Utilization of 3D evaluation for assessing selective caries removal practice in pre-clinical dental students: a pilot study

BACKGROUND

Practicing and assessment of selective caries removal techniques in dental students remain challenges in many dental schools. The aim of this study was to utilize a 3D assessment technique, within a designated acceptable range of deviation, to evaluate the tendency of dental students in performing selective caries removal (SCR). The correlation between 3D assessment results and the conventional rubric rated by an instructor was also determined.

METHODS

Fifth-year dental students (n = 61) performed the SCR task on 3D-printed teeth containing simulated deep caries lesions in occlusal and proximal surfaces. One instructor assessed the results using a conventional analytic rubric. The excavated teeth were additionally evaluated using 3D analysis software with the designated acceptable range of deviations (± 0.5 mm) from the standard cavities. The average root mean square (RMS) value, representing the deviation between student-prepared cavities and the predefined standard cavities, was recorded. A tendency towards over-excavation was defined for RMS values > 0.5 mm, and towards under-excavation for RMS values < 0.5 mm.

RESULTS

The mean (min-max) of RMS was 0.27 (0.18-0.40) for occlusal and 0.29 (0.20-0.57)for proximal cavities. A tendency of dental students toward over-excavation was observed in both occlusal (74%) and proximal cavities (87%). There was a moderate negative correlation between the RMS values and the traditional rubric scores for both occlusal (R2 = 0.148, P = 0.002) and proximal cavities (R2 = 0.107, P = 0.010).

CONCLUSIONS

The 3D evaluation technique effectively revealed specific tendencies in dental students' caries removal skills. The integration of computerized assessments with traditional methods could potentially assist the instructors in delivering more objective and specific feedback to students. Further research is encouraged to investigate the impact of this assessment technique on improving student performance in selective caries removal skills.

Comparing the efficacies of two chemo-mechanical caries removal agents (2.25% sodium hypochlorite gel and brix 3000), in caries removal and patient cooperation: A randomized controlled clinical trial

INTRODUCTION

This study compared and evaluated the effectiveness of Brix 3000 and 2.25 % sodium hypochlorite (NaOCl) gel with conventional rotary instrumentation method in caries excavation of primary molars. The null hypothesis: no difference between the two tested chemo-mechanical caries removal (CMCR) agents used in this trial.

MATERIALS AND METHODS

a randomized controlled clinical trial conducted with 32 children suffering from proximal caries of primary maxillary molars, age ranging between 6 and 9 years old. Subjects were randomly assigned into three groups: Brix 3000, NaOCl gel, and conventional with 10, 12, and 10 teeth in each group, respectively. After isolation of selected teeth, either CMCR agent were applied for two minutes. The application was repeated as needed until a caries-free surface was obtained. The conventional group used low-speed burs to excavate all carious lesions. The time required to obtain a caries-free result for each testing method was recorded. Wong-Baker FACES pain rating scale was used to assess the acceptance of the technique used by the child.

RESULTS

Conventional treatment required significantly less time for caries removal compared to Brix 3000 (P = .002) and NaOCl gel (P = .000). No significant difference observed between Brix 3000 and NaOCl gel (P = .679). Statistically higher pain scores were observed with conventional treatment compared to both Brix 3000 (P = .000) and NaOCl gel (P = .005). Pain scores were lower with Brix 3000, and NaOCl gel with no significant difference observed between the CMCR agents (p = .690).

CONCLUSIONS

CMCR agents that are effective in removing the carious dentine of primary teeth without negatively affecting the cooperation of children.

CLINICAL SIGNIFICANCE

The use of a 2.25 % sodium hypochlorite gel can be an effective and well-tolerated method of removing decay from primary teeth and reduce the trauma associated with conventional rotary caries removal.

An RCT of atraumatic restorative treatment for older adults: 5 year results

OBJECTIVES

to compare the survival of ART and a conventional restorative technique (CT) for restoring carious lesions in older adults after 5 years.

METHODS

In this parallel randomised controlled clinical trial, 219 independently-living adults were recruited from a dental hospital/community and a geriatric day hospital. Ninety-nine patients who met the inclusion criteria and presented with carious lesions were randomly allocated to receive either ART or conventional restorations (anaesthesia, rotary instruments and resin-modified glass ionomer). The status of restorations was assessed 6 months, 1, 2 and 5 years after restoration placement. Estimates of cumulative survival were calculated for each interval between assessments and a Cox Proportional Hazards (PH) model was fitted to the interval-censored survival time.

RESULTS

Three hundred restorations (ART n=142; CT n=158) were placed on 99 patients, 46 males and 53 females, with a mean age of 73.2, SD: 6.8 (65-90 yrs). After 5 years, ART and CT presented cumulative probability of survival of 85% and 79% (p=0.8095), respectively.

CONCLUSIONS

ART presents survival rates comparable to a conventional technique, when treating older adults after 5 years. The ART approach could be a useful tool to provide dental care for older adults particularly in the nonclinical setting. (Trial Registration number: ISRCTN 76299321).

CLINICAL RELEVANCE

This study shows that ART presents survival rates comparable to conventional techniques to treat carious lesions in older patients after 5 years. It is well accepted by this age cohort, and therefore could be an alternative to treat the elderly, especially those who are homebound or cannot attend the dentist.

Management of deep carious lesions and pulps exposed during carious tissue removal in adults: a questionnaire study among dentists in Finland

OBJECTIVES

To find out which management methods are preferred by dentists in Finland for a deep carious lesion or a pulp exposed during carious tissue removal in adult patients.

MATERIALS AND METHODS

An electronic questionnaire consisting of 25 questions was sent to 1000 randomly sampled dentists in Finland. The response rate was 32%.

RESULTS

Less invasive excavation strategies (stepwise or selective removal) were preferred by 64% for an asymptomatic deep lesion, while 34% chose nonselective removal to hard dentine. In the presence of an asymptomatic pulpal exposure, vital pulp therapy was preferred, as 71% of the respondents chose direct pulp capping (DPC) or partial pulpotomy, compared to root canal treatment (26%). Mineral trioxide aggregate (MTA) and calcium hydroxide-based materials were both chosen by 40% for vital pulp therapy. In the management of a deep carious lesion, less invasive excavation strategies were significantly associated with having clinical guidelines vs. no guidelines at the practice [odds ratio (OR) 3.5, confidence interval (CI) 1.4-9.0]. MTA was favored over other DPC materials significantly more often by those who had attended continuing education courses during the last 3 years (OR 2.8, CI 1.2-6.5).

CONCLUSIONS

Less invasive management strategies have been adopted into clinical practice by the majority of dentists in Finland. There is a need to encourage the use of MTA in the case of a pulpal exposure.

CLINICAL RELEVANCE

The results of this study can be utilized in continuing education, to raise awareness of management strategies supported by present scientific evidence.

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.

Comparison of the efficacy of chemicomechanical caries removal with conventional methods - a clinical study

BACKGROUND

There has been considerable interest in developing alternative methods of cavity preparation and caries removal due to disadvantages of using traditional rotating instruments which can result in heat, pressure ,dentin dessication, vibration and pain. Hence, the aim of this study was to compare different methods of caries removal in terms of efficacy, time taken and pain during caries removal.

MATERIALS & METHODS

A total of 150 carious teeth were selected among 80 children of 6-10 years of age, following Radiovisiography (RVG) according to specific inclusion criteria and caries removal was done by hand instruments ,air rotor and carisolv respectively. The efficacy, time taken and pain threshold were evaluated during caries removal by Ericson D et al scale, Time scale (Raber H et al), visual analogue scale (Nayak R et al) and verbal pain scale (Cinzia Brunelli et al) respectively. Data was collected and statistically analysed.

RESULTS

Mean value of time taken for removal of caries by carisolv group (580.26 sec) was found to be significantly higher as compared to conventional hand excavation and air rotor. Air rotor was found to be the most efficient method (mean value 1.20). Mean value of pain perception was significantly less with carisolv (0.82) as compared to air rotor and hand instrument.

CONCLUSION

It was concluded that chemicomechanical removal of caries with Carisolv was found to be effective measure of caries removal and could be considered as viable alternatives to painful procedures like airotor in management of dental caries especially in children. How to cite this article: Goomer P, Jain R L, Kaur H, Sood R. Comparison of the Efficacy of Chemicomechanical Caries Removal with Conventional Methods - A Clinical Study. J Int Oral Health 2013; 5(3):42-47.