Comparative evaluation of effects of chemo-mechanical and conventional caries removal on dentinal morphology and its bonding characteristics — An SEM study

Comparative evaluation of efficacy of two minimally invasive caries removal techniques on fracture resistance of the teeth restored with composite: An SEM study

Aim:

The aim of the study was to evaluate and compare the efficacy and fracture resistance of the teeth restored with composite using two minimally invasive caries removal techniques under a scanning electron microscope.

Materials and Methodology:

Forty-five freshly extracted human permanent molars with Class I and II dentinal caries were selected. Diamond bur group (15): The carious lesion was excavated using round diamond bur until hard dentine was detected. Polymer bur group (15): Carious lesion was removed using polymer burs in circular motions. V-cariesolve gel group (15): Carious lesion was covered with V-cariesolve gel for 30 s and was scraped using a spoon excavator. The time required for the caries removal by each group was recorded. The effectiveness of caries excavation was verified using caries indicator dye. The smear layer removal was assessed using a scanning electron microscope. The cavities were restored with composite resin and fracture resistance of teeth was evaluated. All the data were tabulated and analyzed using Kruskal–Wallis test for overall comparison followed by Mann–Whitney U-test for pairwise comparison.

Results:

The mean time taken for caries excavation by diamond bur group was less (86.13 s), retention of smear layer was less with diamond bur group, and the median score for staining of infected dentin was more (3) in V-cariesolve gel group. Fracture resistance was highest (1.53) with diamond bur group (P < 0.001).

Conclusion:

Caries removal efficacy and fracture resistance for diamond bur group were better compared to polymer bur group and v-cariesolve gel.

SEM Analysis of Residual Dentin Surface in Primary Teeth Using Different Chemomechanical Caries Removal Agents

BACKGROUND

The purpose of this in vitro study was to analyze the residual dentinal surfaces following caries removal using two chemomechanical methods (Papacarie Duo and Carie Care), by scanning electron microscopy (SEM).

STUDY DESIGN

Twenty extracted primary molars with active occlusal carious lesions were randomly assigned two groups depending on the CMCR agent used for the caries excavation - Group 1 - with Papacarie Duo and Group - 2 with Carie Care. After the caries excavation, the specimens were subjected to SEM analysis.

RESULTS

Though both the agents showed the minimal smear layer with the patent dentinal tubules, Carie care showed patent dentinal tubules with a clearly exposed peritubular and intertubular collagen network.

CONCLUSION

Carie Care treated surface exhibited better surface morphology of residual dentin.

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 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.