Primary Teeth Research Articles

Evaluation of Papacarie®, Carie-Care™, BRIX3000™ and conventional hand instrumentation for caries removal in primary teeth: a randomized control study.

In the current odontological era, carious lesions are removed while tooth tissue is preserved. Most of these ideals are met by chemomechanical caries removal (CMCR) methods, which are easy and comfortable to use, differentiate and eliminate infected tissues, minimize pressure, vibration and heat, and are cost-effective. This study examines the efficacy of commercially available CMCR agents, namely Papacarie®, Carie-Care™ and BRIX3000™, and a conventional hand instrumentation method for caries removal in deciduous molars in terms of time consumption, ease of application, and pain perception. For this randomized clinical trial, 120 children aged 4 to 9 years were selected and randomly allocated to four groups of 30 patients each. Time consumption, ease of application, and pain perception were evaluated at three intervals: pre-, during- and post-caries removal, using Wong-Baker FACES (WBF) Pain Rating Scale and the Face, Legs, Activity, Cry, Consolability (FLACC) scale. The results showed that among the compared materials and conventional hand instrumentation technique, Carie-Care™ was statistically found to be the least time-consuming with a p-value of 0.019, have the least pain perception with a p-value of 0.02, and was clinically the best with respect to manipulation and handling. While all three CMCR agents aid in the removal of carious tissue, Carie-Care™ was the most effective based on time consumption, pain perception and simplicity of administration.

Clinical and Microbiological Evaluation of Smartprep Burs in Caries Removal in Primary Teeth

Purpose: To evaluate the efficacy of smartprep burs in caries removal in primary teeth clinically and microbiologically, also to assess the time taken for caries removal and the pain perception experienced by children compared with conventional carbide burs and sharp spoon excavator. Materials and Methods: A total of 51 teeth from children ranging from 4 -9 years old of both sexes, were selected for this study after they met inclusion criteria. The teeth were randomly assigned to three groups, seventeen teeth for each group. The patients were recalled at 1, 6 weeks and 3 months for clinical evaluation. Results: Microbiologically the highest mean bacterial reduction was recorded significantly in Group II (conventional carbide bur) (p value > 0.05). While, there was no significant difference between Smart burs and spoon excavator (p value =0.9). Clinically the median of caries detector dye scores was significantly lower in the conventional group compared to other groups (p value < 0.05). The mean time for caries removal was significantly different between groups, the highest value was recorded by Smart burs and the least one by conventional burs (p value < 0.05). The median of pain score was insignificantly highest in the conventional group followed by spoon excavator and smart bur had the least value (p value =0.166). Conclusions: Smart bur produced great reduction in bacterial count and considered the least painful technique while it took the longest time. It can be used as an alternative to the mechanical method for children but need further studies.

Clinical and Microbiological Evaluation of Smartprep Burs in Caries Removal in Primary Teeth

Purpose: To evaluate the efficacy of smartprep burs in caries removal in primary teeth clinically and microbiologically, also to assess the time taken for caries removal and the pain perception experienced by children compared with conventional carbide burs and sharp spoon excavator. Materials and Methods: A total of 51 teeth from children ranging from 4 -9 years old of both sexes, were selected for this study after they met inclusion criteria. The teeth were randomly assigned to three groups, seventeen teeth for each group. The patients were recalled at 1, 6 weeks and 3 months for clinical evaluation. Results: Microbiologically the highest mean bacterial reduction was recorded significantly in Group II (conventional carbide bur) (p value > 0.05). While, there was no significant difference between Smart burs and spoon excavator (p value =0.9). Clinically the median of caries detector dye scores was significantly lower in the conventional group compared to other groups (p value < 0.05). The mean time for caries removal was significantly different between groups, the highest value was recorded by Smart burs and the least one by conventional burs (p value < 0.05). The median of pain score was insignificantly highest in the conventional group followed by spoon excavator and smart bur had the least value (p value =0.166). Conclusions: Smart bur produced great reduction in bacterial count and considered the least painful technique while it took the longest time. It can be used as an alternative to the mechanical method for children but need further studies.

A comparative evaluation of micro shear bond strength and microleakage between the resin-modified glass ionomer cement and residual dentin following excavation of carious dentin using Carie CareTMand conventional caries removal in primary teeth: an in vitro study.

52 primary teeth with dentinal caries were randomly grouped into group I, where caries removal was done using the conventional method, and group II which used Carie Care TM. All the teeth were restored using RMGIC. Micro shear bond strength between the residual dentin and the cement was tested using universal testing machine and the dye penetration method was used for microleakage testing. Independent t-test was performed for intergroup comparison. Pearson chi-square test was carried out to evaluate the microleakage patterns in the enamel and dentin. The mean micro-shear bond strength of group I was 6.03±1.6 and that of group II was 8.54±2.92; this difference was statistically significant with a p-value of 0.012. Microleakage was higher in the test group (1.38±0.51) than the control group (0.77±0.6) and was significant with a p -value of .036. Papain-based chemomechanical agent Carie Care TMcan be used as an alternative method to conventional caries removal. However, further studies need to explore methods to improve the marginal sealing capacity of RMGIC to the residual dentin after chemomechanical caries removal.

Evaluation of caries removal using papain versus conventional bur in primary teeth

IntroductionConventional treatments for caries removal in children are often associated with pain and fear, so chemomechanical caries removal agents as Brix 3000 have been developed as one of minimally invasive technique which consists of applying a proteolytic substance that only softens the infected dentin tissue and preserves healthy tooth tissue providing more comfortable, and conservative treatment.ObjectivesThe aim of this study was to evaluate the clinical efficacy of papain compared to the conventional bur preparation in caries removal in primary teeth.Patients and methodsA randomized controlled clinical trial with sample consisted of 30 healthy children aged from 4 to 7 years old. On 60 bilaterally cavitated primary molars, a split mouth approach was used, where caries excavation was carried out with Brix 3000 on one side and traditional burs on the other. The variables evaluated were pain response, the average treatment time needed and Streptococcus mutans and Lactobacillus counts before and after caries removal.ResultsRegarding pain response, there was a statistically significant difference between the two techniques, however Brix 3000's caries removal time was significantly longer than the bur's. S. mutans and Lactobacillus counts were reduced using each of the methods, and a statistically significant difference was found; however, the reduction was slightly greater using the chemomechanical method than the conventional method, but this difference was not statistically significant.ConclusionsBrix 3000 is an efficient alternative for caries removal in primary teeth with no pain and great microbiological efficacy, however it requires longer time.

Selective stepwise caries removal in primary teeth: a microbiological assessment on surviving microbiota

Partial caries removal performed by the stepwise treatment has a high rate of clinical success and promotes a reduction of microorganisms in carious dentin. However, the adaptive behavior of these cloistered bacteria is not entirely clear. Aim: This study aimed to evaluate the carious dentin and quantify the microorganisms Streptococcus mutans and Lactobacillus acidophilus at the first intervention and after 90 days, assessing the acidogenicity and aciduricity of these bacteria isolated from the lesions. Methods: Twenty patients presenting deep caries lesion in primary molars eligible to receive the stepwise treatment were selected, dentin samples were collected in two different moments: in the first intervention, just after partial caries removal; and in the second intervention, during the reopening of the cavity (90 days after the temporary sealing of the lesion). The samples were processed for microbiological analyses via culture, identification and quantification. The bacteria isolates were subjected to phenotypic tests of acidogenicity and aciduricity. Dentin consistency and color was also recorded by a calibrated examiner. Data were statistically analyzed. Results: There was a reduction in the number of viable microorganisms while dentin rehardening and browning was noted (p&lt;.05), but no change occurred in the acidogenicity and aciduricity properties of Streptococcus mutans and Lactobacillus acidophilus over time. Conclusion: Thus, the stepwise treatment promoted clinical changes as darkening and hardening of carious dentine and promoted a reduction in the number of viable microorganisms, but no influence was found on the phenotypic characteristics of acidogenicity and aciduricity of the species analyzed after 90 days.

Deep carious lesions management in children and adolescents: a questionnaire survey among dentists practicing paediatric dentistry in France

While many questionnaire surveys have been undertaken worldwide to investigate practices toward deep carious lesion (DCL) management in adults, very few are related to children and adolescents. The present cross-sectional study aimed to assess DCL management in children and adolescents among dentists practicing paediatric dentistry in France (Fr-DPPDs). The secondary objective was to compare practices between Fr-DPPDs and dentists registered in the European Academy of Paediatric Dentistry (EAPD). A questionnaire was electronically administrated to members of the CEOP (College des Enseignants en Odontologie Pediatrique), the SFOP (Societe Francaise d’Odontologie Pediatrique), and the EAPD. Descriptive analyses, Chi-square and McNemar tests, ANOVA, crude and adjusted binary logistic regression analyses were performed. A total of 99 Fr-DPPDs and 146 EAPD members answered the questionnaire. Among the Fr-DPPDs, the preferred caries removal (CR) methods were the complete CR in one step for primary teeth and mature permanent teeth (respectively, 70% and 48%) and in two steps for immature permanent teeth (39%). EAPD members were more likely, than Fr-DPPDs, to choose selective CR versus complete CR in primary teeth (odds ratio = 2.60; 95% CI 1.39–4.85). Moreover, for primary or immature permanent teeth, general practitioners were less likely to choose selective CR than specialists and exclusive practitioners in paediatric dentistry, (p < 0.001). Tooth type [primary, permanent (immature or mature)] seemed to influence DCL management. Fr-DPPS should prioritise pulpal vitality when managing DCL.

Survival of composite restorations after selective or total caries removal in primary teeth and predictors of failures: A 36-months randomized controlled trial

ObjectivesThe aim of this study was to assess the survival of composite restorations after selective (SCR) or total caries removal (TCR) and determine predictors of failures after 36 months. Methods120 teeth with deep occlusal or occlusal-proximal carious lesions were randomly divided into control (TCR; n = 54; 69% Class II) and test (SCR; n = 66; 63% Class II) groups. Clinical evaluation was applied using the USPHS criteria, and the presence of Charlie or Delta scores at the marginal integrity were considered as a failure. ResultsThe overall survival rate of restorations was 68% after 36 months, 81% for TCR and 57% for SCR (p = 0.004). The multivariable Cox Regression model demonstrated that restorations performed after SCR had 3.44 times greater probability of failure compared to TCR (p = 0.006). The other two predictors for failure of restorations were teeth with Class II cavities (hazard ratio = 3.3) and children with gingival bleeding over 20% (hazard ratio = 2.5). ConclusionsPerforming composite restorations after SCR in primary teeth had success rate significantly lower than restorations performed after TCR. Complex cavities and worst patient´s oral hygiene were found to be predictors of failure of restorations. Clinical significanceAlthough SCR has been demonstrating high rates of pulp preservation, clinicians should consider that composite restorations fail in a higher frequency compared to TCR in primary teeth and, in some circumstances, may be preferable in terms of restoration longevity.

Efficacy and Efficiency of Papacarie versus Conventional Method in Caries Removal in Primary Teeth: An SEM Study.

Background:Chemomechanical methods such as Papacarie were developed as alternate dental caries removal methods to overcome major disadvantages of the conventional drilling technique. However, few studies have demonstrated the efficacy of Papacarie for caries removal using scanning electron microscope (SEM).Objectives:The purpose of this study was to compare the efficacy and efficiency of Papacarie and the conventional bur method in caries removal from primary teeth.Materials and Methods:In this in vitro study, 30 freshly extracted, human primary molars with dentinal caries were obtained from the outpatient clinics at the Dental Hospital of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Each tooth was sectioned mesiodistally into two halves through the center of the lesion, and each half was randomly subjected to caries removal by Papacarie (Group I) and excavation using the conventional bur method (Group II). Time taken (efficiency) for removal of caries was noted using a stopwatch. Samples were then examined under SEM for presence of bacterial colonies (efficacy). For efficiency, data were analyzed using chi-square, and for efficacy, using t-test.Results:There was no significant difference in the presence of bacteria in both groups under SEM (Papacarie = 23.3%; conventional method = 16.7%; P = 0.52). However, significantly more time was taken for caries removal with Papacarie (mean = 351.56 s) than with the conventional bur method (mean = 158.41 s) (P < 0.0001).Conclusion:Papacarie is as effective in removing dentinal bacteria as the conventional caries removal method but is less efficient, as the time taken for excavation was longer.

Caries removal by Er,Cr:YSGG laser and Air-rotor handpiece comparison in primary teeth treatment: an in vivo study.

The aim of this study was to evaluate and compare caries removal by Er,Cr:YSGG Laser and conventional method using Air-rotor handpiece in primary teeth. 25 children with at least two class I carious lesions on primary teeth with Diagnodent readings not differing more than ± 10 for both teeth were included in the study. All 50 teeth in the study received treatment by the same operator. Time taken for caries removal was recorded using a timer. Pain assessment was done using Wong Baker Modified Faces Pain Rating Scale and Visual Analog Scale before and after the procedure. After caries removal, caries detection dye was applied to the prepared cavity to check the efficacy of the procedure. In addition, after completion of treatment, each child was asked to indicate which method of caries removal, Er,Cr:YSGG Laser or Air-rotor handpiece, was more comfortable. The difference between the mean values for post-procedural Wong Baker Faces Pain Rating Scale scores and Visual Analog Scale scores in Group A and Group B were compared, which showed that children experienced less pain during the caries removal procedure with Er,Cr:YSGG Laser than with Air-rotor handpiece. Time taken for caries removal procedure was more in Group A than in Group B. It was seen that in both the groups caries detection dye was completely removed and both the procedures were equally efficacious for caries removal. Children indicated caries removal procedure with Laser to be more comfortable. Within the parameters and limitations of the present study, it is suggested that Er,Cr:YSGG Laser seems to be an acceptable tool for caries removal in primary teeth. Children found caries removal with Er,Cr:YSGG Laser to be more comfortable even though time taken was more than the conventional method using Air-rotor handpiece.

Bromelain vs Papain Gel for Caries Removal in Primary Teeth

The aim of the study was to evaluate and compare bromelain with papain as the chemomechanical caries removal agent in relation to their efficacy. Thirty extracted primary molars with active carious lesion extending into dentin were selected. The samples were randomly divided into groups by sectioning the samples into two halves. Group I-cavity prepared using papain gel; group II-cavity prepared using bromelain gel. Time taken for caries removal in both the groups (I and II) was recorded with the help of a stopwatch. Following caries removal, the amount of remaining demineralized dentin was measured with the help of stereomicroscope and weld check (biological image analysis) software. t test is used to evaluate the significance of study parameters on continuous scale between two groups on metric parameters. The mean of residual carious dentin thickness obtained from the group II (bromelain) was 36.74 μm, which was much lower than that obtained from group I (papain) with a mean of 73.84 μm. The mean time taken in the group II (bromelain) was 335.30 seconds which was nearly equal to the mean time of group I (papain) of 352.33 seconds. The amount of remaining demineralized dentin was found to be lower in bromelain group than the papain group and time taken for the carious dentin removal was almost found similar in both bromelain and papain groups. It may be concluded that bromelain was more effective in amount of caries removal than papain. Chemomechanical caries removal with the organic gels pose a great benefit as they are less invasive and has low side effects and cost-effective. How to cite this article: Reddy VK, Nagar P, Reddy S, et al. Bromelain vs Papain Gel for Caries Removal in Primary Teeth. J Contemp Dent Pract 2019;20(11):1345-1349.

Caries removal in primary teeth using Papacarie.

Data sourcesPubMed, Embase, Cochrane Central Register of Controlled Trials and the Web of Science were searched. Whether any limits on language were applied remains unclear. Studies published up to January 2018 were included.Study selectionTwo reviewers independently selected randomised or controlled clinical trials (RCTs, CCTs) investigating carious tissue removal using Papacarie, an enzyme-based chemomechanical method, versus conventional' techniques in primary molars in children or adolescents.Data extraction and synthesisData were abstracted independently by two reviewers and risk of bias assessed. Three outcomes, bacterial counts after carious tissue removal (measure: log10 colony-forming units [CFU]), pain (measured on Wong-Baker scale) and the time needed for carious tissue removal (in seconds), were submitted to meta-analysis (effect estimate: weighted means).ResultsSix RCTs and four CCTs, published 2009-2016, were included. After Papacarie-based removal, fewer bacteria remained compared with conventional treatment (MD 0.57 log10 CFU, 95% CI 0.04 to 1.09, based on two studies). Pain was also significantly lower in the Papacarie group (-1.01, -1.72 to -0.30, based on three studies). Papacarie-based removal took significantly longer (200.8 seconds, 152.5 to 249.1, based on seven studies).ConclusionsPapacarie-based carious tissue removal is efficacious for bacteria removal, and exerts significantly less pain than conventional removal. However, treatment times are longer.

Effects of Papacarie on children with dental caries in primary teeth: a systematic review and meta-analysis.

Caries in primary teeth hinder the child to bite and chew and influence their development. Papacarie has the characteristics of selective removal of decayed tissue and can preserve healthy dentine to the maximum, but its efficiency has not been critically evaluated compared to conventional method. This review is aiming at comparing the Papacarie and traditional method in caries removal in primary dental caries with children. Comprehensive literature searching at PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science to January 2018. Six randomized controlled trials (RCTs) and four prospective controlled clinical trials (CCTs) were included. The microbiota in caries dentine was significantly reduced using the Papacarie treatment (MD = 0.57, 95% CI 0.04 to 1.09, P = 0.03), and the anxiety feeling declined more in the Papacarie group (MD = -1.01, 95% CI -1.72 to -0.30, P < 0.005). There was a greater 200.79 (MD = 200.79, 95%CI 152.50 to 249.09, P < 0.00001) increase in time taken for the Papacarie treatment compared with the conventional method. Papacarie exerts a positive effect in reducing the bacteria and decreases the pain during caries removal in primary teeth although it costed a longer treatment time compared with the conventional method.

Microleakage Evaluation of Composite Restorations Following Papain-Based Chemo-Mechanical Caries Removal in Primary Teeth.

To evaluate the microleakage of composite restorations following Papain-based chemo-mechanical caries removal compared to the conventional drilling method. The characteristic of the hybrid layer was also studied using scanning electron microscopy. The sample included thirty freshly extracted and exfoliated primary molars with open proximal carious dentin lesions. Teeth were divided into two equal groups, according to method of caries removal. Following caries removal, cavity preparations were restored with composite resin. After thermocycling, teeth were sealed apically and coated with nail polish except the surface of restorations and the surrounding 1mm. Teeth were immersed in basic fuschin dye solution, then they were sectioned mesiodistally. The extent of dye penetration was detected using a light stereomicroscope. After microleakage test, the resin/dentin interface was examined using scanning electron microscopy. There was no significant difference in the degree of leakage between both groups. In the Papacarie group, longer and numerous resin tags were observed with statistically significant thicker hybrid layer than those following the drilling method. However, there was no significant difference between the diameters of resin tags of both groups. Papacarie does not adversely affect the microleakage of composite restorations and provides a suitable surface for bonding.

Dentin Topographic Features following Chemomechanical Caries Removal in Primary Teeth

Study the topographic features of dentin after caries removal with a chemomechanical agent (Papacarie) compared with the conventional drilling method. The sample included 7 exfoliated and extracted primary teeth with carious dentin lesions, not reaching the pulp. Each tooth was sectioned longitudinally through the center of the carious lesions into two halves. The teeth were then divided into two groups according to the method of caries removal. Following caries removal, dentin topography and the cut section were examined using the scanning electron microscope. Papacarie produced an irregular, porous, rough and globular dentin appearance. The dentin surfaces were generally free of smear layer, visible bacteria and the dentinal tubules were opened. The dentin cut surfaces showed patent dentinal tubules with open orifices. The drilling method created a smooth and amorphous surface with a continuous smear layer occluding the dentinal tubules. Numerous bacteria were also observed. The cut dentin surfaces showed patent dentinal tubules with their orifices plugged with smear layer. Papacarie produced a rough and porous surface with partial or complete removal of the smear layer and opened dentinal tubules, while the drill produced a smooth surface with uniform smear layer occluding the dentinal tubules.

Clinical Evaluation of Caries Removal in Primary Teeth Using Carie-care and SmartPrep Burs: An In vivo Study

Background: Ultra conservative caries removal now has become an integral part of Minimal Invasive Dentistry. The main objective of deep caries removal is to conserve the tooth structure as well to maintain the integrity of pulpal health. Aim: To evaluate clinically the efficiency of caries removal using Carie-Care compared to the SmartPrep burs for complete caries excavation. Materials and Methods: Split mouth study was done in 64 children where caries excavation was done using Carie-Care on one side and Smart burs on the other side. The parameters assessed were complete caries excavation, pain reaction, need for local anesthesia and mean time required. Results: The differences between complete caries excavation, pain reaction and need for local anesthesia using both the techniques were statistically insignificant. Whereas the time taken for caries removal using Carie-Care was significantly less than Smart burs (P = 0.001). Conclusion: Both the techniques can be used effectively for caries excavation in primary teeth.

Caries removal in deciduous teeth using an Er:YAG laser: a randomized split-mouth clinical trial.

The aim of the present clinical randomized split-mouth study was to evaluate the effectiveness and efficiency of an Er:YAG laser for caries removal in primary molars, microbiological dentin analysis, and clinical restorations after 1 year in 29 children. The children's teeth were randomized into two groups: (I) an Er:YAG laser group and (II) a bur preparation group. The efficiency of the treatments (the time necessary for the removal of carious tissue) was evaluated based on the time spent on caries removal in the deciduous molars. The effectiveness (caries removal capacity) of the caries removal was determined by means of a blind test in which the examiner performed a tactile and visual examination of the dentin. Microbiological analysis was performed by counting the Streptococcus mutans and Lactobacillus sp in the remaining dentin. Clinical analysis of restorations was performed using the USPHS method in combination with photographs of restored teeth, 7 days after the restorative procedure and again after 1 year. All cavities were restored with the Adper Single Bond 2/Filtek Z350 system. The obtained data were analyzed with a significance level of 5 %. The Er:YAG laser was less effective and had the same efficacy as bur preparation during caries removal at the pulpal wall of deciduous molars. In the surrounding walls, bur preparation was the more effective method. Regardless of the method employed, the affected dentin in the pulpal wall had similar amounts of S. mutans and Lactobacillus sp. The restorations were clinically accepted by the USPHS method over a 1-year period. It can be concluded that caries removal with an Er:YAG laser has no influence on the clinical behavior of restorations. Irradiation with an Er:YAG laser is appropriate for caries removal in primary teeth.

The Partial Removal of Carious Tissue may Arrest Caries Progression in Primary Teeth

Caries removal in primary teeth—a systematic review. Ferreira JM, Pinheiro SL, Sampaio FC, de Menezes VA. Quintessence Int 2012;43(1):e9-15. Anne C. O'Connell, BA, BDent Sc, MS To attempt to determine what extent of caries removal is required to arrest caries in primary teeth Information not available Systematic review Level 2: Limited-quality, patient-oriented evidence Grade B: Inconsistent or limited-quality patient-oriented evidence

Clinical Evaluation of Caries Removal in Primary Teeth using Conventional, Chemomechanical and Laser Technique: An in vivo Study

To evaluate four different techniques of caries excavation in primary teeth in terms of efficacy, efficiency and pain experienced during the procedure. Sample of 120 teeth from children aged 5 to 9 years were equally divided into 4 groups - Air rotor (group A), Carisolv (group B), Papacarie (group C) and Er:YAG laser (group D). Visual and tactile criteria along with DIAGNOdent pen value was used to evaluate efficacy. Time was recorded to determine efficiency and FLACC scale was used to assess the pain experienced. Air rotor and laser were more effective and efficient method whereas laser and CMCR methods were more comfortable methods. Laser irradiation and CMCR methods are comparable to conventional methods in terms of effectiveness and are less painful methods. Newer techniques of CMCR and laser irradiation of dentinal caries are minimally invasive methods and are less painful and thus should be more frequently employed in pediatric dentistry.

Partial caries removal in primary teeth: association of clinical parameters with microbiological status

Partial caries removal in primary teeth: association of clinical parameters with microbiological status