Chemical, morphological and microhardness changes of dentine after chemomechanical caries removal

Microhardness and elemental analysis of ion-releasing restoration/ dentin interface following enzymatic chemomechanical caries excavation

BACKGROUND

This study was conducted to compare chemical, elemental and surface properties of sound and carious dentin after application of two restorative materials resin-modified glassionomer claimed to be bioactive and glass hybrid restorative material after enzymatic chemomechanical caries removal (CMCR) agent.

METHODS

Forty carious and twenty non-carious human permanent molars were used. Molars were randomly distributed into three main groups: Group 1 (negative control) - sound molars, Group 2 (positive control) - molars were left without caries removal and Group 3 (Test Group) caries excavated with enzymatic based CMCR agent. After caries excavation and restoration application, all specimens were prepared Vickers microhardness test (VHN), for elemental analysis using Energy Dispersive Xray (EDX) mapping and finally chemical analysis using Micro-Raman microscopy.

RESULTS

Vickers microhardness values of dentin with the claimed bioactive GIC specimens was statistically higher than with glass hybrid GIC specimens. EDX analysis at the junction estimated: Calcium and Phosphorus of the glass hybrid GIC showed insignificantly higher mean valued than that of the bioactive GIC. Silica and Aluminum mean values at the junction were significantly higher with bioactive GIC specimens than glass hybrid GIC specimen. Micro-raman spectroscopy revealed that bioactive GIC specimens showed higher frequencies of v 1 PO 4, which indicated high level of remineralization.

CONCLUSIONS

It was concluded that ion-releasing bioactive resin-based restorative material had increased the microhardness and remineralization rate of carries affected and sound dentin. In addition, enzymatic caries excavation with papain-based CMCR agent has no adverse effect on dentin substrate.

An in vitro assessment of the residual dentin after using three minimally invasive caries removal techniques

To evaluate the efficiency and effectiveness of three minimally invasive (MI) techniques in removing deep dentin carious lesions. Forty extracted carious molars were treated by conventional rotary excavation (control), chemomechanical caries removal agent (Brix 3000), ultrasonic abrasion (WOODPECKER, GUILIN, China); and Er, Cr: YSGG laser ablation (BIOLASE San Clemente, CA, USA). The assessments include; the excavation time, DIAGNOdent pen, Raman spectroscopy, Vickers microhardness, and scanning electron microscope combined with energy dispersive X-ray spectroscopy (SEM-EDX). The rotary method recorded the shortest excavation time (p < 0.001), Brix 3000 gel was the slowest. DIAGNOdent pen values ranged between 14 and 18 in the remaining dentin and laser-ablated surfaces recorded the lowest reading (p < 0.001). The Ca:P ratios of the remaining dentin were close to sound dentin after all excavation methods; however, it was higher in the ultrasonic technique (p < 0.05). The bur-excavated dentin showed higher phosphate and lower matrix contents with higher tissue hardness that was comparable to sound dentin indicating the non-selectiveness of this technique in removing the potentially repairable dentin tissue. In contrast, the MI techniques exhibited lower phosphate and higher organic contents associated with lower microhardness in the deeper dentin layers. This was associated with smooth residual dentin without smearing and patent dentinal tubules. This study supports the efficiency of using MI methods in caries removal as conservative alternatives to rotary excavation, providing a promising strategy for the clinical dental practice.

The in-vitro development of novel enzyme-based chemo-mechanical caries removal agents

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.

Effect of viscosity of experimental universal adhesive on bond strength to dentin prepared with Er:YAG laser

The aim of this study was to clarify the effect of universal adhesive (UA) viscosity on the bond strength of resin composite to dentin prepared with Er:YAG laser. Four experimental UAs (SI-1, SI-2, SI-3, and SI-4) were developed by adding 1, 2, 3, and 4 wt/% nanosilica to BeautyBond Xtreme (Shofu), respectively. BeautyBond Xtreme was used as a control (SI-0). The viscosities of experimental UAs were measured using a B-type viscometer. After bovine mandibular anterior teeth were ground with #600 emery paper to obtain the flattened dentin surfaces, the dentin surfaces were cut thinly by irradiating the Er:YAG laser. Specimens were prepared using the respective UA and flowable resin composite and subjected to the microtensile bond strength (µTBS) test. The data from viscosity measurement and the μTBS test were statistically analyzed using the Kruskal-Wallis test. The mean values of viscosity significantly differed among the all experimental groups (p < 0.01). The μTBS of SI-1 and SI-2 was significantly higher than that of SI-0, SI-3, and SI-4 (p < 0.001). The μTBS of SI-0 was significantly lower than that of SI-4 (p < 0.001). The viscosities of the experimental universal adhesives significantly affected their bond strength to laser-cut dentin.

Chemomechanical Caries Removal Methods: A Literature Review

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.

A Bibliometric Analysis (2010-2020) of the Dental Scientific Literature on Chemo-Mechanical Methods of Caries Removal Using Carisolv and BRIX3000

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.

Evaluation of developmentally hypomineralised enamel after surface pretreatment with Papacarie Duo gel and different etching modes: an in vitro SEM and AFM study

PURPOSE

This study aimed at investigating the surface morphology and nanotopography of normal enamel (NE) and developmentally hypomineralised enamel (HE) when subjected to various pretreatment protocols under scanning electron microscopy (SEM) and atomic force microscopy (AFM).

METHODS

Sixteen NE, 16 creamy/white (CW) HE and 16 yellow/brown (YB) HE specimens sectioned from extracted hypomineralised first permanent molars (FPMs) were included in this study. They were randomly distributed into 12 experimental groups (n = 4). Each group involved the following: (1) deproteinisation with Papacarie Duo^® gel or no deproteinisation, and (2) the use of Scotchbond™ Universal Adhesive (Scotchbond) in self-etch (SE) mode or 37% phosphoric acid etchant. Subsequently, the surface morphology and nanotopography of pretreated enamel specimens were evaluated under SEM and AFM, respectively.

RESULTS

SEM observation showed that deproteinisation with Papacarie Duo^® gel before phosphoric acid etching led to favourable etching patterns. This was consistent across all groups irrespective of the type of enamel specimen and the severity of hypomineralisation. In contrast, AFM results identified three factors that influenced surface parameters: (1) type of enamel specimen, (2) severity of hypomineralisation and (3) etching mode. YB HE recorded higher surface roughness values than CW HE and NE when subjected to the same pretreatment protocol. Deproteinisation and the application of Scotchbond in SE mode led to minimal topographic changes; however, acid etching was associated with an increase in surface roughness.

CONCLUSION

Deproteinisation with Papacarie Duo^® gel followed by acid etching contributed to improved etching patterns on HE.

Changes in Oral Health Policies and Guidelines During the COVID-19 Pandemic

The aim of this study was to describe the changes in oral health policies and guidelines in response to the Coronavirus disease 2019 (COVID-19) pandemic in different countries and regions around the world. Information on oral health policies and guidelines from 9 countries (Canada, China including Hong Kong, Egypt, India, Japan, New Zealand, Nigeria, Switzerland, and Thailand) were summarized, and sources of the information were mostly the national or regional health authorities and/or dental council/associations. The changes made to the oral health guidelines depended on the severity of the COVID-19 pandemic. This included suspension of non-emergency dental care services at the peak of the COVID-19 outbreak, and easing the restrictions on non-essential and elective dental care when the pandemic became under control. The COVID-19 risk mitigation strategies include strict adherence to infection control practices (use of hand sanitizers, facemask and maintaining social distancing), reducing the amount of aerosol production in the dental setting, and managing the quality of air in the dental treatment rooms by reducing the use of air conditioners and improving air exchange. The COVID-19 pandemic has shown a major impact on dental practice. Dental professionals are trying to adapt to the new norms, while the medium to long-term impact of COVID-19 on dentistry needs further investigation.

Evaluation and comparison of cytotoxicity and bioactivity of chemomechanical caries removal agents on stem cells from human exfoliated deciduous teeth

AIM

To investigate and compare the cytotoxicity and bioactivity of CMCR agents on stem cells derived from exfoliated deciduous teeth.

METHODOLOGY

MTT assay, flow cytometry, Alizarin Red staining and scratch assay were used to assess the cellular viability, apoptosis, calcium matrix deposits and cell migration, respectively. The gene expression of ALP and BMP-2 was measured with RT-PCR. One-way ANOVA and Bonferroni post-test was used for statistical analysis.

RESULTS

0.5% Carisolv showed highest cell proliferation and calcium matrix formation, whereas 0.5% Papacarie reported the highest% live cells and cell migration. The highest mRNA expression of ALP and BMP-2 was reported in SHEDs cultured in 0.5% Papacarie (after 72 h incubation) and 0.5% Carisolv (after 24 h incubation), respectively.

CONCLUSION

CMCR agents are biocompatible and bioactive when cultured in stem cells derived from exfoliated primary teeth.

Ultrastructure and properties of primary carious molars treated using the Hall Technique

BACKGROUND

The Hall Technique (HT) is a method of restoring decayed primary teeth using stainless steel crowns (SSCs) without tooth preparation, caries removal, or local anaesthetic.

AIM

To investigate the ultrastructural, biomechanical, and chemical characteristics of teeth managed with the Hall Technique in comparison with conventional SSC (controls).

DESIGN

Twelve HT-treated primary molars and four controls were analysed. Teeth were dehydrated in ethanol, embedded in methylmethacrylate, mesio-distally sectioned, X-rayed, mounted, and polished. Biomechanical, ultrastructural, and chemical characterisation was performed for carious lesion and sound areas of each specimen.

RESULTS

Pre-treatment and post-treatment X-rays showed evidence of little to no caries progression over time. In carious lesions, mean hardness and elastic modulus values were lower in HT-treated teeth than in controls. In both controls and HT-treated teeth, carious lesions had the lowest %wt of Ca and P of all tissues sampled.

CONCLUSIONS

Although the retained carious tissue was biomechanically more compromised in HT-treated teeth, the Ca and P values were higher than reported elsewhere for carious lesions in primary molars, suggesting remineralisation may have occurred in caries in HT-treated teeth. Future investigations will help elucidate the processes involved with carious lesion arrest under SSC.

The roughness of deciduous dentin surface and shear bond strength of glass ionomers in the treatment with four minimally invasive techniques

The concept of minimally invasive technique in dentistry emphasizes conservative strategies in the management of caries, which results in less destruction of healthy tooth structure. The use of different techniques seems to interfere in the roughness of dentin and the mechanisms of adhesion with the restorative material. This study characterized the roughness of deciduous dentin surface treated with four minimally invasive techniques using profilometry, atomic force microscopy (AFM) and scanning electron microscopy (SEM); moreover, shear bond strength of Vitremer™ glass ionomer was determined. Samples were divided into four groups: G1_CB carbide bur, G2_PB polymer bur, G3_C Carisolv™, and G4_AA air abrasive. No differences were found between groups before and after treatment in the roughness. Samples treated with a carbide bur presented a smear layer; smart bur surface exhibited the remains of the material; G3_C Carisolv™ showed a rough surface, and air abrasive presented particle traces. Concerning the shear bond strength of Vitremer™ glass ionomer were not found differences after treatment (p > 0.05). It is concluded that roughness showed characteristic patterns derived from the technique used and the shear bond strength is not significantly affected after using any minimally invasive method.

The concept of minimally invasive technique in dentistry emphasizes conservative strategies in the management of caries, which results in less destruction of healthy tooth structure.

Surgical Management of Caries Lesions: Selective Removal of Carious Tissues

Traditionally, before placing a restoration, excavation of tissues affected by caries was recommended. The goal was to have all walls of the cavity on sound, hard dentin, even when at risk of pulpal exposure. Current understanding of the caries process indicates that preserving tooth structure can lead to better long-term outcomes. Selective caries excavation refers to preserving tooth structure by delineating excavation in the pulpal and axial wall according to lesion severity and depth as well as pulpal health while keeping all cavity margins on sound tooth structure. Compounding evidence indicates that when a good marginal seal is present, the lesion will arrest.

Systematic Review and Meta-Analysis of Randomized Clinical Trials on Chemomechanical Caries Removal

OBJECTIVES

The aim of this review was to assess the methodologies used in previously published prospective randomized clinical trials on chemomechanical caries removal and to conduct a meta-analysis to quantify the differences in the excavation time between chemomechanical and conventional caries removal methods.

METHODS

An electronic search was performed using Scopus, PubMed, EBSCO host, and Cochrane Library databases. The following categories were excluded during the assessment process: non-English studies published before 2000, animal studies, review articles, laboratory studies, case reports, and nonrandomized or retrospective clinical trials. The methodologies of the selected clinical trials were assessed. Furthermore, the reviewed clinical trials were subjected to meta-analysis for quantifying the differences in excavation time between the chemomechanical and the conventional caries removal techniques.

RESULTS

Only 19 randomized clinical trials fit the inclusion criteria of this systematic review. None of the 19 reviewed trials completely fulfilled Delphi's ideal criteria for quality assessment of randomized clinical trials. The meta-analysis results revealed that the shortest mean excavation time was recorded for rotary caries excavation (2.99±0.001 minutes), followed by the enzyme-based chemomechanical caries removal method (6.36±0.08 minutes) and the the hand excavation method (atraumatic restorative technique; 6.98±0.17 minutes). The longest caries excavation time was recorded for the sodium hypochlorite-based chemomechanical caries removal method (8.12±0.02 minutes).

CONCLUSIONS

It was found that none of the current reviewed trials fulfilled all the ideal requirements of clinical trials. Furthermore, the current scientific evidence shows that the sodium hypochlorite-based (Carisolv) chemomechanical caries removal method was more time consuming when compared to the enzyme-based (Papacarie) chemomechanical and the conventional caries removal methods. Further prospective randomized controlled clinical trials evaluating the long-term follow-up of papain-treated permanent teeth are needed.

Effect of a Papain-based Chemomechanical Agent on Structure of Dentin and Bond Strength: An in vitro Study

Aim

To evaluate the microtensile bond strength of teeth restored with packable composite after removing caries with three chemomechanical caries removal agents (Carisolv, Papacarie and Carie-care) and also to analyze its effect on chemical composition of dentin using energy-dispersive X-ray (EDX) analysis.

Design

A total of 40 carious molars with 1 to 1.5 mm of remaining dentin were selected and divided into four groups of 20 each. Group I (control)—bur, group II—Carisolv, group III—Papacarie, group IV—Carie-care. A total of 15 samples from each group were restored with composite; 1 mm thick sections were made and were debonded under tensile load. Remaining five samples from each group were subjected to EDX for elemental analysis of dentin surface.

Results

No statistically significant difference in the bond strength values and Ca/P ratio was observed between control group and three chemomechanical agents tested in the study.

Conclusion

None of the chemomechanical agents tested in the study adversely affected the bond strength of composite resin to caries-affected dentin. Therefore, newer papain-based chemomechanical agent Carie-care can be considered as an equally effective economical alternative to commonly used agents Carisolv and Papacarie.

How to cite this article: Nair S, Nadig RR, Pai VS, Gowda Y. Effect of a Papain-based Chemomechanical Agent on Structure of Dentin and Bond Strength: An in vitro Study. Int J Clin Pediatr Dent 2018;11(3):161-166.

A Comparative Evaluation of Time-dependent Changes on the Surface Hardness of Bulk Cure Composites: An in vitro Study

Objectives

The objective of this in vitro study was to assess the surface hardness through Vickers hardness (VH) test of one conventional hybrid resin composites (Filtek Z350), compared with that of two bulk cure resin composites (SDR™, Tetric N Ceram®).

Materials and methods

Twenty specimens of each material were prepared in cylindrical aluminum molds with an internal diameter of 5 mm and depth of 4 mm, 10 (incremental curing) and 10 (bulk curing).

The surface of each specimen was covered with a transparent plastic matrix strip before light curing with conventional visible light for 40 seconds. The specimens thus obtained were stored in deionized water and transferred to an incubator at 37°C for 24 hours to simulate clinical conditions. After 24 hours, the microhardness of each specimen was measured using a Vickers indenter, with a load of 100 gm and dwell time of 15 seconds (HV 0.2/40).

The specimens were further subjected to VH test in an interval of 7, 30, and 90 days. The data were subjected to statistical analysis—Student’s t test, analysis of variance, and post hoc Tukey’s test.

Results

The present study showed that SDR™ in bulk curing showed consistently greater value of hardness and was comparable to traditional incremental cured Filtek Z350, highlighting the advantages of the new SDR technology.

How to cite this article: Sarma A, Nagar P. A Comparative Evaluation of Time-dependent Changes on the Surface Hardness of Bulk Cure Composites: An in vitro Study. Int J Clin Pediatr Dent 2018;11(3):183-187.

Comparative Evaluation of Various Temperature Changes on Stress Distribution in Class II Mesial-occlusal-distal Preparation restored with Different Restorative Materials: A Finite Element Analysis

Introduction

The principal goal of dentistry is to maintain and improve the quality of life of the dental patients. As many of these objectives require the replacement or alterations of the existing tooth structure, the main challenge for centuries has been the development and selection of biocompatible materials that can withstand the unique conditions of the oral environment.

Finite element analysis (FEA) is a modern technique of numerical stress analysis that has become a solution to the task of predicting failure due to unknown stresses by showing problem areas in a material and allowing designers to see all of theoretical stresses within.

Aims and objectives

To evaluate and compare the effect of various temperature changes on the stress distribution, in class II mesial-occlusal-distal (MOD) cavity when restored with different restorative materials, using the finite element method (FEM).

Materials and methods

Using FEA, various thermal stresses generated in class II MOD lesion using different restorative materials were studied.

Results

The computer-generated models of intact tooth and teeth restored with the different restorative materials were designed, and thermal stress at different temperatures was observed when subjected to the thermal loads of 5°C, 20°C, 36°C, and 55°C. From the results of the study, it can be concluded that glass ionomer cement (GIC) performed best, followed by intact tooth, composite resin, silver amalgam, and zinc oxide eugenol cement.

Conclusion

Restoration of class II MOD lesions with materials of lower modulus of elasticity and lower coefficient of thermal expansion will enable better stress distribution.

How to cite this article: Srivastava B, Devi NN, Gupta N, Singh R. Comparative Evaluation of Various Temperature Changes on Stress Distribution in Class II Mesial-occlusal-distal Preparation restored with Different Restorative Materials: A Finite Element Analysis. Int J Clin Pediatr Dent 2018;11(3):167-170.

Evaluation of Changes in Salivary pH after Intake of Different Eatables and Beverages in Children at Different Time Intervals

Introduction

Dissolution of the enamel in the form of erosion has increased due to shift in eating habits toward carbonated drinks like soft drink and chocolates.

Aim

The purpose of this study was to evaluate changes in the salivary pH after intake of different eatables and beverages in children at different time intervals.

Study design

Using standard salivary tests, this study was conducted as a case-control study. Fifty children between ages of 8 and 12 years having strict vegetarian diet were included in the study.

Materials and methods

Oral prophylaxis was done and salivary buffer capacity for stimulated saliva was measured. Before the saliva collection, each of the children was informed not to eat or drink anything for up to 2 hours just before the appointment.

Results

On pairwise evaluation, all the differences were found to be significant statistically except between baseline vs 30 minutes. Maximum mean difference was calculated and observed between baseline and immediately after intake of fruit juice and immediate after 30 minutes, 0.953 and 0.963 respectively, while minimum difference was calculated and observed between baseline and 30 minutes after intake of fruit juice (0.010).

Conclusion

Maximum drop was seen in cold drink when compared with fruit juice. The maximum pH increase was observed in cream biscuits with 7.63 ± 0.20. It was observed that in all the groups, the pH gradually got back to near normal levels due to the buffering mechanism of saliva.How to cite this article: Pachori A, Kambalimath H, Maran S, Niranjan B, Bhambhani G, Malhotra G. Evaluation of Changes in Salivary pH after Intake of Different Eatables and Beverages in Children at Different Time Intervals. Int J Clin Pediatr Dent 2018;11(3):177-182.

Pediatric Dental Appointments No-show: Rates and Reasons

Aim

To determine the frequency and reasons of missed and canceled pediatric dental appointments and identifying the factors associated with it among the patients visiting the pediatric dental clinic of the dental college in Navi Mumbai, Maharashtra, India. To assess the parents' perception regarding the treatment of their children and to explore the merit of different management strategies regarding the missed appointments.

Materials and methods

Self-administered questionnaires were handed over to the parents in the waiting area, whose children were undergoing treatment in the pediatric dental clinic. Questionnaire included questions pertaining to the sociodemo-graphic characteristics, methods of remembering appointments, and satisfaction with the overall past clinic experience.

Results

Of the 294 surveyed sample, 52.0% stated that they have missed an appointment. Highest percentage of the patients had missed due to parents' forgetfulness and patient's exams; 52.0% relied on their memory to remember their appointments, and 44.5% used their diaries and mobiles as a means of reminders. For canceling an appointment, most of them stated that patient was unwell and parents' commitments toward other work led to an increase in rates of no-shows. Socioeconomic status and the methods of remembering the appointment date were found to be significantly correlated with missing an appointment among the surveyed sample (p < 0.05); 48.3% said that they would want a call from the dentist a day prior to their appointment as a reminder.

Conclusion

Around one half of the patients attending the pediatric dental clinic missed their appointments. Patients most likely to fail to keep an appointment was the one who was young, remembered appointment via memory, came from a high socioeconomic class, most of them were males, and had previously broken appointments, while patients preferred receiving a call from the dentist as a reminder aide.

Clinical significance

Missing appointment creates a series of problems. Firstly, it deprives another patient the opportunity of getting treated. Secondly, it contributes to the development of long waiting list for dental services. Thirdly, it affects the patient's treatment time and may cause increase in the dental emergencies leading to a disruption in the doctor-patient relationship and behavioral management problems.How to cite this article: Bhatia R, Vora EC, Panda A. Pediatric Dental Appointments No-show: Rates and Reasons. Int J Clin Pediatr Dent 2018;11(3):171-176.

X-ray microtomography assessment of Carisolv and Papacarie effect on dentin mineral density and amount of removed tissue

OBJECTIVE

The aim of the present study was to directly compare Carisolv and Papacarie regarding the volume of removed tissue (RT) and dentin mineral density (DMD) after excavation.

MATERIALS AND METHODS

Twenty permanent molars were randomized into two groups where caries was excavated using Carisolv or Papacarie followed by removal of softened tissue by a blunt instrument. X-ray microtomography was used to scan teeth before and after excavation generating two- and three-dimensional images that were used to calculate the percentage of RT relative to baseline tooth tissue volume and DMD that was categorized into sound dentin (>1.11 g/cm³) and residual caries (≤1.11 g/cm³). The two groups were compared using t-test Fisher exact test.

RESULTS

DMD was higher after Papacarie than Carisolv (mean = 1.70 and 1.14, p = .14) with higher percentage of cases with sound dentin (70 and 60%, p = 1.00). The percentage of RT was lower after Papacarie than Carisolv (7.40 and 8.95%, p = .31) with 22.95% less RT in cases that ended with sound dentin after excavation.

CONCLUSIONS

There was higher DMD, more sound dentin and less RT when Papacarie was used compared to Carisolv.

Effect of different fluoride varnishes on remineralization of artificial enamel carious lesions

OBJECTIVES

To compare remineralization potential of topical fluoride varnishes with added calcium phosphate-based delivery systems on artificial enamel caries.

METHODS

Human enamel specimens (n = 60) were randomly divided into six groups: Group 0: Control (no varnish), Group 1: Duraphat^® , Group 2: MI Varnish^™ , Group 3: Embrace^™ Varnish, Group 4: Enamel Pro^® Varnish, and Group 5: Clinpro^™ White Varnish. Specimens were immersed in demineralizing solution for 96 h to create artificial caries lesion. Each specimen was then immersed in artificial saliva for 6 h after fluoride varnish application and pH cycling was performed for 8 days. Specimens were evaluated using Knoop surface microhardness (KHN) and transverse microradiography (TMR). One-way anova test was performed to examine the effect of fluoride varnishes on change in percentage of surface hardness recovery (%SHR), change in lesion depth (ΔLD), and change in mineral loss (ΔΔZ) with the significance limit set at 5%.

RESULTS

%SHR of enamel following treatment with Group 1 was significantly higher than Group 3 and Group 4. Conversely, ΔLD and ΔΔZ of Group 1 were significantly higher than Group 2, Group 3, and Group 4. No significant differences in %SHR, ΔLD, and ΔΔZ were found between Group 1 and Group 5.

CONCLUSIONS

Duraphat^® alone achieves significant remineralization of enamel carious lesions. Clinpro^™ White Varnish had similar enamel remineralization effect as Duraphat^® .

Dentin Topographic Features following Chemomechanical Caries Removal in Primary Teeth

AIM

Study the topographic features of dentin after caries removal with a chemomechanical agent (Papacarie) compared with the conventional drilling method.

STUDY DESIGN

The sample included 7 exfoliated and extracted primary teeth with carious dentin lesions, not reaching the pulp. Each tooth was sectioned longitudinally through the center of the carious lesions into two halves. The teeth were then divided into two groups according to the method of caries removal. Following caries removal, dentin topography and the cut section were examined using the scanning electron microscope.

RESULTS

Papacarie produced an irregular, porous, rough and globular dentin appearance. The dentin surfaces were generally free of smear layer, visible bacteria and the dentinal tubules were opened. The dentin cut surfaces showed patent dentinal tubules with open orifices. The drilling method created a smooth and amorphous surface with a continuous smear layer occluding the dentinal tubules. Numerous bacteria were also observed. The cut dentin surfaces showed patent dentinal tubules with their orifices plugged with smear layer.

CONCLUSIONS

Papacarie produced a rough and porous surface with partial or complete removal of the smear layer and opened dentinal tubules, while the drill produced a smooth surface with uniform smear layer occluding the dentinal tubules.

Microindentation hardness and calcium/phosphorus ratio of dentin following excavation of dental caries lesions with different techniques

BACKGROUND

The aim of this in vitro study was to evaluate the microindentation hardness and chemical composition of residual dentin left at the cavity bottom following removal of carious dentin using the Carisolv chemomechanical and Er:YAG laser caries excavation methods in comparison with the conventional tungsten-carbide bur excavation.

METHODS

Sixty-nine extracted permanent teeth with occlusal dentin caries were assigned into three groups according to caries removal technique. Carious dentin excavation was guided by tactile method and a caries-staining dye. In stereomicroscope images (100×) of the samples, the presence or absence of residual caries was defined. The Knoop hardness value of the cavity floor was determined and atomic analysis of treated cavities was performed by energy dispersive X-ray spectroscopy.

RESULTS

The Knoop hardness value of residual dentin left at the cavity bottom was lower (One-way ANOVA, Dunnett-C, p < 0.05) and the percentage of samples with remaining carious dentin was higher after Carisolv excavation than those obtained after conventional and laser excavations (Kruskal-Wallis, Mann-Whitney U, p < 0.05). No significant differences were found between the quantities of calcium content (Ca wt%), phosphorus content (P wt%) and calcium/phosphorus ratio of the cavities treated by three techniques (Kruskal-Wallis, Mann-Whitney U, p > 0.05).

CONCLUSION

The results indicated that Er:YAG laser was more comparable to conventional bur excavation than chemomechanical method in the efficacy of caries removal with regard to microindentation hardness of remaining dentin and both Carisolv gel and Er:YAG laser did not alter chemical composition of residual dentin in the treated cavities.

Data Fitting to Study Ablated Hard Dental Tissues by Nanosecond Laser Irradiation

Laser ablation of dental hard tissues is one of the most important laser applications in dentistry. Many works have reported the interaction of laser radiations with tooth material to optimize laser parameters such as wavelength, energy density, etc. This work has focused on determining the relationship between energy density and ablation thresholds using pulsed, 5 nanosecond, neodymium-doped yttrium aluminum garnet; Nd:Y3Al5O12 (Nd:YAG) laser at 1064 nanometer. For enamel and dentin tissues, the ablations have been performed using laser-induced breakdown spectroscopy (LIBS) technique. The ablation thresholds and relationship between energy densities and peak areas of calcium lines, which appeared in LIBS, were determined using data fitting. Furthermore, the morphological changes were studied using Scanning Electron Microscope (SEM). Moreover, the chemical stability of the tooth material after ablation has been studied using Energy-Dispersive X-Ray Spectroscopy (EDX). The differences between carbon atomic % of non-irradiated and irradiated samples were tested using statistical t-test. Results revealed that the best fitting between energy densities and peak areas of calcium lines were exponential and linear for enamel and dentin, respectively. In addition, the ablation threshold of Nd:YAG lasers in enamel was higher than that of dentin. The morphology of the surrounded ablated region of enamel showed thermal damages. For enamel, the EDX quantitative analysis showed that the atomic % of carbon increased significantly when laser energy density increased.

Caries Removal by Chemomechanical (Carisolv™) vs. Rotary Drill: A Systematic Review

Background:

Chemomechanical caries removal is an effective alternative to the traditional rotary drilling method. The advantages of chemomechanical techniques in terms of the need for anesthesia, pain perception and patient preference are systematically reviewed and a meta-analysis of the time required for caries removal is reported.

Method:

Randomized controlled studies of comparison of chemomechanical techniques with conventional rotary drill were selected from a systematic search of standard biomedical databases, including the PubMed and Cochrane clinical trials. Non-repeated search results were screened for relevance and risk of bias assessment, followed by methodology assessment. Statistical models were applied to the outcome parameters - time required, pain perception, need of anesthesia and patient preference - extracted from the studies.

Results:

Out of the 111 non-repeated search results, 26 studies receiving a low bias score were selected for the review, and 16 randomized clinical trials of rotary and Carisolv techniques were considered for meta-analysis. Meta-analysis by fixed effect as well as random effect models indicate that Carisolv takes more time (3.65 ± 0.05 and 4.09 ± 0.29 min) than rotary drill (8.65 ± 0.09 and 8.97 ± 0.66 min) method. Advantages of reduced pain (14.67 for Carisolv vs. 6.76 for rotary drill), need for anesthesia (1.59% vs. 10.52%) outweigh the longer time requirement and make it the preferred (18.68% vs. 4.69%) method.

Conclusion:

Chemomechanical techniques stand out as a minimally invasive and preferred method based on the meta-analyses. Evaluation of pain experienced using robust methods is needed to strengthen the evidence for their use.

Chemomechanical versus drilling methods for caries removal: an in vitro study

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.

Effect of papain-based gel on type I collagen--spectroscopy applied for microstructural analysis

Considering the improvement of biomaterials that facilitate atraumatic restorative techniques in dentistry, a papain-based gel can be used in the chemomechanical removal of decayed dental tissue. However, there is no information regarding the influence of this gel on the structure of sound collagen. The aim of the present study was to investigate the adsorption of a papain-based gel (Papacarie^TM) to collagen and determine collagen integrity after treatment. A pilot study was first performed with 10 samples of type I collagen membrane obtained from bovine Achilles deep tendon to compare the influence of hydration (Milli-Q water) on infrared bands of collagen. In a further experiment, 10 samples of type I collagen membrane were used to evaluate the effects of Papacarie^TM on the collagen microstructure. All analyses were performed using the attenuated total reflectance technique of Fourier transform infrared (ATR-FTIR). The results demonstrated that the application of Papacarie^TM does not lead to the degradation of collagen and this product can be safely used in minimally invasive dentistry. As the integrity of sound collagen is preserved after the application of the papain-based gel, this product is indicated for the selective removal of infected dentin, leaving the affected dentin intact and capable of re-mineralization.

Effect of chemomechanical caries removal on bonding of resin-modified glass ionomer cement adhesives to caries-affected dentine

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.

Current update of chemomechanical caries removal methods

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.

Evaluation of Marginal Leakage and Shear Bond Strength of Bonded Restorations in Primary Teeth after Caries Removal by Conventional and Chemomechanical Techniques

Background/Purpose. To evaluate and compare the marginal leakage and shear bond strength between conventional and Papacarie techniques of caries removal in primary molars. Materials and Methods. Sixty freshly extracted human carious primary molars were randomly divided into two groups: group I—caries removal by conventional method and group II—caries removal using Papacarie. After bonded restorations, both groups were further randomly subdivided into four subgroups for marginal leakage and shear bond strength evaluation. Results. Papacarie treated teeth (46.70%) showed less marginal leakage when compared to conventionally treated teeth (86.70%) for caries removal. The mean shear bond strength was found more in Papacarie treated teeth (12.91 MPa) than in those treated conventionally (9.64 MPa) for caries removal. Conclusion. Papacarie showed less marginal leakage and more shear bond strength when compared to those treated conventionally for caries removal.