Caries Removal Method Research Articles

A Prospectiv ospective-Randomiz e-Randomized Study: The Impact of F ed Study: The Impact of Four Diff our Different Caries Remo Caries Removal Method on P al Method on Pain and Clinical E ain and Clinical Evaluations aluations

Objective: There are many different methods for removing caries. In this study, to evaluate four caries removal methods in terms of patient comfort and to evaluate the clinical success of restorations according to modified-USPHS criteria. Methods: In 31 patients with at least 4 Class II caries in their posterior teeth, 4 teeth were randomly divided into four groups and 4 different methods (conventional method, Carisolv, Papacarie, Er-Cr:YSGG Laser) were used for caries removal. Pain formation during caries removal was determined by FACE Pain Scale questionnaire. The restorations were controlled with Modified-USPHS criteria in 3-6-12 months period. Mann-Whitney U test for two-group comparisons, Kruskal Wallis H test for comparison of three or more groups, Wilcoxon Sign test was used to examine the changes according to time (p < 0.05). Results: A significant difference was found between conventional methods and alternative methods in terms of pain tolerance. In the 1-year clinical evaluation of the restorations, there was a significant decrease in the postoperative sensitivity in all groups. A significant difference was detected in Carisolv and laser groups between 6-months and 12-months for marginal coloration. A significant difference was found between the conventional and laser groups between 6-months and 12-months in terms of color match. Conclusion: The success of restorations, efficacy and efficiency of the methods used in the evaluation of all groups were found to be successful. In terms of patient comfort, all alternative methods gave positive results.

Factors Affecting the Decision-making of Direct Pulp Capping Procedures among Dental Practitioners: A Multinational Survey from 16 Countries with Meta-analysis

IntroductionDirect pulp capping (DPC) procedures require the placement of a bioactive material over an exposure site without selective pulp tissue removal. This web-based multicentered survey had 3 purposes: (1) to investigate the factors that affect clinicians’ decisions in DPC cases, (2) to determine which method of caries removal is preferred, and (3) to evaluate the preferred capping material for DPC. MethodsThe questionnaire comprised 3 sections. The first part comprised questions regarding demographic features. The second part comprised questions on how treatment plans change according to factors such as nature, location, number and size of the pulp exposure, and patients’ age. The third part composed of questions on the common materials and techniques used in DPC. To estimate the effect size, the risk ratio (RR) and 95% confidence interval (CI) were calculated using a meta-analysis software. ResultsA tendency toward more invasive treatment was observed for the clinical scenario with carious-exposed pulp (RR = 2.86, 95% CI: 2.46, 2.32; P < .001) as opposed to the clinical scenario with 2 pulp exposures (RR = 1.38, 95% CI: 1.24, 1.53; P < .001). Complete caries removal was significantly preferred to selective caries removal (RR = 4.59, 95% CI: 3.70, 5.69; P < .001). Among the capping materials, calcium silicate-based materials were preferred over calcium hydroxide-based materials (RR = 0.58, 95% CI: 0.44, 0.76; P < .05). ConclusionsWhile carious-exposed pulp is the most important factor in clinical decisions regarding DPC, the number of exposures has the least impact. Overall, complete caries removal was preferred over selective caries removal. In addition, the use of calcium silicate-based materials appears to have replaced calcium hydroxide-based materials.

Evaluation of the Efficacy of Recent Caries Removal Techniques: An In Vitro Study.

Dentistry is undergoing a gentle revolution that will consign drill and fill to history. In order to increase the acceptance of dental treatment, efforts are directed toward changing traditional painful dentistry into a new concept of painless dentistry. It is common practice to utilize burs for caries removal and cavity preparation. Chemomechanical caries removal is a painless procedure that uses a chemical substance to eradicate diseased dentine. With the Food and Drug Administration (FDA) approval of Erbium-doped yttrium-aluminum-garnet (Er: YAG) laser systems for caries removal and cavity preparation, the discipline of laser operational dentistry was born out of a desire to find a way to remove the decay without causing any pain or stress to the surrounding healthy tissue. This in vitro research aimed to assess the relative advantages of chemomechanical and laser caries extraction techniques in comparison to the more traditional bur technique. The efficacy of each method was evaluated by microscopic examination of samples treated with each experimental method. We also evaluated the efficiency of each method by recording the time required for caries excavation. The methods used for caries excavation were bur excavation, chemo-mechanical method, and laser method. Histological slices were produced after all the samples had been treated with the experimental techniques, and they were studied using a binocular light transmission microscope. The samples were then scored as '0' for absence and '1' for the presence of demineralized dentine. These scores and the time recorded for each method were subjected to statistical analysis. This study found no statistically significant difference in the effectiveness of the different approaches to removing caries; however, bur excavation was the quickest and chemo-mechanical was the slowest, with the latter not being useful in cases with low caries activity. The laser method of caries removal doesn't remove caries existing in the undercut areas of the cavity thus making the use of bur mandatory. With more practice and experience, the chemo-mechanical and laser methods can be used in a more efficient way to render painless operative procedures to patients.

Dentine Mineral Changes Induced by Polyalkenoate Cements after Different Selective Caries Removal Techniques: An in vitro Study

This study aimed at evaluating the mineral variation induced by polyalkenoate cements in residual dentine after different caries removal methods. Ten extracted sound molars were selected, and five cavities were prepared on the occlusal surface of each specimen. Carious lesions were generated using a microbial protocol, while the caries removal was performed using bur, hand excavator, or two papain-based chemo-mechanical agents. One cavity was left unexcavated in each tooth. Cavities were restored using a zinc polycarboxylate cement (ZPC; n = 25), or a glass ionomer cement (GIC) was used (n = 25). Subsequently, the specimens were stored under simulated pulpal pressure for 45 days. Micro-CT scanning was performed after caries formation, removal, and restoration. Cavity volumes (mm³) and mineral density (MD) changes were calculated. Remineralisation ability was investigated by scanning electron microscopy (SEM) and Fourier-transformed infrared spectroscopy (FTIR). Statistical analysis was performed (5% significance level). Baseline caries, cavity volume, and MD increase after caries removal were similar to all excavation groups (p > 0.05). MD was higher in ZPC compared to GIC (p < 0.05). SEM revealed that the chemo-mechanical techniques produced a smoother dentine surface compared to mechanical methods. FTIR showed silicon-based minerals in GIC-treated dentine, while ZPC-treated presented mineral deposits characterised by amorphous calcium phosphate. In both cases, the presence of carbonates was detected on dentine surfaces. All caries removal techniques performed similarly in terms of carious dentine excavation. ZPC can be used as dentine replacement material after caries removal as it may induce higher MD increase in residual dentine via deposition of calcium phosphates, compared to GIC.

Caries removal techniques: An update on relevant factors

Introduction: Dental caries is a chronic infectious disease with a multifactorial etiology that leads to the destruction of the dental tissues.Objective: To analyze the literature on the influence of chemical-mechanical and conventional caries removal methods, as well as self-etching and wash-and-rinse adhesive systems on adhesion forces.Methodology: A compilation of articles published in the last 5 years was carried out using PubMed, Google Scholar and SCOPUS. Abstracts and full texts were identified that included information on factors influencing resin application:

Knowledge, awareness and attitude among dentists of North India regarding use of Silver Diamine Fluoride (SDF) in preventing dental caries.

AIM- To evaluate the knowledge, awareness and attitude of the dentist from North India towards Silver Diamine Fluoride (SDF) use in preventing dental caries. MATERIALS AND METHODS- An online survey was conducted among dentists of North India using online questionnaire to assess the knowledge, experience, and attitude of dentists regarding the use of SDF. 107 dentists participated in the online survey. Data obtained were analysed statistically. RESULTS-Most participants revealed they were somewhat taught about SDF. 29 % of the participants agreed that SDF can be used as an alternative to the conventional method of caries removal. Nearly about 32.7 % of the participants do not know regarding the application protocol interval for SDF. CONCLUSION- Knowledge about SDF among dental practitioners in North India was low to moderate. Increasing SDF knowledge among dentists may serve as an alternative for treating young patients who cannot co-operate with the traditional dental treatment. Keywords: Dental Caries, Questionnaires, Silver Diamine Fluoride, Survey.

Efficiency of ER:YAG laser therapy in combination with behaviour management technique in reducing anxiety among paediatric dental patients – a study protocol for a randomised clinical trial

IntroductionWhen providing dental care to children with a high level of dental anxiety, the range of approaches is divided into two sections: use of behaviour management techniques (BMTs) and application...

Evaluation of Caries Removal Efficacy Using BRIX 3000 and Atraumatic Restorative Treatment in Primary Molars: A Clinical Comparative Study

The aim of the present study was to compare and evaluate the efficacy of two minimally invasive methods in the removal of infected carious dentin in primary molars. Eighty primary molars with class I occlusal caries involving dentin were selected and allocated to either of the two groups using convenient sampling. Group A (n = 40) caries were excavated using BRIX 3000 and in Group B (n = 40) atraumatic restorative treatment (ART) caries were excavated using hand instruments only. In both groups, caries removal efficacy was evaluated clinically using caries detection dye (Sable and Sleek), and the patient's discomfort level was noted using the Wong-Baker faces pain rating scale (WBFPS). The results indicated that BRIX 3000 was effective in the removal of caries from primary molars with a significant difference. While there was no statistically significant difference seen in pain perception on caries excavation using both the methods. Although, a mild discomfort was noted in Group B. Comparing the two minimally invasive techniques, the new chemomechanical solution (BRIX 3000) was an effective method for the removal of caries from primary molars. So, it can be considered an alternative to the conventional caries removal method in treating pediatric dental patients. BRIX 3000 gel is effective in the removal of caries in children who are anxious and apprehensive as it is a noninvasive method of treatment in the pediatric age group.

A Bibliometric Analysis (2010-2020) of the Dental Scientific Literature on Chemo-Mechanical Methods of Caries Removal Using Carisolv and BRIX3000.

Reports in the literature have proposed and analyzed several minimally invasive techniques for caries removal in recent decades. In light of recent events surrounding the ongoing epidemiological context, concerns have been raised regarding the generation of aerosols during dental procedures. The aim of our research was to provide an overview of the scientific literature on the topic of chemo-mechanical caries removal (CMCR) methods, focusing on two products (Carisolv, BRIX3000), commercially available in Europe. A bibliometric analysis was used to investigate the scientific articles included in Web of Science (WoS) Core Collection database, published from January 2010 to December 2020. We analyzed the co-occurrence of all keywords (Author Keywords and the KeyWords Plus section), co-authorship and co-citation, using the free software VOSviewer. Our bibliometric analysis revealed a worldwide interest in the subject of chemo-mechanical methods of caries removal, which has transcended the area of pediatric dentistry. The analyzed studies have been conducted mainly in high-income countries that have developed sanitary policies regarding prevention and early treatment of carious lesions as a health priority.

Effectiveness of Different Methods in Removing Dentin Caries of Primary Teeth: Micro-CT and SEM Evaluation.

With the recent improvements in technology, the expectation of minimal invasion and maximal comfort in caries removal techniques is increasing. This study aims to examine the effectiveness of six caries removal methods in primary teeth. Sixty primary molars (10 teeth in each groups) were used. The groups were: Group I (Tungsten Carbide Bur), Group II (Sono abrasion), Group III (Air abrasion), Group IV (Carisolv), Group V (Er:YAG Laser), Group VI (ART). In micro-CT scanning, mineral density at the cavity floor was examined before and after caries removal. After caries removal, the patency of the dentinal tubules was examined in two teeth from each group on SEM images. Statistical analyses were performed using Kruskal-Wallis, Wilcoxon tests. For six different caries removal methods, tooth mineral (inorganic, total) densities at cavity floors were compared among the groups after the procedures, and no statistically significant difference was found (p>0.05). On the SEM images, it was seen that the dentinal tubules were exposed and no smear layer was formed in the Carisolv group. Significant rough surfaces were exposed in the laser group. It was observed that alternative caries removal methods are at least as effective as the traditional method in primary teeth for clinical applications.

Microleakage Evaluation of Glass Hybrid Restoration Following Usage of Papain-Based Gel and Ceramic Bur for Caries Removal

Introduction: In the field of pediatric dentistry, an urge to adopt a more comfortable, minimally invasive, and stressless technique for caries removal became a must. Coronavirus disease-2019 outbreak necessitates a paradigm change in the global health care protocols, requiring alternative, nonaerosol generating approaches. This study aimed to measure and compare the influence of two methods of caries removal, namely, Brix3000 and CeraBur, on the microleakage of glass hybrid restorative material. Materials and Methods: Thirty human primary molar teeth with accessible occluso-gingival carious cavitation were randomly allocated into CeraBur and Brix3000 groups. After selective caries excavation, samples were restored with Equia Forte HT, thermocycled, dipped in thiazine dye, washed, and sectioned through the restoration center. Then microleakage was measured using a stereomicroscope (30× magnification) at both occlusal and gingival margins. Results: No statistically significant difference was found between the two methods of caries removal (CeraBur and Brix3000) at both occlusal (P = 1.000) and gingival margins (P = 0.612). Conclusions: Brix3000 caries removing gel did not negatively affect the microleakage of Equia Forte HT compared to the CeraBur and hence can be used alternatively to the conventional drilling methods.

Comparative evaluation of caries removal efficacy between chemomechanical agents &amp; conventional methods regarding time consumption

Introduction: The use of minimally invasive procedures and attention to patient comfort are of great importance, especially for dental treatment in young children. This has led to the development of chemomechanical methods for caries removal. Aim: To evaluate and compare the efficacy in terms of time consumption between the chemomechanical caries removal agent Papacarie and conventional method of caries removal. Methods: Subjects for this study were chosen from the outpatients of the Dept of Pediatric &amp; Preventive Dentistry, Karpaga Vinayaga Institute of Dental Sciences. Twenty five children (age 6 -10 years) with bilateral frank cavitated lesions were included in this study. Bilateral primary teeth with comparable degrees of carious destruction were chosen in each child for caries removal with Papacarie and rotary instruments. The time taken for caries removal was measured using stopwatch. Results The time taken for caries removal in chemomechanical caries removal method was longer than the conventional method which was assessed using the student t test. Conclusions: Papacarie can be an effective clinical alternative treatment for the removal of occlusal dentinal caries in cavitated primary molars but requires longer time as compared to conventional method.

Examination of caries‐affected dentin and composite‐resin interface after different caries removal methods: A scanning electron microscope study

To evaluate the caries-affected dentin and composite-resin interface with scanning electron microscopy (SEM) after different caries removal methods in human molars. Twelve with extensive approximal caries lesions that did not reach the pulp and five caries-free molars (control group [CG]) were used. Carious teeth were divided into four experimental groups: Atraumatic Restorative Treatment (ART), Rotary Instrument (RI), Photo-Ablation, and Papain-Based Enzymatic Gel (Brix 3000®, Brix, Brazil). Class II slot cavities were prepared with RI in the CG. Then all caries removed teeth and control groups were restored (All-Bond Universal, BISCO, USA; Clearfil MajestyES-2, Kuraray, Japan). Specimens were prepared for SEM examinations. Hybrid layer (HL) thicknesses were measured using ImageJ programme. Gap measurements were performed with micro-CT. Data were analyzed with ANOVA and posthoc Dunnett's t-tests (p <.05). The highest HL thickness was found in Photo-Ablation Group, and a statistically significant difference was observed among the control and experimental groups (p < .05). The lowest HL thickness was measured in the Enzymatic Gel Group. In terms of internal gap formation, CG showed statistically significant differences compared to the other groups (p < .05). The highest internal gap was observed in RI Group, while the lowest gap was observed in CG. According to SEM, a uniform HL and resin tags were seen in the CG. Smear layer, irregular HL, and gap formation were observed in ART Group. In RI Group, nonuniform HL formation and resin tags were observed. In Photo-Ablation Group, a uniform HL without smear layer and internal gap was observed. In the Enzymatic Gel Group, both opened dentinal tubules, and melting-like formations were observed on the dentin surface. Especially melting-like formations were observed in peritubular dentin. It can be concluded that all caries removal methods except rotary instrumentation were conservative methods, which preserve more healthy dental tissues. RESEARCH HIGHLIGHTS: Among the caries removal procedures, the photo-ablation caries removal method stands out with the highest hybrid layer (HL) thickness and the lowest internal gap formation. Despite having the lowest HL thickness, the enzymatic gel method can be advantageous for patients requesting an alternative caries removal instead of a rotary instrument.

Comparative study of caries removal using BRIX 3000 and classic mechanical method

Introduction. In dental practice, despite the constant improvement of dental equipment and materials, caries removal using rotational instruments is still not a satisfactory way. The caries removal treatment constantly offers numerous alternatives in order to replace machine tools, and one of them is the chemo-mechanical method. The aim of this paper is to examine the effectiveness of the chemo-mechanical method of caries removal using BRIX 3000 and classic method. Material and Method. We used BRIX 3000; a material intended for atraumatic caries removal. Both caries elimination methods were performed in 40 patients with evident carious lesions. Twenty patients underwent atraumatic caries removal while in the other twenty carious tissue was removed using rotating instruments. Results. BRIX 3000 was effective in caries removal. A significant reduction in the use of local anesthetics was noticed. Patients did not experience discomfort or pain during treatment with BRIX 3000, but the duration of caries removal using this atraumatic method was significantly longer than with the classic method. Conclusion. Atraumatic method of caries removal is an adequate alternative to conventional therapeutic procedures for caries removal, which finds a place in the domain of modern minimally invasive dentistry.

Comparison of Various Caries Removal Methods

Comparison of Various Caries Removal Methods

Removal of Caries by Chemomechanical Caries Removal (CMCR) Methods

Removal of Caries by Chemomechanical Caries Removal (CMCR) Methods

Comparison of the Effectiveness of Chemo-mechanical and Traditional Caries Removal Methods in Primary Teeth Using Micro-Computed Tomography

Purpose: The purpose of this study was to evaluate dentin mineral density before and after caries removal with the traditional caries removal technique and chemo-mechanical method, with or without the use of caries detection dye. Our null hypothesis was that the chemo-mechanical method with minimally invasive treatment would achieve an effect similar to that of conservative pediatric dentistry treatment. Materials &amp; Methods: Forty-eight medium-sized, interfacial decayed primary molar teeth without pulpal perforation were selected. Two groups were formed by Papacarie Duo and conventional method; then four sub-groups were formed by two caries detection dye applied or not applied groups, twelve teeth were randomly divided into each group. The teeth were then treated with chemo mechanical and traditional caries removal approach. Teeth were scanned with the same voxel sizes using micro-computed tomography images to figure out the difference dentin mineral density and to calculate the removed dentinal volume after chemo-mechanical or traditional method application. Results: The results showed increase of cavity volume in the chemo-mechanical and traditional method groups. No significant difference was found for cavity volume and dentinal carious volume in both groups (p&gt;0.05). The mineral density values of demineralized dentin were between 0.52-0.66 g/cm3 before caries removal, and 1.39-1.59 g/cm3 after removing caries. These values were found to be within the range of healthy dentin mineral density values again without any significant difference between groups (p&gt;0.05). Conclusion: In conclusion, chemo-mechanical methods can be used effectively for removing the caries in the primary molar teeth similar to conservative treatments.

MICROLEAKAGE EVALUATION OF COMPOSITE RESTORATION FOLLOWING CARIES REMOVAL USING CERAMIC BUR IN PRIMARY TEETH (AN IN VITRO STUDY)

ABSTRACTIntroduction: Conservative caries removal is the corner stone of minimally invasive dentistry. Ceramic bur is a self-limiting technique for caries removal in pediatric dentistry.Objectives: The aim of the study is to evaluate microleakage of adhesive restorations (in vitro) using Ceramic bur to remove caries versus conventional drilling method.Materials and methods: forty exfoliated carious primary teeth were allocated at random into two groups according to method of caries removal. Group I (n=20) caries removal by Ceramic bur, Group II (n=20) caries removal by conventional tungsten carbide bur, followed by composite restorations of all prepared cavities. Teeth were thermo-cycled for 500 cycles between 5 C and 55 C, dwell time 10 seconds for 500 cycles and immersed into one percent methylene blue dye for 24h.Teeth were sectioned in a bucco-lingual direction longitudinally and then studied using stereomicroscope at x20 magnification for dye penetration assessment. Data were collected and subjected to Mann Whitney U test. Results: No significant difference was noted in median microleakage scores and distance of stain penetration in millimeters between the two groups (Ceramic bur) and (conventional tungsten carbide bur) at a p value (0.097) and (0.289) respectively.Conclusion: Microleakage of composite restoration is not adversely affected by caries removal using Ceramic bur.

Comparative Study of Erbium Laser Versus A Chemo-Mechanical Caries Removal Method in Primary Teeth

Comparative Study of Erbium Laser Versus A Chemo-Mechanical Caries Removal Method in Primary Teeth

Clinical and Microbiological Assessment of Carisolv and Polymer Bur for Selective Caries Removal in Primary Molars.

Aim and objectiveTo assess the efficacy of the new Carisolv system and Polymer bur (SmartbursII®) for selective caries removal in primary molars clinically and microbiologically, compared with the conventional mechanical method.Materials and methodsSixty children with class I active carious lesions were selected. The children were randomly allocated to three groups (n = 20) according to the caries removal method. Under rubber dam isolation, dentin samples were taken before and after caries removal for microbial culture. Time spent in each technique was recorded. The clinical efficacy of caries removal was verified using caries detector dye. Patient satisfaction toward the treatment was evaluated using a facial image scale.ResultsThe median of caries detector dye scores was significantly lower in the conventional group compared to others (p value < 0.05). The mean time for caries removal was the longest with Carisolv (p value < 0.05). The median of facial image scale scores was significantly higher in the conventional group compared with others (p value < 0.05). The mean total viable bacterial count after caries removal was significantly higher in polymer bur group compared with others (p value < 0.05). While, there was no significant difference between Carisolv and conventional groups (p value > 0.05).ConclusionThe clinical efficacy of caries removal was highest with the mechanical method. Carisolv took the longest time for caries removal. Patient satisfaction was higher with Carisolv and polymer bur than the mechanical method. The antimicrobial efficacy of Carisolv and the mechanical method was higher than the polymer bur.Clinical significanceCarisolv is a viable alternative to the mechanical method in the management of dental caries, especially in children. Further studies are needed to assess the efficacy of caries removal by SmartbursII®.How to cite this articleAsal MA, Abdellatif AM, Hammouda HE. Clinical and Microbiological Assessment of Carisolv and Polymer Bur for Selective Caries Removal in Primary Molars. Int J Clin Pediatr Dent 2021;14(3):357–363.