Deep Carious Lesions Research Articles

Stepwise removal compared to complete removal for deep carious lesions.

Carious lesions have traditionally been treated by non-selective (complete or total) removal of carious tissue. However, due to its risks and adverse effects, carious tissue removal techniques have been developed, based on the preservation of tooth tissue, including the stepwise removal. The objective of this summary is to clarify the uncertainty about the effectiveness and safety of the stepwise removal technique compared to complete removal. To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by searching multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from identified reviews, reanalyzed data from primary studies, performed a meta-analysis, and prepared summary tables of results using the GRADE method. We identified three systematic reviews that included five primary studies, four of them corresponding to randomized trials. We concluded that stepwise removal may reduce the risk of pulp exposure, the risk of signs and symptoms of pulp disease and the risk of restoration failure, but the certainty of the evidence is low.

Chemo-mechanical removal versus conventional removal for deep caries lesion.

Dental caries have been traditionally managed with the non-selective removal of carious tissue (total removal). However, the adverse effects and fear that this technique produces in patients has promoted the use of more conservative caries removal techniques such as chemo-mechanical removal, but there is still controversy regarding its effectiveness and safety. We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings tables using the GRADE approach. We identified seven systematic reviews including 34 studies overall, of which 30 correspond to randomized trials. We concluded that chemo-mechanical caries removal probably reduces the need for anesthesia. Additionally, chemo-mechanical caries removal may decrease the pain experienced by the patient, decrease the risk of restoration failure and increase the time of the procedure for the removal of deep caries, but the certainty of the evidence is low. We are uncertain whether chemo-mechanical caries removal reduces the risk of pulp exposure as the certainty of the evidence has been assessed as very low.

Which is the most effective biomaterial in indirect pulp capping? 4- year comparative randomized clinical trial.

The aim of this study is to compare the clinical outcomes of Mineral Trioxide Aggregate (MTA) and calcium hydroxide pulp capping after complete caries removal. In 73 regular patients (47 women, 26 men; age 20.65±3.02 years), having at least one deep carious lesion was recruited. Following complete caries removal, the pulp was indirectly capped with either MTA(n=51) or calcium hydroxide (n =49), randomly. Final restoration with a resin-based composite in a single session was performed. Clinical parameters including pulp vitality, sensitivity to cold or heat stimulants, percussion tests and discomfort during chewing and color were recorded after 6 months, 1 year, 2- year, 3- year and 4- year. Data were analysed statistically (p<0.05). After 4- year, the survival rates were 86% (for MTA), and 82.9% (for calcium hydroxide). Totally, 8 teeth from calcium hydroxide group and 7 teeth from MTA group were endodontically treated. No significant difference was detected between the groups in terms of pulp vitality (p=0.613). Grey discoloration rate was 63% in MTA group. Both pulp-capping materials, MTA and calcium hydroxide showed similar clinically successful performance in terms of pulp vitality in the treatment of deep dentin caries lesions after 4- year.

An investigation into the management of the deep carious lesion by general dental practitioners in the UK.

Objectives As techniques and dental materials have evolved, the management of deep carious lesions has also changed. This study investigated how UK-based general dental practitioners (GDPs) managed deep carious lesions in permanent, vital teeth and factors that influence their choices.Methods This mixed-method study employed an online questionnaire as its primary source of quantitative data collection. The questionnaire enquired about GDPs': a) demographics; b) working environment; and c) whether they had postgraduate training that covered caries management/minimally invasive dentistry (MID). Respondents were presented with a clinical case to elicit qualitative data. Relevant questions were asked in order to examine current practice and explore treatment among the respondents.Results In total, 239 responses were received. Overall, 168 (70% [95% CI 64%, 76%]) of the respondents chose a partial caries removal technique, 155 (69.3% [95% CI 60%, 72%]) used an adhesive restorative material and 205 (85.8% [95% CI 81%, 89%]) advised fluoride adjuncts. However, rubber dam (75; 31.4% [95% CI 26%, 38%]) and saliva testing (17; 7.1% [95% CI 4%, 11%]) were not routinely used. A significant relationship between those who had postgraduate training and those who chose partial caries removal as their treatment choice (χ2 = 6.27; p = 0.01) was noted. Respondents working in an NHS-based practice were significantly (χ2 = 34.98; p <0.001) more likely to restore teeth with amalgam.Conclusions There is an inconsistent management protocol when presented with a deep carious lesion, but partial caries removal is more widely adopted than previously reported. Rubber dam isolation was not routinely used when choosing to restore a deep carious lesion. Those who have had postgraduate training felt more confident in offering MID, so there is a clear need for further education to ensure its engagement.

In Vitro Analysis of Organic Ester Functional Groups in Carious Dentine

Background: With the implementation of minimally invasive selective caries removal protocols to treat cavitated, deep carious dentine lesions, there is a need to investigate specific biochemical moiety distributions to help characterise and distinguish between infected (contaminated) and affected (demineralised) zones within the dentine lesion. The present in vitro investigation aimed to compare the distribution of ester functional groups (1740 cm−1) within carious dentine tissue (infected and affected dentine). The null hypothesis stipulated that there are no differences in ester function intensity/distribution within carious dentine lesions. Materials and Methods: From a total of five extracted human molar teeth with carious dentine lesions, 246 points from 10 sections of carious dentine were examined using high-resolution Raman spectroscopy and characterised into infected, affected and sound dentine. The peak intensity of the characteristic vibration mode of the ester function was calculated from sample scans. Results: Analyses indicated a statistically significant difference in the spectroscopic vibration bands of esters between the infected and affected dentine zones. Conclusion: The ester functional group is higher in intensity in the caries-infected dentine zone compared to the affected tissue. This finding could be used to develop an objective indicator for the selective operative management of carious dentine.

Clinical Outcome of Direct Pulp Therapy in Primary Teeth: A Systematic Review and Meta-analysis.

Direct pulp treatment is carried out when a healthy pulp gets mechanically/accidentally exposed during the operative procedures or trauma. To determine the effects of various direct pulp capping materials as measured by the clinical and radiographic analysis. Two reviewers performed a database search of the studies published between January 2005 and November 2020. The inclusion criteria were papers published in the English language; children aged 3-12 years having deep carious lesions in primary teeth. All potential studies were acknowledged by their title and abstract. The full-text analysis of potentially relevant studies, the selected studies were included in the systematic review. A meta-analysis calculation was performed for the overall data and the subgroup data. The database searching led to 57 articles, which were of direct pulp treatment in primary teeth, after the removal of duplicates, 55 records remained but did not meet all inclusion criteria. A high variability was observed among the papers. Further filtering with criteria led to nine articles, which met all inclusion criteria. Meta-analysis demonstrated the success rates of DPT in primary teeth (95% confidence interval -0.799-0.898); P < 0.001. Clinical assessments of various direct pulp capping materials suggested 84.9% of success irrespective of the material used. The nine studies were heterogeneous according to the random effect model (P < 0.001, I2 = 84.08%). Direct pulp treatment has the advantage of being a conservative vital pulp therapy reducing the need for a more invasive treatment.

Advantages of Glass Ionomer Cement as A Base Rather than A Varnish in Pulp Capping

Indirect pulp treatment (IPT) or indirect pulp capping (IPC) is a conservative alternative therapy for primary and permanent teeth that have deep carious lesions nearing the pulp in the absence of any symptomatology related to pulp degeneration. This is achieved by removing only weakened, humid dentinal tissue that does not resist manual excavation, and intentionally leaving behind the deep most layer adjacent to the pulp. The healing mechanism in pulp capping involves the repair in the dento-pulpal complex through the formation of a dentin-like matrix known as tertiary dentin by dental pulp. Several dental materials have been used as IPC agents for the maintenance of vitality of deeply carious teeth. Glass ionomer cement (GIC) offers a combination of strength, rigidity and fluoride dispensing properties of silicate particles along with the biocompatibility and adhesive properties of a polyacrylic acid. The cement’s adhesion, based on an ion exchange mechanism with the dental tissue, is a unique phenomenon. Although, the adhesive strength has only been understood scarcely so far, it is known that the occurrence of bond failure in case of GIC is mostly from cohesive breakdown in the cement as opposed to adhesive failure at the dento-cement interface. Due to low amounts of polymerization related material contraction, GIC has proven to retain better than composite resins and provides a superior quality of bacterial seal. This seal prevents the progression of pulpal inflammation by preventing further microleakage of bacteria, endotoxins, and lipopolysaccharides at the dentin and glass ionomer interface. New generations of light cure GIC offer even greater retention to dentinal surfaces than traditional chemically cured GIC. However, the cement is appropriate only as an IPC.

Dilute Silver Diamine Fluoride (1:10) Versus Light Cure Calcium Hydroxide as Indirect Pulp Capping Agents in Primary Molars - A Randomized Clinical Trial.

To evaluate the clinical and radiographic outcomes of diluted silver diamine fluoride (1:10) and light cure calcium hydroxide as indirect pulp capping agents in primary molars. Fifty-six primary molars requiring indirect pulp treatment were randomly allocated to two groups: Dilute SDF (one drop of SDF mixed with 9 drops of distilled water giving a 1:10 dilution) and light cure calcium hydroxide. The indirect pulp treatment was followed by glass ionomer cement restoration and all primary molars received stainless steel crown as full coverage restoration. The teeth were followed up both clinically and radiographically at 1,6- and 12-months' time interval using a pre-determined criterion. The results were statistically analyzed using Chi square analysis. The significance level was set at p ≤0.05. Overall clinical and radiographic success rate of indirect pulp treatment with SDF was 96% and with light cure calcium hydroxide was 91.6% respectively at the end of 12 months but the difference was not statistically significant (p>0.05). Dilute silver diamine fluoride (1:10) can be advocated as potential indirect pulp capping agent in primary molars with deep carious lesions.

Effect of Probiotics Administration on Oral Health Among Children

Probiotics are by definition live microbial feed supplements that, as shown in clinical trials, improve the host animal's gut microbial balance. Dietary changes, an increase in the consumption of indigestible carbohydrates, and the consumption of live bacteria with human origin are all methods for influencing the microflora. This latter idea is often frequently referred to as replacement therapy or bacteriotherapy. Due to their naturally occurring casein, calcium, and phosphorus content, milk products are regarded safe for teeth and may have positive effects on the salivary microbial composition and the suppression of caries development. Bifidobacteria are common in deep caries lesions in the mouth and may be crucial to the development of caries. Although the impact on people with the greater levels of salivary mutans streptococci has been found to be rather small, yogurt with living bacteria generally had a significantly lowering effect on these bacteria. Lactobacilli are more closely related to carious dentine and the progressing front of caries lesions than to the start of the dental caries process. They have the ability to create low molecular weight bacteriocins with inhibitory activity against a variety of bacterial species, including oral streptococci.

Comparison of three different materials used for indirect pulp capping in permanent molars: An in vivo study.

Background:Pulp capping should always be considered as the primary treatment of choice for teeth without irreversible pulpitis in lesions approaching dental pulp. The predictability of vital pulp therapy has improved with the introduction of newer bioceramic materials.Aim:The aim of this study was to evaluate the clinical success of Biodentine, calcium hydroxide (CH), and mineral trioxide aggregate (MTA) as pulp capping materials for indirect pulp capping in carious permanent teeth.Materials and Methods:Indirect pulp capping was done for 36 molars of 36 patients with deep caries lesions. They were randomly divided into three groups: Biodentine group (12 teeth), MTA group (12 teeth), and CH group (12 teeth). Patients were recalled at 1, 3, and 6 months to evaluate the clinical success of the treatment outcome.Statistical Analysis:All statistical analysis was performed using SPSS software version 21.0. Pearson's Chi-square test was used to compare the success and failure rates between Biodentine, MTA, and Ca(OH)2 at three different time intervals (30, 90, and 180 days) and also the overall success and failure rates between Biodentine, MTA, and Ca(OH)2 irrespective of the time intervals. P < 0.05 was considered statistically significant.Results:In a statistical trial/study, the pulp capping materials gave different success rates, 91.67% success in the Biodentine group, 83.33% success in the MTA group, and 58.33% success in the CH group. The results were not statistically significant.Conclusion:Indirect pulp capping with calcium silicate materials provided better results compared to that of calcium hydroxide.

Does selective caries removal in combination with antimicrobial photodynamic therapy affect the clinical performance of adhesive restorations of primary or permanent teeth? A systematic review with meta-analysis.

to answer the following question: Does the SCR technique in combination with aPDT affect the clinical performance of adhesive restorations in deep carious lesions of primary or permanent teeth? a systematic review was conducted. Five databases, supplemented by trial registers, google scholar, manual search, personal communications, and grey literature were investigated. Randomized clinical trials were included. Two independent reviewers selected the studies, extracted qualitatively the data, and evaluated the risk of bias (using Cochrane Collaboration's tool and Robot Reviewer program). The certainty of the evidence was accessed based on The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A meta-analysis of comparable data was performed with RevMan software 5.3. A total of 39 articles and 3 studies were found. The final selection included 3 articles with a total of 82 participants. No studies were found on permanent teeth. The studies presented low risk of bias. Considering the treatment in the experimental (SCR + aPDT) or control groups (SCR), no difference on clinical performance of adhesive restorations in deep caries of primary teeth was observed after 6 months (p = 0.78; CI -0.01 (-0.09, 0.07)) or 12 months (p =0.75; CI -0.02 (-0.12, 0.08)). All outcomes presented moderate certainty of evidence mainly due to the small sample size that downgrade the GRADE scores. based on moderate certainty of the evidence, the clinical use of aPDT as an adjuvant of SCR has potential indication for treatment in deep caries of primary teeth. However, studies with more follow up and on permanent teeth are missing with the necessity for further research.

Novel endodontic simulation trainer for dental pulpotomy and pulp capping

Pulp exposures are the common problems encountered during the management of deep carious lesions in children and adolescents. The clinical skill plays an important role to achieve cooperation, reduced chair side time, and total patient care. This article describes a novel endodontic simulation trainer for dental pulpotomy and pulp capping. The simulator described in the article provides advantages such as life size design, easy to use, and cheaper to fabricate with good functional fidelity. This invention has the advantage that the pellet is replaceable, and so the procedure can be done multiple times simply by replacing it with a new pellet.

Management preference of deep carious lesion in permanent mature teeth among dentists in Riyadh city

Introduction: The management of deep caries lesion can be accomplished by complete caries excavation, partial caries removal, and stepwise excavation techniques. Dentists do not agree on a single management due to available evidence about the effectiveness of different treatment options of deep carious lesion that are inconsistent. Aim: The aim is to investigate the attitude and behavior of management preference of deep caries in mature permanent teeth among dentists in Riyadh city. In addition, to compare these findings with academic standards, World Dental Federation and International Caries Consensus cooperation (ICCC). Materials and Methods: A randomized cross-sectional study was conducted in which 540 questionnaires were distributed to dentists in Riyadh city. The questionnaire included four clinical scenarios to investigate the participant's attitude and behavior of management preference of deep carious lesion of permanent teeth in Riyadh city in 2019. Results and Discussion: Response rate was 74%. Findings illustrate that 86.8% of participants preferred complete caries excavation in case of deep caries with no pain nor risk of pulpal exposure. 41.3% of the participants preferred complete caries excavation in case of deep caries with no pain but risk of pulpal exposure presence. 64.8% participants preferred complete caries excavation in case of deep caries with pain on provocation and no risk of pulpal exposure. 58.3% participants preferred root canal treatment in case of deep caries with pain on provocation and with risk of pulpal exposure. About 76.80% of participants believed that after 2 years from complete caries removal, a high success rate (more than 80%) will result. Conclusion: The majority of participants prefer more invasive approaches in the treatment of deep carious lesions and unaware of the minimally invasive dentistry.

Penetration of Silver Diamine Fluoride in Deep Carious Lesions of Human Permanent Teeth: An In Vitro Study.

Background When silver diamine fluoride (SDF) is used in conjunction with conservative caries removal in deep carious lesions, the distribution depth of silver is critical for safety and effectiveness. Objective The purpose of this study is to determine the effect of selected caries removal on silver penetration when 38% SDF is applied to deep carious lesions in permanent teeth. Methods Extracted permanent teeth with caries extending to the inner third of the dentin were used (N = 18). The periphery of the carious lesion was completely removed to the dentinoenamel junction (DEJ). In group A (n = 9), no further removal of carious tissue was performed, leaving necrotic dentin inner to the DEJ, whereas in group B (n = 9) superficial necrotic dentin was completely removed until leathery, slightly moist, reasonably soft dentin remained. SDF was applied for 3 minutes in both groups. Microcomputer tomography (micro-CT) and field emission scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (FESEM-EDS) were used to measure mineral density and silver distribution. The silver penetration depth/lesion depth (PD/LD) ratio was calculated for each sample. The Mann–Whitney U test was used to compare differences between the two groups. Results The micro-CT analysis showed that the PD/LD ratios of group B (1.07–2.29) were marginally greater than those of group A (1.00–1.31). However, a statistically significant difference was not observed (pvalue = 0.5078). When stratified by remaining dentin thickness (RDT), the PD/LD ratios of group B were still greater than those of group A only when RDT was >500 µm. The FESEM-EDS analysis indicated that silver particles precipitated throughout the entire thickness of the carious lesions. Conclusion Applying SDF on a deep carious lesion and leaving the necrotic dentin pulpally did not affect silver penetration. However, the extent to which silver penetrates the remaining dentin beneath the lesions is dependent on the amount and characteristics of that dentin.

Children’s self-reported discomfort of restorative treatments for deep caries lesions in primary teeth: Results from a randomized clinical trial

The aim of this study was to evaluate the impact of different restorative techniques to treat deep caries lesions of primary molars on children’s self-reported discomfort. A randomized clinical trial with two parallel arms (1:1) was conducted in São Paulo, Brazil. 4-8 years-old children with at least one occlusal or occlusoproximal deep caries lesion in primary molars were selected. Molars were randomly allocated into two groups: (1) restoration performed with calcium hydroxide cement followed by high-viscosity Glass Ionomer Cement (CHC+HVGIC), and (2) HVGIC restoration. Immediately after the intervention, children reported the experienced discomfort during restoration to an external examiner using a Wong-Baker face-scale. Children’s self-reported discomfort was analyzed using Poisson regression comparing both groups and assessing other variables’ influence (α=5%). One hundred and eight children fulfilled the eligibility criteria and were randomized in the two groups (n=54). Most of the children who received CHC+HVGIC restorations reported none or minimal discomfort (83.3%). Similar scores (92.6%) were reported for those treated with HVGIC (p=0.758). The mean reported discomfort in children with CHC+HVGIC restorations was 0.37(1.01), and 0.41(1.01) for those with HVGIC restorations. Children’s self-reported discomfort was associated with age, sex, children’s cooperation, and intervention duration. We can conclude that CHC+HVGIC or HVGIC restorations result in none or minimal discomfort in the management of deep caries lesions, being considered a reliable option.

Knowledge and Opinions of French Dental Students in Operative Dentistry - Management of Deep Carious Lesions.

A questionnaire survey was recently undertaken among French dental students (FDSs) to investigate their practices, knowledge and opinions in various domains of minimal intervention (MI) in cariology. The present work focuses on management of deep carious lesions (DCLs). The questionnaire was administered (Spring 2018) to all the fifth-year students of the 16 French dental schools. Descriptive analyses were performed. Among 1370 FDSs (response rate: 84.5%), hardness was the most commonly reported criterion for assessing the endpoint of carious tissue removal (53.9%), followed by firm dentin (40.0%). Regarding FDSs' opinion of leaving carious dentine under a restoration, 41.9% of the respondents agreed that carious tissues should always be removed completely. For an asymptomatic tooth with DCLs and exposed pulp, direct pulp capping was mainly chosen (93.9%). In a clinical case correctly diagnosed as a reversible pulpitis by 79.7% of respondents, nearly half of FDSs chose a one-step complete excavation (48.3%) followed by selective excavation (25.1%), then two-step complete excavation (20.9%) and a minority (5.7%) opted for pulpal therapy (biopulpotomy or endodontic treatment). The present results suggest an inadequate dissemination of MI concepts among FDSs towards DCL management. The present results show the need for a harmonisation and a reinforcement of teaching evidence-based MI according to the latest European recommendations.

Comparison of Clinical Success between Three Different Materials- Direct Pulp Capping of Carious Molars- An In-vivo Study

Aim: To evaluate the clinical success of Calcium Hydroxide (CH), Mineral trioxide aggregate (MTA) and Biodentine as pulp capping materials for Direct pulp capping in carious molars.&#x0D; Materials and Methods: Thirty-six molars of thirty-six patients with deep caries lesions, diagnosed with reversible pulpitis were subjected to direct pulp capping treatment. They were randomly divided into three groups, Biodentine (12 teeth) or MTA group (12 teeth) or CH group (12teeth). Simple randomization of three was employed to allocate the treatment materials. Patients were recalled at one, three and six months to evaluate the clinical success of the treatment outcome.&#x0D; Results: In clinical trial/study, the pulp capping materials gave different success rate, 91.67% success in the Biodentine group, 75% success in the MTA group and 41.67% success in Calcium Hydroxide group.&#x0D; Conclusion: In our study the materials tested at 1 month, 3 month and 6-month follow-up, Calcium Silicate materials are better than calcium hydroxide and comparably Biodentine is better than MTA for Direct pulp capping.&#x0D; Clinical Significance: The findings of this clinical trial could promote the reliability of pulp capping materials for treatment of deep carious lesions by conservative approach rather than opting endodontic management.

A prospective clinical study investigating the effectiveness of partial pulpotomy after relating preoperative symptoms to a new and established classification of pulpitis

To prospectively investigate the outcome of partial pulpotomy after 1year, using a hydraulic calcium silicate cement (HCSC) on symptomatic cariously exposed pulps in adult teeth. To compare the traditional American Association of Endodontists (AAE) pulpitis classification with the recently proposed Wolters classification system in predicting the likelihood of treatment failure. Sixty-two symptomatic adult teeth with deep and extremely deep carious lesions were classified according to the Wolters (mild/moderate/severe pulpitis) and the traditional pulpitis classification (reversible/irreversible pulpitis). Eleven teeth were excluded intraoperatively as there was no pulp exposure after non-selective caries removal. The remaining 51 teeth, regardless of diagnosis, were treated by partial pulpotomy, pulpal lavage with 2.5% sodium hypochlorite solution, haemostasis and HCSC application (Biodentine™) as a pulp capping material. A permanent restoration was placed during a second appointment 1-2weeks later. Preoperative tenderness to percussion (TTP), bleeding time and material setting time were recorded as was preoperative and postoperative tooth colour under standardized conditions. Clinical review occurred at regular intervals with clinical/radiographic analysis at 12months. Chi-square analysis and Fisher's exact test assessed different outcomes amongst the diagnostic categories; the Kruskal-Wallis and Wilcoxon rank-sum test assessed influence of pulp bleeding time, TTP or variation in setting time (p<.05). Ten cases were lost to review, and a total of 41 teeth were reviewed at 1year and classified as either "success," "successful but unresponsive to sensibility testing" or "failed." This included five severe, 17moderate and 19mild pulpitis according to Wolters classification or 23 reversible pulpitis and 18 irreversible pulpitis cases by the AAE classification. The majority of the 62 enrolled cases were "extremely deep" (n=50), rather than "deep" (n=12) caries with all failures occurring in the extremely deep group. Partial pulpotomy was 90% successful (100% reversible, 78% irreversible or 100% mild, 88% moderate, 60% severe pulpitis) with a significant difference in outcome between mild and severe pulpitis groups (p=.04). Only one, severe pulpitis/irreversible pulpitis, case failed painfully prior to the 1-year review appointment. Bleeding time (p=.26) and TTP (p=.61) did not influence treatment outcome, whilst Biodentine™ setting time was significantly longer than manufacturers' claim (p<.05). No teeth discoloured. Partial pulpotomy using Biodentine™ was successful for treating symptomatic carious pulpal exposures after 1year, but included cases where pulp vitality could not be confirmed. Within the limitations of this study, cases with signs and symptoms indicative of irreversible pulpitis were not less successful; however, Wolters classification highlighted severe pulpitis to be less successful than mild pulpitis, thereby providing a potential prognostic benefit in diagnostically subdividing pulpitis. Caries depth was an indicator of failure, whilst bleeding time and preoperative tenderness to percussion were not.

Irradiation Time of Photodynamic Therapy to the Number of Lactobacillus acidophilus

Lactobacillus acidophilus (L. acidophilus) is one of the etiological agents for dental caries and dominant in the deep carious lesion. L. acidophilus has also been identified in persistent root canal infection and also related to the failure of endodontic treatment. Photodynamic therapy is a therapeutic process involving the combination of a nontoxic photosensitizer and a light source. The excited photosensitizer reacts with reactive oxygen species (ROS), which induce injury and death of the microorganism. This study aimed to prove the effect of irradiation time of photodynamic therapy to the number of L. acidophilus. Fortytwo Eppendorf tubes were treated with 0.5 ml L. acidophilus distributed into seven groups. Group 1 as the control group received no treatment. Groups 2, 3, 4, 5, 6 and 7 were treated with a combination of 0.5 ml toluidine blue O (TBO) as a photosensitizer and 630 nm photoactivated (Fotosan®) exposure time for 10, 20, 30, 40, 50 and 60 sec. Then, all were stored in an incubator of 37ºC for 48 h. Later, the colony-forming unit (CFU) was counted for each group. There were significant differences in the number of L. acidophilus in CFU of the various irradiation times. The longer the photodynamic therapy irradiation was, the lesser the number of live L. acidophilus became. At 50 sec and 60 sec irradiation, none of the L. acidophilus was found alive.

COMPARISON OF TWO AEROSOL-FREE CARIES REMOVAL METHODS - A SPLIT MOUTH RANDOMIZED CLINICAL TRIAL

Objectives: The management of deep caries lesions in immature permanent molars might be challenging in clinical practice. Minimally invasive caries removal methods can maintain apexogenesis by preventing extensive tissue loss. Here we compare the chemo-mechanical caries removal (CMCR) gel and the polymer bur in terms of time spent on caries removal, patient acceptability, and clinical success. Materials and Methods: The teeth of 30 children were randomly divided into two groups. The duration of each method, the level of cooperation during each method, and the child’s choice of caries removal method were recorded. Patients were followed at 6-month intervals for at least 2 years. Results: The difference between the patients’ preferences was not statistically significant, while the average caries removal time of the polymer bur method was significantly shorter (p &amp;lt; 0.05). The rates of apical closure without pathology in CMCR and polymer bur groups were 63.2% and 73.7%, respectively, whereas 10% of each group underwent further treatments due to the clinical and/or radiographic pathology. Conclusions: These methods were thought to serve as an interim treatment in managing immature permanent teeth with deep caries. Furthermore, these methods, which do not involve water cooling, can also minimize the risk of contamination and cross-infection.