Carious Tissue Research Articles

Deep caries and pulp exposures management preferences in permanent teeth: A survey amongst Spanish dentists.

To assess Spanish dentists' management preferences for deep caries removal and exposed pulps in permanent teeth. A web-based open and anonymous survey was distributed by social media and a specific website for this project amongst dentists practicing in Spain. The questionnaire comprised 40 questions, divided into five sections: (1) demographic data and professional activity; (2) carious tissue removal; (3) decision-making regarding pulp exposure; (4) direct pulp capping and (5) pulpotomy procedures in permanent teeth. Results were descriptively analysed. Logistic regression (95% CI) analyses and X2 tests were carried out. A total of 538 responses were received. Half the respondents (53.7%) preferred to perform complete caries excavation for shallow and moderate carious dentin lesions, and selective excavation to firm dentin for deep lesions (57.8%). Selective removal to soft dentin and stepwise removal were much less indicated (15.4% and 10.9%, respectively). Exposed pulps in asymptomatic teeth were treated by direct pulp capping (over 80%), decreasing in the presence of reversible pulpitis symptoms (57.1%). If irreversible pulpitis was diagnosed, a pulpectomy would be performed by 53.5% and 89.9% of the respondents in, respectively, immature and mature teeth. Pulpotomy was performed routinely only by 26.4% of the clinicians. Patients' attitudes and priorities were the most relevant criteria when performing direct pulp capping and pulpotomy, together with the history of pain and the presence of bleeding. Regarding the clinical procedure, dry cotton was preferred to obtain haemostasis and Biodentine was the material of election. Caries removal preferences and management of pulp exposure by dentists practicing in Spain deviated from vital pulp treatment guidelines, mainly regarding indications and case selection. Pulp exposure was managed by direct pulp capping in asymptomatic cases, whilst immature permanent molars favoured the indication of pulpotomy when pulpitis was diagnosed. Most clinicians used hydraulic calcium silicate cement, specifically Biodentine, to perform vital pulp treatments. Postgraduate formation and continuing education in caries lesions management and vital pulp treatments were consistently related to more conservative and updated decisions.

"Evaluation of Silver Diamine Fluoride Modified Atraumatic Restorative Treatment (SMART) on hypomineralized first permanent molar"- a randomized controlled clinical study.

Restoring first permanent molars affected with molar incisor hypomineralization (MIH) is challenging. Focusing on improving the quality of life for children affected by MIH, at least until the complete eruption of first permanent molars to receive full coverage, to decrease the hypersensitivity and to be able to perform proper oral hygiene measures, the purpose of this study was to compare silver modified atraumatic restorative technique (SMART) versus the conventional restoration and fluoride varnish application on moderate to severe hypomineralized molars. The comparison considered the restoration survival, hypersensitivity, and digital surface area changes after one year follow up. Twenty-eight children were selected (20 girls and 8 boys) with at least 2 MIH molars with the same defect severity. The study comprised 2 groups; MOD group (moderate hypomineralized molar severity) and SEV group (Severe hypomineralized molar severity) (n = 28 tooth). Each group was further subdivided into 2 subgroups according to the technique of restoration: SMART subgroup and CONV subgroup (high viscosity glass ionomer restoration and fluoride varnish application) (each = 14 tooth). Evaluation was done in terms of the restoration survival (6 months and 12 months), hypersensitivity at 1 weak, 6 months and 12 months and occlusal surface area changes at 12 months). Professional Fluoride varnish application and home prophylaxis using MI paste were the protocol for each child patient. There was no significant difference between the 4 subgroups, regarding tooth restoration integrity at 6-months vs. 12-months. However, a statistically significant difference in tooth restoration integrity between the 4 subgroups at 12-months (P = .049). Also, the hypersensitivity score, there was a statistically significant difference between the 4-time intervals (P < .001) and a statistically significant difference in surface area changes between the 4 subgroups. Selective removal of carious tissue and SMART restoration, combined with dental home and professional preventive measures every 3 months maintained the integrity of restorations in severely and moderately affected permanent molars up to 1 year. The study protocol was retrospectively registered on Clinical Trials (NCT05931822-05/ 07/2023).

Antimicrobial Efficacy of Chemomechanical Carie Removal Agents-A Systematic Integrative Review.

Dental caries is the most common oral disease in the world. When treatable, the drilling method continues to be used. This technique has its disadvantages because it is invasive and nonspecific. Chemomechanical carious tissue removal agents (CCRAs) such as Carisolv™ or Papacarie® are non-invasive products that allow for the specific elimination of infected dentin. On the other hand, cariogenic bacteria are largely responsible for the initiation and development of lesions. The aim is to analyze whether CCRAs have a relevant antimicrobial effect on cariogenic bacteria. A bibliographic search strategy was carried out in online databases using PRISMA 2020. The evaluation of the antibacterial efficacy of CCRAs was carried out through the analysis of the reduction in CFUs of cariogenic bacteria, and the presence of bacterial deposits, TVC, SVC and LVC by comparison with conventional drilling methods. The results showed that the percentage of reduction in TVC, SVC and LVC for each agent is mostly high, but not significantly different from mechanical methods. The best results were found with CCRAs when compared to polymeric drills. The results also showed that there is a lack of methodological standardization. CCRAs have been shown to have a relevant antimicrobial effect on cariogenic bacteria; however, more studies need to be carried out using standardized methodologies.

DENTAL REHABILITATION BY THE OCCLUSAL MATRIX TECHNIQUE USING PROVISIONAL RESTORATOR: Case report of a pediatric patient from the city of Mato Verde - MG

The occlusal matrix technique allows the recording of anatomical details of the remaining tooth structure before starting cavity preparation, enabling the reestablishment of the original tooth morphology by means of an occlusal matrix. The objective of this study was to report a clinical case of dental rehabilitation by the occlusal matrix technique using a temporary restorative in pediatric dentistry. This research is an observational descriptive study (committee, nº 6.906.292). The work was conducted in the city of Mato Verde, Minas Gerais, at Faculdade Verde Norte (FAVENORTE). A 7-year-old female patient, together with her guardian, attended the FAVENORTE Dentistry clinic for dental care, complaining that her tooth had some “dark spots”. During the clinical examination, it was observed that tooth 46 had an active carious lesion on the occlusal surface in a region of pits and fissures with shadowing in the underlying dentin (ICDAS – Score 4), but with relatively intact occlusal anatomy. Interproximal radiographic examination showed that the carious lesion was in the dentin, but not close to the pulp. Due to the preservation of the occlusal anatomy of the tooth, the proposed treatment for the patient was the use of the occlusal matrix technique, selective removal of carious tissue, and restoration with composite resin, aiming to restore form and function. The occlusal matrix technique has proven to be an effective and efficient approach in the rehabilitation of carious lesions on occlusal surfaces, especially in pediatric patients. The technique allowed the faithful reproduction of the original anatomy of the tooth, which is essential for the maintenance of masticatory function, esthetics and occlusal integrity.

Evaluation of staining potential of Silver Diamine Fluoride, Potassium Iodide, Nanosilver Fluoride: an in vitro study

BackgroundThe black staining effect of silver-containing solutions for use to arrest caries can have a negative aesthetic impact on children and parents. This study aims to assess the staining effects of Silver Diamine Fluoride/Potassium Iodide (SDF/KI), SDF and Nanosilver Fluoride (NSF).Materials and methodsForty-four extracted carious primary molars were collected and randomly divided into four groups (n = 11). The carious tissue in all teeth was removed using a chemo-mechanical caries removal agent with an excavator. After caries removal in all groups, SDF, SDF/KI, and NSF were applied to the different groups, while no solution was applied to the control group. Subsequently, the teeth in all groups were restored with compomer. Color values L*, a* and b* were measured using a spectrophotometer at three time points: immediately after compomer restoration (T0), one week later (T1), and four week later (T2). Changes in brightness (ΔL) and color (ΔE) over time were calculated and comparisons among groups were made.ResultsThe SDF solution induced statistically significant black staining (p = 0.013) and a decrease in L* value (p < 0.001) on the compomer material compared to the other groups over time.ConclusionsIt was observed that SDF/KI has the potential to reduce the black staining effect of SDF, though not entirely. Novel experimental solutions like NSF may offer an alternative to counteract the staining effect of SDF.

Microtensile bond strength and nanoleakage of self-etching adhesives containing different concentrations of 45S5 bioactive glass in caries-affected dentin

ObjectiveTo evaluate microtensile bond strength (μTBS) and nanoleakage (NL%) of self-etching adhesive systems containing different concentrations of bioactive particles when applied to caries-affected dentin: immediately and after 1 year of storage. Materials and methodsThree experimental self-etching adhesive systems were developed: (1) Experimental control adhesive (without glass), (2) adhesive containing 5 % 45S5 glass (45S5 5 %), and (3) adhesive containing 20 % 45S5 glass (45S5 20 %). Sound human molars were used (n = 7). The dentin surface was exposed, and half of the specimens were subjected to artificial caries induction, followed by partial removal of the carious tissue. Adhesives were applied to the dentin surface, and teeth were restored with composite resin and sectioned. Specimens undertook microtensile bond strength tests in a universal testing machine (Instron 3342) at 24-h and 1-year. Interfaces of the sectioned specimens were observed under a stereomicroscope to obtain the fracture mode. For nanoleakage test, specimens were infiltrated with silver nitrate and the interface was analyzed using a Scanning Electron Microscope (SEM) at 24-h and 1-year. Data were subjected to ANOVA test (three-way) and Holm-Sidak post-hoc (α = 0.05). ResultsFor μTBS (p = 0.574) and NL (p = 0.334) tests, there was no interaction between the 3 main factors (Material vs. Substrate vs. Time). There was an interaction between dentin and material for μTBS (p < 0.001) and NL (p = 0.005) tests. Bioactive adhesives with 5 % and 20 % concentration were not influenced by the type of dentin (p < 0.05). There was a reduction in μTBS values and an increase in NL values for the adhesive without bioactive glass in dentin affected by caries (p > 0.05). ConclusionBioactive glasses had therapeutic action on dentin. The bond strength values of bioactive adhesives were maintained in caries-affected dentin and had low nanoleakage values. Clinical significanceSelf-etching adhesives containing 45S5 bioactive glass have the potential to preserve the dentin substrate and improve the longevity of restorations with composite resins.

Therapeutic management of cavitated caries lesion in a patient with sensory processing disorder

Caries disease is still an important public health problem. Although preventing the disease is simple, it is still a challenge due to the interaction of cariogenic factors. One of the forms of treatment is the selective removal of carious tissue, which consists of the total removal of carious tissue from the surrounding walls, preserving the affected tissue in the pulp wall, as it is a tissue capable of remineralization. In the conservative philosophy, there are alternative therapies to the use of manual cutting instruments and the use of rotary instruments - such as the use of chemical agents. These materials help the professional in the selective removal of decayed dentin tissue. The more conservative philosophy is an excellent alternative for patients with Sensory Processing Disorder, as it generates less sound, olfactory, thermal and tactile stimuli – also improving the pain experience. This makes it possible to provide the patient with individualized care, taking into account and respecting their limitations and needs.

Clinical conduct of dentists in the treatment of deep dental carious lesions

Different techniques are employed to contain the carious process: non-invasive, microinvasive, and invasive, and with restorative needs. Thus, it is essential that dentists are duly updated regarding scientific evidence and perform with skill and precision the techniques proposed as treatment, being aware of the consequences and risks, and aiming at the most conservative therapy. Objective: To identify the clinical practices for the treatment of deep carious lesions used by dental surgeons of the Family Health Strategy (FHS) program of a Brazilian city. Material and methods: This was a quantitative and cross-sectional study carried out with 43 dental surgeons from the FHS program in the city of Sobral, State of Ceará, Brazil, using a Google Forms online questionnaire, containing questions related to the clinical criteria used during caries removal, deep dentin caries removal techniques, lining materials, survival rate of some treatments, in addition to sociodemographic data and questions regarding professional qualification. Results: Among those interviewed, 62.8% were aged between 25 and 30 years. Most dentists (58.7%) considered that the cavity floor should be hard at the end of the carious dentin removal, which demonstrates the non[1]adherence to Selective Carious Tissue Removal (SCTR) protocols. Only 25.6% considered SCTR a treatment with a chance of success and a 2-year survival rate greater than 80%. More than half of the interviewees (51.2%) disagreed with the maintenance of carious tissue in the axial/pulp walls of deep cavities to preserve pulp vitality. More invasive treatments were preferred in a greater proportion by dentists who work exclusively in the public sector (66.7%) compared to those who also work in the private sector (17.6%) [p=0.002], with an evident need for cariology education workshops and more studies on the topic. Conclusion: The dentists who participated in the study showed little adherence to less invasive techniques in the treatment of deep carious lesions.

Short-Wavelength Infrared Imaging of Infected and Affected Dentin.

Stains produced by bacteria or those found in blood and food byproducts accumulate in highly porous caries lesions. They can interfere with accurate diagnosis and the selective removal of carious tissue during cavity preparations. Short-wavelength infrared (SWIR) imaging studies have shown that stain molecules do not absorb light beyond 1200 nm. The objective of this study was to image affected and infected dentin atSWIR wavelengths. Sections of 3 mm thickness were cut from the extracted teeth with deep dentinal lesions. The sound (normal), affected (stained), and infected (demineralized) dentin on each section were examined with reflected light at wavelengths from 400 to 1700 nm, red and green fluorescence, and with optical coherence tomography (OCT). Microcomputed tomography (microCT) was used to measure the mineral density at each location investigated. Significant (p < 0.05) differences were observed in the reflected light intensity at 400-850 nm and for fluorescence between the sound, affected, and infected dentin. SWIR imaging did not show significant reductions in reflectivity for the affected and infected dentin. SWIR images may be valuable for monitoring the lateral spread of dentinal lesions on the occlusal surfaces of teeth.

Comparative Meta-Analysis of Minimally Invasive and Conventional Approaches for Caries Removal in Permanent Dentition.

Background and Objectives: Addressing deep carious lesions poses significant challenges in daily dental practice due to the inherent complexity of their treatment. Traditionally, complete removal of carious tissues has been the norm, potentially leading to pulp tissue exposure and subsequent pulpitis. In contemporary dentistry, there is a growing preference for minimally invasive techniques, such as selective removal, offering a more conservative approach with enhanced predictability and success rates. Materials and Methods: Our study commenced with a comprehensive systematic review. After that, we performed a meta-analysis focused exclusively on randomized controlled trials involving permanent dentition. Our investigation incorporated seven selected articles, which scrutinized success rates and the incidence of pulp exposure in minimally invasive techniques (MIT) versus conventional techniques (CT). Statistical analysis employed U Mann-Whitney and Wilcoxon tests to interpret the results. Results: Although the difference did not reach statistical significance, MIT demonstrated marginally superior success rates compared to CT. Furthermore, MIT exhibited a lower percentage of pulp exposure when contrasted with CT. However, due to the limited sample size, statistical significance for this difference could not be established. Conclusions: Minimally invasive techniques for caries removal emerge as a conservative and promising approach to safeguard pulp tissues in comparison to conventional techniques. The need for additional randomized controlled trials is emphasized to unequivocally establish the superior success rates of these procedures over their conventional counterparts.

Clinical outcome of direct pulp capping by using mineral trioxide aggregate and calcium hydroxide in the mature permanent teeth during the carious tissue removal.

Objective: To compare the clinical outcome in between the mineral trioxide aggregate (MTA) and calcium hydroxide (CaOH) during the direct pulp capping in mature permanent teeth. Study Design: Comparative Cross Sectional. Setting: Department of Operative Dentistry and Endodontics, Institute of Dentistry, Liaquat University of Medical &amp; Health Sciences Jamshoro / Hyderabad. Period: January 2022 to December 2022. Material &amp; Methods: We included all patients who had vital pulp, reversible pulpitis, mature teeth with closed apex, and were between the ages of 18 and 35, regardless of gender. Two groups of patients with equal numbers were formed. Those in groups A and B. Patients in Group A received MTA treatment, whereas those in Group B received CaOH treatment. Patients in both groups were encouraged to follow up to check on the discomfort and sensitivity of the tooth after 24 hours, a week, three months and six months. Data were gathered using a research proforma. Results: The mean age of the patients was 27.13+4.59 years in CaOH group and 27.43+4.40 years in MTA group. Pre- operatively the most of the patients had moderate to severe pain in both groups as 40.0% and 46.7% in CaOH group and 20.0% and 80.0% in MTA group respectively. Severity of the post-operative pain was less in MTA group while findings were statistically insignificant (p-0.143). On the pain assessment after 3 months, only 13.3% cases had mild pain in CaOH group, while no any case found with pain in MTA group (p-0.038). Post operative pain on 7th month was almost decreased complete in both groups. Test validity was positive in all of the cases till 6th months follow-up, which indicted that no nay cases had developed narcosis after treatment in both groups. Furthermore, in this study, there was no any cases found with radiological abnormalities during follow- up of 24 hours to 6 month post-operatively in both groups. Conclusion: After direct pulp capping in adult permanent teeth, both mineral trioxide aggregate and calcium hydroxide were demonstrated to be effective. However, MTA seems to be more effective than calcium hydroxide in preserving long-term pulp vitality.

Volumetric analysis after caries excavation with caries detecting dyes and chemomechanical caries removal agents using 3D scanner-a randomised clinical trial

AimThis research aimed to use an extra-oral 3D scanner for conducting volumetric analysis after caries excavation using caries-detecting dyes and chemomechanical caries removal agents in individuals with occlusal and proximal carious lesions.MethodsPatients with occlusal (A1, A2, A3) and proximal carious lesions (B1, B2, B3) were treated with the conventional rotary technique, caries detecting dyes (CDD) and chemomechanical caries removal (CMCR) method on 90 teeth (n = 45 for each). Group A1, B1: Excavation was performed using diamond points. Group A2, B2: CDD (Sable Seek™ caries indicator, Ultradent) was applied and left for 10 s, and then the cavity was rinsed and dried. For caries removal, diamond points or excavators were used. Group A3 and B3: BRIX3000 papain gel was applied with a micro-brush for 20 s and was activated for 2 min, and then the carious tissue was removed with a sharp spoon excavator. Post-excavation cavity volume analysis was performed using a 3D scanner. The time required and the verbal pain score (VPS) for pain were scored during excavation. Post-restoration evaluation was performed at 1, 3, and 6 months FDI (Federation Dentaire Internationale) criteria.ResultsComparison of age, time and volume with study groups were made using Independent Sample’ t’ test and one-way analysis of variance (ANOVA) for two and more than two groups, respectively. Using Cohen’s Kappa Statistics, evaluators 1 and 2 agreed on caries removal status aesthetic, functional and biological properties at different follow-ups. The chi-square test revealed that the rotary groups [A1(2.5 ± 0.4 min) B1(4.0 ± 0.4 min)] had significantly less (p = 0.000) mean procedural time than CDD [A2(4.5 ± 0.4 min) B2(5.7 ± 0.4 min)] and CMCR [A3(5.4 ± 0.7 min) B3(6.2 ± 0.6 min)] groups. The CMCR group showed better patient acceptance and less pain during caries excavation than the rotary and CDD groups. CMCR group showed significantly less mean caries excavated volume(p = 0.000). Evaluation of restoration after 1-, 3-, and 6-month intervals was acceptable for all the groups.ConclusionBrix3000 helps effectively remove denatured teeth with less pain or sensitivity. The time required for caries removal was lowest in the rotary method and highest in the brix3000 group, while the volume of caries removed was the lowest for brix3000 and highest for the rotary group.

Which caries removal method to select?

Searches were carried out using PubMed/MEDLINE and Web of Science databases between January 2008 and January 2023. Only articles in English language were included. Boolean operators were used to search: "permanent teeth" OR "permanent tooth" OR "permanent dentition" AND "deep caries" OR "stepwise" AND "partial caries removal OR "stepwise caries removal" OR "pulp vitality" OR "healing rate". Inclusion criteria were randomised controlled trials, which compared the total removal of carious tissue with either a selective or stepwise removal in permanent teeth with deep carious lesions. Criteria also required a follow up of at least 6 months and publications in English. Exclusion criteria were articles in other languages, articles not comparing different types of total or selective caries removal and articles published before January 2008. Data extraction followed PRISMA guidelines. Two reviewers independently screened articles, analysing titles and abstracts using Rayyan's Intelligent Systematic Review Platform. They also collected data and risk of bias assessed using the Cochrane Risk of Bias Tool for Randomised Trials, dividing articles into high risk of bias, few concerns and low risk of bias. A third researcher resolved conflict or doubt in case of divided opinions. In total, 105 articles were identified, and 10 duplicates removed. 95 articles were reviewed by title and abstract and 75 of these did not meet the inclusion criteria. 20 articles were then read, excluding a further 15 due to comparing only partial removal or non-selective caries removal or absence of numerical data. This left 5 articles which met eligibility criteria. These were randomised controlled trials between 2010 and 2021. Follow up ranged from 1 month to 5 years. The inclusion and exclusion criteria in all studies had similar clinical parameters. 3 studies performed management only on permanent molars, whilst the rest also included management on permanent incisors/canines/premolars and molars. Management of caries was divided into non-selective caries removal vs partial caries removal (either selective or stepwise). All but 2 studies included specific information about the materials used. Liners were calcium hydroxide or Dycal, provisional restorations were glass ionomer cements or Ketax Molar and definitive restorations were Herculite Tetric N-Ceram resin, Ivolclar Vivadent or amalgam. Clinical success or failure was measured using pulp vitality, absence of periapical lesions, radiographic analysis and lack of symptoms. Clinical follow up was evaluated by external examiners, although 2 studies did not specify this clearly. There were a variety of tools used for statistical analysis in each study. When comparing non-selective caries removal with either selective or stepwise, 3 studies proposed statistically significant differences in terms of longevity, marginal integrity and success rate of restorations. 1 study stated inexistence of statistically relevant divergences between procedures. Non-selective caries removal is not highly recommended for deep carious lesions and may be considered invasive and risks pulpal exposure. Both selective and stepwise removal are considered conservative approaches. Selective removal is considered the best management option in the short term (with 1.5 years follow up), predominantly related to a lower risk of pulpal exposure. At 5 years, however, the results of selective were similar to those of non-selective, accepting the null hypothesis. There were also no differences in success rates for materials used for definitive restorations.

Association of Papacarie Duo® and low-level laser in antimicrobial photodynamic therapy (aPDT).

Dental caries is a multifactorial, non-communicable disease. Effective treatment options for minimally invasive removal of carious tissue include Papacarie Duo® gel and antimicrobial photodynamic therapy (aPDT). aPDT involves a combination of a light source and photosensitizer. Given that Papacarie Duo® contains a percentage of blue dye, this study aims to explore the antimicrobial potential of Papacarie Duo® when associated with a light source against Streptococcus mutans strains. The chosen light source was a low-power diode laser (λ = 660nm, E = 3J, P = 100 mW, t = 30s). To assess antimicrobial capacity, planktonic suspensions of Streptococcus mutans were plated on Brain Heart Infusion Agar (BHI) to observe the formation of inhibition halos. The studied groups included methylene blue (0.005%), Papacarie Duo®, distilled water (negative control), 2% chlorhexidine (positive control), Papacarie Duo® + laser, and methylene blue (0.005%) + laser. Following distribution onto plates, each group was incubated at 37°C for 48h under microaerophilic conditions. Inhibition halos were subsequently measured using a digital caliper. The results showed that chlorhexidine had the greatest antimicrobial effect followed by the group of irradiated methylene blue and irradiated Papacarie Duo®. All experimental groups demonstrated antimicrobial potential, excluding the negative control group. The study concludes that Papacarie Duo® exhibits antimicrobial properties when associated with a low-power diode laser.

Effect of calcium-coacervate infiltration of artificial enamel caries lesions in de- and remineralizing conditions

ObjectivesCalcium-coacervate emulsions (CC) might be considered as mineral precursors to foster remineralization of carious dental hard tissues. This study analyzed the instant effect of repeated infiltration of artificial caries lesions with a CC emulsion as well as the effects of subsequent exposure of CC-infiltrated lesions to demineralizing and remineralizing environments. MethodsBovine enamel specimens were partly covered with varnish to leave three exposed windows. Artificial enamel caries lesions were created (pH 4.95, 17d). Baseline controls (BL) were obtained by preparing a thin section of each specimen. Specimens were allocated to five groups. In three groups lesions were etched with 37 % phosphoric acid gel, infiltrated with dipotassium hydrogen phosphate and subsequently with a calcium coacervate emulsion, prepared by mixing CaCl2 ⋅ 2H2O with polyacrylic acid sodium salt (PAA-Na). Subsequently, the infiltration effect was either analyzed immediately (Inf.) or after exposition to either de- (Inf.+DS) or remineralizing solution (Inf.+RS) for 10 or 20 days, respectively. In two control groups specimens were exposed to either DS or RS, respectively without prior CC infiltration. Integrated mineral loss [ΔZ(vol%×µm)] was analyzed using transverse microradiography (TMR). ResultsInfiltration of enamel caries lesions with coacervate solution resulted in only subtle immediate mineral gain even if repeated. When exposed to demineralizing conditions, infiltrated lesions showed significantly less mineral loss compared to untreated controls (p < 0.05; Kruskal Wallis) and exhibited characteristic mineral depositions within the lesion body. ConclusionsWhile immediate mineral gain by infiltration was only modest, the CC-emulsion might be able to prevent demineralization in acidic conditions. Clinical significanceCalcium coacervates might act protective against further demineralization when infiltrated into enamel caries lesions.

Treatment strategies for deep caries

Deep caries occurs when caries progresses to the deep dentin layer, and further progression has the risk of pulp exposure, which may affect pulp vitality and tooth longevity. Currently, there are no objective standards for the diagnosis of deep caries. In addition, traditional therapy for deep caries emphasizes complete debridement of the decayed tissue, resulting in an incremental high risk of pulp exposure. There are different views on how to deal with the remaining dentin after caries removal, and root canal treatment is often adopted directly after pulp exposure. In recent years, due to advances in dental pulp biology, bioactive pulp-capping materials, and clinical evidence-based medicine, the principle of deep caries treatment has shifted to pulp protection. Based on the latest international research progress, evidence-based medicine and expert consensus, we present a series of advancements in this article, including the terminology of deep caries, pathological changes and defense mechanisms of the pulp close to the deep caries, treatment principles of deep caries, technical strategies for carious tissues removal, and the decision-making of treatment protocols after pulp exposure, with the aim of enhancing the understanding of deep caries among dentists, as well as providing a reference for the clinical diagnosis and treatment of deep caries.

Cognitive Biases Influence Clinical Practice of Selective Removal of Carious Tissue by Dentists and Students: An Exploratory Study

Cognitive Biases Influence Clinical Practice of Selective Removal of Carious Tissue by Dentists and Students: An Exploratory Study

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.

Viability and oxidative stress of dental pulp cells after indirect application of chemomechanical agents: An invitro study.

This study evaluated the transdentinal cytotoxic effects of enzymatic agents (EA) for chemomechanical carious tissue removal on human dental pulp cells. The groups were based on the performed dentine treatments (n = 8): G1: Positive Control (PC - no treatment); G2: Negative Control (NC - 35% H2 O2 for 2 min); G3: Brix 3000™ (BX) for 30 s; G4: BX for 2 min; G5: Papacarie Duo™ (PD) for 30 s; G6: PD for 2 min. The cells were evaluated for viability (VB; MTT assay) and production of reactive oxygen species (ROS; DCFH-DA assay) and nitric oxide (NO; Griess reagent). A scanning electron microscope provided morphological chemical analyses and energy-dispersive X-ray spectroscopy. The data were submitted to the one-way anova statistical test complemented by Tukey (p < .05). Cell viability decreased by 21.1% and 58.4% in G5 and G6, respectively. ROS production in G3 and G4 maintained basal levels but increased by 171.2% and 75.1% in G5 and G6, respectively. The Brix3000™ enzymatic agent did not cause indirect cytotoxic effects on pulp cells, regardless of the application time. Conversely, Papacarie Duo™ reduced viability and increased ROS production by pulp cells.

Relation Of Habitual Of Brushing Teeth With Candida sp. Colony Count in Children Dental Caries Under 10 Years Old

The dental and oral disease problem faced by the Indonesian population as well as in other developing countries is dental caries tissue disease. Bacteria colonize the oral cavity to produce acid, resulting in a demineralization process in dental caries tissue. Candida albicans is the main agent of oral candidiasis. The development of these two microorganisms interacts with each other to form a layer of biofilm, which is the beginning of caries. Candidiasis is a fungal infection caused by Candida sp., which is the normal microflora in the oral cavity. This study aims to analyze the relationship between tooth brushing habits and the number of Candida sp. in dental caries in children under 10 years of age. This research is an analytic survey with a cross-sectional approach. Based on research on the relationship between brushing teeth and the number of Candida sp. in children under 10 years of age at SDN 01 Petung Bondowoso students, it can be seen that out of a total of 13 respondents (100%) who have poor tooth brushing habits, there are 7 respondents (53.8%) who have a small number of colonies and 6 respondents (46.2%) who have many colonies. Meanwhile, out of a total of 41 respondents (100%) who had the habit of brushing their teeth well, it was found that 41 respondents (100%) had a small number of colonies and none had many colonies. Based on the Chi-Square test, the results obtained were p = 0.000. Because p = 0.000 0.05, it can be interpreted that there is a relationship between brushing teeth and the number of candida fungal colonies in dental caries in children under 10 years of age. This can also be interpreted as meaning that the better the habit of brushing your teeth, the fewer the number of candida fungal colonies, and vice versa.