Clinical evaluation of chemomechanical caries removal in primary molars and its acceptance by patients

Interventions for treating cavitated or dentine carious lesions

BACKGROUND

Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC).

OBJECTIVES

To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro-cavitated lesions, or occlusal lesions that are clinically non-cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps.

SEARCH METHODS

An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies.  SELECTION CRITERIA: We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non- or micro-cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions).

DATA COLLECTION AND ANALYSIS

Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta-analysis to assess and rank the relative effectiveness of different interventions.

MAIN RESULTS

We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty-four studies used a parallel-group design and three were split-mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non-cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth.  Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing  with sealant materials (2); sealant materials versus no sealing (2).  Follow-up times varied from no follow-up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months. All studies were at overall high risk of bias. Effect of interventions Sealing using sealants versus other interventions for non-cavitated or cavitated but not deep lesions There was insufficient evidence of a difference between sealing with sealants and CR (OR 5.00, 95% CI 0.51 to 49.27; 1 study, 41 teeth, permanent teeth, cavitated), sealing versus SE (OR 3.11, 95% CI 0.11 to 85.52; 2 studies, 82 primary teeth, cavitated) or sealing versus no treatment (OR 0.05, 95% CI 0.00 to 2.71; 2 studies, 103 permanent teeth, non-cavitated), but we assessed all as very low-certainty evidence. HT, CR, SE, NRCC for cavitated, but not deep lesions in primary teeth The odds of failure may be higher for CR than HT (OR 8.35, 95% CI 3.73 to 18.68; 2 studies, 249 teeth; low-certainty evidence) and lower for HT than NRCC (OR 0.19, 95% CI 0.05 to 0.74; 1 study, 84 teeth, very low-certainty evidence). There was insufficient evidence of a difference between SE versus HT (OR 8.94, 95% CI 0.57 to 139.67; 2 studies, 586 teeth) or CR versus NRCC (OR 1.16, 95% CI 0.50 to 2.71; 1 study, 102 teeth), both very low-certainty evidence. CR, SE, SW for deep lesions The odds of failure were higher for CR than SW in permanent teeth (OR 2.06, 95% CI 1.34 to 3.17; 3 studies, 398 teeth; moderate-certainty evidence), but not primary teeth (OR 2.43, 95% CI 0.65 to 9.12; 1 study, 63 teeth; very low-certainty evidence). The odds of failure may be higher for CR than SE in permanent teeth (OR 11.32, 95% CI 1.97 to 65.02; 2 studies, 179 teeth) and primary teeth (OR 4.43, 95% CI 1.04 to 18.77; 4 studies, 265 teeth), both very low-certainty evidence. Notably, two studies compared CR versus SE in cavitated, but not deep lesions, with insufficient evidence of a difference in outcome (OR 0.62, 95% CI 0.21 to 1.88; 204 teeth; very low-certainty evidence). The odds of failure were higher for SW than SE in permanent teeth (OR 2.25, 95% CI 1.33 to 3.82; 3 studies, 371 teeth; moderate-certainty evidence), but not primary teeth (OR 2.05, 95% CI 0.49 to 8.62; 2 studies, 126 teeth; very low-certainty evidence). For deep lesions, a network meta-analysis showed the probability of failure to be greatest for CR compared with SE, SW and HT.

AUTHORS' CONCLUSIONS

Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition. Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons.

BRIX3000® Papain Gel for Cavity Treatment in the Adult Patient

Tooth decay is a multifactorial disease. Fermentable sugar, host factors, and cariogenic microbial flora are several agents that influence dental structure. In literature, alternative protocols for treating cavities are always of interest in terms of reducing pain and preserving tissue. In this case report, the use of a new gel-based on papain, which has a chemical effect on bacteria and allows the consistency of the altered tissue to be modified, leads to a less traumatic removal of the infected tissue. In this case report, BRIX3000, a gel with papain as its main ingredient, was used to treat an interproximal cavity on an upper premolar of a 35-year-old man frightened of the turbine. After a clinical check of all the systematic conditions and a first view of the oral cavity, the protocol was explained to the patient, and informed consent was obtained. The protocol involved applying the papain gel directly to the cavity, and after 2.5–3 minutes, it was removed. The complete removal of the infected tissue was achieved in three steps. The patient reported no discomfort, and the cavity was completely treated and ready to be restored. In conclusion, BRIX3000 seems to be a good alternative to the turbine in cavity treatment, particularly in patients who have discomfort during traditional treatments and are frightened of the turbine.

New treatment method for pain and reduction of local anesthesia use in deep caries

Chemo-mechanical caries removal methods are known to be more effective compared with conventional methods in pain reduction. Carie-care™, a chemo-mechanical caries removal agent, was introduced in 2010 but a systematic review of its efficacy has not yet been performed. The purpose of this study was to investigate the effectiveness of Carie-care™ on the outcomes of treatment of caries in children and adolescents. The primary outcome was pain while the secondary outcomes included complete caries removal (CCR), time, need for local anesthesia and behavioral response changes.

A Comprehensive literature search was performed in PubMed, EMBASE, and the Cochrane Library up to 30 September 2018. The following keywords were used in the search: ‘chemo-mechanical caries removal agent’, ‘dental caries’, ‘Carie-care’, ‘chemo-mechanical caries removal’, ‘chemo-mechanical caries excavation’, other related keywords, and their combinations. From 942 studies identified, 16 were analyzed. Finally, 4 studies met the eligibility criteria and 260 teeth in 120 children and adolescents were included in this review.

This review showed that Carie-care™ reduces pain during caries treatment but requires a longer time for effective treatment than conventional methods. Local anesthesia was not required in the Chemo-mechanical caries removal (CMCR) group. In addition, dental anxiety decreased compared to the control group, and co-operation was more positive. Therefore, it may be a useful alternative to conventional methods in children and adolescents, but further verification through additional studies is 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.

Effects of Papacarie on children with dental caries in primary teeth: a systematic review and meta-analysis

BACKGROUND

Caries in primary teeth hinder the child to bite and chew and influence their development. Papacarie has the characteristics of selective removal of decayed tissue and can preserve healthy dentine to the maximum, but its efficiency has not been critically evaluated compared to conventional method.

AIM

This review is aiming at comparing the Papacarie and traditional method in caries removal in primary dental caries with children.

DESIGN

Comprehensive literature searching at PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science to January 2018.

RESULTS

Six randomized controlled trials (RCTs) and four prospective controlled clinical trials (CCTs) were included. The microbiota in caries dentine was significantly reduced using the Papacarie treatment (MD = 0.57, 95% CI 0.04 to 1.09, P = 0.03), and the anxiety feeling declined more in the Papacarie group (MD = -1.01, 95% CI -1.72 to -0.30, P < 0.005). There was a greater 200.79 (MD = 200.79, 95%CI 152.50 to 249.09, P < 0.00001) increase in time taken for the Papacarie treatment compared with the conventional method.

CONCLUSION

Papacarie exerts a positive effect in reducing the bacteria and decreases the pain during caries removal in primary teeth although it costed a longer treatment time compared with the conventional method.

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.

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.

Chemomechanical caries removal method versus mechanical caries removal methods in clinical and community-based setting: A comparative in vivo study

Objective:

To compare the effectiveness of various caries removal techniques in mandibular primary molars using Smart Burs, atraumatic restorative technique (ART) (mechanical caries removal) and Carie-care (chemomechanical caries removal [CMCR]) among primary school children in clinical and community-based settings.

Materials and Methods:

A total of 80 carious primary mandibular molars were selected for the study from the dental clinic and community. They were equally assigned to four groups according to caries removal technique and also by the operating site. In Group 1, caries was removed using Carie-care in the dental clinic and in Group 2, with Smart Burs in the dental clinic. In Group 3, caries was removed using Carie-care in the field and in Group 4, with the ART in the field. The time taken for caries removal, the efficacy of caries removal and patient acceptance were evaluated with different caries removal techniques.

Statistical Analysis:

The obtained data were subjected to statistical analysis by ANOVA test.

Results:

In clinical settings, Carie-care was time-consuming but was more efficient with increased acceptance than Smart Burs and the result was found to be significant statistically (P < 0.05). In community-based settings, Carie-care was more efficient, less time consuming, and showed an increased acceptance when compared to atraumatic restorative treatment and the result was found to be significant statistically (P < 0.05).

Conclusions:

The CMCR technique was superior to the mechanical caries removal technique in primary teeth among school children in terms of time, efficacy, and acceptance in both clinical- and community-based settings.

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.

Efficacy of antimicrobial property of two commercially available chemomechanical caries removal agents (Carisolv and Papacarie): An ex vivo study

PURPOSE

The purpose of the study is to evaluate the antimicrobial efficacy of Carisolv and Papacarie. There are only a few studies comparing the primary teeth. The objective of this study is to assess the effects of Carisolv and Papacarie on cariogenic flora and to compare them.

MATERIALS AND METHODS

Fifteen children aged 4-8 years who had at least two primary molars with broad occlusal cavitated lesions showing brown and softened dentin samples were selected. The selected 30 teeth were randomly divided into two groups of 15 teeth each for Carisolv and Papacarie. Dentin samples of both groups were taken prior to and following caries removal. The total viable count and lactobacilli count were determined and expressed as colony forming units per milliliter. The two methods of caries removal were then compared and the data were statistically analyzed.

RESULTS

The data of both agents (groups) were analyzed by Wilcoxon signed-rank test before and after application and showed statistical significance. Inter-comparison of data of both groups was analyzed by Mann-Whitney U test for total viable count and total Lactobacillus count which showed no statistical significance.

CONCLUSION

Carisolv and Papacarie have similar antibacterial efficacy against cariogenic flora as chemomechanical caries removal agents.

Recent vs Conventional Methods of Caries Removal: A Comparative in vivo Study in Pediatric Patients

Aims: To compare the three different methods of caries removal, conventional method using Airotor and chemomechanical method using Carisolv and Papacarie.

Settings and design: The patients with multiple carious teeth were selected either in the deciduous dentition or mixed dentition. Ninety primary molars were selected from 30 children (10 males and 20 females) between the age group 6 and 9 years.

Materials and methods: After caries excavation, cavities were evaluated for caries removal or clinical efficacy by the tactile and visual criteria, microbiological efficacy, time taken for the procedure. Patient acceptability toward the treatment was also checked with the help of a visual analog scale (VAS). The observations thus obtained were subjected to statistical analysis using analysis of variance (ANOVA), Mann-Whitney U-test and Kruskal-Wallis test.

Results: The clinical efficacy of caries removal was highest with Airotor while the microbiological efficacy of caries removal was almost comparable with Airotor, Carisolv and Papacarie caries removal methods. The time taken to remove caries by Airotor method was observed to be least while the patient acceptance was found to be highest with Papacarie method.

How to cite this article: Chowdhry S, Saha S, Samadi F, Jaiswal JN, Garg A, Chowdhry P. Recent vs Conventional Methods of Caries Removal: A Comparative in vivo Study in Pediatric Patients. Int J Clin Pediatr Dent 2015;8(1):6-11.

Comparison of Carisolv system vs traditional rotating instruments for caries removal in the primary dentition: A systematic review and meta-analysis

OBJECTIVE

The purpose of this systematic review and meta-analysis was to evaluate the reliability of the Carisolv system with respect to drilling regarding the full removal of decayed hard tissues in primary dentition. A systematic review of the literature was conducted to identify controlled trails, randomized controlled trials and clinical trials that compared the Carisolv system to the traditional mechanical caries removal in the primary dentition.

MATERIALS AND METHODS

The main relevant databases were searched: MEDLINE via PUBMED, Web of Science and SCOPUS. Complete caries removal, length of working time and need of local anesthesia were the outcomes evaluated.

RESULTS

A total of 195 studies were identified and complete analysis of 28 studies was performed; finally, 10 papers were included. The trials included involved a total of 348 patients for 532 treated teeth. There was no significant difference in terms of clinical efficacy between the Carisolv and the rotary instrument (z = 0.68, p = 0.50), whereas the treatment with Carisolv was significantly longer in terms of time with respect to the rotary instruments (z = 10.49, p < 0.01). The chemo mechanical technique reduces the need for local anesthesia, with a difference between two types of treatment near to statistical significance (z = 1.91 p = 0.06).

CONCLUSIONS

This systematic review indicates that the clinical efficacy of chemo-mechanical removal with Carisolv seems as reliable as the rotary instruments. However, the results should be interpreted cautiously due to the heterogeneity among study designs and to the shortage of available data. Further large-scale, well-designed randomized controlled trials are needed.

A comparative clinical study of various methods of caries removal in children

AIM

The aim of the study was to compare the efficacy of caries removal, time taken and to evaluate the pain threshold experienced by children during various caries removal methods.

METHODS

One hundred and twenty patients aged between 4 and 14 years requiring dental restorations were selected. Caries removal was completed using an air-rotor, hand instruments, Carisolv and polymer burs. The efficacy, time taken and pain thresholds were evaluated during caries removal by Ericsson et al. scale, visual analogue scale and verbal pain scale, respectively.

STATISTICAL ANALYSIS

Data was collected and statistically analysed using one-way analysis of variance followed by Post Hoc comparison by Bonferroni method. The skewed data was analysed amongst groups by applying Kruskal-Wallis test followed by probability adjustment by Mann-Whitney test.

RESULT

These results indicated that the efficacy of caries removal was highest with air-rotor and was least by the hand instrument, whilst Carisolv® was least painful and the most time-consuming method.

CONCLUSIONS

Caries removal with polymer burs and Carisolv were found to be as effective in caries removal and could be considered as alternatives to painful procedures as air-rotor in management of caries especially in children.

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.

The Antibacterial Effects of Apacaries Gel on Streptococcus mutans: An in vitro Study

Background: New approaches for chemomechanical caries removal require effective materials with antibacterial properties for removal of infected dentin. Apacaries gel is a newly developed material comprised polyphenol from mangosteen extracts and papain mixed in gel preparation.

Aim: This study evaluated the antibacterial effects of Apacaries gel on Streptococcus mutans in vitro.

Materials and methods: Mangosteen pericarp powder was extracted. The amount of phenolic compounds was determined using the Folin-Ciocalteu method. The time-kill kinetics were investigated. Mangosteen extract and papain were mixed with gel base to develop Apacaries gel. The inhibition zone of the Apacaries gel was determined using agar well diffusion methods.

Results: The mangosteen pericarp extract, which contains α-mangostin, was active against S. mutans strain ATCC25175. The time-kill kinetics curve showed that applying 1 mg/ml of mangosteen extract can reduce S. mutans by 50% within approximately 5 seconds; after this reduction, the bacterial count rapidly dropped to 0 within 60 seconds. Using mangosteen extract and papain mixture gel preparation resulted in a larger inhibition zone than using the mangosteen extract gel or papain gel separately.

Conclusion: Apacaries gel can effectively inhibit S. mutans strain ATCC25175. Apacaries is capable of S. mutans inhibition better than both mangosteen extract or papain separately.

How to cite this article: Juntavee A, Peerapattana J, Ratanathongkam A, Nualkaew N, Chatchiwiwattana S, Treesuwan P.

The Antibacterial Effects of Apacaries Gel on Streptococcus mutans: An in vitro Study. Int J Clin Pediatr Dent 2014;7(2):77-81.

Efficacy of chemomechanical caries removal in reducing cariogenic microbiota: a randomized clinical trial

The aim of this study was to compare the efficacy of chemochemical methods (Carisolv™ and Papacárie®) versus the manual method (excavators) in reducing the cariogenic microbiota in dentine caries of primary teeth. Forty-six healthy children (5 to 9 years old) having at least one primary tooth with a cavitated dentine carious lesion were included in the study. The teeth presented no clinical or radiographic signs of pulpal involvement. The sample of 74 teeth was randomly divided into three different groups: Papacárie® (n = 25), Carisolv™ (n = 27) and Manual (n = 22). Samples of carious and sound dentine were collected with sterile excavators before and after caries removal in the three groups. The dentine samples were transferred to glass tubes containing a 1mL thioglycollate medium used as a carrier and enriched for microbiological detection of mutans streptococci and Lactobacillus spp, after incubation for 6h at room temperature. The minimum detection value for colony forming units (CFU) was 3.3 x 102 CFU/ml, and the results were converted into scores from 0 to 4. A significant difference was observed in relation to the microbiological scores before and after caries removal for all methods (Wilcoxon test; p < 0.001). The use of chemomechanical methods for caries removal did not improve the reduction of cariogenic microorganisms in dentine caries lesions, in comparison with manual excavation.

Evaluation of the Efficiency and Effectiveness of Three Minimally Invasive Methods of Caries Removal: An in vitro Study

BACKGROUND

Many chemomechanical caries removal (CMCR) agents have been introduced and marketed since 1970s, with each new one being better and effective than the previously introduced. Papacarie and Carisolv are new systems in the field of CMCR techniques. These are reportedly minimally invasive methods of removing carious dentin while preserving sound dentin.

AIM

To compare the Efficiency (time taken for caries removal) and effectiveness (Knoop hardness number of the remaining dentin) of caries removal by three minimally invasive methods, i.e. hand excavation and chemomechanical caries removal using Carisolv and Papacarie.

MATERIALS AND METHODS

Thirty recently extracted human permanent molars with occlusal carious lesions were divided randomly in three equal groups and bisected through the middle of the lesion mesiodistally and excavated by two methods on each tooth.

RESULTS

Statistically significant difference was present among three methods with respect to time and knoop hardness values (KHN) of the remaining dentin.

CONCLUSION

The Efficiency of Hand method is better compared to CMCR techniques and effectiveness of CMCR techniques is better than Hand method in terms of dentin preservation so the chances of maintaining vitality of the pulp will be enhanced. How to cite this article: Boob AR, Manjula M, Reddy ER, Srilaxmi N, Rani T. Evaluation of the Efficiency and Effectiveness of Three Minimally Invasive Methods of Caries Removal: An in vitro Study. Int J Clin Pediatr Dent 2014;7(1):11-18.

Effect of two different chemomechanical caries removal agents on dentin microhardness: An in vitro study

Aim:

The aim of this in vitro study was to evaluate the effect of two different chemomechanical caries removal (CMCR) agents on dentin microhardness.

Materials and Methods:

In this study, the crown portion of ten carious-free and ten caries-affected teeth were selected. In carious-free samples, the teeth were decoronated at the level of cemento – enamel junction. Only the crown portion of the teeth was selected. Occlusal one-third of the crowns were cross-sectioned and discarded to expose the dentin, and it was divided into two groups, five teeth in each group. Then, they were further sectioned longitudinally through the centre. In one group, no agent was applied on one half and Carisolv was applied on other half. In another group, no agent was applied on one-half and Carie-Care was applied on the other half for 1 min. In carious samples, the crowns were sectioned through the centre of carious lesion. Carisolv was applied on one-half and Carie-Care was applied on the other half. After using CMCR agents, surface hardness of dentin was examined using Vickers hardness number (VHN).

Statistical Analysis and Results:

The data were analyzed using t-test and one-way analysis of variance (ANOVA). There were no significant difference among normal dentin (62.91 ± 2.76), Carisolv-treated normal dentin (61.72 ± 2.89), and Carie-Care-treated normal dentin (61.90 ± 3.19). In carious samples, the results of Carisolv-treated dentin (58.57 ± 2.62) was not statistically significantly different from those of the Carie-Care-treated dentin (56.77 ± 4.41).

Conclusion:

In conclusion, neither of the CMCR methods caused a significant change in the microhardness of normal dentin and the treated carious dentin.

Comparison of Marginal Microleakage of Glass Ionomer Restorations in Primary Molars Prepared by Chemo-mechanical Caries Removal (CMCR), Erbium: Yttrium Aluminum-Garnet (Er:YAG) Laser and Atraumatic Restorative Technique (ART)

Background: It is important to emphasize that the aspects of pretreatment techniques, as well as the composition and mechanism of adhesion, may decisively influence the effectiveness of the restorative materials in sealing cavity margins and preventing marginal leakage.

Aims: This study assessed the in vitro influence of surface preparation techniques on the microleakage of glass ionomer restorations in primary teeth.

Materials and methods: The study groups were divided into three different techniques: (1) The chemomechanical caries removal (CMCR) method using the Apacaries gel, (2) the erbium:yttrium aluminum-garnet (Er:YAG) laser method and (3) the atraumatic restorative technique (ART). The teeth restored with a glass ionomer restorative material (Fuji IX GP capsule, GC Corporation, Tokyo, Japan). The dye penetration was measured in micrometers using a polarized light microscope and specific computer software.

Results: The results showed that the mean microleakage level after was lowest with the CMCR method using Apacaries gel and highest with the Er:YAG laser. There was a statistically significant difference regarding the mean microleakage level between the group with the CMCR method using Apacaries gel and the Er:YAG laser.

Conclusion: Marginal leakage was significantly higher with preparations made using the Er:YAG laser than with the CMCR method using Apacaries gel and spoon excavator (p < 0.05).

How to cite this article: Juntavee A, Juntavee N, Peerapattana J, Nualkaew N, Sutthisawat S. Comparison of Marginal Microleakage of Glass Ionomer Restorations in Primary Molars Prepared by Chemomechanical Caries Removal (CMCR), Erbium: Yttrium Aluminum-Garnet (Er:YAG) Laser and Atraumatic Restorative Technique (ART). Int J Clin Pediatr Dent 2013;6(2):75-79.

A comparative microbiological study to assess caries excavation by conventional rotary method and a chemo-mechanical method

AIMS

This study was aimed to determine the effectiveness of Papacárie(®) for caries removal as compared to the conventional method with respect to microbial flora, time, the amount of tissue removal, child's behavior, pain perception, and preference of treatment.

MATERIALS AND METHODS

Sixty primary molars of 30 children of age 4-9 years were selected randomly and divided into two groups of 30 teeth each: Group A treated by conventional method and group B with Papacárie(®) method.

RESULTS

Comparatively, no statistical difference was seen in microbial growth, total bacterial count, and lactobacilli count in both the groups (P = 0.36). The mean cavity entrance size with group A was 0.98133 mm and group B was 0.26083 mm (P < 0.001). The mean preparation time for group A was 4.7 Mins (minutes) and group B was 17.96 min s (P < 0.001). Majority of kids of both group A and B scored 3 (Frankl Behavior Rating Scale) before and after the treatment showing no statistical difference in their behavioral score (P = 1). In group A 50% of children experienced no pain as compared to 86.7% in group B (P = 0.01). There was no statistical difference in the preference of treatment (P = 0.12).

CONCLUSION

Thus, the Chemo mechanical caries removal method can be considered as an effective method to control pain and preserve sound tooth structure during caries excavation.

Alternative treatment strategies for carious primary teeth: An overview of the evidence

BACKGROUND

Dental decay in children's primary teeth is a major health problem in the Great Britain with, in some areas, nearly 60% of five-year-olds having some experience of caries and 16% already having had at least one tooth extracted. Whilst currently accepted best practice for the management of carious primary teeth involves complete caries removal and placement of a plastic restoration, such conventional treatment is unpopular with general dental practitioners. Indeed, less than 15% of carious cavities in five-year-olds are currently restored and as such, there has been recent interest in alternative 'minimal intervention' treatment techniques for managing dental caries.

REVIEW

This review summarises the literature and also recent research efforts directed towards understanding the role of alternative treatment regimens including: (1) alternative techniques for cavity preparation and excavation and (2) the isolation of the carious process (in some cases, using cariostatic materials) from the oral environment or sealing in dental caries.

Clinical evaluation of a chemomechanical method for caries removal in children and adolescents

OBJECTIVE

The purpose of this study was to make a clinical comparison of the chemomechanical method for caries removal and the conventional rotary instruments technique when used in children and adolescents.

MATERIAL AND METHODS

The study comprised 120 patients aged 3-17 years randomized into two groups: caries were removed chemomechanically in 60 patients and 60 patients received conventional treatment with rotary instruments. The outcome variables were: clinically complete caries removal, pain during caries removal, need for local anesthesia, treatment time, preferences of patients, and clinical success of the restorations during the 12-month evaluation period.

RESULTS

Complete caries removal was achieved in 92% of chemomechanically treated teeth and in all teeth treated with rotary instruments (p>0.05). The chemomechanical method significantly reduced the need for local anesthesia (p<0.001). Eighty-five percent of patients treated with Carisolv and 47% treated with rotary instruments were satisfied with the treatment (p<0.05). The mean time for chemomechanical caries removal was 11.2 ± 3.3 min and 5.2 ± 2.8 min for caries removal with rotary instruments (p<0.001). At the end of the 12-month evaluation period, there was no observed influence of the caries removal method on the survival of the restorations.

CONCLUSIONS

The chemomechanical caries removal technique is an adequate alternative to the conventional rotary instruments method and is advantageous in pediatric dentistry.

Permeability evaluation after decay removal in primary teeth with current caries-excavation techniques

AIM

The goal of the study was to evaluate the effect of caries removal by three various methods on the permeability of class II composite resin restorations in primary molar teeth.

MATERIALS AND METHODS

Forty-five recently extracted primary molars were randomly assigned to three groups for three different methods of caries removal; group 1-mechanical, group 2-caries detector dye, and group 3-Carisolv (n = 15). After that, class II cavities in all groups were restored with the adhesive (Opti Bond Solo Plus) that was applied according to the manufacturer's instruction and a posterior composite (Herculite XRV), which was used incrementally. After 24 hours the samples were thermocycled in water for 500 cycles between 5 and 55°C with a dwell time of 30 sec. Permeability was assessed by the fluid filtration method. The data were analyzed using the ANOVA test while study groups were compared with Tukey test for statistically significant differences at a 5% significance level.

RESULTS

The evaluation of tested groups indicated that the highest (0.80) and least (0.37) mean of permeability was observed in group 2 and 3 respectively. Significant difference was revealed among the tested groups (p = 0.045). The comparison of Carisolv and caries detector dye groups indicated a statistically significant difference (p = 0.037). There was not any significant difference between Carisolv or caries dye in the conventional group.

CONCLUSION

Using the chemomechanical and staining methods for caries removal had no more detrimental effect on permeability than the conventional technique. However, caries detection dye for caries removal could be more harmful than chemomechanical method.

CLINICAL SIGNIFICANCE

None of the current caries-excavation techniques could eliminate permeability in class II composite resin restorations. Furthermore, staining methods do not have an adverse effect on sealing ability in comparison to the conventional technique.

Comparsion of the efficacy of chemomechanical and mechanical methods of caries removal in the reduction of Streptococcus mutans and Lactobacillus spp in carious dentine of primary teeth

The methods of caries removal have been the subject of many studies over the last years. At present, methods involving the least tissue invasion have been outstanding in the field of surgical-restorative treatment. In this context, the Carisolv™ system has appeared as a less traumatic and less invasive approach, particularly in pedodontics. Thus, the objective of the present study was to carry out a comparative analysis of the dentinal structure of primary molars before and after the removal of carious tissue by mechanical (low speed drills and conventional dentinal curettes) and chemomechanical (Carisolv™ kit) procedures based on quantitative culture for cariogenic bacteria to determine the number of bacteria present in the carious dentine after both treatments. Sixty primary molars from children ranging in age from 4 to 8 years, with active occlusal caries in dentine, were divided into two groups (A and B) of 30 teeth each, with group A having been treated by the chemomechanical technique and group B by the mechanical technique. Dentin samples were placed in glass vials containing 1 mL thioglycolate broth and submitted to culture to determine the number of S. mutans and Lactobacillus per mg of decayed dentine. The results did not reveal significant differences between the two methods of caries removal; however, the chemomechanical method was more efficient in completely eliminating S. mutans (p=0.02). In summary, the present results confirm previous studies showing that the two methods are comparable in reducing Lactobacillus, but Carisolv™ is more effective in the elimination of S. mutans.

The evaluation of the vector system in removal of carious tissue

The aim of this study was to evaluate the Vector system in comparison to the conventional technique in cavity preparation. Four extracted primary teeth with no restorations and similar fissure carious lesions and four permanent teeth extracted for orthodontic reasons were used. Class I preparations were made provided that the caries depth remained within the dentin limits. Two teeth were treated with an aerator, the other two had carious tissue removed with the Vector system. Prepared cavities were evaluated with scanning electron microscopy for the surface roughness of the dentine and enamel and for the carious tissue removal efficiency. This pilot study determined that it is possible to remove carious tissue and perform cavity preparation with the Vector system. According to this preliminary evaluation of surface quality, a cavity prepared with the Vector treatment system, allows for a slicker floor, and a more regular enamel-dentine line than that prepared with an aerator. However, the Vector system requires a longer treatment time which we believe may be a negative point, especially for young patients.

Two years survival rate of class II composite resin restorations prepared by ART with and without a chemomechanical caries removal gel in primary molars

The aim was to test the null hypotheses that there is no difference: (1) in carious lesion development at the restoration margin between class II composite resin restorations in primary molars produced through the atraumatic restorative treatment (ART) with and without a chemomechanical caries removal gel and (2) in the survival rate of class II composite resin restorations between two treatment groups after 2 years. Three hundred twenty-seven children with 568 class II cavitated lesions were included in a parallel mouth study design. Four operators placed resin composite (Filtek Z 250) restorations bonded with a self-etch adhesive (Adper prompt L pop). Two independent examiners evaluated the restorations after 0.5, 1, and 2 years using the modified Ryge criteria. The Kaplan-Meier survival method was applied to estimate survival percentages. A high proportion of restorations were lost during the study period. Therefore, the first hypothesis could not be tested. No statistically significant difference was observed between the cumulative survival percentages of restorations produced by the two treatment approaches over the 2-year period (ART, 54.1 +/- 3.4%; ART with Carisolv, 46.0 +/- 3.4%). This hypothesis was accepted. ART with chemomechanical gel might not provide an added benefit increasing the survival percentages of ART class II composite resin restorations in primary teeth.

Fluorescence of primary dentine after chemomechanical and conventional rotary excavation

AIM

This was to compare fluorescence values of dentine remaining after caries removal using chemomechanical systems and conventional rotary methods.

STUDY DESIGN

In vitro study.

METHODS

30 extracted primary teeth with proximal carious cavities were divided into three groups according to caries removal method: Carisolv, Papacarie and conventional low speed rotary burs. Carious (initial) and remaining (final) dentine evaluations were assessed by visual-tactile examination and DIAGNOdent. Transversal microhardness (TMH) of remaining dentine was evaluated. Fluorescence and TMH values were submitted to two-way ANOVA and the post hoc Tukey test (alpha = 0.05) and Pearson's linear correlation.

RESULTS

Two-way ANOVA revealed that fluorescence values were similar between conventional rotary excavation, Carisolv and Papacarie groups (p = 0.0542). No statistically significant differences (p = 0.1147) were found to TMH values. No correlation was found between fluorescence and TMH values (r = -0.0273).

CONCLUSION

All caries excavation methods resulted in similar remaining dentine fluorescence values. No correlation was found between fluorescence values and TMH of remaining dentine.

Chemomechanical caries removal in children: an operator's and pediatric patients' responses

BACKGROUND

This study investigated an operator's and pediatric patients' responses to chemo-mechanical caries removal (CMCR) versus the traditional method (TM) of caries removal using a handpiece and a round bur when treating dentinal-depth occlusal lesions with minimal enamel access in primary molars.

METHODS

Data were collected from 50 children at baseline and before, during and after caries removal using CMCR or TM. The subjects in the CMCR group were on average younger than the subjects in the TM group and had more deep lesions.

RESULTS

The operator rated CMCR as needing more clinical and technical effort and more total effort than TM. He was less satisfied with CMCR than with TM. Subjects in the CMCR group perceived the time needed for treatment as significantly longer than did the subjects in the TM group. Fear of the dentist decreased in subjects in the TM group from before to after the operative appointment, while it increased in subjects in the CMCR group.

CONCLUSIONS

The authors found no direct advantage in using CMCR over using TM.

CLINICAL IMPLICATIONS

CMCR cannot be recommended as an alternative to TM when treating dentinal depth occlusal lesions with minimal access in primary molars.

Chemomechanical caries removal in children: efficacy and efficiency

BACKGROUND

The authors investigated the effectiveness of chemomechanical caries removal (CMCR) compared with the traditional method (TM) of caries removal using a round bur when treating dentinal-depth occlusal lesions with minimal enamel access in primary molars. The authors also compare CMCR with TM to determine if it had a higher efficacy and could be used more frequently without the subject's having to undergo local anesthesia.

METHODS

The authors collected data from 50 children during operative appointments at which caries was removed using one of the two methods.

RESULTS

Complete caries removal within 15 minutes was achieved in only 57.7 percent of the CMCR-treated teeth. In 42.3 percent of these teeth, residual caries was removed using TM. CMCR was almost eight times more time-consuming than was TM when used to excavate dentinal-depth occlusal lesions with minimal cavitation. There was no significant difference between CMCR and TM in the number of subjects who needed to undergo local anesthesia.

CONCLUSIONS

The authors found no direct clinical advantage in using CMCR over using TM for treating occlusal dentinal lesions with minimal cavitation in pediatric patients.

Evaluation of the methodologies used in clinical trials and effectiveness of chemo-mechanical caries removal with CarisolvTM

This investigation aims to discuss the methodologies applied in clinical trials published about CarisolvTM, in order to assess the best scientific evidence concerning chemo-mechanical caries removal. Papers concerning the use of CarisolvTM were sought using a search strategy. The titles and abstracts of all the reports identified through the search were analyzed by a single reviewer. The inclusion criterion involved: clinical trials having CarisolvTM in one of the study groups. Then, those that fulfilled the inclusion criterion underwent methodology assessment and data extraction. Only 12 papers met the inclusion criterion. It was observed that none of these studies complied with all the evaluated research methodological principles required in order to have power of evidence generation. CarisolvTM proved to be effective in caries removal. Appointment mean time was greater, but the perceived time was shorter than that using conventional techniques due to patients' perception of more comfort and a reduction of anesthesia needs. There were no adverse effect in long-term assessments. In studies with microbiological evaluation of the remaining dentine, it was observed that both the conventional and chemo-mechanical methods produced statistically significant reduction on counts of viable microorganisms.

Clinical evaluation of chemomechanical and mechanical caries removal: status of the restorations at 3, 6, 9 and 12 months

In this study, the clinical efficacy of Carisolvtrade mark system and the hand excavation method in the removal of occlusal dentine caries of primary molar teeth was evaluated. Both Carisolv system and hand excavation method were applied for the removal of caries on different teeth of the same children. After the removal of the caries, Dyract AP materials were used to restore the teeth. The clinical follow-up was made every 3 months within a year. The clinical evaluations of restorations were carried out in accordance with US Public Health Service (USPHS) criteria. To determine whether there was any statistical difference between the groups, chi-square analysis was used. During both excavation methods, pain occurrence and the need for anesthesia and the time spent were all recorded. The time spent for the removal of caries in Carisolv system and in hand excavation method was 9.03+/-4.14 min (mean+/-SD) and 7.34+/-3.41 min (mean+/-SD), respectively (P>0.05). At the end of 1 year, differences between Carisolv and hand excavation groups in terms of marginal adaptation and secondary caries were found to be statistically insignificant (P>0.05). During the removal of caries, certain children complained about pain both in Carisolv system and hand excavation method (7.1 and 35.7%, respectively). As a result, it can be argued that Carisolv system is effective in the removal of caries and causes minimum level pain occurrence. Compared to hand excavation, Carisolv system seems to be a promising restorative approach to remove occlusal caries in primary molar teeth. Studies of longer duration are needed to confirm these findings.

Clinical randomized controlled trial of chemomechanical caries removal (Carisolv)

OBJECTIVES

The purpose of this study was to compare the chemomechanical caries-removal system (Carisolv) with high-speed excavation in cavitated occlusal caries of primary molars. Design and setting. The study was a randomized controlled, clinical trial in which the two techniques were compared in each subject. Participants were chosen from public schools, in Maracaibo County, Zulia State, Venezuela.

SAMPLE AND METHODS

The sample consisted of 80 primary molars selected from 40 children (mean age 7.7+/-0.7 years). Each patient had at least two contralateral primary molars with cavitated occlusal caries and approximately equal-size access to lesions. The outcome variables were: clinically complete caries removal, size of the opening of the cavity, volume of carious tissue removed, pain during caries removal, anaesthesia requested by the patient, caries-removal time, and behaviour and preference of patients.

RESULTS

All treated molars were clinically caries free whichever caries-removal procedure was used. When Carisolv' was used the final cavity entrance sizes were smaller (P<0.001) and the estimated volume of tissue removed was less (P<0.001). The time taken for caries removal was three times longer (7.51+/-1.83 min, P<0.001). Some pain was reported by seven (17.5%) participants when Carisolv was used, compared with 16 (40%) when high-speed excavation was used (P<0.05). Using the Carisolv method there was a higher proportion of patients with positive behaviour (P<0.01), and 71.0% (P<0.05) preferred this treatment.

CONCLUSION

Carisolv is an effective clinical alternative treatment for the removal of occlusal dentinal caries in cavitated primary molars; it is more conservative of dental tissue and appeared to be more comfortable for most patients, although the clinical time spent is longer than when using high-speed excavation.

Comparison of chemomechanical caries removal using Carisolv or conventional hand excavation in deciduous teeth in vitro

OBJECTIVES

The purpose of the present study was to compare the efficacy of chemomechanical caries removal (Carisolv) to conventional hand excavation in deciduous teeth.

METHODS

Twenty-two freshly extracted teeth with varying degree of caries were treated using both of these methods. One part of each caries lesion was prepared using the Carisolv method and the other part using conventional hand excavation. The third (middle) part was left untreated to serve as control. Histological preparations of each tooth were then made and examined in order to compare the quality of the preparations. Length and area of residual caries, microhardness of the dentine in each group and time needed for preparation were analysed.

RESULTS

The results showed that there was no significant difference in the amount of residual caries in the cavity walls treated using the two methods.

CONCLUSIONS

The Carisolv method was significantly more time consuming than conventional preparation using hand excavator. However, both methods removed caries efficiently.

Influence of Carisolv on resin adhesion for two different adhesive systems to sound human primary dentin and young permanent dentin

OBJECTIVE

This study evaluated the influence of Carisolv (Medi Team) for resin adhesion to sound human primary and young permanent dentin.

METHODS

The buccal surfaces of 28 primary molars and 64 premolars were used. Two adhesive systems and resin composites were used; SE: Clearfil SE (Kuraray) and Clearfil APX (Kuraray), and SB: Single Bond (3M) and Z250 (3M). Six groups were prepared. Groups 1-2 were primary dentin and Groups 3-6 were permanent dentin. Groups 1 and 3: SE was used. Groups 2 and 4: treated with Carisolv and then primed, SE was used. Group 5: SB was used. Group 6: treated with Carisolv and then etched, SB was used. The microstructural effects of primer or etchant, and Carisolv plus primer or etchant applied to dentin were evaluated by SEM. In addition, the microstructure of the resin-dentin interfaces of each group was studied using SEM. Shear bond strengths (SBS) were tested, and the failed surfaces were observed using SEM. Data was statistically analyzed using ANOVA with subsequent application of Fisher's PLSD at p<0.05.

RESULTS

The mean SBS (unit: MPa) of Groups 1-6 were: 27.8, 19.2, 21.3, 21.7, 6.7 and 7.6. The SBS of Group 2 was significantly lower than that of Group 1. There was no significant difference of the SBS among Groups 1 and 4, 2, 3 and 4, and 5 and 6. In SE groups, the hybrid layer for primary dentin was thicker than that for permanent dentin.

CONCLUSIONS

Carisolv treatment before priming significantly decreased the SBS to primary dentin in SE groups, but did not influence the SBS to permanent dentin in both SE and SB groups.

In vitro comparison of the efficacy of CarisolvTM and conventional rotary instrument in caries removal

The purpose of this in vitro study was to compare the efficacy of a new chemomechanical caries removal agent, Carisolv (MediTeam AB, Sävedalen, Sweden), with conventional slow-speed rotary instrument (bur). Fourteen extracted human molar teeth with deep dentine caries and no enamel coverage were selected for the study. Their laser fluorescence values were over 30 (DIAGNOdent; KaVo, Biberach, Germany). After the teeth were sectioned through the centre of the carious lesion, one half was removed with conventional drilling (bur); the other half was removed with Carisolv gel. Removal of carious dentine was continued until the lesion was deemed caries-free by visual and tactile criteria. The preparation time for each caries removal technique was also noted. The two halves of each tooth were fixed in 10% buffered-formaldehyde for 1 week. They were then decalcified, dehydrated and embedded in paraffin blocks for histological studies. After taking serial sections of 5 microm thickness, sections were mounted on glass slides, deparaffinized, dehydrated and stained with toluidine blue for observation under a light microscope. Each section was examined for the presence of bacteria. Complete removal of caries was achieved in 13 (93%) of 14 conventionally prepared teeth, and 5 (36%) of 14 chemomechanically prepared teeth (P < 0.05). Mean (+/-SD) time for caries removal was 272 s (+/-53.3) with Carisolv, and 116 s (+/-49.4) with drilling. The results of this study suggest that conventional rotary instrument (bur) was more effective than Carisolv in removal of carious tissue and also takes shorter time.

Comparative Study of Carious Dentin Removal by Er,Cr:YSGG Laser and Carisolv

OBJECTIVE

The present study aimed to compare carious dentin removal by air turbine, Carisolv and erbium,chromium:yttrium,scandium,gallium,garnet (Er,Cr:YSGG) laser, and examine morphological changes before and after these caries removal techniques under light microscopy and scanning electron microscopy (SEM).

BACKGROUND DATA

Although there have been numerous studies on removing caries by Er,Cr:YSGG laser, none has compared Er,Cr:YSGG laser and Carisolv, or reported on the usage of DIAGNOdent as a diagnostic tool particularly for advanced caries in in vitro experiments.

MATERIALS AND METHODS

Sixty extracted human teeth diagnosed as advanced caries were divided into three groups based on the treatment received, namely air turbine, Carisolv, and Er,Cr:YSGG laser groups. Each group was sub-divided into two in order to examine the results with or without finishing using nylon brush, 15% ethylene diamine tetraacetic acid (EDTA) or low-power laser, respectively. After evaluation by DIAGNOdent, specimens were observed under light microscopy or SEM.

RESULTS

Light microscopic observations varied considerably in the three treatment groups. SEM revealed that the surfaces treated by air turbine were very smooth, but with substantial debris. The Carisolv group exhibited a very rough surface with a thick smear layer, while the Er,Cr:YSGG group demonstrated smooth undulations with little smear layer and debris. Among the finishing techniques, the laser group demonstrated the best efficiency. DIAGNOdent scores supported the results of light microscopy.

CONCLUSION

These results suggest that caries removal by Er,Cr:YSGG laser is very effective even without finishing and DIAGNOdent is useful for diagnosing advanced caries in in vitro experiments.

Chemomechanical caries removal in primary teeth in a group of anxious children

Chemomechanical removal of dental caries has considerable potential in the treatment of patients with management problems, especially in paediatric dentistry. The aim of this study was to assess the acceptance and success of the technique in young nervous patients. A group of 20 patients, aged between 4 and 10 years with a high level of dental anxiety was selected. The study achieved a success rate of over 90% in acceptance of cavity preparation by this procedure followed by placement of a restoration. The length of time required for cavity preparation was comparable with conventional methods. The need for local anaesthesia was reduced or eliminated and the children did not complain of any pain during the procedure. It is concluded that chemomechanical caries removal in vivo in primary teeth is an effective alternative to conventional mechanical caries removal and is advantageous in patients who have a phobia to the dental handpiece and/or injections.

Microtensile bond strengths to caries-affected dentine treated with Carisolv

BACKGROUND

Little information is available regarding the bonding performance of adhesive restorative materials to caries-affected dentine after the use of Carisolv. The aim of this study was to compare the microtensile bond strengths of two resin-based adhesives, a conventional glass ionomer cement and resin modified glass ionomer cement to 'normal' dentine and caries-affected dentine after Carisolv treatment.

METHODS

Specimens were prepared using molar teeth with small carious lesions. Caries was removed with the Carisolv solution and the whole surface was bonded with either SE Bond, One Coat Bond, Fuji IX or Fuji II LC. After 24 hours, specimens were prepared for the microtensile bond strength test and stressed in tension at 1 mm/min until rupture of the bond. Mean bond strengths and mode of failure were determined and analysed with the LSD test and chi square test respectively.

RESULTS

The results showed no statistical difference for SE Bond, One Coat Bond or Fuji IX, but a difference was observed for the resin-modified GIC, Fuji II LC.

CONCLUSIONS

It was concluded that carious dentine treated with Carisolv did not affect the adhesion of the adhesive restorative materials tested in this study with the exception of Fuji II LC.

Clinical evaluation of the Carisolv chemomechanical caries removal technique according to the site/stage concept, a revised caries classification system

The objective of the present study was to assess the efficiency and benefit of a chemomechanical system for carious dentin removal, Carisolv, in general practice. A revised caries classification, the site/stage concept, was used to describe the clinical situations of all carious lesions treated. The study was performed by 12 investigators, and 120 carious lesions were treated with Carisolv. Sixty percent of the cases were treated without anaesthesia, and we found a significant correlation between chemomechanical treatment without anaesthesia and absence of pain ( P=0.01). In 78.3% of the cases, carious dentin was totally removed with Carisolv, and in 21.7%, the dentin treatment was completed by drilling. In cases performed with Carisolv alone, the time required to remove carious dentin was 11.1+/-9.51 min (mean+/-SD). Treatment time was equivalent for all sites and increased significantly with each successive stage of lesion progression ( P<0.001). In 82.5% of cases, the clinicians were satisfied with Carisolv, and in 99.2%, so were the patients. We conclude that, using clinical examination methods, Carisolv seems to remove carious dentin at all sites and stages of carious lesions but must be made more efficient for use in general practice.

Advances in paediatric dentistry

The problems facing paediatric dentists have not changed over the years, management of caries and orodental trauma still takes up the greatest proportion of their time. What has changed are the treatments available and in this paper some of the more interesting recent developments in this field are summarised.