Efficacy of Caries Removal by Carie-Care and Erbium-doped Yttrium Aluminum Garnet Laser in Primary Molars: A Scanning Electron Microscope Study

Assessment of the efficiency of dental excavation methods using laser speckle imaging

This paper introduces a novel application of the laser speckle technique in dentistry, focusing on assessing the efficiency of dental excavation methods used to remove decayed tooth structure. The aim is to evaluate the efficiency of two chemo-mechanical agents and the high-speed drill using the laser speckle technique, which offers objective, non-invasive, and real-time evaluation capabilities. Extracted human primary molars with active occlusal carious lesions were sectioned into three parts, with each part allocated to one of three groups: Group 1 (Brix3000®), Group 2 (Papacarie DUO®), and Group 3 (High-speed drill mechanical caries removal). Caries removal was performed using the designated agent or method for each group. After caries excavation, speckle imaging using a 632.8 nm laser was conducted. Additionally, SEM was used to acquire micro-photographs of the surface morphology of the treated samples. The findings reveal insights into the comparative efficiency of the three dental excavation agents and methods using the laser speckle technique. The speckle parameters extracted from speckle patterns generated by treated teeth provide valuable information for evaluating the performance of the excavation methods. The scanning electron microscopy images also offer detailed visual evidence to support the analysis. This paper demonstrates the potential of the laser speckle technique for assessing the efficiency of dental excavation methods. The objective, non-invasive, and real-time evaluation provided offers advantages over subjective visual assessment and manual measurements.

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.

In vitro effect of Er: YAG laser irradiation in caries cavity preparation on biobehaviors of adjacent human dental pulp cells in the pulp chamber

The erbium-doped yttrium aluminum garnet (Er: YAG) laser has been successfully applied in caries removal; however, little is known about proper parameters of Er: YAG laser on different conditions of caries removal, especially the influence of Er: YAG irradiation on human dental pulp cells (hDPCs). Here, we tested the effects of Er: YAG laser at different output energy levels (100, 200, 300, 400, and 500 mJ) on biobehaviors of hDPCs. To simulate clinical deep caries conditions, hDPCs were cultured on the pulpal side of 500-μm-thick dentin disks in an in vitro pulp chamber model. Temperature change, structural change, and ablation depth of dentin disk were also recorded. The findings suggested that the biological behaviors of hDPCs are strongly correlated with the energy output of the Er: YAG laser. Er: YAG laser irradiation at 100 mJ may be proper and safe for deep caries removal since it would not cause any adverse effect on hDPCs biobehaviors.

The effectiveness of Carie-Care™, chemomechanical caries removal technique in primary teeth: randomized controlled clinical trial

BACKGROUND

Chemomechanical techniques for caries removal have been introduced to overcome the shortcomings of the conventional rotatory instruments. This study aimed to clinically evaluate the effectiveness of the chemomechanical method of caries removal (Carie-Care™) over mechanical caries removal through the Atraumatic Restorative Technique in pediatric patients.

METHODS

A randomized controlled clinical trial was conducted. Fifty children fulfilling inclusion criteria were recruited from the outpatient clinic of Pediatric and Dental Public health department, Faculty of Dentistry, Alexandria University. Fifty open carious primary molars were randomly assigned into 2 equal groups according to the method of caries removal. In Group I (test group), caries was removed using the Carie-Care™ system and in Group II (control group), by using mechanical caries removal through the atraumatic restorative technique. Resin modified glass ionomer was used for teeth restoration, the two techniques were compared in each child according to time taken for caries removal, efficacy of caries removal, pain assessment, and child behavior.

RESULTS

The mean time taken for caries removal in the Carie-Care™ treatment group was (575.6 ± 114.8) seconds which was statistically significant higher as compared with the ART treatment group (346.1 ± 97.4) seconds (p < 0.001). The mean score of efficacy in caries removal was (0.6 ± 0.8) in the Carie-Care™ group, and (1.3 ± 0.7) in the ART treatment group. When compared to ART, Carie-Care™ was significantly more efficient in caries removal (p < 0.002). When pain was assessed by the SEM scale, it was observed that the Carie-Care™ caries removal technique showed statistically significantly more comfort during the procedure compared with the ART procedure (p < 0.001).Moreover, children in the Carie-Care™ group enjoyed the process and showed more cooperative behavior when assessed at the end of procedure than those in the ART group with statistically significant difference (p = 0.002).

CONCLUSIONS

Removal of carious tissue in primary teeth using Chemomechanical Carie-Care™ gel proved to be more time consuming than ART, but on the other hand it was more efficient, comfortable, and accepted by the pediatric patients.

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.

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.

The Use of Modern Technologies by Dentists in Poland: Questionnaire among Polish Dentists

Background: From one year to another, dentists have access to more procedures using modern techniques. Many of them can improve the effectiveness of dental procedures and frequently facilitate and accelerate them. Objectives: Technically advanced devices are an important part of modern dentistry. Over the years, there were developed technologies like ultrasounds, lasers, air abrasion, ozonotherapy, caries diagnostic methods, chemomechanical caries removal (CMCR), pulp vitality tests, computer-controlled local anesthetic delivery (CCLAD). The aim of this study was to investigate the requirement of Polish dentists for such technologies. Methods: An anonymous questionnaire was posted on a social media group of dentists from Poland. 187 responses were obtained. Results: It turned out that almost every respondent uses ultrasounds, but other technologies are not as popular. 43% use CCLAD, 33% use diagnostic methods, 28% use air abrasion, 25% use dental lasers, 21% use CMCR, 18% use pulp vitality tests and 6% use ozonotherapy. The most common reason for not using the aforementioned technologies were their high cost and the sufficient effectiveness of raditional methods. There was a correlation between use of a dental laser and CCLAD and size of office, CMCR use and dentists’ work time and air abrasion use and gender. Many dentists claim that they will try one of the modern technologies in the future. Conclusions: It can be concluded that Polish dentists tend to use ultrasounds and CCLAD more than any other technology. In the future this may change, so more studies in this topic are needed.