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Chemomechanical Caries Removal Methods: A Literature Review. Saudi Dent J 2023; 35:233-243. [PMID: 37091279 PMCID: PMC10114597 DOI: 10.1016/j.sdentj.2023.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Aim To provide dental practitioners and researchers with a comprehensive review of the historical development, chemical composition, mechanisms of action, advantages, and drawbacks of different chemomechanical caries removal (CMCR) agents. Methods An electronic search was performed for all articles published on CMCR agents in various databases, including the Web of Science, PubMed, Cochrane, Scopus, and Google Scholar bibliographic databases, from January 1, 1975, to July 31, 2022. Results Records were identified using the following search terms: Brix3000, Carie-Care, Caridex, Carisolv, chemomechanical caries removal, conventional surgical method, and Papacárie. A total of 171 articles were screened based on the titles and abstracts, of which 126 were deemed eligible for inclusion after duplicates were removed. Following a manual search of the reference list, eight articles were added. Articles were then excluded for other reasons, such as being written before 1975, being written in a language other than English, and the non-availability of the full text. Overall, 120 articles were included in the analysis (literature reviews [n = 27], systematic reviews [n = 8], research articles [n = 82], case reports [n = 3]). Conclusion CMCR is a potential method of caries control in the future as an alternative to the conventional surgical approach in standard dentistry applications. It is more widely accepted, less painful, and has comparable efficacy to the conventional surgical method. Clinical significance A continuous trend among manufacturers has been observed since 1975 to reduce the drawbacks of CMCR agents. Moreover, evidence-based minimally invasive techniques, including CMCR agents that require minimal or no aerosol-generating procedures, are preferred while measures to control the spread of coronavirus disease are in force.
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Antimicrobial photodynamic therapy as an adjunctive treatment to ultrasound for the dentin caries-like lesion removal. Photodiagnosis Photodyn Ther 2022; 40:103148. [PMID: 36216023 DOI: 10.1016/j.pdpdt.2022.103148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/18/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To 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. METHODS Bovine 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. RESULTS PLM 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. CONCLUSION Ultrasound 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 SIGNIFICANCE Ultrasound 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.
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Bratu DC, Nikolajevic-Stoican N, Popa G, Pop SI, Dragoș B, Luca MM. A Bibliometric Analysis (2010-2020) of the Dental Scientific Literature on Chemo-Mechanical Methods of Caries Removal Using Carisolv and BRIX3000. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060788. [PMID: 35744051 PMCID: PMC9231379 DOI: 10.3390/medicina58060788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
Reports in the literature have proposed and analyzed several minimally invasive techniques for caries removal in recent decades. In light of recent events surrounding the ongoing epidemiological context, concerns have been raised regarding the generation of aerosols during dental procedures. The aim of our research was to provide an overview of the scientific literature on the topic of chemo-mechanical caries removal (CMCR) methods, focusing on two products (Carisolv, BRIX3000), commercially available in Europe. A bibliometric analysis was used to investigate the scientific articles included in Web of Science (WoS) Core Collection database, published from January 2010 to December 2020. We analyzed the co-occurrence of all keywords (Author Keywords and the KeyWords Plus section), co-authorship and co-citation, using the free software VOSviewer. Our bibliometric analysis revealed a worldwide interest in the subject of chemo-mechanical methods of caries removal, which has transcended the area of pediatric dentistry. The analyzed studies have been conducted mainly in high-income countries that have developed sanitary policies regarding prevention and early treatment of carious lesions as a health priority.
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Affiliation(s)
- Dana Cristina Bratu
- Department of Orthodontics and Dento-Facial Orthopedics, Orthodontic Research Center, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
| | - Nicoleta Nikolajevic-Stoican
- Department of Pediatric Dentistry, Pediatric Dentistry Research Center, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (N.N.-S.); (M.-M.L.)
| | - George Popa
- Department of Orthodontics and Dento-Facial Orthopedics, Orthodontic Research Center, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Correspondence: (G.P.); (S.I.P.)
| | - Silvia Izabella Pop
- Department of Orthodontics, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
- Correspondence: (G.P.); (S.I.P.)
| | - Bianca Dragoș
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 9 Revolutiei 1989 Avenue, 300070 Timisoara, Romania;
| | - Magda-Mihaela Luca
- Department of Pediatric Dentistry, Pediatric Dentistry Research Center, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (N.N.-S.); (M.-M.L.)
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Sajini SI, Alshawi BA, Alharbi LM. Assessment of remineralisation potentials of bioactive dental composite using an in-vitro demineralised dentine model. J Taibah Univ Med Sci 2022; 17:640-647. [PMID: 35983447 PMCID: PMC9356364 DOI: 10.1016/j.jtumed.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/20/2021] [Accepted: 12/01/2021] [Indexed: 11/22/2022] Open
Abstract
Objective Minimally invasive dentistry encourages conservative caries excavation and remineralisation of the remaining dental tissues. However, dentine remineralisation is more difficult than enamel remineralisation due to the differences in their composition. This study aims to assess the remineralisation potential of Activa BioActive-Restorative and Beautifil II restoration on demineralised dentine samples, and compares it with glass-ionomer (GIC) restoration using energy dispersive X-ray (EDX) and Knoop hardness number (KHN). Methods Non-carious extracted molar teeth were used, a total number of ten teeth were sectioned into halves and partially demineralised using 37.0% phosphoric acid for 60 s. All samples are assessed using EDX and KHN prior to restorations. The samples are then subdivided into four groups (n = 5). Group 1 was restored with Activa BioActive-Restorative, Group 2 received Beautifil II, Group 3 was restored with GIC, and the last group was used as a negative control. After storage, the samples were analysed using EDX and KHN. Results The demineralisation protocol with 37.0% phosphoric acid significantly decreased the calcium:phosphate (Ca:P) ratio and KHN. Remineralisation occurred in all groups, but the highest percentage change in Ca:P ratio and KHN was observed in the Activa BioActive-Restorative group (20.7%, 82.0%, respectively), followed by the Beautifil II group, glass ionomer group, and the control group, in that order. Conclusion Activa BioActive-Restorative restoration presents superior remineralisation compared to Beautifil II and glass-ionomer dental restorations.
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Affiliation(s)
- Shara I. Sajini
- Department of Restorative Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, KSA
- Corresponding address: Department of Restorative Dentistry, Faculty of Dentistry, King Abdulaziz University, P.O.Box 80209, Jeddah, 21589, KSA.
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Cascales ÁF, Moscardó AP, Toledano M, Banerjee A, Sauro S. An in-vitro investigation of the bond strength of experimental ion-releasing dental adhesives to caries-affected dentine after 1 year of water storage. J Dent 2022; 119:104075. [DOI: 10.1016/j.jdent.2022.104075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/12/2022] [Accepted: 02/22/2022] [Indexed: 11/15/2022] Open
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Besegato JF, Melo PBGD, Bernardi ACDA, Bagnato VS, Rastelli ANDS. Ultrasound device as a minimally invasive approach for caries dentin removal. Braz Dent J 2022; 33:57-67. [DOI: 10.1590/0103-6440202203878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/08/2021] [Indexed: 11/21/2022] Open
Abstract
Abstract The aim of this study was to evaluate the efficacy of an ultrasound device and the dentin surface morphology after removal of the caries dentin lesions by removal rate and scanning electron microscopy (SEM). The Knoop hardness test on the bovine dentin blocks (n = 20, 4x4x2mm) was performed to standardize the samples and only those with 38 ± 2 KHN were included. The dentin blocks were submitted to induction of artificial caries lesions, using the bacterial model. Strains of Streptococcus mutans and Lactobacillus acidophilus were used for 7 days. The caries dentin lesion was removed for 1 min, according to two methods: G1 - carbide bur under low-speed rotation (control group) and G2 - ultrasound device under refrigeration. For the removal rate, the samples were weighed 3 times: T0 (before induction), T1 (after induction) and T2 (after removal). Morphology evaluation of the residual dentin surface was performed by SEM. Data normality was verified by Shapiro-Wilk test (p ≥ 0.240). T-test for independent samples was applied to evaluate the removal rate. A significance level of 5% was adopted. G2 provided lower removal rate than G1 (G1: 3.68 mg and G2 = 2.26 mg). SEM images showed different morphological characteristics between the groups. G2 showed absent of smear layer, while G1 showed a visible smear layer over the surface. We concluded that ultrasound device provides minimally invasive removal with residual dentin exhibiting open dentin tubules and no smear layer formation and no bacteria, which infer the removal of the infected tissue.
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Self-Limiting versus Rotary Subjective Carious Tissue Removal: A Randomized Controlled Clinical Trial-2-Year Results. J Clin Med 2020; 9:jcm9092738. [PMID: 32854206 PMCID: PMC7564758 DOI: 10.3390/jcm9092738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 12/01/2022] Open
Abstract
Background: the aim of this study was to assess the 2-year pulp survival of deep carious lesions in teeth excavated using a self-limiting protocol in a single-blind randomized controlled clinical trial. Methods: At baseline, 101 teeth with deep carious lesions in 86 patients were excavated randomly using self-limiting or control protocols. Standardized clinical examination and periapical radiographs of teeth were performed after 1- and 2-year follow-ups (REC 14/LO/0880). Results: During the 2-year period of the study, 24 teeth failed (16 and 8 at T12 and T24, respectively). Final analysis shows that 39/63 (61.9%) of teeth were deemed successful (16/33 (48.4%) and 23/30 (76.6%) in the control and experimental groups, respectively with a statistically significant difference (z score = 2.3, p = 0.021). Of teeth with severe and mild symptoms at T0, 42.9% and 36.7% respectively failed at T24 (p > 0.05). Within the self-limiting group, there was a lower success in premolars compared to molars (p < 0.05). Conclusion: after 2 years, there was a statistically significant higher pulp survival rate of teeth with deep carious lesions excavated using self-limiting protocols in patients with reversible pulpitis. Molars showed higher success than premolars in teeth excavated using the self-limiting protocol. There was no statistically significant association between the outcome and the severity of symptoms at T0 (ClinicalTrials.gov NCT03071588).
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Recent Advances and the Potential for Clinical Use of Autofluorescence Detection of Extra-Ophthalmic Tissues. Molecules 2020; 25:molecules25092095. [PMID: 32365790 PMCID: PMC7248908 DOI: 10.3390/molecules25092095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023] Open
Abstract
The autofluorescence (AF) characteristics of endogenous fluorophores allow the label-free assessment and visualization of cells and tissues of the human body. While AF imaging (AFI) is well-established in ophthalmology, its clinical applications are steadily expanding to other disciplines. This review summarizes clinical advances of AF techniques published during the past decade. A systematic search of the MEDLINE database and Cochrane Library databases was performed to identify clinical AF studies in extra-ophthalmic tissues. In total, 1097 articles were identified, of which 113 from internal medicine, surgery, oral medicine, and dermatology were reviewed. While comparable technological standards exist in diabetology and cardiology, in all other disciplines, comparability between studies is limited due to the number of differing AF techniques and non-standardized imaging and data analysis. Clear evidence was found for skin AF as a surrogate for blood glucose homeostasis or cardiovascular risk grading. In thyroid surgery, foremost, less experienced surgeons may benefit from the AF-guided intraoperative separation of parathyroid from thyroid tissue. There is a growing interest in AF techniques in clinical disciplines, and promising advances have been made during the past decade. However, further research and development are mandatory to overcome the existing limitations and to maximize the clinical benefits.
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Alonaizan FA, Alofi RS, AlFawaz YF, Alsahhaf A, Al-Aali KA, Vohra F, Abduljabbar T. Effect of Photodynamic Therapy, Er,Cr:YSGG, and Nd:YAG Laser on the Push-Out Bond Strength of Fiber Post to Root Dentin. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 38:24-29. [PMID: 31386591 DOI: 10.1089/photob.2019.4687] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: To evaluate the push-out bond strength and modes of failure of fiber post to root dentin by using photodynamic therapy (PDT), Er,Cr:YSGG, Nd:YAG laser, and conventional cleaning and shaping (CCS). Materials and methods: Eighty anterior teeth were sectioned in a horizontal manner being 2 mm incisal to the cementoenamel junction, and root canal was prepared for post space. After post space was made, fiber posts were placed inside the root canal system. The fiber posts were subjected to PDT, Er,Cr:YSGG laser, Nd:YAG laser, and conventional cleaning and shaping (CSS) with 20 specimens in each group. Cervical and apical sections were obtained from the specimens. For performing the push-out test, the universal testing machine was used. The formula used for calculating the push-out bond strength was σ = N/mm2. Results: PDT group (8.16 ± 2.19 MPa) achieved the highest mean push-out bond strength, whereas Er,Cr:YSGG (7.24 ± 1.27 MPa) reported the lowest value in the specimens. Among the experimental groups, the ANOVA test expressed statistical difference (p = 0.481). In the cervical segments, the mean push-out bond strength was found to be higher in all of the experimental groups. For the cervical segments, the independent t-test results showed higher mean push-out bond strength values than the apical segments in PDT, Er,Cr:YSGG, Nd:YAG, and CSS groups, respectively (p < 0.05). Twenty failures were observed at the interface level between the adhesive and surface of dentin. Seven failures were found at the interface between mixed and the adhesive and post, respectively. Conclusions: Push-out bond strength to root canal dentin was not affected by PDT, Er,Cr:YSGG, and Nd:YAG laser compared with CCS. However, PDT produced the smallest number of failure modes and slightly higher push-out bond strength to root dentin. Laser treatment using PDT and Er,Cr:YSGG appeared to be clinically efficient showing acceptable push-out bond strength of fiber post with less number of failures at different regions of the root dentin.
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Affiliation(s)
- Faisal Abdullah Alonaizan
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Raneem S Alofi
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Yasser F AlFawaz
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alsahhaf
- Department of Prosthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Khulud Abdulrahman Al-Aali
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Fahim Vohra
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Biological Research in Dental Health, College of Dentistry, Riyadh, Saudi Arabia
| | - Tariq Abduljabbar
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Biological Research in Dental Health, College of Dentistry, Riyadh, Saudi Arabia
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Uchinuma S, Shimada Y, Matin K, Hosaka K, Yoshiyama M, Sumi Y, Tagami J. Effects of UVB and UVC irradiation on cariogenic bacteria in vitro. Lasers Med Sci 2018; 34:981-989. [DOI: 10.1007/s10103-018-2685-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/07/2018] [Indexed: 12/21/2022]
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Baraba A, Kqiku L, Gabrić D, Verzak Ž, Hanscho K, Miletić I. Efficacy of removal of cariogenic bacteria and carious dentin by ablation using different modes of Er:YAG lasers. ACTA ACUST UNITED AC 2018; 51:e6872. [PMID: 29340524 PMCID: PMC5769758 DOI: 10.1590/1414-431x20176872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/07/2017] [Indexed: 04/05/2024]
Abstract
The primary objective of this in vitro study was to evaluate the efficiency of removal of cariogenic bacteria and carious dentin by ablation using two lasers: fluorescence-feedback controlled (FFC) Er:YAG laser and different pulses of Er:YAG laser based on variable square pulse technology (VSPt). The secondary objective was to measure the temperature during laser ablation of carious tissue. Seventy-two extracted human molars were used in this study. Sixty teeth with carious dentin were randomly divided into four experimental groups according to the treatment for caries removal: group 1: 400 µs (FFC group); group 2: super short pulse (SSP group, 50 µs pulse); group 3: medium short pulse (MSP group, 100 µs pulse); group 4: short pulse (SP group, 300 µs pulse) and one positive control group with no treatment. Twelve teeth without carious lesion were used as a negative control group. After caries removal, swabs were taken with cotton pellets and real-time PCR analysis was performed. During caries ablation, a thermal infrared camera was used to measure the temperature changes. In all experimental groups, specimens were free of bacterial contamination after the treatment. In the SSP, MSP and SP groups, temperatures measured during caries ablation were significantly higher compared to temperatures in the FFC group (P<0.001). In this in vitro study, laser treatment for removal of carious dentin and cariogenic bacteria was an efficient treatment modality without causing excessive temperatures that might adversely affect pulp vitality.
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Affiliation(s)
- A Baraba
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - L Kqiku
- University Clinic of Dental Medicine and Oral Health, Division of Prosthodontics, Restorative Dentistry, Periodontology and Implantology, Medical University Graz, Graz, Austria
| | - D Gabrić
- Department of Oral Surgery, School of Dental Medicine, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ž Verzak
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - K Hanscho
- University Clinic of Dental Medicine and Oral Health, Division of Prosthodontics, Restorative Dentistry, Periodontology and Implantology, Medical University Graz, Graz, Austria
| | - I Miletić
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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Costa AR, Garcia-Godoy F, Correr-Sobrinho L, Naves LZ, Raposo LHA, Carvalho FGD, Sinhoreti MAC, Puppin-Rontani RM. Influence of Different Dentin Substrate (Caries-Affected, Caries-Infected, Sound) on Long-Term μTBS. Braz Dent J 2017; 28:16-23. [DOI: 10.1590/0103-6440201700879] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/06/2016] [Indexed: 11/21/2022] Open
Abstract
Abstract The aim of this study was to evaluate the μTBS in different dentin substrates and water-storage periods. Twenty-four dentin blocks obtained from sound third molars were randomly divided into 3 groups: Sound dentin (Sd), Caries-affected dentin (Ca) and Caries-infected dentin (Ci). Dentin blocks from Ca and Ci groups were subjected to artificial caries development (S. mutans biofilm). The softest carious tissue was removed using spherical drills under visual inspection with Caries Detector solution (Ca group). It was considered as Ci (softer and deeply red stained dentin) and Ca (harder and slightly red stained dentin). The Adper Single Bond 2 adhesive system was applied and Z350 composite blocks were built in all groups. Teeth were stored in deionized water for 24 h at 37 ºC and sectioned into beams (1.0 mm2 section area). The beams from each tooth were randomly divided into three storages periods: 24 h, 6 months or 1 year. Specimens were submitted to µTBS using EZ test machine at a crosshead speed of 1.0 mm/min. Failure mode was examined by SEM. Data from µTBS were submitted to split plot two-way ANOVA and Tukey’s HSD tests (a=0.05). The µTBS (MPa) of Sd (41.2) was significantly higher than Ca (32.4) and Ci (27.2), regardless of storage. Ca and Ci after 6 months and 1 year, presented similar µTBS. Mixed and adhesive failures predominated in all groups. The highest µTBS values (48.1±9.1) were found for Sd at 24 h storage. Storage of specimens decreased the µTBS values for all conditions.
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Kitsahawong K, Seminario AL, Pungchanchaikul P, Rattanacharoenthum A, Pitiphat W. Chemomechanical versus drilling methods for caries removal: an in vitro study. Braz Oral Res 2015; 29:1-8. [PMID: 26486767 DOI: 10.1590/1807-3107bor-2015.vol29.0127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/23/2015] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to compare the performance of chemomechanical caries removal (CMCR) with that of conventional drilling for efficacy of caries removal, time spent, morphological changes and microhardness of surface dentin, and microleakage of subsequent restorations. Forty-six carious deciduous molars were randomly divided into two groups: one each for caries removal by (1) CMCR and by (2) drilling. The completeness of caries removal was evaluated by visual and tactile criteria and a caries detector device. Twenty teeth in each group were restored with glass ionomer (GI) and subjected to thermocycling before undergoing microleakage and microhardness tests. In each group, three restored teeth were used for polarized light microscopic analysis, and three unrestored teeth for scanning electron microscopy (SEM). There was no significant difference in the completeness of caries removal between groups. However, time spent for caries removal by CMCR was significantly longer than that required for drilling. Restorations in the CMCR group had significantly more microleakage than those in the drilling group. Dentin hardness of the cavity floor after CMCR was also significantly lower. Microscopic analyses showed roughened and irregular dentin surfaces in the CMCR group, unlike the smooth surfaces observed in the drilling group. In conclusion, CMCR was as efficacious as drilling in term of completeness of caries removal, but required longer excavation times and resulted in lower microhardness of residual dentin as well as more microleakage after restorations with GI. Further laboratory and clinical evaluations on the efficiency and performance of CMCR for the durability of subsequent restorations are required.
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Hamama H, Yiu C, Burrow MF. Effect of chemomechanical caries removal on bonding of resin-modified glass ionomer cement adhesives to caries-affected dentine. Aust Dent J 2015; 60:190-9. [PMID: 25989193 DOI: 10.1111/adj.12318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study evaluated the effect of: (1) chemomechanical caries removal (CMCR); (2) dentine surface treatments and (3) dentine substrates on adhesion of resin-modified glass ionomer cement (RMGIC) adhesives. METHODS One hundred and twenty permanent molars exhibiting moderate cavitation on the occlusal surface into dentine were used. Seventy-five carious molars were used for bond strength testing; the remaining 45 for micromorphological evaluation of the bonded interface. Caries was excavated with NaOCl-based CMCR (Carisolv), enzyme-based CMCR (Papacarie), or conventional rotary caries removal methods. Dentine surface treatment was performed using 37% phosphoric acid, 25-30% PAA or 20% PAA + 3% AlCl3 . RESULTS Three-way ANOVA revealed that all three factors 'caries removal methods', 'dentine surface treatments' and 'dentine substrates' did not significantly affect bond strength (p > 0.05). Scanning electron microscopy micrographs showed that the acid-base resistant layer was thicker in caries-affected dentine compared to sound dentine. CONCLUSIONS NaOCl- and enzyme-based CMCR methods have no adverse effect on adhesion of RMGIC adhesives to sound and caries-affected dentine. Dentine surface treatment with 37% phosphoric acid for 5 s has no negative effect on bonding of RMGIC adhesives to dentine compared with using polyacrylic acid for 10 s. RMGIC adhesives bonded well to both sound and caries-affected dentine.
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Affiliation(s)
- Hhh Hamama
- Aesthetic and Restorative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Cky Yiu
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | - M F Burrow
- Melbourne Dental School, The University of Melbourne, Victoria, Australia
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Hamama H, Yiu C, Burrow M. Current update of chemomechanical caries removal methods. Aust Dent J 2014; 59:446-56; quiz 525. [PMID: 25131424 DOI: 10.1111/adj.12214] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 11/27/2022]
Abstract
Chemomechanical caries removal is an excellent method for minimally invasive caries excavation, and the removal agents are either sodium hypochlorite (NaOCl)- or enzyme-based. The NaOCl-based agents include GK-101, GK-101E (Caridex) and Carisolv, and the enzyme-based agents include Papacarie and the experimental material, Biosolv. This review outlines the changes in chemomechanical caries removal methods and focuses on recently published laboratory and clinical studies. The historical development, mechanism of action, excavation time and biological effects on pulp and dental hard tissues are described. Based on existing evidence, the currently available chemomechanical caries removal methods are viable alternatives to conventional rotary instrument methods. Chemomechanical methods could be extremely useful in very anxious, disabled and paediatric patients. It does seem some of these agents would still benefit from quicker excavation times in order to achieve more universal acceptance. However, as a means of conserving the caries-affected dentine, chemomechanical caries removal is possibly much more successful than conventional rotary instrumentation.
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Affiliation(s)
- H Hamama
- Faculty of Dentistry, Prince Philip Dental Hospital, University of Hong Kong, Hong Kong SAR, China; Department of Conservative Dentistry, Faculty of Dentistry, Mansoura University, Egypt
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16
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Aggarwal V, Singla M, Yadav S, Yadav H. The effect of caries excavation methods on the bond strength of etch-and-rinse and self-etch adhesives to caries affected dentine. Aust Dent J 2013; 58:454-60. [DOI: 10.1111/adj.12121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
- V Aggarwal
- Department of Conservative Dentistry and Endodontics; Faculty of Dentistry; Jamia Millia Islamia; New Delhi India
| | - M Singla
- Department of Conservative Dentistry and Endodontics; SGT Dental College; Gurgaon India
| | - S Yadav
- Department of Conservative Dentistry and Endodontics; SGT Dental College; Gurgaon India
| | - H Yadav
- Department of Prosthodontics; SGT Dental College; Gurgaon India
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17
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Thompson VP, Watson TF, Marshall GW, Blackman BRK, Stansbury JW, Schadler LS, Pearson RA, Libanori R. Outside-the-(cavity-prep)-box thinking. Adv Dent Res 2013; 25:24-32. [PMID: 24129814 PMCID: PMC3797535 DOI: 10.1177/0022034513502207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Direct placement restorative materials must interface with tooth structures that are often compromised by caries or trauma. The material must seal the interface while providing sufficient strength and wear resistance to assure function of the tooth for, ideally, the lifetime of the patient. Needed are direct restorative materials that are less technique-sensitive than current resin-based composite systems while having improved properties. The ideal material could be successfully used in areas of the world with limited infrastructure. Advances in our understanding of the interface between the restoration adhesive system and the stages of carious dentin can be used to promote remineralization. Application of fracture mechanics to adhesion at the tooth-restoration interface can provide insights for improvement. Research in polymer systems suggests alternatives to current composite resin matrix systems to overcome technique sensitivity, while advances in nano- and mesoparticle reinforcement and alignment in composite systems can increase material strength, toughness, and wear resistance, foreshadowing dental application.
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Affiliation(s)
- V P Thompson
- Biomaterials, Biomimetics and Biophotonics Group, King's College London Dental Institute, London, UK
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18
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Hamama HH, Yiu CKY, Burrow MF, King NM. Chemical, morphological and microhardness changes of dentine after chemomechanical caries removal. Aust Dent J 2013; 58:283-92. [DOI: 10.1111/adj.12093] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 11/27/2022]
Affiliation(s)
- HH Hamama
- Paediatric Dentistry and Orthodontics; Faculty of Dentistry; University of Hong Kong; Hong Kong SAR; China
| | - CKY Yiu
- Paediatric Dentistry and Orthodontics; Faculty of Dentistry; University of Hong Kong; Hong Kong SAR; China
| | - MF Burrow
- Oral Diagnosis and Polyclinics; Faculty of Dentistry; University of Hong Kong; Hong Kong SAR; China
| | - NM King
- Paediatric Dentistry; School of Dentistry; Western Australia; Perth; Western Australia
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19
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Minimal intervention dentistry: part 7. Minimally invasive operative caries management: rationale and techniques. Br Dent J 2013; 214:107-11. [DOI: 10.1038/sj.bdj.2013.106] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2012] [Indexed: 11/09/2022]
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20
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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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21
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Almahdy A, Downey FC, Sauro S, Cook RJ, Sherriff M, Richards D, Watson TF, Banerjee A, Festy F. Microbiochemical analysis of carious dentine using Raman and fluorescence spectroscopy. Caries Res 2012; 46:432-40. [PMID: 22739587 DOI: 10.1159/000339487] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 04/27/2012] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to evaluate and correlate objectively the microspectroscopically derived biochemical components of sound, infected and affected carious dentine with their microhardness and autofluorescence (AF) characteristics. Over 3 million high-resolution Raman spectra from 8 extracted human carious teeth were recorded using Raman spectrometer with parallel spectrum acquisition. Green AF signals across each carious lesion from all samples were acquired with a similar spatial resolution using confocal fluorescence microscopy. The Knoop microhardness (KHN) from a total of 233 co-localized areas was recorded from the same samples and allocated subjectively into the three zones. Cluster analysis of the Raman data, performed using in-house software, produced five independent spectral components representing mineral content, protein content, porphyrin fluorescence (PF), putative infected dentine signal (IDS) and affected dentine signal (ADS). The distributions of the 5 Raman components and the AF signal were matched across all samples and their average values were calculated for each corresponding KHN area. The infected dentine was defined significantly by the KHN, AF and by the relative contribution of the mineral, PF and IDS clusters. Protein cluster was not statistically related to the KHN or AF. A delineation between affected and sound dentine was observed using the KHN, AF, PF and ADS parameters. This study concludes that micro-Raman spectroscopy can provide a non-invasive and objective evaluation of different carious dentine zones. Being able to detect and assess clinically the caries-affected dentine during minimally invasive operative caries management is important to control the risk of unnecessary tissue removal.
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Affiliation(s)
- A Almahdy
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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22
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Maltz M, Henz SL, de Oliveira EF, Jardim JJ. Conventional caries removal and sealed caries in permanent teeth: a microbiological evaluation. J Dent 2012; 40:776-82. [PMID: 22664566 DOI: 10.1016/j.jdent.2012.05.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 05/23/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare microbiological infection after conventional carious dentine removal with incomplete carious dentine removal and sealing. METHODS Eighty-seven patients (12-50 years of age) under treatment at the Dental Clinics of the Federal University of Rio Grande do Sul (UFRGS), Brazil, participated in the study. The patients presented 90 posterior permanent teeth with primary caries. The lesions were coronal, active, and reached at least the middle third of the dentine. None of the teeth exhibited spontaneous pain, sensitivity to percussion or apical pathology (detected through radiographic exams). Pulp sensibility was confirmed by the cold test. The lesions were divided into 2 experimental groups: complete caries removal (CCR) based on hardness criteria (n=60 lesions) and incomplete caries removal (ICR) and sealing (n=32 lesions). Microbiological samples were obtained from the initial demineralized dentine, after CCR and after ICR-Seal. RESULTS The number of anaerobic and aerobic bacteria, lactobacilli, and mutans streptococci decreased at the end of treatment (p<0.05). Significantly less anaerobic bacteria (p<0.01), aerobic bacteria (p=0.02), and mutans streptococci (p<0.01) growth was observed after ICR-Seal compared to CCR. The difference in lactobacilli was insignificant (p=0.08). The amount of bacteria detected after conventional caries removal was higher than that which remained in sealed caries lesions. CONCLUSIONS The results suggest it is not necessary to remove all carious dentine before the restoration is placed because over time, sealing of carious dentine results in lower levels of infection than traditional dentine caries removal. CLINICAL SIGNIFICANCE The results of this study indicate that sealed carious dentine was less infected than the remaining dentine left after conventional caries removal and sealing. Our results support treatment of deep carious lesions in one session with incomplete removal of carious dentine.
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Affiliation(s)
- M Maltz
- Faculty of Odontology, Federal University of Rio Grande do Sul, Brazil.
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23
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Magne P, Paranhos MP, Hehn J, Oderich E, Boff LL. Selective masking for thin indirect restorations: can the use of opaque resin affect the dentine bond strength of immediately sealed preparations? J Dent 2011; 39:707-9. [PMID: 21801800 DOI: 10.1016/j.jdent.2011.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 07/02/2011] [Accepted: 07/12/2011] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Evaluate the dentine bond strength using different methods of application of opaque resins to mask dentine discoloration. MATERIALS AND METHODS Dentine was exposed on 21 extracted molars which were assigned to 3 groups: G1: immediate dentine sealing (IDS). G2: IDS+opaque. G3: IDS with adhesive resin mixed with opaque. After 1 week, teeth were restored and beams were fabricated for microtensile testing. Optical microscopy was used to analyse the failure mode. RESULTS Bond strength mean values were statistically different: G1 55.20MPa>G2 45.79MPa>G3 18.96MPa. Failure modes were mostly adhesive for G1 and G3. G2 presented mostly mixed failures. CONCLUSION The use of opaque resin to mask discoloured dentine results in a decrease of bond strength.
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Affiliation(s)
- Pascal Magne
- Don & Sybil Harrington Foundation, Department of Restorative Sciences, Herman Ostrow School of Dentistry, University of Southern California, United States.
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Neves ADA, Coutinho E, Cardoso MV, de Munck J, Van Meerbeek B. Micro-tensile bond strength and interfacial characterization of an adhesive bonded to dentin prepared by contemporary caries-excavation techniques. Dent Mater 2011; 27:552-62. [PMID: 21489617 DOI: 10.1016/j.dental.2011.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 10/24/2010] [Accepted: 02/15/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the micro-tensile bond strength (μTBS) and interfacial characteristics of adhesive-dentin bonds produced after caries-removal with contemporary techniques. METHODS Carious molars were cut at the base of the fissure, exposing 'sound' and 'carious' dentin at different spots. After caries-excavation, a composite was bonded using a 2-step self-etch adhesive. The μTBS was measured and the mode of fracture analyzed using a stereomicroscope and imaged by Feg-SEM, while additional non-fractured specimens were histologically analyzed after Masson's trichrome staining in order to identify potentially incompletely resin-enveloped collagen. RESULTS μTBS to residual caries-excavated dentin was lower than to sound dentin. The different caries-removing techniques had a significant effect on the μTBS. Er:YAG laser guided by a LIF-feedback system (Kavo) resulted in the lowest μTBS (26.8% lower than to 'sound' dentin) and a distinct layer of incompletely resin-enveloped collagen at the interface. Although different degrees of collagen exposure were seen for other caries-removing techniques, such as a thick layer for CeraBur (Komet-Brasseler), some unprotected collagen areas for Cariex (Kavo), or completely resin-enveloped collagen for a tungsten-carbide-bur (Komet), the μTBS appeared not directly affected (10%, 16.6%, and 15.3% lower than to 'sound' dentin, respectively). Carisolv (MediTeam) resulted in the highest μTBS (only 1% reduction compared to that to 'sound' dentin), followed by the tungsten-carbide-bur aided by Caries Detector (Kuraray) (4.8% reduction). Enzymatic caries excavation using the experimental SFC-VIII (3M-ESPE) aided by a disposable plastic instrument resulted in a 19.4% reduction in μTBS as compared to that to 'sound' dentin. SIGNIFICANCE The dentin bonding receptiveness depends to a large extent on the caries-excavation method employed.
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Affiliation(s)
- Aline de 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, Leuven, Belgium
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Li H, Wang WM, Yu SL, Wen Q. Morphological and microtensile bond strength evaluation of three adhesive systems to caries-affected human dentine with chemomechanical caries removal. J Dent 2011; 39:332-9. [PMID: 21333713 DOI: 10.1016/j.jdent.2011.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 12/26/2010] [Accepted: 02/11/2011] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To evaluate the influence of chemomechanical caries removal on bond strengths of three adhesive systems to caries-affected human dentine. METHODS 45 extracted human third molars with occlusal moderate caries were used. One half of each cavity was prepared with chemomechanical method and the other half with bur as the control. Three adhesive systems, Prime&Bond NT (Dentsply, Germany) without any previous conditioning, an etch-and-rinse adhesive (One-Step, Bisco, USA) and a self-etching adhesive (Adper Prompt-L-Pop, 3M ESPE, USA), were applied. The compomer or resin crowns were, then, built up. The prepared specimens were sectioned for scanning electron microscopy (SEM) examination and microtensile bond strength (MTBS) testing. Data were analysed using two-way ANOVA with subsequent application of Student-Newman-Keuls test at p<0.05. RESULTS Opened dentinal tubules and less smear layer were visible by SEM after chemomechanical caries removal, whilst an obvious smear layer covering the dentine surface with occluded tubules was exhibited after bur excavation. Resin tags were seen only in specimens with chemomechanical excavation when Prime&Bond NT system was applied. Statistical analysis of the values of MTBS failed to show significant difference between caries removal methods. However, the values of MTBS for One-Step system achieved with two caries removal methods were both significant higher than other adhesive systems. CONCLUSIONS Chemomechanical caries removal did not influence the bond strengths of the adhesive systems used in this study to caries-affected human dentine. Highest bond strength was achieved with application of etch-and-rinse adhesive system.
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Affiliation(s)
- Heng Li
- Department of Paediatric Dentistry, Institute of Stomatology, Nanjing University Medical School, 30 Zhongyang Road, Nanjing 210008, China
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