Dentin Removal Research Articles

In-vitro comparison of TruNatomy and XP-endo Shaper on amount of dentin removal: A micro-computed tomography study

In-vitro comparison of TruNatomy and XP-endo Shaper on amount of dentin removal: A micro-computed tomography study

Accumulated Hard Tissue Debris and Root Canal Shaping Profiles Following Instrumentation with Gentlefile, One Curve, and Reciproc Blue

IntroductionThis laboratory study aimed to evaluate the accumulated hard tissue debris (AHTD) and shaping performance following root canal instrumentation with a novel stainless steel rotary system (Gentlefile; MedicNRG, Kibbutz Afikim, Israel) compared with two single-file nickel-titanium instruments of different kinematics through micro–computed tomography (micro-CT) analysis. MethodsThirty isthmus-containing mesial roots of human mandibular molars with a curvature of 15°–35° were scanned with micro-CT at an isotropic resolution of 12 μm and randomly assigned to three groups (n = 10) according to the instruments used for canal preparation: Gentlefile (GF; #23/.04), One Curve (OC; #25/.06; Micro-Mega, Besancon, France), and Reciproc Blue R25 (RB; #25/.08; VDW, Munich, Germany). The AHTD, unprepared canal surface area, volume changes, surface area changes, and transportation were evaluated by comparing preoperative and postoperative micro-CT images. In addition, the time required for canal preparation was recorded. Data were statistically analyzed using the one-way analysis of variance (ANOVA) test or the Kruskal-Wallis test at a significance level of 5%. ResultsNo significant differences were observed in the percentage of AHTD or in the unprepared canal surface area between the three groups (P > .05). The RB group demonstrated a significantly greater percentage increase in volume and surface area than the GF group (P < .05). The GF and OC groups showed significantly less transportation at 3 mm from the apex than the RB group (P < .001). The OC group required significantly less time for instrumentation than the RB and GF groups (P < .05). ConclusionsInstrumentation with GF (#23/.04), OC, and RB yielded similar levels of AHTD and unprepared surface area in isthmus-containing curved canals. GF achieved this with less dentin removal and apical transportation, at the expense of a longer preparation time.

Effect of the progressive taper enlargement of buccal root canals of three-rooted maxillary molars: A stepwise micro-CT study.

This study evaluated unprepared canal areas, volume of dentine removal, and dentine thickness after the progressive enlargement of the buccal canals of 22 maxillary molars, with and without the MB2, using instruments with the same tip size (0.25 mm) but 4 different tapers (0.03, 0.05, 0.06 and 0.08 v). Micro-CT scans were performed after each instrument. Data were compared using a general linear mixed model post hoc comparisons with Kenward-Roger for Wald F tests (α = 5%). After each treatment step, it was observed an increase in the percentage volume of removed dentine and a decrease in the unprepared areas and dentine thickness at the pericervical region of all canals (p < 0.05). The percentage reduction of dentine thickness in MB2 canal was higher than in the mesiobuccal and distobuccal canals (p < 0.05). Knowledge of pre-operative dimensions and dentine thickness before enlargement of buccal canals of maxillary molars is an important factor to avoid excessive dentine removal.

Cone-Beam Computed Tomography Evaluation of Rotary MM Files vs Manual K Files in Primary Molars: An In Vitro Study.

Rotary instrumentation in pediatric dentistry is an emerging concept, thus this study was performed to evaluate the remaining dentine thickness (RDT), canal transportation, centering ability, quality of obturation using cone-beam computed tomography (CBCT), and the time efficiency of rotary versus manual instrumentation in mandibular second primary molars. Forty mandibular primary second molars (160 canals) were randomly and equally allocated to four groups. Instrumentation was done using K files in groups I and II; in each group, the obturation was done by two different obturation techniques; incremental technique and disposable syringe technique, respectively. MM rotary files (Innovative Material and Devices, Inc. [IMD], Shanghai, China) were used in groups III and IV; in each group, the obturation was done by incremental technique and disposable syringe technique. Preoperative and postoperative CBCT scans were performed and evaluated for the RDT, centering ability, canal transportation, and the canal filling quality, which was assessed as (underfill, optimal fill, and overfill). Instrumentation time was recorded for groups I and II collectively (manual instrumentation), and groups II and III collectively (rotary instrumentation). Statistical analysis was done using Chi-square, ANOVA, and post hoc Tukey tests, at p < 0.05). The MM rotary file removed a significantly less amount of dentine at all levels specifically at the middle section (p = 0.003). The canal transportation was significantly higher in the manual group at the cervical level (p = 0.022). In all sections, the rotary group had significantly higher values of centering ratio than the manual group (p < 0.05), which means a lower deviation of rotary instruments. For both types of files, there was no significant difference between different obturation techniques (p > 0.05). Instrumentation time was significantly lower in the rotary group (p < 0.001). Regarding the dentine removal and the shaping ability of MM files acceptable results were obtained; however, no significant difference between the different obturation techniques. Notable time efficiency was reported in the rotary files as well. The use of rotary files resulted in better conservation of tooth structure, better canal centering, and obturation quality as well as less canal transportation and less instrumentation time compared to manual K files.

Assessment of the Apical Transportation and Quantity of Root Canal Dentin Removed Using Different New Rotary File Systems: An Original Study.

The rotary systems have found a common application in the clinical practice for the endodontic therapies. Hence, we compared three recent endodontic systems for the comparison of the dentine removal and the apical transportation particularly in the curved canals. Oneshape, Pro Taper Next, and Edgefile X3 were the three systems that were compared. Thirty maxillary mesio buccal canals of the human permanent teeth were compared due to its curved nature. The volume of dentin removed and apical transportation (mm) were measured using micro-computed tomographic imaging (mm). Both the coronal section and the entire canal length had their dentin removed in accordance with measurements. Total dentine removed, coronal dentine removed, and the canal transportations were compared for the three rotary file systems. The values were compared with appropriate statistical tests for evaluating the significance. There was no statistically significant difference between the three file systems for the dentin removed. The mean canal transportation was 0.33 ± 0.12, 0.21 ± 0.25, and 0.23 ± 0.21 mm, respectively, for Oneshape, Pro Taper Next, and Typhoon CM. In terms of statistics, there were no appreciable variations among the three rotary tools for apical transfer. The three rotary systems were comparable for the apical transportation and the dentine removal. Despite variations in the magnitude of apical enlargements, none of the instrumentation methods detected apical transportation.

Shaping ability of WaveOne Gold and OneReci by using two apical sizes: a micro-computed tomographic assessment.

OneReci (MicroMega, Besançon, France) is a recently introduced single-file reciprocating system with scarce information revealed on its shaping ability. This study aimed to compare the shaping abilities of OneReci and a well-documented single-file reciprocating system WaveOne Gold (WOG; Dentsply Maillefer, Ballaigues, Switzerland) and evaluate the effect of increased apical enlargement on the preparation quality, using micro-computed tomography (micro-CT). After an initial micro-CT scanning, twenty mesial root canals of mandibular molars were anatomically matched. The canals were assigned to two experimental groups (n=10), using OneReci or WOG in different canals of the same root. The glide paths were created, and root canals were prepared twice, using size 25 and 35 instruments of the systems, respectively. The specimens were scanned with micro-CT after each preparation. The increase in canal volume, amount of dentin removal, unprepared root canal surface, canal transportation, centering ratio and preparation times were assessed. The data were analysed with independent sample t-tests, variance analyses, Friedman and Mann-Whitney U tests. The significance level was set at 5%. Each preparation increased the canal volume and dentin removal while decreasing the unprepared root surface. The difference between the systems became significant after preparation with size 35 instruments (p<0.05). Regarding canal transportation and centering ratio, the difference was insignificant (p>0.05). The first preparation step (glide path + size 25 instrument) was significantly faster in the OneReci group (p<0.05). Preparation with size 25 instruments of the systems appeared to be safe with similar shaping performances. Larger apical preparation promoted significantly higher dentin removal, volume increase, and prepared surface area in WOG.

Comparative evaluation of different instrument kinematics on contact percentage, dentin removal and apical debris extrusion in oval canals.

The aim of this study was to compare four different instrument kinematics in oval canals. Distal root of sixty extracted first mandibular molars with single oval canal were allocated randomly to four groups (n = 15) namely protaper universal [PTU] (Rotary), self-adjusting file [SAF] (Adaptive), TruShape [TS] (Rotary) and WaveOne [WO] (Reciprocating). The percentage of untouched and touched surfaces of the root canal was evaluated using micro-computed tomography (MCT). Pre- and post-instrumentation weight was assessed using digital microbalance for determining the amount of dentin removed and apical extrusion of debris. The results were tabulated, and their mean difference was statistically analysed using one-way ANOVA and Tukey's HSD test. PTU and SAF exhibited significantly less mean percentage of untouched surface compared to TS. TS files removed less dentin and extruded less debris in long oval canals.

Impact of Endodontic Irrigant Activation on Smear Layer Removal and Surface Disintegration of Root Canal Dentine In Vitro.

The objective of this study was to compare the ability of different endodontic irrigation activation methods to enable irrigant penetration, remove the smear layer from root canal walls after preparation, and investigate surface effects on dentine. Root canals of 90 single-rooted teeth were prepared and irrigated with EDTA (17%) and sodium hypochlorite (5%), where both irrigants or sodium hypochlorite only were activated as follows: conventional needle irrigation, ultrasonic activation, sonic activation (EDDY), or laser-based activation (photon-induced photoacoustic streaming/PIPS). For the evaluation of irrigant penetration into dentinal tubules, methylene blue was injected and activated as well. Subsequently, teeth were sectioned horizontally, and dye penetration depths were measured. Alternating sections were split in halves and randomly selected for scanning electron microscopic analysis. Root canal dentine was assessed for smear layer removal and surface disintegration according to a defined scoring system. The data were analyzed statistically with nonparametric and chi-squared tests for whole teeth and separately for coronal, middle, and apical thirds. All the tested activation methods removed a thicker smear layer than needle irrigation only. Additional activation of EDTA improved penetration depths of the irrigants, but not the smear layer removal. Surface disintegration of root canal dentine was observed with the additional activation of EDTA and particularly after laser-based techniques. Additional activation of EDTA does not seem to offer any convincing advantages in terms of irrigant penetration or smear layer removal but disrupts the dentine surface. Especially laser-based activation resulted in undesirable destruction of root canal wall dentine.

Evaluation of root canal cleaning efficacy of selfadjusting files, protaper rotary, and manual K-Files in primary teeth - An In vitro Comparative study.

The success of pulpectomy depends on complete eradication of microbial load by cleaning and shaping the primary root canals that is difficult to achieve because of anatomical intricacy of primary pulp dentin complex. Numerous instruments were tried, however, they proved to be inadequate. Selfadjusting file (SAF) is a newer file system that facilitates less dentin removal with maximal cleansing of root canals. To evaluate and compare the in vitro root canal cleaning efficacy with SAF, Protaper Universal, and Hand K-files in primary teeth. Sixty extracted primary anterior teeth were randomly divided into three groups by lottery method. Access cavity was prepared, the canals were enlarged up to 20 K file, and an Indian ink was injected into each canal. Then the Group I (n = 20) was treated with SAF, Group II (n = 20) with Rotary Protaper Universal and Group III (n = 20) with Hand K-files and the root canal cleaning efficacy was evaluated based on the amount of Indian ink remaining in the canal walls under stereomicroscopy. Data were analyzed using Kruskal-Wallis one way ANOVA test and post hoc Tuckey test for intragroup and intergroup comparison, respectively. A statistically highly significant difference was observed with SAF (mean = 1.5), Protaper (mean = 2.5), and Hand K-files (mean = 2.9). However, there was no significant difference in root canal cleaning efficacy with Protaper Universal and Hand K-files. The SAFs had shown superior cleaning efficacy compared with rotary Protaper Universal and manual K files.

Application of Scanning Acoustic Microscopy for Detection of Dental Caries Lesion

Introduction: A scanning acoustic microscope (SAM) is an apparatus for imaging acoustic properties. This apparatus can non-invasively and rapidly evaluate the hardness of materials in the elastic region. This device shows great potential for the diagnosis of dental caries in the clinical setting. However, since the tissue elastic modulus measured using a SAM is a property of the elastic region and the Knoop hardness is a property of the plastic region, the hardness properties differ completely. Therefore, we investigated whether the acoustic impedance measured using a SAM is related to the Knoop hardness, which is used as the standard for removal of carious dentin. Method: Polished sections were prepared from 20 extracted carious wisdom teeth. The acoustic impedance and Knoop hardness were measured for each section. In addition to comparing carious and healthy dentin in SAM images, we evaluated the difference between the carious and healthy dentin in terms of the acoustic impedance and Knoop hardness. We also evaluated the correlation between the Knoop hardness and acoustic impedance. Results: The SAM images were visualized as two-dimensional color images based on the acoustic impedance values. The mean acoustic impedance of carious dentin was significantly lower than that of healthy dentin, showing a similar trend as Knoop hardness. A strong correlation was observed between the two. Discussion: The acoustic impedance values obtained through acoustic microscopy differed significantly between carious and sound dentin. Both types of dentins were visualized using two-dimensional color images. A strong correlation was observed between the acoustic impedance value, which indicates the hardness of the elastic region, and the Knoop hardness, which indicates the hardness of the plastic region. The results of the present study indicate that acoustic impedance accurately reflects the hardness of dentin.

Evaluation of Root Dentin Removal and Apical Debris Extrusion during Root Canal Preparation Related to the Different Endodontic Access Cavities: An In-vitro Study

Introduction: The restricted access cavity and the remaining roof of the pulp chamber may change the angle at which the instrument enters the root canal, which could have an impact on the effectiveness of chemo-mechanical canal preparation, potentially leading to endodontic mishaps. Aim: To evaluate the effect of the Traditional Endodontic Cavity (TEC) and Conservative Endodontic Cavity (CEC) on the amount of Root Dentin Removal (RDR) and the related Apical Debris Extrusion (ADE) in the curved root canals prepared with ProTaper Next (PTN) and TruNatomy (TN). Materials and Methods: The in-vitro study included a total of 120 extracted human mandibular molars, separated into four groups (n=30) based on the type of endodontic cavity and file used: TEC-TN, CEC-TN, TEC-PTN, and CEC-PTN. Before biomechanical preparation, Cone Beam Computed Tomography (CBCT) scans were taken. During the preparation, apically extruded debris was collected in Eppendorf tubes. After canal preparation, a post-CBCT scan was performed, and the RDR was evaluated by comparing the pre- and post-CBCT scans. To determine the amount of ADE, the weight of the clear tubes was subtracted from the weight of the tubes containing the debris. The data were analysed using one-way analysis of variance and post-hoc Tukey test. The significance level was set at p&lt;0.05. Results: Analysis and comparison of four groups each with n=-30 extracted mandibular molars was done in the present study. The CEC-PTN group showed the highest total RDR of 0.32. Additionally, the CEC-PTN group produced the highest ADE with statistically significant differences between the TECTN, CEC-TN, and TEC-PTN groups (p&lt;0.05). Conclusion: The CEC causes engagement of the rotary instrument with the dentinal wall, leading to RDR, debris production, and ultimately more ADE compared to TEC. The TN file caused less RDR and ADE in both endodontic access cavities compared to the PTN file.

Chapter 9.3: Current Concepts of Caries Removal in Daily Practice.

Although the discussion about the amount of carious dentin to be removed during cavity preparation is quite old, concepts for caries removal have evolved and changed considerably over the last decades. The antiquate understanding that it was necessary to eliminate the microbial contamination of a cavity before placing the restoration was replaced by the current knowledge that maintaining contaminated dentin beneath restorations is inevitable and is not associated with treatment failure. This chapter brings together the body of evidence behind carious dentin removal to indicate a conservative treatment, aiming to preserve both tooth vitality and structure. Studies that evaluated the effects of sealing contaminated dentin are described, which are focused on different outcomes, such as microbiological counts, clinical characteristics, laboratory analysis, and radiographic findings. Long-term studies and randomized clinical trials also support the current recommendations. After addressing the available literature on this topic, this chapter concludes that (1) the amount of carious dentin to be removed should be defined by lesion depth; (2) sealing and/or selective caries removal to firm dentin is recommended for the management of shallow and moderate lesions; (3) the selective caries removal to soft dentin in a single session is indicated for deep caries lesions aiming to preserve tooth vitality; and (4) the use of a cavity liner after selective caries removal seems to be an unnecessary clinical step.

Comparison of five single-file systems in the preparation of severely curved root canals: an ex vivo study

BackgroundThe ex vivo study is to compare the root canal preparation outcomes achieved by five nickel–titanium single-file instrumentation systems (M3-L, Reciproc Blue, V-Taper 2H, WaveOne Gold, XP-endo Shaper) in severely curved molar root canals.MethodsA total of 60 root canals were selected from extracted human molar teeth with curvatures ranging from 25° to 50° and divided into five groups based on the instrumentation system employed (n = 12). Before and after root canal preparation, a Micro-CT scan was taken, and pre- and post-operative data were analyzed to evaluate the following parameters: volume increment of root canals (VI), untouched root canal areas (UTA), and canal transportation (CT). Apically extruded debris (AD) was collected during preparation. After that, all samples were separated into two parts and examined respectively by scanning electron microscope (SEM) to assess cleaning ability. Data were statistically analyzed with ANOVA (UTA, AD, VI) or Kruskal–Wallis test (CT, SEM-score), the level of significance was set at α = 0.05.ResultsThere were no significant differences between the five systems regarding the AD, VI, and UTA parameters (P > 0.05). In terms of CT, no significant difference was noted at the straight section of canal and apical levels, while XP-endo Shaper showed less canal transportation than M3-L at the level of curved vertex (P < 0.05), and the centering ability of V-Taper 2H was significantly better than WaveOne Gold at the initial point of bending (P < 0.05). Debris and smear layers were present on the canal walls of all specimens, the apical thirds of the canal presented higher SEM scores than the coronal thirds in all groups (P < 0.05). Reciproc Blue and XP-endo Shaper showed fewer smear scores than WaveOne Gold in the apical thirds (P < 0.01 and P < 0.05, respectively), and no statistical difference was found between other groups in the middle and coronal thirds.ConclusionThe five single-file systems evaluated performed equally in apically debris extrusion, dentin removal, and untouched root canal areas, while XP-endo Shaper and V-Taper 2H resulted in less canal transportation compared to M3-L and WaveOne Gold. Regarding cleaning ability, Reciproc Blue and XP-endo Shaper were associated with less smear layer than WaveOne Gold in the apical thirds.

Efficacy of Papain Gel—A Smart Alternative to Conventional Methods of Carious Dentin Removal: An In Vitro Study

Efficacy of Papain Gel—A Smart Alternative to Conventional Methods of Carious Dentin Removal: An In Vitro Study

Chemical-Mechanical Removal Of Infected Dentin in caries treatment

Chemical-Mechanical Removal Of Infected Dentin in caries treatment

Guided Endodontics in Calcified Root Canals

Introduction: Endoguide is a device that has significantly aids the treatment of calcified root canals. This device involves modern technologies as 3D printing and computed tomography, which increase the accuracy of dental work. Guided endodontics has currently been emphasized because it facilitates more complex endodontic treatments, such as partial or total obliteration of the root canals precluding the conventional endodontic treatment. This method has demonstrated high percentages of safety for both patient and dentist. It is a fast endodontic access system that prevents perforations, unnecessary removal of dentin and tooth structure. This treatment method is more effective than conventional methods for locating calcified root canals due to its accuracy, speed of time and precision of direction.&#x0D; Objective: To review the current literature on Endoguide in calcified root canals, analyze its practice, advantages, disadvantages, indications and limitations.&#x0D; Material and Methods: The study was conducted on 20 papers in Portuguese and English from the year 2016 to April 2022, and a classic article from year 1995, searched in the databases PubMed, Google Scholar and Bireme. The following keywords were used: Calcified canal, Guided endodontics, Endodontic access, Endoguide.&#x0D; Results: This technique showed greater predictability in calcified canals, reducing the risk of perforations and allowing faster and more efficient access, with many advantages, except for its high cost.&#x0D; Conclusion: Based on this literature review, it can be suggested that the Endoguide technique in calcified canals provides great benefits to both dentist and patient, such as reduction of clinical time, agility and confidence in treatment, reduced risk of accidents and complications such as perforations and unnecessary dentin removal.

Effect of caries excavation by Carisolv and SmartPrep burs on dentin hardness — An in vitro study

Objective: The purpose of this study was to comparatively evaluate two caries excavation methods-Smartprep(SS White) burs and Carisolv (Carisolv™) by measuring the Vickers hardness of prepared cavity. Materials and Methods: 40 extracted human molars with moderate occlusal caries were used in this study. Teeth with moderate caries extending till dentin without pulp involvement were selected. RVG was used to assess the depth of the cavity. The samples were divided into 2 groups, Group I by Smart prep burs and Group II using Carisolv. Each groups were subjected to morphological analysis under scanning electron microscope. Results: The samples prepared with Carisolv showed least difference in hardness values between the prepared surface and surrounding dentin compared to Smartprep burs. SEM analysis with Smartprep burs revealed surface covered with debris and smear layer while Carisolv showed rough and scaly surface with large areas with open dentinal tubules. Conclusion: Removal of infected carious dentin was superior when Carisolv was employed as compared to SmartPrep burs. The results concluded that smear layer removal of Carisolv was superior when compared to SmartPrep burs.

Effect of Method of Removing Caries-Affected Dentin on the Bond Strength of Composite Resin to Root Canal Dentin.

The adhesion of composite resin to caries-affected dentin differs from the adhesion of resin to sound dentin. We evaluated the bond strengths of dual-cure resin composites applied to caries-affected root canal dentin under various clinical conditions and using several caries removal indicators. In the dye stain 1 group, caries were removed to a pale pink stain level using a caries detector. In the dye stain 2 group, caries were removed to a stain-free level using a caries detector. In the probing group, caries were removed to the level of hardness based on probing with a sharp explorer. Additionally, a sound dentin group was used as a control. We compared the resin composite microtensile bond strengths and failure mode distribution among the groups. The bond strengths (MPa) of the probing (64.6 ± 11.9) and the sound dentin (68.7 ± 11.1) groups were significantly higher than those of the dye stain 1 (46.9 ± 7.9) and 2 (47.5 ± 8.4) groups (p &lt; 0.05). The removal of caries-affected dentin using a dentin-hardness-based technique showed higher tensile strength than that using a dye stain technique involving removal to any color level. Thus, the caries removal technique used on root canal dentin affects the bond strength of the resin composite.

The influence of finishing lines and margin location on enamel and dentin removal for indirect partial restorations: A micro-CT quantitative evaluation

ObjectivesThis in vitro research aimed to quantitatively evaluate the enamel and dentin tissue removal and the residual adhesion surface area (RAS) after different margin designs and locations for indirect partial restorations (IPR). MethodsA human molar was scanned using a Micro-CT and the STL file obtained was used to 3D-print 50 resin-tooth replicas. IPR standardized preparations were performed. The specimens were randomly assigned to 5 groups (n = 10), according to preparation and margin location to the dental equator (DE): 1) Rounded shoulder above the DE (SA); 2) Hollow chamfer above the DE (CA); 3) Butt joint above the DE (BJ); 4) Rounded shoulder below the DE (SB); 5) Chamfer below the DE (CB). Then, the tooth replicas were scanned and each STL file was aligned and superimposed to the original STL model file. Data of enamel and dentin volume removal and RAS were assessed and statistically analyzed (one-way ANOVA and Kruskal-Wallis tests for the two dental substrates respectively). Significance was set at p<0.05. ResultsDifferences in dental tissue reductions were related to the margin location. Above the equator, SA, CA, and BJ performed comparably (p>0.05). Below the equator, CB was significantly more conservative in enamel reduction than SB (p<0.05) and showed the highest enamel adhesive surface exposure among the tested preparations (p<0.05). ConclusionsWhen the preparation margin is placed above DE, BJ determines a greater exposure of dentin, reducing the adhesive surface in enamel. Below DE, SB seems to be more aggressive in terms of tissue removal compared to CB. Clinical SignificanceThe results of this in vitro study suggest that in teeth requiring partial restoration with the margin below the dental equator, a chamfer preparation would be more conservative than a shoulder preparation. When above the equator, preparations with flat designs would expose more dentine providing a worse substrate for adhesion.

Antimicrobial photodynamic therapy as an adjunctive treatment to ultrasound for the dentin caries-like lesion removal

ObjectiveTo evaluate in vitro the efficacy of ultrasound device to remove caries-like dentin and the curcumin-mediated antimicrobial photodynamic therapy (aPDT) to decontaminate the affected dentin. MethodsBovine dentin specimens (n = 173) of 4 × 4 × 2 mm were first submitted to Knoop surface microhardness to standardize the specimens (29 ± 3 KHN). Artificial caries lesion was induced by Streptococcus mutans strain by biological model for 7 days. Infected dentin was removed (1 min) with the following techniques: dentin excavator, bur at low-speed rotation and ultrasound device. After that, aPDT application was performed using blue LED under 460 nm. Polarized light microscopy (PLM), removal rate (n = 10), cross-sectional microhardness (n = 10), colony forming units per milliliter (CFU) (n = 9) and confocal laser microscopy (CM) (n = 2) were performed. ANOVA with Welch correction, post-hoc Games-Howell and two-way ANOVA followed by Tukey's post-hoc tests were used. ResultsPLM confirmed the caries lesion formation with a depth of ∼147.9 µm. Groups treated with ultrasound showed lower removal rate (p = 0.001). Regardless of the treatment, the microhardness values increased as function of depth (p ≤ 0.05). Carbide bur showed the highest microhardness value, followed by ultrasound and excavator. CFU and CM showed a significant reduction in S. mutans after aPDT application. ConclusionUltrasound was efficient, since it removed infected dentin, preserving the affected dentin and aPDT can be used as a complementary therapy to decontaminate the affected dentin. Clinical significanceUltrasound device may help the clinician to remove dentin caries-like lesions since it is a conservative technique and provided the removal of infected dentin, preserving the affected dentin. aPDT application may be used as a complimentary technique to promote antibacterial effect and possibly minimize the risk of secondary caries.