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Al-Badri H, Al-Shammaree SA, Banerjee A, Al-Taee LA. The in-vitro development of novel enzyme-based chemo-mechanical caries removal agents. J Dent 2023; 138:104714. [PMID: 37734529 DOI: 10.1016/j.jdent.2023.104714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES Bromelain is a potent proteolytic enzyme that has a unique functionality makes it valuable for various therapeutic purposes. This study aimed to develop three novel formulations based on bromelain to be used as chemomechanical caries removal agents. METHODS The novel agents were prepared using different concentrations of bromelain (10-40 wt. %), with and without 0.1-0.3 wt. % chloramine T or 0.5-1.5 wt. % chlorhexidine (CHX). Based on the enzymatic activity test, three formulations were selected; 30 % bromelain (F1), 30 % bromelain-0.1 % chloramine (F2) and 30 % bromelain-1.5 % CHX (F3). The assessments included molecular docking, Fourier-transform infrared spectroscopy (FTIR), viscosity and pH measurements. The efficiency of caries removal was assessed by DIAGNOdent pen, measuring the excavation time and number of applications, followed by a morphological evaluation of the remaining dentine using scanning electron microscopy (SEM). The results were compared to Brix 3000 as a control. RESULTS The chloramine and chlorhexidine were chemically compatible with bromelain without compromising the enzyme activity. All experimental formulations showed higher viscosity and pH in comparison to Brix 3000. The DIAGNOdent readings were <20 in all groups, and the lowest readings were observed in F2. The excavation time and number of applications were lowest in F2 and F1. Both F2 and F3 produced smooth dentine surfaces with less tissue debris, but more patent dentine tubules were observed in F1 and F2. CONCLUSIONS The bromelain-contained formulations showed a potential to be used as chemomechanical caries removal agents in vitro. Further laboratory and clinical studies are needed to validate this claim. CLINICAL SIGNIFICANCE The bromelain from pineapple stem has broad specificity for cleavage the peptide bonds in denatured protein to facilitate their removal. The study proved the efficiency of this enzyme to remove the dental caries chemomechanically when used alone or conjugated with chloramine and/or chlorhexidine to enhance the disinfecting and cleansing properties.
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Affiliation(s)
- Huda Al-Badri
- Department of Conservative and Aesthetic Dentistry, Baghdad College of Dentistry, University of Baghdad, Baghdad, Iraq
| | | | - Avijit Banerjee
- Centre for Oral Clinical & Translational Sciences, King's College London, Guy's Hospital, London, UK
| | - Lamis A Al-Taee
- Department of Conservative and Aesthetic Dentistry, Baghdad College of Dentistry, University of Baghdad, Baghdad, Iraq.
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Cheng X, Tian T, Tian Y, Xiang D, Qiu J, Liu X, Yu Q. Erbium:Yttrium Aluminum Garnet Laser-Activated Sodium Hypochlorite Irrigation: A Promising Procedure for Minimally Invasive Endodontics. Photomed Laser Surg 2017; 35:695-701. [PMID: 28922064 DOI: 10.1089/pho.2017.4274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study was to evaluate the potential of Erbium:Yttrium Aluminum Garnet laser-activated sodium hypochlorite irrigation (Er:YAG + NaOCl) for minimally invasive endodontics (MIE). BACKGROUND DATA Er:YAG laser irradiation can dramatically enhance the penetration of NaOCl, which may be a promising protocol for MIE. METHODS Extracted human teeth were contaminated with Enterococcus faecalis for 4 weeks. The infected canals were then shaped to different apical terminal working widths (ATWW, 15#/0.04, 20#/0.04, 25#/0.04, 30#/0.04, and 40#/0.04) and treated with either Er:YAG + NaOCl (0.3 W, 20 sec) or NaOCl alone. Then, the ATWW were fixed at 15#/0.04, and the canals were treated with Er:YAG + NaOCl at 0.3 W for 40 and 60 sec, or at 0.5 and 1.0 W for 20 sec. Finally, bacterial reductions were evaluated using the cell count method. RESULTS Er:YAG + NaOCl showed a higher disinfection efficacy at each ATWW compared with NaOCl alone (p < 0.001). The maximum bacterial reduction was 99.9% for the 40#/Er:YAG + NaOCl group and 93.6% for the 40#/NaOCl group. To achieve similar disinfection efficacy, the Er:YAG + NaOCl group needed a smaller ATWW than the NaOCl group. At a fixed ATWW, increasing the output power of the Er:YAG laser was more effective than increasing the radiation time to improve the disinfection efficacy of Er:YAG + NaOCl. The 15#/Er:YAG + NaOCl group reached the maximum bacterial reduction of 99.2% when the Er:YAG laser was activated at 1.0 W for 20 sec. CONCLUSIONS The 15#/Er:YAG + NaOCl with the Er:YAG laser irradiation at 1.0 W for 20 sec may be considered a promising procedure for MIE.
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Affiliation(s)
- Xiaogang Cheng
- 1 State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University , Xi'an, P.R. China .,2 Biomedical Sciences Department, Texas A&M University College of Dentistry , Dallas, Texas
| | - Tiantian Tian
- 1 State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University , Xi'an, P.R. China .,3 Department of Operative Dentistry and Endodontics, Weifang People's Hospital , Weifang, P.R. China
| | - Yu Tian
- 1 State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University , Xi'an, P.R. China
| | - Doudou Xiang
- 1 State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University , Xi'an, P.R. China
| | - Jun Qiu
- 1 State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University , Xi'an, P.R. China
| | - Xiaohua Liu
- 2 Biomedical Sciences Department, Texas A&M University College of Dentistry , Dallas, Texas
| | - Qing Yu
- 1 State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University , Xi'an, P.R. China
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Cheng X, Chen B, Qiu J, He W, Lv H, Qu T, Yu Q, Tian Y. Bactericidal effect of Er:YAG laser combined with sodium hypochlorite irrigation against Enterococcus faecalis deep inside dentinal tubules in experimentally infected root canals. J Med Microbiol 2016; 65:176-187. [PMID: 26645354 DOI: 10.1099/jmm.0.000205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- X. Cheng
- State Key Laboratory of Military Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, Fourth Military Medical University, 145 West Chang-le Road, Xi'an 710032, Shaanxi, P.R. China
| | - B. Chen
- State Key Laboratory of Military Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, Fourth Military Medical University, 145 West Chang-le Road, Xi'an 710032, Shaanxi, P.R. China
- Department of Stomatology, 81 Hospital of PLA, Nanjing 210000, Jiangsu, P.R. China
| | - J. Qiu
- State Key Laboratory of Military Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, Fourth Military Medical University, 145 West Chang-le Road, Xi'an 710032, Shaanxi, P.R. China
| | - W. He
- State Key Laboratory of Military Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, Fourth Military Medical University, 145 West Chang-le Road, Xi'an 710032, Shaanxi, P.R. China
| | - H. Lv
- State Key Laboratory of Military Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, Fourth Military Medical University, 145 West Chang-le Road, Xi'an 710032, Shaanxi, P.R. China
| | - T. Qu
- State Key Laboratory of Military Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, Fourth Military Medical University, 145 West Chang-le Road, Xi'an 710032, Shaanxi, P.R. China
| | - Q. Yu
- State Key Laboratory of Military Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, Fourth Military Medical University, 145 West Chang-le Road, Xi'an 710032, Shaanxi, P.R. China
| | - Y. Tian
- State Key Laboratory of Military Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, Fourth Military Medical University, 145 West Chang-le Road, Xi'an 710032, Shaanxi, P.R. China
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Mollica FB, Rocha Gomes Torres C, Gonçalves SEDP, Mancini MNG. Dentine microhardness after different methods for detection and removal of carious dentine tissue. J Appl Oral Sci 2013; 20:449-54. [PMID: 23032207 PMCID: PMC3881824 DOI: 10.1590/s1678-77572012000400010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 10/25/2011] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED There are several methods for identifying carious dentinal tissue aiming to avoid removal of healthy dentinal tissue. OBJECTIVES The purpose of this study was to test different methods for the detection of carious dentinal tissue regarding the amount of carious tissue removed and the remaining dentin microhardness after caries removal. MATERIAL AND METHODS The dentin surfaces of 20 bovine teeth were exposed and half of the surface was protected with nail polish. Cariogenic challenge was performed by immersion in a demineralizing solution for 14 days. After transverse cross-section of the crown, the specimens were divided into four groups (n=10), according to the method used to identify and remove the carious tissue: "Papacárie", Caries-detector dye, DIAGNOdent and Tactile method. After caries removal, the cross-sectional surface was included in acrylic resin and polished. In a microhardness tester, the removed dentin thickness and the Vickers microhardness of the following regions were evaluated: remaining dentin after caries removal and superficial and deep healthy dentin. RESULTS ANOVA and Tukey's test (α=0.05) were performed, except for DIAGNOdent, which did not detect the presence of caries. Results for removed dentin thickness were: "Papacárie" (424.7 ± 105.0; a), Caries-detector dye (370.5 ± 78.3; ab), Tactile method (322.8 ± 51.5; bc). Results for the remaining dentin microhardness were: "Papacárie" (42.2 ± 10.5; bc), Caries-detector dye (44.6 ± 11.8; abc), Tactile method (24.3 ± 9.0; d). CONCLUSIONS DIAGNOdent did not detect the presence of carious tissue; Tactile method and "Papacárie" resulted in the least and the most dentinal thickness removal, respectively; Tactile method differed significantly from "Papacárie" and Caries-detector dye in terms of the remaining dentin microhardness, and Tactile method was the one which presented the lowest microhardness values.
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Affiliation(s)
- Fernanda Brandão Mollica
- Department of Restorative Dentistry, São José dos Campos Faculty of Dentistry, Univ. Estadual Paulista, São José dos Campos, SP, Brazil.
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Schwass DR, Leichter JW, Purton DG, Swain MV. Evaluating the efficiency of caries removal using an Er:YAG laser driven by fluorescence feedback control. Arch Oral Biol 2012; 58:603-10. [PMID: 23123070 DOI: 10.1016/j.archoralbio.2012.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/21/2012] [Accepted: 09/25/2012] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Caries lesions in dental hard tissues autofluoresce when exposed to light of certain wavelengths, whereas sound tissues do not, and this can be used as an in vitro histological marker for dental caries. Detection of autofluorescence is the basis of KaVo DIAGNOdent™ technology, and provides objective feedback control of laser-stimulated ablation of dental caries for the KaVo Key Laser 3™. This Er:YAG laser operates at 2940nm wavelength, and is effective at removal of infected dental hard tissues. Micro-computed tomography (micro-CT) allows the non-invasive investigation of three-dimensional structures and analysis of mineral density profiles of dentine following laser ablation. OBJECTIVE To evaluate removal of infected, demineralised dentine by Er:YAG irradiation with a laser feedback mechanism, using micro-CT. DESIGN 27 carious teeth (1 control) and 1 sound tooth, treated with the KaVo Key Laser 3™ using a KaVo™ non-contact 2060 handpiece at specific feedback settings, were examined using a Skyscan 1172 Micro-CT, to observe the efficiency of demineralised dentine removal. Grey scale images obtained were colour rendered to assist detection of demineralised tissue if present. RESULTS Complete removal of demineralised tissue occurred with laser-stimulated ablation under feedback control at values of 7 and 8 when measured by micro-CT. At greater values, removal of demineralised dentine was incomplete. CONCLUSION Examination of dental tissues by micro-CT allowed determination of the efficiency of Er:YAG laser-stimulated ablation. Feedback control of the KaVo Key Laser 3™ appeared to operate like a cut-off switch when infected dentine was eliminated, at a threshold of between 6 and 7.
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Affiliation(s)
- Donald R Schwass
- Department of Oral Rehabilitation, School of Dentistry, University of Otago, Dunedin, New Zealand.
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Sirin Karaarslan E, Yildiz E, Cebe M, Yegin Z, Ozturk B. Evaluation of micro-tensile bond strength of caries-affected human dentine after three different caries removal techniques. J Dent 2012; 40:793-801. [DOI: 10.1016/j.jdent.2012.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 05/08/2012] [Accepted: 05/28/2012] [Indexed: 11/29/2022] Open
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Raucci-Neto W, Chinelatti MA, Ito IY, Pécora JD, Palma-Dibb RG. Influence of Er:YAG laser frequency on dentin caries removal capacity. Microsc Res Tech 2011; 74:281-6. [DOI: 10.1002/jemt.20902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 06/06/2010] [Indexed: 11/10/2022]
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Neves AA, Coutinho E, De Munck J, Lambrechts P, Van Meerbeek B. Does DIAGNOdent provide a reliable caries-removal endpoint? J Dent 2011; 39:351-60. [PMID: 21334416 DOI: 10.1016/j.jdent.2011.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 11/16/2010] [Accepted: 02/12/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To compare mineral density of residual dentine after excavation with different caries-removal techniques and to evaluate the diagnostic potential of laser-induced fluorescence (LIF), measured by DIAGNOdent, as a tool to determine the caries-removal endpoint. METHODS Carious teeth were excavated by tungsten-carbide round burs (Komet), ceramic burs (CeraBurs, Komet), sono-abrasion (Cariex TC tips, Kavo), and by chemo-mechanical excavation using two enzyme-based solutions (exp. SFC-V and SFC-VIII, 3M-ESPE) or a sodium hypochlorite-based solution (Carisolv, MediTeam). The caries-excavated teeth were scanned by micro-CT (1172, Skyscan), after which the mineral density at the bottom dentine was correlated to LIF measurements at the same region. A micro-CT threshold for dentine caries was defined by comparison with surface-hardness measurements. The intensity of dentine staining was evaluated by analysing the component 'L*' in CIE-L*a*b-converted images from the excavated teeth. RESULTS No statistically significant difference in mineral density was found at the bottom of the cavities prepared with the different caries-excavation techniques, except for exp. SFC-V that left residual dentine with a significantly higher mineral density than when CeraBurs were used (Tukey-Kramer, p<0.05). Absence of residual caries was associated with darker staining of dentine. No significant correlation was found between the distance from the deepest cavity point to the pulp-chamber roof and LIF measurements. A strong negative correlation (R=-0.86, p<0.01) was however found between L* values and LIF measurements, indicating that staining in residual dentine leads to higher LIF measurements. CONCLUSIONS LIF measured by DIAGNOdent is influenced by staining in residual dentine. Therefore, its use to determine the caries-removal endpoint is doubtful.
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Affiliation(s)
- Aline A Neves
- Leuven BIOMAT Research Cluster, Department of Conservative Dentistry, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Catholic University of Leuven, Kapucijnenvoer 7, B-3000 Leuven, Belgium
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Eguro T, Aoki A, Maeda T, Takasaki AA, Hasegawa M, Ogawa M, Suzuki T, Yonemoto K, Ishikawa I, Izumi Y, Katsuumi I. Energy output reduction and surface alteration of quartz and sapphire tips following Er:YAG laser contact irradiation for tooth enamel ablation. Lasers Surg Med 2009; 41:595-604. [DOI: 10.1002/lsm.20806] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cavity size difference after caries removal by a fluorescence-controlled Er:YAG laser and by conventional bur treatment. Clin Oral Investig 2008; 12:311-8. [DOI: 10.1007/s00784-008-0203-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 04/29/2008] [Indexed: 11/25/2022]
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Krause F, Braun A, Lotz G, Kneist S, Jepsen S, Eberhard J. Evaluation of selective caries removal in deciduous teeth by a fluorescence feedback-controlled Er:YAG laser in vivo. Clin Oral Investig 2008; 12:209-15. [PMID: 18224360 DOI: 10.1007/s00784-007-0169-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Accepted: 11/26/2007] [Indexed: 11/24/2022]
Abstract
This study investigated the ability and efficacy of an Er:YAG laser with a fluorescence feedback system for caries removal in deciduous teeth. Seventy-nine carious lesions were excavated using a fluorescence-controlled Er:YAG laser. Endpoint of treatment was defined by emission of fluorescence from the dentine surface below the pre-selected threshold level of 7 units and the subsequent termination of Er:YAG laser radiation. Dentine samples were obtained from the cavity floor, and viable counts of both Streptococcus mutans and Lactobacilli, expressed as colony forming units (log CFU), were evaluated. Preparation time was recorded to assess efficacy of the treatment procedure. S. mutans and/or Lactobacilli were found in 25 out of 79 lesions. Regarding the counts for S. mutans and Lactobacilli, the median log CFU was 0 (min, 0; max, 5.5) and 0 (min, 0; max, 6), respectively, with 2.4% of all samples yielding more than 100 CFU S. mutans and 4.8% yielding more than 100 CFU Lactobacilli. In 8 out of 79 cases, laser excavated cavities were not judged being caries-free using the conventional tactile criterion for assessing caries tissue. Focussing on these teeth, the median log CFU was 0 (min, 0; max, 0.5) for S. mutans and 0 (min, 0; max, 1.6) for Lactobacilli. The mean time for treatment was 2.3+/-1.2 min. Of the children, 93.8% rated the laser treatment to be comfortable. The study indicates that the fluorescence feedback-controlled Er:YAG laser might be an appropriate device for caries removal in children using the suggested threshold level of 7 units.
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Affiliation(s)
- Felix Krause
- Department of Operative Dentistry and Periodontology, University of Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany.
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Krause F, Braun A, Eberhard J, Jepsen S. Laser fluorescence measurements compared to electrical resistance of residual dentine in excavated cavities in vivo. Caries Res 2007; 41:135-40. [PMID: 17284915 DOI: 10.1159/000098047] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Accepted: 07/20/2006] [Indexed: 11/19/2022] Open
Abstract
It has been suggested that laser fluorescence close to the dental pulp shows higher values than more distant measurements. The aim of this study was to assess fluorescence on the cavity floor and to correlate these measurements with electrical resistance as a measure of residual dentine thickness. Thirty carious lesions were excavated with a bur. The endpoint of caries removal was determined by visual, tactile and auditory means. Fluorescence was measured with the Diagnodent device and with the fluorescence feedback system of a therapeutic Er:YAG laser. Electrical resistance of the residual dentine (Prepometer units, PU) was measured with a proprietary device. Significant differences were observed between the fluorescence systems (p < 0.05). For Diagnodent, a decrease of electrical resistance of the residual dentine resulted in an increase of the fluorescence values of 2.99 units/PU (95% CI = 2.00-3.97) and an increase of 0.30 units/PU (95% CI = 0.19-0.40) for the fluorescence feedback system. For zero electrical resistance, a predicted maximum value of 51.5 units (95% CI = 41.3-61.7) was calculated for the Diagnodent and 5.1 units (95% CI = 4.1-6.2) for the feedback system. The study indicates that using the suggested detection cut-off with the Diagnodent device may be not suited to assess the endpoint of caries removal close to the dental pulp. Employing the Key Laser III, values up to 6 units might be caused solely by close proximity to the pulp, which should be considered when caries removal by laser is controlled by laser fluorescence feedback.
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Affiliation(s)
- F Krause
- Department of Operative Dentistry and Periodontology, University of Bonn, Bonn, Germany.
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Laser literature watch. Photomed Laser Surg 2006; 24:537-71. [PMID: 16942439 DOI: 10.1089/pho.2006.24.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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