Management Of Carious Lesions Research Articles

The Effectiveness of Remineralization with Compound Silver Nanoparticles and Fluoride Varnish in Carious Lesions in Primary Teeth: A Randomized Split-Mouth Clinical Trial.

Background: Anti-cariogenic properties of silver nanoparticles and fluorides have been probed mainly in vitro and with the objetive to evaluate the remineralizing effects of an applied silver nanoparticle compound plus fluoride varnish, a randomized split-mouth clinical trial was conducted in children aged 6 to 7 years. Methods: The project was approved by the ethics committee of the faculty. Primary molars were randomly distributed into two groups, as follows: Group A was treated with a compound based on silver nanoparticles plus fluoride varnish (SNP-FV), and Group B was treated with a silver diamine fluoride compound (SDF-KI), which is the current standard treatment. Laser fluorescence with a DIAGNOdent pen was used for the evaluation, with follow-up examinations at 15 days, 6 months, and 12 months. ANOVA test was used to compare the groups. The results showed a decrease in demineralization was observed after treatment with SNP-FV; similar results were observed after treatment with SDF-KI. Within each group, there were favorable changes. In the SDF-KI group, the differences in demineralization were 25.63 at 15 days, 29.37 at 6 months, and 30.6 at one year (p < 0.05). Meanwhile, in the SNP-FV group, the decreases were 22.7 at 15 days, 28.78 at 6 months, and 31.11 at one year (p < 0.05). Conclusions: The SNP-FV combined treatment represents an alternative remineralizing treatment for the management of carious lesions in the dentin of primary molars.

Mapping Systematic Reviews on the Management of Dental Caries in Primary Teeth: A Meta-Research.

Systematic reviews (SRs) represent the most robust source of evidence for informing decision-making. While there are rigorous protocols for properly conducting SRs, sometimes the methodological biases in the primary studies are accounted for in the conclusions of the SRs. This study aimed to map the evidence regarding the management of caries lesions in primary teeth. Two reviewers conducted a systematic search up to March 2024 in electronic data-bases. Any SR concerning the management of caries lesions in primary teeth was considered eli-gible. About 162 SRs were included. Among these, 80 focused on restorative treatments, 64 on endodontic treatments, and 18 on non-invasive treatments. Only 42.6% presented a study registra-tion protocol. The majority (67.9%) performed a meta-analysis, while a minority exclusively car-ried out qualitative data analysis. Despite 92.6% of the SRs evaluating the methodological quality or risk of bias of the primary studies using some tool, only 24% assessed the certainty of evidence using the GRADE approach, resulting in classifications ranging from very low to moderate. There is a limited adherence to study registration protocols, indicating a need for improvements in this practice. Additionally, among the few SRs that used the GRADE approach, the majority demonstrated levels of very low to moderate certainty.

Evaluation of the remineralization potential of self-assembling peptide P11-4 with fluoride compared to fluoride varnish in the management of incipient carious lesions: a randomized controlled clinical trial

ObjectivesThe present trial’s aim was to compare the remineralization potential of self-assembling peptide P11-4 combined with fluoride to that of fluoride varnish.Materials and methodsTwenty-eight participants with 58 incipient carious lesions were enrolled in the present trial. Participants were randomly divided into two groups with 14 participants and 29 incipient lesions in each group. Patients were assigned either to self-assembling peptide combined with fluoride (Curodont Repair Fluoride Plus™) or sodium fluoride varnish (NaF, Bifluorid 10) groups. Both agents were applied according to the manufacturer’s instructions on non-cavitated incipient carious lesions. Lesions were assessed by two calibrated and blinded assessors at baseline, and after one-, three- and six-months using a laser fluorescence device (DIAGNOdent).ResultsAlthough laser fluorescence scores significantly improved in both groups over time (p < 0.05), no notable differences were evident between both groups at one-month (p > 0.05). Yet, at three- and six-months statistically lower laser fluorescence readings were evident in the self-assembling peptide combined with fluoride group in comparison to the fluoride alone group (p < 0.05). There was 60% less risk for caries progression for Curodont Repair Fluoride Plus™ when compared to NaF varnish after six months. Self-assembling peptide combined with fluoride was able to change 65.5% of non-cavitated carious lesions from DIAGNOdent score 3 (11–20) to score 1 (0–4). Fluoride varnish was able to change 13.8% of the lesions from score 3 to score 1 after six months.ConclusionsThe self-assembling peptide combined with fluoride varnish showed higher remineralization potential than fluoride varnish alone for incipient carious lesions over a six-months follow up.Clinical relevanceThe combination of self-assembling peptide P11-4 and fluoride could offer a new tool in managing incipient carious lesions.

Management of Non Carious Cervical Lesions: Case Report

Management of Non Carious Cervical Lesions: Case Report

The Assessment of Resin-Based Composite Sealants' Effectiveness in Arresting Non-Cavitated Dentin Carious Lesions (ICDAS 3)-A 12 Month Follow-Up Preliminary Study.

Background and Objectives: The therapeutic management of carious lesions remains a significant focus for researchers, given their persistently high prevalence despite being largely preventable. This study aimed to compare the effectiveness of a composite resin-based sealant material in halting extended non-cavitated dentin carious lesions when used therapeutically versus preventively on caries-free teeth over a period of twelve months. Materials and Methods: out of the 236 children examined, 45 were excluded from the study due to non-compliance with the inclusion criteria. Thus, the study included 191 children aged 10-12 years, and 764 molars in total. Results: among these molars, 171 were caries-free (ICDAS II code 0), forming the Control group, while 180 molars were classified with an ICDAS II score of 3, forming the Study group. All molars were sealed and evaluated at 6- and 12-month follow-up intervals. Both intervals revealed statistically significant differences (p < 0.05) in sealant retention and carious lesion development between sound (ICDAS code 0) and decayed (ICDAS code 3) teeth. Conclusions: the findings did not support the effectiveness of sealants in halting non-cavitated dentin carious lesions classified as ICDAS II with code 3 compared to their preventive application in sound teeth classified as ICDAS II with code 0.

Preventive management of carious lesions: from non-invasive to micro-invasive operative interventions.

Understanding that dental carious lesions occur as a result of the action of micro-organisms in the dental plaque biofilm, where demineralisation on the tooth surface is the first sign of the disease, such incipient lesions can be treated using preventive, non-operative and minimally invasive operative dentistry. If the caries process is left unmanaged, the lesions progress towards cavitation, leading to more invasive treatments. This article discusses the principles of preventive, non-invasive and micro-invasive treatments of early carious lesions, outlining the clinical situations where these therapies can be applied.

Remineralization and inactivation of carious lesions treated with silver fluoride in Brazilian children with special healthcare needs.

Providing conventional, restorative dental care to children with special healthcare needs (CSHCN) often requires sedation using general anesthesia. Saliva consistency, diet, and oral hygiene practice are different for CSHCN, and limited evidence is available on the efficacy of silver fluoride (SF) for the management of carious lesions for this vulnerable population. Parents of CSHCN were educated about silver fluoride as a treatment option for caries. In total, 550 carious lesions from 100 participants were identified and scored according to the Nyvad Caries criteria. A total of 100 lesions with Nyvad scores 1, 2, and 3 were treated with a single application of silver fluoride and observed postoperatively at 1, 3, and 6 weeks. The results indicate statistically significant (p < 0.05) differences in lesion remineralization over the 6-week follow-up period. At the 6-week follow-up, more than 85% of all lesions were remineralized across all children, regardless of condition or original Nyvad score of 1, 2, or 3. A single application of silver fluoride has demonstrated effectiveness in remineralization and inactivation of carious lesions over 6 weeks among Brazilian CSHCN. Silver fluoride should be considered an option for the management of carious lesions among CSHCN. Further studies are recommended, including larger sample sizes, longer follow-up times, a second application of SF, and different special needs conditions.

Managing the deep carious lesion biomimetically without pulpal involvement

During the last 20 years, the restorative approach has evolved from the mechanical retention to the advanced adhesion. This transition was fostered by the development and the improvements in the adhesive materials and the increasing demand of the esthetics among the patients. Resultingly, Composites today have become the material of choice for both the anterior as well as posterior restorations. The Science, Principles and the techniques of advanced adhesive dentistry are known as biomimetic dentistry. The major goal of biomimetic dentistry is to preserve the vitality of the pulp and conserve maximum intact tooth structure. The management of deep carious lesions approaching a healthy pulp presents a significant challenge to a clinician. The traditional management of carious lesions dictates the removal of all the infected and affected dentin. Several studies call this approach into question. This article presents a systematic approach to manage the deep carious lesions in the vital teeth preserving its vitality &amp; conserving maximum intact tooth structure for the long term biomimetic function.

In vitro remineralization of adjacent interproximal enamel carious lesions in primary molars using a bioactive bulk-fill composite

BackgroundSurface remineralization is recommended for the management of active non-cavitated interproximal carious lesions in primary teeth. According to the American Academy of Pediatric Dentistry, a recently recognized category of materials called bioactive restorative materials can be used for remineralization. This study aimed to evaluate the release of fluoride (F), calcium (Ca) and phosphate (P) ions from Predicta® Bioactive Bulk-fill composite compared with EQUIA Forte® and Filtek™ Z350 and to determine the remineralization effect of these 3 restorative materials on adjacent initial interproximal enamel carious lesions.MethodsThe release of F, Ca and P ions from 3 groups ((n = 10/group) (Group 1- Predicta®, Group 2- EQUIA Forte® and Group 3- Filtek™ Z350)) was determined at 1st, 4th, 7th and 14th days. After creating artificial carious lesions, human enamel samples were randomly assigned into 3 groups (n = 13/group) which were placed in contact with occluso-proximal restorative materials and exposed to a 14-day pH cycling period. Surface microhardness was determined using a Knoop microhardness assay at baseline, after artificial carious lesions formation and after pH cycling. The difference in the percentage of surface microhardness recovery (%SMHR) among groups was compared. Mineral deposition was analyzed with energy-dispersive x-ray spectroscopy (EDS) and the enamel surface morphology was evaluated with scanning electron microscopy (SEM). Kruskal-Wallis’s test with Dunn’s post hoc test and one-way ANOVA with Tukey’s post hoc test were used for data analysis.ResultsEQUIA Forte® released the highest cumulative amount of F and P ions, followed by Predicta® and Filtek™ Z350. Predicta® released higher amount of Ca ions than EQUIA Forte® and Filtek™ Z350. Predicta® demonstrated the highest %SMHR, followed by EQUIA Forte® and Filtek™ Z350. There was a significant difference in the %SMHR between Predicta® and Filtek™ Z350 (p < 0.05). However, EQUIA Forte® demonstrated the highest fluoride content, followed by Predicta® and Filtek™ Z350. The SEM images of EQUIA Forte® and Predicta® revealed the greater mineral deposition.ConclusionPredicta® demonstrated a marked increase in surface microhardness and fluoride content of adjacent initial interproximal enamel carious lesions in primary molars compared with Filtek™ Z350. Predicta® is an alternative restorative material to remineralize adjacent initial interproximal enamel carious lesions in primary molars, especially in high-risk caries patients.

Remineralization potential of apacider gel on enamel and cementum surrounding margin of ceramic restoration.

Modern management of carious lesions has been targeted upon using remineralizing agents. This study investigated the remineralization potential of apacider gel (AG) and casein phosphopeptide-amorphous calcium fluoride phosphate (CA) on enamel and cementum around the cavosurface area of the ceramic margin. Seventy-five extracted human mandibular molars were sectioned at 0.8 mm above and below the cemento-enamel junction (CEJ) to remove the CEJ portions and replaced them with glass ceramic disks by bonding them to the crown and root portions with resin cement. The enamel and cementum area of 4x4 mm2 surrounding ceramic was demineralized with Carbopol-907. The demineralized surfaces were treated with either AG or CA, while one group was left with no treatment (NT) and served as control. Vickers microhardness was determined before-, after demineralization, and after remineralization. The percentage of hardness recovery (%HR), and remineralization potential (%RP) were analyzed with ANOVA and Bonferroni's test (α=0.05). Polarized light microscopy (PLM) was assessed for lesion depth. Scanning electron microscopy (SEM) was investigated for surface alterations. Significant differences in remineralization were found upon various remineralizing agents compared to NT for both enamel and cementum (p<0.05). No significant difference in %HR and %RP was observed between AG and CA (p>0.05). However, AG signified greater decrease in lesion depth and better improvement in surface characteristics for both enamel and cementum than CA. AG possesses comparable remineralization ability to CA. However, decreasing in carious lesion depth was evinced with using AG more than CA. AG was recommended as a potential remineralization material for handling initial caries for both enamel and cementum. Key words:Apacider, artificial carious lesion, CCP-ACFP, remineralizationCare Team.

Mineralizing agents to manage early carious lesions. Part I: mode of action

Dental caries remains a major global health challenge affecting millions of people worldwide, with both major health and financial implications. The minimum intervention oral healthcare (MIOC) delivery framework aims to improve caries management through early diagnosis and the use of remineralization strategies in primary and secondary preventive approaches. The landmark discovery of fluoride in caries remineralization resulted in an increase in research on such non-operative approaches. With an improved understanding of the biochemistry of caries and the demineralization-remineralization balance within dental hard tissues, researchers and clinicians currently seek new therapies to improve the non-operative management of early carious lesions. New remineralization technologies have been introduced in recent years, with varying chemistries, modes of action and degrees of success. This article, the first of a two-part series, explores the chemistry and mode of action of currently available remineralization technologies, outlining their clinical effectiveness and use in dental caries management. CPD/Clinical Relevance: A scientific understanding of ever-evolving remineralization technologies is necessary for clinicians.

Minimally invasive selective caries removal: a clinical guide

An evolving understanding of the carious process, along with new research in adhesive restorative materials, has led to a more conservative, minimally invasive and biologically-based approach to managing dental carious lesions. The growing volume of literature has also demonstrated prognostic success in the selective caries excavation technique, subsequently preventing excessive tooth structure removal and injury to the dentine-pulp complex, which maintains pulp vitality and improves the long-term prognosis of the tooth. However, at present, there remains a limited volume of high-quality evidence to support selective caries removal, which subsequently could partly explain some resistance to its use in clinical practice. This clinical technique guide aims to demonstrate the management of carious lesions of moderate-to-deep depth in permanent teeth based on current minimally invasive dental literature.

A systematic review on the effect of silver diamine fluoride for management of dental caries in permanent teeth.

The objective of this review is to assess the available literature systematically related to the effect of silver diamine fluoride (SDF) for the management of occlusal and root carious lesions in permanent teeth regardless of age. MATERIALSANDMETHODS: This systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Review and Meta-Analyses statement. A literature search was performed usingPubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, DOAJ, and Open Gray with no language restrictions up to December 2022. Three reviewers critically assessed the studies for eligibility. Any disputes between the reviewers were handled by a fourth independent reviewer. The quality assessment and data extraction of the studies were performed. A total of 2176 studies were screened. The titles and abstracts of the studies were then reviewed (n = 346), and 52 studies met the search criteria. Following the full-text review, 11 studies investigated the effect of SDF against other treatments such as chlorhexidine, sodium fluoride, ammonium bifluoride, tricalcium silicate paste, casein phosphopeptide amorphous calcium phosphate, glass ionomer cement (GIC) combined with fluoride varnish, resin-modified GIC, and atraumatic restorative treatment were assessed. Within the limitations of this review, the use of SDF is promising with high preventative fractions in permanent teeth of children and older populations when compared to other topical applications such as dental varnish containing sodium fluoride.

The revolutionary evolution in carious lesion management.

Contemporary paradigms of dental caries management focus on the biological approaches to treating the disease and its principal symptom, the carious lesion. This narrative review traces the evolution of carious lesion management from the operative and invasive approaches of G. V. Black's era to the current period of minimally invasive biological approaches. The paper explains the rationale for adopting biological approaches to dental caries management and lists the five core principles of this management approach. The paper also details the aims, features, and the most recent evidence base for the different biological carious lesion management approaches. Based on current practice guidelines, collated clinical pathways for lesion management are also presented in the paper to aid clinicians in their decision-making. It is hoped that the biological rationale and evidence summarized in this paper will bolster the shift to modern biological carious lesion management approaches among dental practitioners.

COMPARATIVE EVALUATION OF REMINERALIZING POTENTIAL OF DIFFERENT COMMERCIALLY AVAILABLE REMINERALIZING AGENTS : AN IN VITRO SCANNING ELECTRON MICROSCOPY/EDS STUDY

Background - Modern dentistry aims at non-invasive &amp; biological approach using remineralizing agents for management of early carious lesion. Aim- To evaluate and compare the remineralizing potential of three commercially available remineralizing agents containing SDF(Fagamin), CPP-ACPF(GC Tooth Mousse Plus) and BiominF(Elsenz) on demineralized enamel. Material and methods- Samples from forty extracted premolar teeth were selected and subjected to demineralizing solution for 96 hrs to create white spot lesion. The demineralized samples were randomly allocated into four groups:Group I(control group), Group II(SDF),Group III(CPPACPF),Group IV(Elsenz). White spot lesion containing demineralized samples were subjected to the test agents for 5 minutes everyday for 30 days. Scanning electron microscope (SEM) and Energy dispersive Spectroscopy (EDS) analysis were carried out at pre-remineralization and post-remineralization stage. The data were analyzed using SPSS 19.0 software Statistical Analysis- with one-way ANOVA and paired t-test. Results- All three test agents showed signicant remineralization of previously demineralized lesions. However, Elsenz showed the greatest remineralization, followed by SDF and then CPP-ACPF paste. Elsenz proved to be Conclusion- the best remineralizing agent and can be strongly recommended as an alternative to other remineralizing agents used in this study.

The clinical success of ART restorations and Hall technique in primary molars: a randomized 18-month follow-up study.

The aim of the study was to evaluate the clinical and radiographic success of the Hall technique (HT) and atraumatic restorative treatment (ART) restorations using high-viscosity glass-ionomer cement for the management of occlusal carious lesions in primary molars. This randomized clinical study observed 40 children (aged 5-6 years). For each child, one tooth was treated with HT and one with ART. The primary outcome measures for HT restorations were successful, minor, and major failure rates. Clinical evaluations of ART restorations were performed according to the modified United States Public Health Service criteria during 18-month follow-up. McNemar test was used for statistical analysis. Thirty of 40 (75%) participants returned for 18 months of follow-up. In the clinical evaluations of teeth that were treated with HT, the patients did not have complaints of pain or other symptoms, all crowns remained in the oral cavity, the gums were healthy, and the teeth were functional in all evaluations. At the end of the 18-month follow-up, the surface texture and marginal integrity criteria of ART restorations were recorded as 26.7% and 33.3%, respectively. In the radiographic evaluation of 30 patients treated with ART and HT, all restorations were considered successful. The 18-month clinical and radiographic results after treatments applied to single-surface cavities in anxious children showed that both treatment methods were successful.

Knowledge on Attitude and Barriers toward Silver Diamine Fluoride among Dental Practitioners in Tricity, India

Aim: To evaluate the dentist’s knowledge, attitudes, and barriers towards silver diamine fluoride (SDF) in Tricity (Panchkula, Chandigarh, Mohali), India. Materials and Methods: A cross-sectional study was conducted using a selfadministered online questionnaire among 422 dental practitioners in Tricity (Panchkula, Chandigarh, Mohali), India from 25th August 2021 to 10th September 2021. The outcome variable of the study were knowledge, attitude, and barriers toward Silver Diamine Fluoride. A pretested questionnaire on a 5-point Likert scale was used. Results: A total of 55% of respondents strongly agreed and agreed that SDF is a good treatment option for primary teeth that are not in the esthetic zone. The barrier to its usage is being not readily available commercially, with the highest score of 48%. Conclusion: Increased efforts in SDF education may lead to greater use of this innovative approach to the management of cavitated carious lesions. The most cited barrier to the use of SDF is tooth staining associated with arresting caries.

Knowledge of undergraduate dental students regarding management of caries lesions

ObjectivesUnderstanding of lifelong control of disease processes associated with caries and its management is an essential part of dental education. This study evaluated the dental students’ knowledge of caries diagnosis and management using the International Caries Classification and Management System (ICCMS).MethodsA survey was conducted among undergraduate dental students at two dental schools, attending the sixth (centre 1) and seventh semester (centre 2), respectively. Medical histories, clinical images and radiographs of 12 patients were compiled as anonymous cases. For each case, a specific lesion was to be assessed. In addition, the students should determine the patient’s caries risk and select a treatment option. An expert report (consensus decision) was used as the reference standard. For statistical analysis, kappa statistics and binomial tests were used.ResultsA total of 46 students participated in this study. The percentage of agreement of responses to the reference was: centre 1: 40.7–51.3%, centre 2: 57.9–67.9%. The corresponding Kappa values were: centre 1: 0.073–0.175, centre 2: 0.315–0.432. Overall, students tended to underestimate the codes compared to the reference standard (p < 0.001).ConclusionIntroducing systematic content about caries diagnosis and management such as ICDAS and ICCMS in the learning objectives of undergraduate dental students can be proposed. However, in order to improve diagnosis and enable a more reliable choice of treatment options, attention should also be given to the way they are didactically taught.

Minimally invasive treatment of dental caries, an update

The importance of this research lies in the effectiveness of the different minimally invasive techniques for the management of carious lesions. Objective: To analyze the minimally invasive treatment for the removal of carious lesions. The techniques evaluated were: conventional method, ART, papacarie, laser and abrasive air. Methodology: A compilation of articles published in the last 5 years was carried out using the PubMed electronic database. Abstracts and full texts were identified that included information on the techniques for minimally invasive treatment of carious lesions: the conventional method, ART, papacarie, laser and abrasive air. Results: The conventional technique is the most commonly used at present, but it is the most aggressive because it removes both healthy and infected tissue. ART is one of the most economical and least painful measures for caries management. Papacarie is a minimally invasive chemical removal method and does not require local anesthesia. Laser for caries removal is expensive, but it is one of the least abrasive ways to manage it, and the abrasive air does not irritate pulp or adjacent tissues. Conclusions: Removal of dental caries with rotary instruments is frequently associated with thermal and pressure effects on the pulp, resulting in pain. Due to the shortcomings of the bur, alternatives such as chemo-mechanical caries removal with sharp instruments (ART), laser and abrasive air were developed, which have a disintegrating effect on the caries tissue, while leaving healthy dentin largely intact.

Management of initial carious lesions of hypomineralized molars (MIH) with silver diamine fluoride or silver-modified atraumatic restorative treatment (SMART): 1-year results of a prospective, randomized clinical trial.

ObjectivesThis study evaluated and compared the effect of silver diamine fluoride (SDF) and silver-modified atraumatic restorative treatment (SMART) sealants for the treatment of initial carious lesions of permanent molars affected by molar incisor hypomineralization (MIH).MethodsOne hundred and twelve hypomineralized permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF and SMART sealant groups (n = 56 teeth/group) in a split-mouth fashion. Hypersensitivity, formation of caries, and enamel breakdown were evaluated in both groups. Hypersensitivity was assessed by Schiff Cold Air Sensitivity Scale (SCASS), and clinical assessments of SMART sealants were performed according to modified USPHS criteria at 1, 6, and 12 months. The data were analyzed statistically using Fisher’s exact test, Kaplan–Meier analysis, Mann–Whitney U test, and Friedman test.ResultsTwenty-six hypomineralized molars with marked baseline hypersensitivity showed significantly lower SCASS scores at all evaluation periods (p < 0.001). There was no significant difference in hypersensitivity scores between the groups at the repeated applications of SDF at 1, 6, and 12 months. The cumulative survival rates of SMART sealants on occlusal and palatal surfaces were 88.7% and 58.8%, respectively.ConclusionsIn hypomineralized molars, both SDF and SMART sealants showed favorable short-term prevention against dental caries while providing effective desensitization. Marginal discoloration was the most common side effect of the SMART sealants as a result of SDF application.Clinical SignificanceBoth SDF and SMART sealants showed similar short-term effectiveness as non-aerosol procedures in arresting enamel caries and reducing hypersensitivity in hypomineralized molars.Trial registrationClinical Trials Registration Number: NCT03862014.