Caries Removal Method Research Articles

Clinical and Microbiological Evaluation of the Carious Dentin Before and After Application of Papacarie Gel

To evaluate clinically and microbiologically the efficacy of Papacarie in the removal of carious dentin in both permanent and primary teeth. Thirty permanent and primary molars with dentinal carious lesions were excavated and subjected to clinical and microbiological assessment before and after application of Papacarie. The gel was further tested for in vitro antimicrobial efficacy against standard cariogenic micro-organisms using agar diffusion assay. Papacarie was able to differentiate between infected and affected dentin clinically along with high patient comfort during caries excavation. The mean time taken for caries removal and restoration was observed to be 4.17 +/- 0.40 min. and 8.57 +/- 0.45 min. for permanent teeth and 4.21 +/- 0.36 min. and 9.24 +/- 0.58 min. for primary teeth. There was a significant reduction in the total viable colony forming units from the dentin samples before and after application of Papacarie. It was also observed that Papacarie had no inhibitory effect on standard cariogenic microorganisms in the agar diffusion assay. Papacarie is an effective caries removal method clinically in both permanent and primary teeth. The number of viable microorganisms after complete caries excavation using Papacarie still appears to be high and this bacterial count should be tackled by a suitable restorative material with potent antimicrobial activity.

Evaluation of Three Different Caries Removal Techniques in Children: A Comparative Clinical Study

To evaluate and compare the efficacy of chemo mechanical (carie care) caries removal method with rotary and hand excavation by assessing the amount of time taken, the pain response experienced by the children and the amount of residual caries left out. Twenty patients between the age groups of 5-7 years were selected and caries removal was done by airotor hand instruments and cariecare gel. The efficacy, time taken and pain threshold was evaluated during caries removal. significant results were obtained when inter group comparison were made. it was concluded that cariecare was efficient in caries removal and can be used as an alternative for the airotor in management of dental caries especially in children.

Chemical, morphological and microhardness changes of dentine after chemomechanical caries removal

This study compared the chemical, morphological and microhardness changes in carious dentine following application of NaOCl-based (Carisolv), papain-based (Papacarie) chemomechanical caries removal agents with conventional rotary method. Thirty-two carious and eight non-carious human permanent molars were used. The carious molars were randomly distributed into four groups: Group 1 (positive control) - molars were left without caries removal; Group 2 - caries excavated with rotary method; Group 3 - caries excavated with Carisolv; Group 4 - caries excavated with Papacarie. Group 5 (negative control) consisted of eight sound molars. After caries excavation, all specimens were prepared for chemical, morphological analysis and Vickers hardness testing. EDX analysis showed no significant difference in Ca wt%, P wt% and Ca/P ratio among Groups 2 to 5. Vickers hardness of dentine from Groups 3 and 4 was significantly lower (p<0.05) than for Groups 2 and 5. The use of Papacarie resulted in a dentine surface without smear layer and patent tubules, while Carisolv resulted in a dentine surface exhibiting two patterns: (1) the presence of smear layer or (2) patent tubules with partial smear layer formation. Papain-based (Papacarie) chemomechanical caries removal method is a reliable alternative to conventional rotary and NaOCl-based (Carisolv) caries removal.

Comparison of Marginal Microleakage of Glass Ionomer Restorations in Primary Molars Prepared by Chemo-mechanical Caries Removal (CMCR), Erbium: Yttrium Aluminum-Garnet (Er:YAG) Laser and Atraumatic Restorative Technique (ART).

ABSTRACTBackground: It is important to emphasize that the aspects of pretreatment techniques, as well as the composition and mechanism of adhesion, may decisively influence the effectiveness of the restorative materials in sealing cavity margins and preventing marginal leakage.Aims: This study assessed the in vitro influence of surface preparation techniques on the microleakage of glass ionomer restorations in primary teeth.Materials and methods: The study groups were divided into three different techniques: (1) The chemomechanical caries removal (CMCR) method using the Apacaries gel, (2) the erbium:yttrium aluminum-garnet (Er:YAG) laser method and (3) the atraumatic restorative technique (ART). The teeth restored with a glass ionomer restorative material (Fuji IX GP capsule, GC Corporation, Tokyo, Japan). The dye penetration was measured in micrometers using a polarized light microscope and specific computer software.Results: The results showed that the mean microleakage level after was lowest with the CMCR method using Apacaries gel and highest with the Er:YAG laser. There was a statistically significant difference regarding the mean microleakage level between the group with the CMCR method using Apacaries gel and the Er:YAG laser.Conclusion: Marginal leakage was significantly higher with preparations made using the Er:YAG laser than with the CMCR method using Apacaries gel and spoon excavator (p < 0.05).How to cite this article: Juntavee A, Juntavee N, Peerapattana J, Nualkaew N, Sutthisawat S. Comparison of Marginal Microleakage of Glass Ionomer Restorations in Primary Molars Prepared by Chemomechanical Caries Removal (CMCR), Erbium: Yttrium Aluminum-Garnet (Er:YAG) Laser and Atraumatic Restorative Technique (ART). Int J Clin Pediatr Dent 2013;6(2):75-79.

Carisolv- An Innovative Method of Caries Removal

The use of minimal invasive dentistry and attention to patient comfort is of utmost importance especially for the school children and anxious and uncooperative patients. This demanded the newer patient friendly technique in dentistry amongst which is the Chemo mechanical caries removal (CMCR). CMCR involves the selective caries removal of carious dentine. As only the carious dentine is removed the painful removal of sound dentine is avoided and the anxiety due to the vibration of the handpiece is also reduced thus it appears to be more comfortable to the patient. CMCR although more prolonged procedure, is effective in caries removal. Thus CMCR is an effective alternate method for caries removal; it is more conservative and appears to be more comfortable for the patients.

The use of an Er:YAG laser to remove demineralized dentin and its influence on dentin permeability

The purpose of this study was to analyze, correlate, and compare the demineralization and permeability of dentin remaining after caries removal with either an Er:YAG laser, a bur, or a curette. Thirty human dentin fragments were immersed in a demineralizing solution for 20 days and were randomly divided into three groups (n = 10) for the removal of the demineralized lesion. The groups were G1-Er:YAG laser (200 mJ/6 Hz; noncontact at 12 mm; spot: 0.63 mm), G2-Bur, and G3-Curette. The specimens were then immersed in a 10% copper sulfate solution, then in a 1% dithiooxamide alcoholic solution for 30 min and kept in ammonia vapor for 7 days. Next, the specimens were examined with optical microscopy. The amount of demineralized dentin and the level of copper ion infiltration in the dentin were quantified in μm using Axion Vision software. Data were analyzed with the Kruskal-Wallis test (p < 0.05) and Pearson's Correlation test. The analysis revealed no significant differences between the three caries removal methods in terms of their capacity to remove demineralized tissue (G1: 10.6 μm; G2: 8.4 μm; G3: 11 μm), although the laser removal generated more tissue permeability than the others methods (G1: 17.6 μm; G2: 6.6 μm; G3: 5.5 μm). The correlation between the remaining demineralized dentin and the dentin permeability was moderate for the conventional methods and higher for the Er:YAG laser. It can therefore be concluded that the laser produced an increase in permeability that was directly proportional to the amount of demineralized tissue removal.

Comparative evaluation of effects of chemo-mechanical and conventional caries removal on dentinal morphology and its bonding characteristics — An SEM study

To compare the efficacy of three caries removal techniques namely: Papacarie(®), calcium hydroxide and rotary instruments by SEM analyses of the micro-morphology of residual dentine and resin tags at resin-dentine interface. 45 extracted human permanent molar teeth, with occlusal caries extending up to dentine, were divided into two groups (Group 1 and 2) and each group was subdivided into three subgroups: subgroup A included teeth treated with conventional rotary method, subgroup B and C included those treated with calcium hydroxide and Papacarie(®) respectively. Group 1 samples were prepared for viewing the micro-morphology of residual dentine (2000x and 5000x) and Group 2 samples were filled with composite resin and analysed for resin tag formation (1000x) under SEM. Papacarie(®) showed minimal smear layer and open dentinal tubules. Calcium hydroxide and rotary instruments showed a typical smear layer and occluded dentinal tubules. Resin tags obtained with Papacarie(®) were the longest and significantly superior to those obtained with rotary and calcium hydroxide. Papacarie(®) exhibited better bonding characteristics of residual dentine than calcium hydroxide and rotary method of caries removal. Thus, Papacarie(®) is a suitable alternative to conventional method of caries removal, especially in paediatric patients.

Atraumatic Restorative Treatment in permanent molars: a systematic review

Aim: This paper presents a systematic review of studies published within the last 10 years on Atraumatic Restorative Treatment (ART) in permanent molars. Methods: A systematic search was carried out in the MEDLINE and PubMed databases from April 1st 2001 to December 31st 2010 using the term “atraumatic restorative treatment” and in the LILACS database using the term “tratamento restaurador atraumatico”. The selection of publications was based on the following criteria: texts written in English, Spanish or Portuguese; presence of an abstract; and investigation of clinical aspects related to ART in permanent molars. Results: The analysis of abstracts led to the selection of 26 studies. Recent clinical studies on ART in permanent molars of children, adolescents and young adults mainly address the survival of restorations through a comparison between caries removal methods and restorative materials. The publications report a survival success rate of ART restorations ranging from 30 to 100% in permanent molars, which is similar to that reported for treatments employing conventional methods and materials. The success rate of ART sealants ranged from 6.2 to 98.5%. The number of studies reporting on the retention and caries preventive effect of ART sealants was small. Conclusions: This systematic review revealed high survival rates for single-surface ART restorations in permanent molars and lower success rates for multiple-surface restorations. Clinical studies conducted with children, adolescents and young adults demonstrate a reliable clinical performance of single-surface and multi-surface ART restorations for 3-year and 2-year periods, respectively. However, long-term clinical studies are scarce and most of them focus on one-surface cavities. The survival rates observed, especially for single-surface restorations, confirm the potential of the ART approach for restoring and saving permanent molars. More clinical studies are required on the retention and caries preventive effect of ART sealants.

Evaluation of micro-tensile bond strength of caries-affected human dentine after three different caries removal techniques

ObjectiveThis study evaluated the effect that different techniques for removing dental caries had on the strength of the microtensile bond to caries-affected human dentine created by three bonding agents. Materials and methodsForty-five human molar teeth containing carious lesions were randomly divided into three groups according to the technique that would be used to remove the caries: a conventional bur, an Er:YAG laser or a chemo-mechanical Carisolv® gel (n=15). Next, each of the three removal-technique groups was divided into three subgroups according to the bonding agents that would be used: Clearfil® SE Bond, G-Bond®, or Adper® Single Bond 2 (n=5). Three 1mm2 stick-shaped microtensile specimens from each tooth were prepared with a slow-speed diamond saw sectioning machine fitted with a diamond-rim blade (n=15 specimens). For each removal technique one dentine sample was analysed using scanning electron microscopy. ResultsThere were statistically significant differences in the resulting tensile strength of the bond among the techniques used to remove the caries and there were also statistically significant differences in the strength of the bond among the adhesive systems used. The etch-and-rinse adhesive system was the most affected by the technique used to remove the caries; of the three techniques tested, the chemo-mechanical removal technique worked best with the two-step self etch adhesive system. ConclusionThe bond strength values of the etch-and-rinse adhesive system were affected by the caries removal techniques used in the present study. However, in the one- and two-step self etch adhesive systems, bond strength values were not affected by the caries removal techniques applied. While a chemo-mechanical caries removal technique, similar to Carisolv®, may be suggested with self etch adhesive systems, in caries removal techniques with laser, etch-and-rinse systems might be preferred. Clinical significanceCaries removal methods may lead to differences in the characteristics of dentine surface. Dentine ultra structure generally affects the bonding of adhesive materials commonly used in restorative dentistry. Whereas etch-and-rinse system, like the ones used in the present study, are affected by these changes, the self etch systems are not affected. Hence, clinicians may opt for caries removal methods and systems appropriate for each patient and practice.

Differential Resin-Dentin Bonds Created after Caries Removal with Polymer Burs

The objective of this article was to investigate the effect of carbide and polymer burs caries removal methods on the bond strength of different adhesives to dentin. Resin restorations were performed in sound and caries-affected dentin, after using polymer or carbide burs and bonding with four different adhesive (Single bond, SB; Clearfil SE bond, SEB; FL-Bond II, FLB; and Fuji II-LC, FUJI). Microtensile bond strength (MTBS) was measured. Data were analyzed with ANOVA and Student-Newman-Keuls tests. Debonded surfaces were observed by scanning electron microscopy. Bonded interfaces were examined using light microscopy (Masson's trichrome staining). In sound dentin, MTBS was similar for SEB and SB, and higher than that of FLB and FUJI. Bond strength to carbide bur prepared dentin was similar for SB, SEB, and FLB; FUJI presented the lowest. SB applied on polymer bur excavated dentin presented similar values to those of the carbide bur group; MTBS attained by SEB, FLB, and FUJI decreased when bonding to dentin treated with polymer burs; FUJI yielded pretesting failures in all specimens. Polymer burs created a thick smear layer that was not infiltrated by tested self-etching agents. The bonding effectiveness of self-etching and glass-ionomer-like adhesives to dentin decreased when polymer burs were used.

Comparison of mechanical and chemomechanical methods of caries removal in deciduous and permanent teeth: A SEM study

Mechanical method of caries removal is associated with the removal of sound tooth structure, production of pain, heat, annoying sounds, and vibrations. Chemomechanical caries removal method is based on removal of only carious dentin leaving sound dentin intact. The aim of this study was to compare the efficacy of mechanical and chemomechanical methods of caries removal in deciduous and permanent teeth. A total of 30 carious teeth including 15 deciduous and 15 permanent teeth having dentinal caries selected randomly and cut into two halves through center of the lesion, were subjected to caries removal by mechanical (Group A), and chemomechanical methods (Group B). Time taken for removal of caries was noted with stopwatch. Samples were prepared and seen under the scanning electron microscope for the presence of bacterial colonies. Data were analyzed using statistical package for social sciences (SPSS) Software. No significant difference was found for the presence of bacterial colonies in both groups of deciduous and permanent teeth; however, time taken for caries removal by the chemomechanical method was twice than the mechanical method. despite the insignificant presence of bacterial colonies and twice time taken as compared to mechanical method, chemomechanical method was easy to introduce, was painless, did not form smear layer and conserved the sound tooth structure.

Microhardness of dentin reminiscent after different methods of caries removal

Microhardness of dentin reminiscent after different methods of caries removal

Morphological Changes in the Caries Excavated Dentin Prepared by Rotary, Carisolv™ and Er, Cr: YSGG Laser (Biolase™) Instruments: A Scanning Electron Microscopic Evaluation

The in vitro study presented in this article was performed to evaluate the morphological changes in caries excavated dentin after using three different caries removal methods. These methods include mechanical, chemomechanical (Carisolv™) and Er, Cr: YSGG Laser (Biolase™) by means of scanning electron microscope. Extracted carious human molars were ground to flat surfaces to expose caries surrounded by sound dentin. The caries were then removed with tungsten carbide bur and airotor handpiece (G1), by chemomechanical (Carisolv™) method (G2), and by irradiation with an Er, Cr: YSGG Laser (Biolase™) unit (G3). The samples were then observed under a scanning electron microscope (SEM) with different magnification powers (×800, ×2000 and ×5000). SEM study revealed a considerable difference in the surface characteristics of the dental tissue. The surface which was treated with Er, Cr: YSGG laser (Erbium, Chromium: Yttrium – Scandium – Gallium – Garnet) showed the best result with no residual smear layer followed by surfaces which were chemomechanically excavated with Carisolv™ gel. The treatment with mechanical method resulted in a surface with a smear layer without any micro retention. Thus, from the results obtained, it was concluded that Er, Cr: YSGG laser produced a scaly, irregular and rugged tooth surface without smear layer, which can be of highly retentive nature. Carisolv™ treated dentin showed uneven surfaces with many undermined areas. There were partially patented dentinal tubules and residues of contaminant smear layer. The dentin surfaces prepared using tungsten carbide bur and spoon excavator produced smearing and smear plugs in the tubular orifices.

A comparative microbiological study to assess caries excavation by conventional rotary method and a chemo-mechanical method

Aims:This study was aimed to determine the effectiveness of Papacárie® for caries removal as compared to the conventional method with respect to microbial flora, time, the amount of tissue removal, child's behavior, pain perception, and preference of treatment.Materials and Methods:Sixty primary molars of 30 children of age 4-9 years were selected randomly and divided into two groups of 30 teeth each: Group A treated by conventional method and group B with Papacárie® method.Results:Comparatively, no statistical difference was seen in microbial growth, total bacterial count, and lactobacilli count in both the groups (P = 0.36). The mean cavity entrance size with group A was 0.98133 mm and group B was 0.26083 mm (P < 0.001). The mean preparation time for group A was 4.7 Mins (minutes) and group B was 17.96 min s (P < 0.001). Majority of kids of both group A and B scored 3 (Frankl Behavior Rating Scale) before and after the treatment showing no statistical difference in their behavioral score (P = 1). In group A 50% of children experienced no pain as compared to 86.7% in group B (P = 0.01). There was no statistical difference in the preference of treatment (P = 0.12).Conclusion:Thus, the Chemo mechanical caries removal method can be considered as an effective method to control pain and preserve sound tooth structure during caries excavation.

EFFICACY OF CHEMO-MECHANICALMETHOD (CARISOLV) OF CARIES REMOVAL WITH THAT OF HAND CUTTING AND ROTARY CUTTING INSTRUMENTS

Background and objectives : To evaluate the efficacy of chemo-mechanical method (carisolv) of caries removal with that of hand cutting and rotary cutting instruments with the help of knoop hardness measurements of the cavity floor. Method : The 45 carious molars were subjected to caries detector (Kavo DIAGNOdent) to assess the extent of the lesion before and after the study. The selected samples was divided into 4 groups of 15 teeth each. The first 3 groups were taken as study group Group I (Carisolv), Group II (Hand excavation), Group III (Carbide bur), and Group IV (Control). The treated cavities were cross-sectioned perpendicularly along the long axis of the tooth through the middle of the treated cavity and then subjected to knoop hardness test. Results : The knoop hardness of the remaining dentin thickness was least for group II (hand excavation) and highest excavation for control group IV (normal dentin), group I (carisolv) and group III (carbide bur) showed KHN values that was not statistically significant when compared to group IV. On comparing group I with group III the KHN of remaining dentin thickness of group III was more than group I but this was not statistically significant. Conclusion : It was thus concluded that group II (hand excavation) showed the least knoop hardness value and group I (carisolv) and group III (bur) showed similar to that of normal dentin although values of group III was more than group I but it was not statistically significant.

Comparative clinical evaluation of chemomechanical caries removal agent Papacarie® with conventional method among rural population in India: in vivo study

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 antimicrobial efficacy, efficacy in terms of time consumption and pain perception of chemomechanical caries removal agent Papacarie® and conventional method of caries removal. Methods: Subjects for this study were chosen from children admitted to dental clinic for restorative procedures. Forty children (age 4-8 years) with early childhood caries were included in this study. Two primary teeth with comparable degrees of carious destruction were chosen in each child for caries removal with either Papacarie® or rotary instruments. The time taken for caries removal was measured using stopwatch. Pain response during caries removal was evaluated using the Wong Baker Face Pain Scale. Dentin samples of both groups were taken prior to, and after caries removal for microbiological analysis. Results The time taken for caries removal in chemomechanical caries removal method was three times longer than the conventional method. Pain score during chemomechanical method of caries removal was 1.525 as compared with 6.65 when conventional method was used. The antimicrobial efficacy of chemomechanical caries removal was significantly similar to conventional method. Conclusions: Papacarie® can be an effective clinical alternative treatment for the removal of occlusal dentinal caries in cavitated primary molars.

An Evaluation of Different Caries Removal Techniques in Primary Teeth: A Comparitive Clinical Study

To compare the efficacy of caries removal, time taken and to evaluate the pain threshold experienced by the patient during various caries removal methods. Eighty patients between the age groups of 5-9 years were selected and caries removal was done by hand instruments, airotor, carisolv and papacarie. The efficacy, time taken and the pain threshold was evaluated during the caries removal by Ericson D et al scale, visual analogue scale respectively. Highly significant relation (< 0.05) was observed when intergroup comparison was made using one way analysis of variance (ANOVA). It was concluded that chemomechanical removal of caries with Papacarie and Carisolv were found to be effective measures of caries removal and could be considered as viable alternatives to painful procedures like Airotor in management of dental caries especially in children.

Morphological and microtensile bond strength evaluation of three adhesive systems to caries-affected human dentine with chemomechanical caries removal

Objectives To evaluate the influence of chemomechanical caries removal on bond strengths of three adhesive systems to caries-affected human dentine. Methods 45 extracted human third molars with occlusal moderate caries were used. One half of each cavity was prepared with chemomechanical method and the other half with bur as the control. Three adhesive systems, Prime&Bond NT (Dentsply, Germany) without any previous conditioning, an etch-and-rinse adhesive (One-Step, Bisco, USA) and a self-etching adhesive (Adper Prompt-L-Pop, 3M ESPE, USA), were applied. The compomer or resin crowns were, then, built up. The prepared specimens were sectioned for scanning electron microscopy (SEM) examination and microtensile bond strength (MTBS) testing. Data were analysed using two-way ANOVA with subsequent application of Student–Newman–Keuls test at p < 0.05. Results Opened dentinal tubules and less smear layer were visible by SEM after chemomechanical caries removal, whilst an obvious smear layer covering the dentine surface with occluded tubules was exhibited after bur excavation. Resin tags were seen only in specimens with chemomechanical excavation when Prime&Bond NT system was applied. Statistical analysis of the values of MTBS failed to show significant difference between caries removal methods. However, the values of MTBS for One-Step system achieved with two caries removal methods were both significant higher than other adhesive systems. Conclusions Chemomechanical caries removal did not influence the bond strengths of the adhesive systems used in this study to caries-affected human dentine. Highest bond strength was achieved with application of etch-and-rinse adhesive system.

Utilização da técnica da abrasão ultrassônica em Odontopediatria

A breakthrough has occurred in clinical making, improvement occurs in restorative techniques. An example is the system with ultrasonic tips CVD that has been the subject of various researches and its application has been trying to address the shortcomings of conventional diamond burs. The technique for wearing teeth is through vibration, resulting in less noise, heat and pressure. The technique of ultrasonic abrasion has been used in pediatric dentistry, as well as in several areas of dentistry because of its indications and advantages. Thus, this study aimed to review the literature onto the main features of using ultrasonic abrasion, as an alternative method of caries removal in pediatric patients.

Permeability Evaluation after Decay Removal in Primary Teeth with Current Caries-excavation Techniques

The goal of the study was to evaluate the effect of caries removal by three various methods on the permeability of class II composite resin restorations in primary molar teeth. Forty-five recently extracted primary molars were randomly assigned to three groups for three different methods of caries removal; group 1-mechanical, group 2-caries detector dye, and group 3-Carisolv (n = 15). After that, class II cavities in all groups were restored with the adhesive (Opti Bond Solo Plus) that was applied according to the manufacturer's instruction and a posterior composite (Herculite XRV), which was used incrementally. After 24 hours the samples were thermocycled in water for 500 cycles between 5 and 55°C with a dwell time of 30 sec. Permeability was assessed by the fluid filtration method. The data were analyzed using the ANOVA test while study groups were compared with Tukey test for statistically significant differences at a 5% significance level. The evaluation of tested groups indicated that the highest (0.80) and least (0.37) mean of permeability was observed in group 2 and 3 respectively. Significant difference was revealed among the tested groups (p = 0.045). The comparison of Carisolv and caries detector dye groups indicated a statistically significant difference (p = 0.037). There was not any significant difference between Carisolv or caries dye in the conventional group. Using the chemomechanical and staining methods for caries removal had no more detrimental effect on permeability than the conventional technique. However, caries detection dye for caries removal could be more harmful than chemomechanical method. None of the current caries-excavation techniques could eliminate permeability in class II composite resin restorations. Furthermore, staining methods do not have an adverse effect on sealing ability in comparison to the conventional technique.