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Mandetta ARH, Bortoletto CC, Sobral APT, Gonçalves MLL, Motta LJ, Horliana ACRT, Ferrari RAM, Prates RA, Deana AM, Cordeiro RDCL, Pinto LAMDS, Fernandes KPS, Bussadori SK. Evaluation of antimicrobial photodynamic therapy and minimal intervention associated with deproteinisation in permanent teeth with molar incisor hypomineralisation: study protocol for a clinical, controlled, blinded trial. BMJ Open 2023; 13:e076226. [PMID: 38101830 PMCID: PMC10729058 DOI: 10.1136/bmjopen-2023-076226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Molar incisor hypomineralisation (MIH) is a qualitative defect of enamel development that occurs in the mineralisation phase. MIH affects one or more permanent molars and, occasionally, permanent incisors. The aim of the proposed study is to evaluate the clinical effect of antimicrobial photodynamic therapy (aPDT) on permanent teeth with MIH through decontamination and sensitivity control. METHODS AND ANALYSIS Patients from 8 to 12 years of age with permanent molars will be randomly allocated to three groups. Group 1: selective chemical-mechanical removal of carious dentinal tissue around the walls of the cavity with Papacárie Duo and a curette followed by the application of aPDT and deproteinisation with Papacárie Duo; group 2: selective removal of carious dentinal tissue around the walls of the cavity with a curette, followed by the application of aPDT and deproteinisation with a 5% sodium hypochlorite solution; group 3: selective removal of carious dentinal tissue using a curette. The selected teeth must have a carious lesion in the dentin and posteruptive enamel breakdown on one or more surfaces with an indication for clinical restorative treatment. The teeth will subsequently be restored using a mixed technique with resin-modified glass ionomer cement and bulk-fill composite resin. The data will be submitted to descriptive statistical analysis. Associations with age and sex will be tested using either the χ2 test or Fisher's exact test. Pearson's correlation coefficients will be calculated to determine the strength of correlations between variables. Comparisons of the microbiological results (colony-forming units) will be performed using analysis of variance and the Kruskal-Wallis test. Kaplan-Meier survival analysis will be performed to assess the performance of the restorations. ETHICS AND DISSEMINATION This protocol has been approved by the Human Research Ethics Committee of Nove de Julho University (certificate number: 61027522.0.0000.5511/approval date: 23 August 2022). The findings will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05443035.
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Affiliation(s)
- Amanda Rafaelly Honório Mandetta
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, Campus Vergueiro, São Paulo, SP, Brazil
| | | | - Ana Paula Taboada Sobral
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos, Santos, SP, Brazil
- School of Dentistry, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Marcela Letícia Leal Gonçalves
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos, Santos, SP, Brazil
- School of Dentistry, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Lara Jansiski Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, Campus Vergueiro, São Paulo, SP, Brazil
| | | | - Raquel Agnelli Mesquita Ferrari
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, Campus Vergueiro, São Paulo, SP, Brazil
| | - Renato Araujo Prates
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, Campus Vergueiro, São Paulo, SP, Brazil
| | - Alessandro Melo Deana
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, Campus Vergueiro, São Paulo, SP, Brazil
| | - Rita de Cássia Loiola Cordeiro
- Research of Department of Pediatric Dentistry, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Araraquara, Araraquara, SP, Brazil
| | | | - Kristianne Porta Santos Fernandes
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, Campus Vergueiro, São Paulo, SP, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, Campus Vergueiro, São Paulo, SP, Brazil
- School of Dentistry, Universidade Metropolitana de Santos, Santos, SP, Brazil
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Chua SKX, Sim YF, Wang WC, Mok BYY, Yu VSH. One-year outcome of selective caries removal versus pulpotomy treatment of deep caries: A pilot randomized controlled trial. Int Endod J 2023; 56:1459-1474. [PMID: 37795835 DOI: 10.1111/iej.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/20/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
AIM This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine. METHODOLOGY This two-armed, parallel-group, randomized, superiority trial included vital mature permanent teeth with deep primary or secondary caries diagnosed radiographically as being at least 75% into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were blindly allocated to receive either SCR or Pulpotomy using computer-generated randomized patient codes concealed in opaque envelopes. All teeth were reviewed clinically and radiographically at 6 months and 1 year post-treatment. Using a significance level of p < .05, the log rank test and Cox proportional hazards regression were used to compare the outcome of SCR and Pulpotomy and to identify potential prognostic factors, respectively. RESULTS In all, 58 teeth in the SCR group and 55 teeth in the pulpotomy group completed treatment, after excluding 6 teeth because they did not complete the allocated treatment and another due to severe periodontal disease. At one year, 57/58 (98.3%) teeth from the SCR group and 48/55 (87.3%) teeth from the Pulpotomy group were available for analysis. One tooth in the Pulpotomy group (2.1%) and eight teeth in the SCR group (14.0%) required the further intervention of root canal treatment (p < .05). There were no other significant prognostic factors for survival. Overall, 91.4% of teeth treated with either SCR or Pulpotomy survived without requiring further intervention over a period of one year. No other adverse events occurred over the review period. CONCLUSION Within the limitations of this study, Pulpotomy fares better than SCR in preserving the remaining pulp and periapical health. As a treatment modality, Pulpotomy carries greater cost outlay to patient and takes a longer time to complete treatment than SCR. Long-term follow-up is needed to study the pulpal and restorative outcomes of Pulpotomy and SCR.
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Affiliation(s)
- S K X Chua
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - Y F Sim
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - W C Wang
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - B Y Y Mok
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - V S H Yu
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
- Oral Care Health Innovation and Designs Singapore (ORCHIDS), National University of Singapore, Singapore City, Singapore
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Yao Y, Luo A, Hao Y. Selective versus stepwise removal of deep carious lesions: A meta-analysis of randomized controlled trials. J Dent Sci 2023; 18:17-26. [PMID: 36643250 PMCID: PMC9831820 DOI: 10.1016/j.jds.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/25/2022] [Indexed: 01/18/2023] Open
Abstract
Background/purpose Stepwise removal (SWR) and selective removal (SCR) are proposed techniques to treat deep carious lesions, but it is currently uncertain which technique is better. This meta-analysis aimed to compare the therapeutic effects of SCR and SWR for deep carious lesions in both primary and permanent teeth. Materials and methods PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP databases were searched until June 9, 2021. Success was the primary outcome. Secondary outcomes included pulp exposure, tooth extraction, pulp necrosis, pulpitis, and endodontic treatment. The effect size of each outcome was tested for heterogeneity. The source of heterogeneity was explored by meta regression analysis. Subgroup analysis and sensitivity analysis were conducted for the outcomes. Results Nine studies of 1550 patients with 1929 deep carious teeth were included. SCR had a significantly higher success rate than SWR (pooled relative risk [RR] = 1.123, 95% confidence interval [CI] = 1.056-1.194, I2 = 52.3%, P < 0.001). The incidence of pulp exposure was significantly lower in the SCR group than that in the SWR group (pooled RR = 0.266, 95%CI = 0.096-0.740, I2 = 0.0%, P = 0.011). The incidence of pulp necrosis in the SCR group was approximately 14.2% of that in the SWR group (pooled RR = 0.142, 95%CI = 0.026-0.789, I2 = 0.0%, P = 0.026). Compared with SWR, SCR reduced the incidence of pulpitis by about 76.3% (pooled RR = 0.237, 95%CI = 0.090-0.623, I2 = 0.0%, P = 0.003). Conclusion SCR may be a better treatment for deep caries to achieve better outcomes than SWR. Future research on comparing SCR and SWR for different outcomes in deep carious lesions is warranted to confirm our findings.
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Affiliation(s)
| | | | - Yanhong Hao
- Corresponding author. Department of Stomatology, Peking University Shenzhen Hospital, No. 1120 Lianhua road, Futain District, Shenzhen 518000, Guangdong, P. R. China.
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Al-Ali M, Camilleri J. The scientific management of deep carious lesions in vital teeth using contemporary materials—A narrative review. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.1048137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AimThe aim of this article is to review the scientific evidence for deep caries removal in permanent vital teeth and the choice of dentine replacement material and restoration of the teeth to maintain long term tooth vitality and function.MethodThe two position statements namely the European Society of Endodontology and the American Association of Endodontists position statements on vital pulp therapy will be scrutinized and compared with regards to the deep caries removal strategy and assessed for evidence of best practice. The properties of materials used to manage vital pulps and the best way to restore the teeth will be reviewed and guidance on the full management of vital teeth will be suggested.ConclusionsPromoting new treatment modalities for reversible and irreversible pulpitis allowing for pulp preservation should be considered. Although debatable, cases with deep caries should be managed by complete non-selective caries removal which will allow for pulpal management if needed and a more predictable outcome can be expected when using the new materials and treatment modalities of vital pulp therapy.
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Gürcan AT, Bayram M. Children's dental treatment requirements of first permanent molars with poor prognosis. Clin Oral Investig 2021; 26:803-812. [PMID: 34240243 DOI: 10.1007/s00784-021-04059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/26/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This retrospective study aimed to (i) survey the correlation between decayed, missing, filled teeth (DMFT), and presence of first permanent molars (FPMs) with poor prognosis and (ii) evaluate the treatment requirements. MATERIALS AND METHODS Seven hundred seventy-three children with fully erupted FPMs were included in this study. DMFT for the permanent dentition, FPMs, and Global DMFT were evaluated based on clinical and radiographic evaluation. The ratio of deep dentin caries (DDC) and apical lesion presence among FPMs, including treatment requirements, were analysed. Spearman rank correlation coefficient and t tests were used for statistical analysis. RESULTS The caries prevalence was found at 61.4%, where the mean DMFT was calculated as 1.89 ± 2.15. There was a positive correlation between DMFT values and age (rs = 0.27). On the other hand, there was a negative correlation between global DMFT values and age (rs = - 0.29). Regarding treatment needs of FPM with poor prognosis, 12.03% of the teeth needed pulpectomy, 8.93% pulpotomy, 8.93% pulp capping, and 5.3% extraction. Having higher DMFT values was correlated significantly (p < 0.01) with the presence of DDC (rs = 0.50) and apical lesion (rs = 0.34). Susceptibility to DDC and apical lesions was significantly higher at mandible than maxilla (p < 0.01). The correlation was significant between DMFT values and apical lesion presence (p < 0.01). CONCLUSION The ratio of FPMs with poor prognosis was found high in the study group. Treatment requirements of FPMs increased with age, and pulp interventions often took part in the majority. This study successfully concluded that higher DMFT values were correlated with the presence of DDC and apical lesion. CLINICAL RELEVANCE FPMs with poor prognosis demonstrate a risk factor for apical lesion presence.
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Affiliation(s)
- Aliye Tuğçe Gürcan
- Department of Pediatric Dentistry, School of Dentistry, Altınbaş University, 34147, Istanbul, Turkey.
| | - Merve Bayram
- Department of Pedodontics, School of Dentistry, Istanbul Medipol University, Istanbul, Turkey
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Substantial regional differences in the biomechanical behavior of molar treated with selective caries tissue removal technique: a finite element study. Dent Mater 2021; 37:e162-e175. [PMID: 33358015 DOI: 10.1016/j.dental.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/07/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Selective caries removal (SCR) is recommended over non-selective removal for managing deep carious lesions to avoid pulp exposure and maintain pulp vitality. During SCR, residual carious dentin is left behind and sealed beneath the restoration. The biomechanical effects of such residual lesions on the restored tooth remain unclear and were assessed using finite element modeling (FEM). METHODS Based on μ-CT images of a healthy permanent human third molar, we developed five finite element models. Generic class I and II cavity restorations were modeled where residual lesions of variable sizes were either left or fully removed on occlusal and proximal surfaces. The cavities were restored with adhesive composite. All 3D-FE models were compared with a model of a healthy, non-treated molar. A vertical load of 100 N was applied onto the occlusal surface. RESULTS Regardless of the lesion size, in molars with occlusal lesions higher mean stresses were predicted along the filling-lesion interface than in all other models. The smallest occlusal lesion (Ø1 = 1 mm) resulted in the highest maximum stresses at the filling-lesion interface with large stress concentrations at the filling walls indicating failure risk. In conclusion, lesion site and extent are influencing parameters affecting the filling-lesion interactions and thus the biomechanical behavior of the tooth after SCR. SIGNIFICANCE Retaining carious lesions around the pulpal floor affects the deformation and stress states in tooth-filling complexes. The higher stresses observed in molars with occlusal lesions may affect restoration stability and longevity. Suprisingly, more extended occlusal lesions may provide a more favorable tooth performance than less extended ones. In contrast, in molars with proximal lesions the residual lesion had only limited effect on the tooth's biomechanical condition.
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Sahin N, Saygili S, Akcay M. Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial. Clin Oral Investig 2021; 25:3945-3955. [PMID: 33404764 DOI: 10.1007/s00784-020-03724-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this randomized, controlled, three-arm parallel group, and double-blinded clinical trial was to evaluate the clinical, radiographic, and histopathological success of three different pulp-capping materials in one-stage indirect pulp treatment of primary teeth. MATERIALS AND METHODS The study included a total of 109 patients aged 5-9 years who had primary teeth with deep carious lesions and symptoms of reversible pulpitis. The teeth were divided into three groups according to the pulp-capping agents: (I) hard-setting calcium hydroxide (Dycal) (control group) (n = 36), (II) bioactive tricalcium silicate (Biodentine) (n = 37), and (III) resin-based tricalcium silicate (TheraCal LC) (n = 36). All the teeth were evaluated clinically and radiographically at 6, 12, 18, and 24 months postoperatively. A total of 23 primary mandibular second molars that were in their regular exfoliation period (24-40 months) were extracted and fixed in 10% formaldehyde solution. The specimens were evaluated histologically to assess the integrity of the odontoblastic layer, tertiary dentin formation quality of the dentin formed, severity of pulpitis, and other pulpal changes. Data were analyzed using Fisher's exact test, Pearson's chi-square test, and McNemar's test (p = 0.05). RESULTS At the end of the 24-month follow-up period, the clinical and radiographic success rates for Dycal, Biodentine, and TheraCal LC were 100%, 100%, and 93.3%, respectively, and there was no significant difference among the groups (p > 0.05). However, the TheraCal LC group was statistically unsuccessful when compared to the other groups with regard to the integrity of the odontoblastic layer, severity of pulpitis, and other pulpal changes in histological examination (p < 0.05). CONCLUSION Indirect pulp capping exhibited high clinical and radiographic success rates in the treatment of primary teeth regardless of the chosen pulp-capping agent. However, histological examination indicated that the pulp status was affected by the chosen capping material especially when selecting a resin-containing material such as TheraCal LC. CLINICAL RELEVANCE Resin-free calcium silicate-based materials appear to be more favorable in the indirect pulp treatment of primary teeth, particularly in young-age groups that require long-term success.
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Affiliation(s)
- Nur Sahin
- Department of Pedodontics, Faculty of Dentistry, Izmir Katip Celebi University, 35640, Izmir, Turkey
| | - Suna Saygili
- Department of Histology and Embryology, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Merve Akcay
- Department of Pedodontics, Faculty of Dentistry, Izmir Katip Celebi University, 35640, Izmir, Turkey.
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Santana MLC, Paiva LFS, Carneiro VSM, Gomes ASL, Cenci MS, Faria-E-Silva AL. Fracture resistance of extensive bulk-fill composite restorations after selective caries removal. Braz Oral Res 2020; 34:e111. [PMID: 32876124 DOI: 10.1590/1807-3107bor-2020.vol34.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/10/2020] [Indexed: 11/22/2022] Open
Abstract
This study evaluated the effect of selective carious tissue removal on the fracture strength and failure mode of composite restorations in molars presenting only the buccal cusps. Deep cavities were prepared on the occlusal surface, and the lingual cusps were removed. Carious lesions in the middle of the pulpal wall were artificially induced with acetic acid (pH = 4.5) for 35 days. The demineralized dentin was left intact or was completely removed prior to restoration with a bulk-fill composite (n = 10). Images of the specimens were obtained by optical coherence tomography (OCT) before and after the caries induction/removal. The mechanical resistance to fracture by axial compressive loading and the failure type and extension were determined. The pulpal wall/composite interface of the fractured specimens was analyzed by OCT. The data were analyzed for significance with t-tests (α = 0.05). The deepest cavities and a more frequent occurrence of pulpal exposure were observed more often for non-selective carious tissue removal. The protocol of carious tissue removal did not affect the fracture strength (p = 0.554). An increased occurrence of catastrophic failures involving the roots was observed for non-selective carious tissue removal. Some occurrences of restoration displacement or cracks throughout the resin-dentin were observed only for the selective carious tissue approach. Selective carious tissue removal is a feasible approach to extensively damaged teeth since it reduced the occurrence of pulpal exposure and root fractures, without compromising the fracture strength.
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Affiliation(s)
| | | | | | | | - Maximiliano Sérgio Cenci
- Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Ricucci D, Siqueira JF, Rôças IN, Lipski M, Shiban A, Tay FR. Pulp and dentine responses to selective caries excavation: A histological and histobacteriological human study. J Dent 2020; 100:103430. [PMID: 32673638 DOI: 10.1016/j.jdent.2020.103430] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/07/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The present study investigated the histobacteriological condition of human carious dentine, and the histological response of dental pulps after selective caries excavation to firm dentine and cavity restoration with adhesive procedures. METHODS Twelve vital teeth with medium/deep occlusal caries from 12 patients were scheduled for extraction. The patients gave consent to have caries removed selectively and the cavity restored with adhesive procedures prior to extraction. Caries excavation was achieved using burs and sharp hand excavators until "leathery" or "firm" dentine was encountered. After extraction, the teeth were completely-demineralised, processed for light microscopy, serial-sectioned and stained with haematoxylin and eosin staining for histological examination of dentine characteristics and pulpal responses. Additional sections were stained with Taylor-modified Brown and Brenn technique for histobacteriological examination of bacteria infiltration of the dentinal tubules and dental pulp. RESULTS The 12 teeth showed varying degrees of tertiary dentine formation. Chronic inflammatory cell infiltrates were identified in the pulp of all specimens and appeared as scattered inflammatory cells or exiguous localised accumulations. Capillaries were heavily congested with erythrocytes and polymorphonuclear leukocytes. A large amount of stainable bacteria was observed in the dentine subjacent to the cavity floor in all specimens. CONCLUSIONS The present study demonstrated that "leathery" or "firm" carious dentine is infected. The remnant bacteria in the dentine provoked subclinical pulpal inflammation over the entire evaluation period. The presence of potentially-arrested caries does not necessarily mean that bacterial infection is absent or under control. CLINICAL SIGNIFICANCE Knowledge on the pulpal response to active caries and the inflammatory responses associated with bacteria ingress into dentine is paramount in helping clinicians make an informed, rational choice based on biologically-robust principles.
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Affiliation(s)
| | - José F Siqueira
- Department of Endodontics, Faculty of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - Isabela N Rôças
- Department of Endodontics, Faculty of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - Mariusz Lipski
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Amal Shiban
- Department of Restorative Dental Science, Faculty of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, GA, USA.
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Restorations after selective caries removal: 5-Year randomized trial. J Dent 2020; 99:103416. [PMID: 32585263 DOI: 10.1016/j.jdent.2020.103416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To compare the survival of restorations placed in deep caries lesions after selective caries removal to soft dentin (SCRSD) over a 5-year period. A secondary aim was to investigate whether the material (amalgam or resin composite) affected the survival of restorations. METHODS This study used data derived from a multicenter randomized controlled clinical trial (Clinical trials registration NCT00887952). Inclusion criteria were: patients with permanent molars presenting occlusal or proximal deep caries lesions (≥1/2 of the dentin thickness on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions. The teeth were randomized into SCRSD and restoration in a single visit or stepwise excavation (SW). Each of these groups was divided according to the filling material: amalgam (AM) or resin composite (RC). Survival analyses were performed to estimate therapy success rates over 5 years (adjusted Weibull regression model). RESULTS 172 restorations were evaluated, 95 from SCRSD group and 77 from SW group, being 61 AMG and 111 RC. The 5-year survival analysis showed similar success rates for SW (76 %) and SCRSD (79 %) as well as for AM and RC (p > 0.05). CONCLUSION This study showed that, after a 5-year follow-up period, the presence of decayed tissue beneath restorations in deep caries lesions did not seem to affect restoration survival. Amalgam and resin composite restorations had similar survival rates, irrespective of the caries removal technique used - SCRSD or SW. CLINICAL SIGNIFICANCE Selective caries removal to soft dentin can be used in the management of deep caries to avoid pulp exposure and preserve tooth structure without affecting restoration longevity.
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EXPERIMENTAL MORPHOLOGICAL STUDY OF DENTAL PULP LESIONS AT DIFFERENT STAGES OF DENTAL CARIES. WORLD OF MEDICINE AND BIOLOGY 2020. [DOI: 10.26724/2079-8334-2020-1-71-176-180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Selective, stepwise, or nonselective removal of carious tissue: which technique offers lower risk for the treatment of dental caries in permanent teeth? A systematic review and meta-analysis. Clin Oral Investig 2019; 24:521-532. [DOI: 10.1007/s00784-019-03114-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/01/2019] [Indexed: 01/08/2023]
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Vieira LDS, Paschoal MAB, de Barros Motta P, Ferri EP, Ribeiro CDPV, dos Santos-Pinto LAM, Motta LJ, Gonçalves MLL, Horliana ACRT, Fernandes KPS, Ferrari RAM, Deana AM, Bussadori SK. Antimicrobial photodynamic therapy on teeth with molar incisor hypomineralization-controlled clinical trial. Medicine (Baltimore) 2019; 98:e17355. [PMID: 31574879 PMCID: PMC6775381 DOI: 10.1097/md.0000000000017355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Molar incisor hypomineralization (MIH) is a change in the formation of dental enamel of systemic origin that affects at least one of the first 4 permanent molars and usually affects incisors. During the eruption, the affected surfaces tend to fracture, exposing the dentin, which causes excessive sensitivity in addition to making the region very susceptible to the appearance of carious lesions. The objective of this research will be to evaluate the clinical effect of antimicrobial photodynamic therapy (aPDT) in permanent teeth with severe and sensitive MIH. METHODS The methodology will be based on the selection of patients from 6 to 12 years of age with permanent molar teeth, randomly divided in 2 groups. The selected teeth should have MIH on the occlusal surface, indicated for clinical restorative treatment. In Group 1, aPDT will be applied for the treatment of infected dentin. Afterward, the teeth will be restored with high viscosity glass ionomer cement. In Group 2, the removal of the softened dentin around the side walls of the cavity with sharp dentine curettes and posterior restoration with high viscosity glass ionomer cement will be performed. All patients will have clinical and radiographic follow-up with a time interval of 6 and 12 months. The data obtained will be submitted to descriptive statistical analysis to evaluate the association of categorical variables. Chi-square test and Fisher exact test will be applied, to analyze the correlation between the continuous variables, Pearson correlation test will be applied. For the analysis of dentin density in the scanned radiographic images and the microbiological results for colony-forming units, ANOVA and Kruskal-Wallis will be applied. DISCUSSION Often in the presence of severe MIH, the presence of dentin sensitivity is also associated with caries lesion, making it even more necessary to respect the principles of minimal intervention. TRIAL REGISTRATION NCT03904641.
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Singh S, Mittal S, Tewari S. Effect of Different Liners on Pulpal Outcome after Partial Caries Removal: A Preliminary 12 Months Randomised Controlled Trial. Caries Res 2019; 53:547-554. [DOI: 10.1159/000499131] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 02/22/2019] [Indexed: 11/19/2022] Open
Abstract
Aim: The aim of this double-blinded parallel randomised controlled trial was to compare the effect of different liners on 12-month pulp health outcomes after partial caries removal (PCR) with composite restorations in permanent molars. Methods: The study was registered at clinicaltrials.gov with registration No. NCT0328695 and conducted in the Department of Conservative dentistry and Endodontics, Post Graduate Institute of Dental Sciences Rohtak with no external financial support. One hundred and ninety-eight participants (116 males, 82 females and age 14–54 years) with vital permanent mature mandibular molars having deep caries involving two-thirds or more of dentin were randomised to calcium hydroxide (CH), resin-modified GIC (RMGIC) and no liner (DC) groups after PCR. After a follow-up time of 12 months, success was defined as positive response to pulp sensibility and absence of periapical alterations. Results: Categorical variables were compared using chi-square test. Two analytical approaches were used, such as intention-to-treat and per-protocol approach. Success rates in per-protocol approach were 96.8, 96.5, and 94.6% for CH, RMGIC and DC groups, respectively with no significant difference between 3 groups (p = 0.811). None of the baseline variables had any significant influence on the treatment success. Conclusion: Partial caries excavation has a high success rate to treat deep carious lesions in permanent teeth after 12 months of follow-up, indicating that the retention of carious dentin does not interfere with pulp vitality or restoration survival. Also, the success of the treatment is independent of the lining material used over the demineralized dentin.
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Costa-Santos L, Silva-Júnior ZS, Sfalcin RA, da Mota ACC, Horliana ACRT, Motta LJ, Mesquita-Ferrari RA, Fernandes KPS, Prates RA, Silva DFT, Deana A, Bussadori SK. The effect of antimicrobial photodynamic therapy on infected dentin in primary teeth: A randomized controlled clinical trial protocol. Medicine (Baltimore) 2019; 98:e15110. [PMID: 30985667 PMCID: PMC6485871 DOI: 10.1097/md.0000000000015110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Antimicrobial photodynamic therapy (aPDT) has been used for the treatment of dental caries. Papacarie is a gel composed of papain and chloramine employed for the partial removal of carious tissue, effective against bacteria, however, some studies report that this antibacterial action is not quite so evident. The aim of this study is to evaluate the clinical effect of aPDT on infected dentin in dental caries lesion in primary teeth. METHODS Thirty-two primary molars with deep occlusal dental caries will be selected and divided in 2 groups: G1 - caries removal with a low-speed drill and G2 - application of aPDT with PapacarieMBlue. After treatment, all the teeth will be restored with glass ionomer cement and followed up clinically and radiographically, with evaluations at 3, 6, and 12 months. Dentin samples before and after treatment will be analyzed microbiologically. The data will be submitted to descriptive statistical analysis of the association between the categorical variables and both age and gender using the chi-square test and Fisher exact text. The Student t test and analysis of variance will be used for the comparison of mean signs and symptoms of reversible pulpitis. Pearson correlation coefficients will be calculated for the analysis of correlations among the continuous variables. DISCUSSION Adding methylene blue dye to the formula of PapacarieMBlue might potentiate the antimicrobial action of aPDT and work more effectively on the infected dentin combined with a conservative, minimally invasive treatment. TRIAL REGISTRATION NCT02734420 on 10 march 2016.
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Rosa WLO, Lima VP, Moraes RR, Piva E, Silva AF. Is a calcium hydroxide liner necessary in the treatment of deep caries lesions? A systematic review and meta‐analysis. Int Endod J 2018; 52:588-603. [DOI: 10.1111/iej.13034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
- W. L. O. Rosa
- Graduate Program in Dentistry Department of Restorative Dentistry Federal University of Pelotas Pelotas RS Brazil
| | - V. P. Lima
- Graduate Program in Dentistry Department of Restorative Dentistry Federal University of Pelotas Pelotas RS Brazil
| | - R. R. Moraes
- Graduate Program in Dentistry Department of Restorative Dentistry Federal University of Pelotas Pelotas RS Brazil
| | - E. Piva
- Graduate Program in Dentistry Department of Restorative Dentistry Federal University of Pelotas Pelotas RS Brazil
| | - A. F. Silva
- Graduate Program in Dentistry Department of Restorative Dentistry Federal University of Pelotas Pelotas RS Brazil
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Hosida TY, Delbem ACB, Morais LA, Moraes JCS, Duque C, Souza JAS, Pedrini D. Ion release, antimicrobial and physio-mechanical properties of glass ionomer cement containing micro or nanosized hexametaphosphate, and their effect on enamel demineralization. Clin Oral Investig 2018; 23:2345-2354. [PMID: 30298451 DOI: 10.1007/s00784-018-2674-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate the effects of hexametaphosphate microparticles (mHMP) or nanoparticles (nHMP) incorporated in glass ionomer cement (GIC) on antimicrobial and physico-mechanical properties, fluoride (F) release, and enamel demineralization. MATERIAL AND METHODS HMP solutions were obtained at concentrations of 1, 3, 6, 9, and 12%, for screening of antimicrobial activity. Next, mHMP or nHMP at 6, 9, and 12% were incorporated into a resin-modified GIC and the antibacterial activity was evaluated. The resistance to diametral tensile and compressive strength, surface hardness, and degree of monomer conversion as well as F and HMP releases of GICs were determined. Furthermore, specimens were attached to enamel blocks and submitted to pH-cycling, and mineral loss was determined. Parametric and non-parametric tests were performed, after checking data homoscedasticity (p < 0.05). RESULTS HMP solutions at 6, 9, and 12% demonstrated the best antibacterial activity. GIC containing HMP showed better antibacterial effects at 9 and 12% for nHMP. Regarding F and HMP releases, the highest levels of release occurred for groups containing 9 and 12% nHMP. With the increase in HMP concentration, there was lower mineral loss. However, the incorporation of mHMP or nHMP in GIC reduced values of physico-mechanical properties when compared to the control GIC. CONCLUSIONS nHMP improves antimicrobial activity and fluoride release, and decreases enamel demineralization, but reduces the physico-mechanical properties of GIC. CLINICAL RELEVANCE The association of GIC/HMP could be an alternative material for patients at high risk for dental caries and could be indicated for low-stress regions or provisional restorations.
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Affiliation(s)
- Thayse Yumi Hosida
- Department of Pediatric Dentistry and Public Health, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Alberto Carlos Botazzo Delbem
- Department of Pediatric Dentistry and Public Health, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Leonardo Antônio Morais
- Department of Pediatric Dentistry and Public Health, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - João Carlos Silos Moraes
- Department of Physics and Chemistry, São Paulo State University (UNESP), Ilha Solteira, SP, Brazil
| | - Cristiane Duque
- Department of Pediatric Dentistry and Public Health, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - José Antônio Santos Souza
- Department of Pediatric Dentistry and Public Health, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Denise Pedrini
- Department of Surgery and Integrated Clinic, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba, SP, Brazil. .,Disciplina de Clínica Integrada, Faculdade de Odontologia de Araçatuba - UNESP, Rua José Bonifácio 1193, Araçatuba, SP, 16015-050, Brazil.
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Mello B, C Stafuzza T, Vitor L, Rios D, Silva T, Machado M, M Oliveira T. Evaluation of Dentin-Pulp Complex Response after Conservative Clinical Procedures in Primary Teeth. Int J Clin Pediatr Dent 2018; 11:188-192. [PMID: 30131639 PMCID: PMC6102443 DOI: 10.5005/jp-journals-10005-1509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 05/13/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Although selective caries tissue removal decreases the number and diversity of bacteria, stops the caries process, and reduces the risk of pulp exposure, the studies on the minimally removal of caries tissue are limited and further clinical research is necessary in this field. Aim This study aimed to evaluate through clinical and radiographic assessments the in vivo response of the dentin-pulp complex of human deciduous teeth after either partial or total caries removal (TCR). Materials and methods A total of 49 deciduous molars of children aged between 5 and 9 years were carefully selected. The teeth were divided into two groups: Group I: Partial removal of caries; group II: Total removal of caries. Clinical and radiographic evaluations were performed during the period of 4 to 6 months after the procedure. The intraexam-iner reproducibility was determined by Kappa test. Fisher’s exact test was used to determine the statistical difference between groups. Results All teeth showed clinical success during the 4- to 6-month evaluation period. The radiographic evaluation showed 94.2 and 89.6% of success rate in groups I and II respectively. Radiographic results did not show statistically significant differences between the studied groups (p > 0.05). Conclusion The partial caries removal (PCR) showed satisfactory clinical and radiographic outcomes, suggesting that this minimally invasive approach might replace the TCR when correctly indicated. How to cite this article: Mello B, Stafuzza TC, Vitor L, Rios D, Silva T, Machado M, Oliveira TM. Evaluation of Dentin-Pulp Complex Response after Conservative Clinical Procedures in Primary Teeth. Int J Clin Pediatr Dent 2018;11(3):188-192.
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Affiliation(s)
- Bianca Mello
- PhD Student, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Tassia C Stafuzza
- PhD Student, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Luciana Vitor
- PhD Student, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Daniela Rios
- Professor, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Thiago Silva
- Professor, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Machado
- Professor, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Thais M Oliveira
- Associate Professor, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
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Li T, Zhai X, Song F, Zhu H. Selective versus non-selective removal for dental caries: a systematic review and meta-analysis. Acta Odontol Scand 2018; 76:135-140. [PMID: 29073814 DOI: 10.1080/00016357.2017.1392602] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Selective and non-selective methods for caries removal were controversial so far, thus we aimed to compare the efficacy of selective and non-selective caries removal by conducting meta-analysis of randomized controlled trials (RCTs). MATERIALS AND METHODS Eligible RCTs studies comparing selective caries removal with non-selective caries removal were retrieved by searching PubMed, EMBASE and Cochrane Library till 15 July 2017. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for outcome indictors, including pulpal exposure, pulpal symptoms and failure using Inverse variance-random effects or Mantel-Haenszel-fixed effects models. RESULTS Totally, seven studies were eligible for the meta-analysis. Compared with the non-selective caries removal group, the risk of pulpal exposure was significantly reduced in the selective caries removal group (OR = 0.11, 95% CI: 0.04-0.30). No significant difference was observed in pulpal symptoms (OR = 0.79, 95% CI: 0.30-2.12) and failure (OR = 1.40, 95% CI: 0.69-2.84) between the groups. CONCLUSIONS The efficacy of selective caries removal appears comparable to that of non-selective caries removal in children, with similar pulpal symptoms and failure, but selective caries removal may result in a low incidence of pulpal exposure. However, larger-scale RCTs with long-term follow-up are required to confirm this conclusion.
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Affiliation(s)
- Ti Li
- Department of Dentistry, People’s Hospital of Weifang, Weifang, Shandong Province, P.R. China
| | - Xiangkai Zhai
- Department of Dentistry, People’s Hospital of Weifang, Weifang, Shandong Province, P.R. China
| | - Feifei Song
- Department of Dentistry, People’s Hospital of Weifang, Weifang, Shandong Province, P.R. China
| | - Hongguang Zhu
- Department of Dentistry, People’s Hospital of Weifang, Weifang, Shandong Province, P.R. China
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Santos PSD, Pedrotti D, Braga MM, Rocha RDO, Lenzi TL. Materials used for indirect pulp treatment in primary teeth: a mixed treatment comparisons meta-analysis. Braz Oral Res 2017; 31:e101. [DOI: 10.1590/1807-3107/2017.vol31.0101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/07/2017] [Indexed: 11/21/2022] Open
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Kuhn E, Reis A, Chibinski ACR, Wambier DS. The influence of the lining material on the repair of the infected dentin in young permanent molars after restoration: A randomized clinical trial. J Conserv Dent 2016; 19:516-521. [PMID: 27994311 PMCID: PMC5146765 DOI: 10.4103/0972-0707.194026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: This study evaluated the impact of liner material on the fluorescence, morphological and mineral characteristics of permanent carious dentin after cavity sealing. Methods: Thirty children (11.0 ± 2.7 years old) presenting at least one active deep carious lesion in permanent molars were selected. Fragments of carious dentin were removed from teeth before lining the cavity (baseline samples) with high-viscosity glass ionomer cement (G1) or an inert material (wax - G2). Cavities were restored with composite resin and reopened 60 days later, and other fragments were removed (60-day sample). The laser fluorescence (LF) readings and morphological and mineral changes of both groups were compared. Results: After 60 days, forty teeth were available for evaluation. Lower LF means were obtained (Wilcoxon signed-rank test; P < 0.05), and enhanced calcium and phosphorus levels were detected for both groups (t-test, P < 0.05). An uptake of fluorine was observed only in G1 (t-test; P < 0.05). Regardless of the group, baseline samples exhibited clear signs of bacterial invasion, and the collagen fibers were exposed; the 60-day samples showed a better-organized tissue with a more compact intertubular dentin. Conclusion: Caries arrestment with dentin reorganization occurs regardless of the lining material placed in contact with the infected dentin.
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Affiliation(s)
- Eunice Kuhn
- Department of Dentistry, State University of Ponta Grossa, Paraná, Brazil
| | - Alessandra Reis
- Department of Dentistry, State University of Ponta Grossa, Paraná, Brazil
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Long-term survival and vitality outcomes of permanent teeth following deep caries treatment with step-wise and partial-caries-removal: A Systematic Review. J Dent 2016; 54:25-32. [PMID: 27664467 DOI: 10.1016/j.jdent.2016.09.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES A systematic review was performed to compare the long-term survival of deep dentine caries-affected permanent teeth treated with partial-caries-removal (PCR) versus similar teeth treated with stepwise-caries-removal techniques (SWT). DATA Clinical studies investigating long-term PCR and SWT outcomes in unrestored permanent teeth with deep dentine caries were evaluated. Failures were defined as loss of pulp vitality or restorative failures following treatment. SOURCES PubMed, Web of Science, Dentistry and Oral Sciences Source, and Central databases were systematically searched. STUDY SELECTION From 136 potentially relevant articles, 9 publications utilizing data from 5 studies (2 RCTs, and 3 observational case-series) reporting outcomes for 426 permanent teeth over two to ten years were analyzed. Regarding restorative failures, >88% success at two years for both techniques was reported. For loss of pulp vitality, observational studies reported >96% vitality at two years for each technique, while one RCT reported significantly higher vitality (p<0.05) at three years for PCR (96%) compared to SWT (83%). Risk of bias was high in all studies. CONCLUSION Successful vitality and restorative outcomes for both PCR and SWT have been demonstrated at two years and beyond in permanent teeth with deep dentine caries. Partial-caries-removal may result in fewer pulpal complications over a three year period than SWT, although claims of a therapeutic advantage are based on very few, limited-quality studies. CLINICAL SIGNIFICANCE Partial-caries-removal and SWT are deep caries management techniques that reduce pulp exposure risk. Permanent teeth with deep dentine caries treated with either technique have a high likelihood for survival beyond two years.
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Kuhn E, Reis A, Campagnoli EB, Chibinski ACR, Carrilho MRDO, Wambier DS. Effect of sealing infected dentin with glass ionomer cement on the abundance and localization of MMP-2, MMP-8, and MMP-9 in young permanent molars in vivo. Int J Paediatr Dent 2016; 26:125-33. [PMID: 25967636 DOI: 10.1111/ipd.12167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The study of MMPs' behavior in carious lesions contributes to the understanding of the mechanisms involved in dentin reorganization after restoration. AIM To compare the abundance and localization of MMPs 2, 8, and 9 in infected dentin before and after restoration. DESIGN The sample consisted of 23 young permanent molars with active deep carious lesions. Infected carious dentin samples were collected from the same tooth at baseline and 60 days after cavity lining with GIC and composite resin restoration and processed for immunohistochemistry assays. After digital images were obtained, two calibrated operators analyzed the samples according to the immunostaining intensity and the MMPs' localization. Chi-square test was used for statistical analysis. RESULTS The intensity of immunostaining for MMP-8 was reduced after 60 days (P = 0.02), and no difference was observed for MMP-2 (P = 0.32) and MMP-9 (P = 0.14). The MMPs' distribution was generalized in the intertubular dentin and absent or located in the intratubular dentin, regardless of the period. CONCLUSION The sealing of infected carious dentin in young permanent molars reduced the expression of MMP-8, which is consistent with the initial remodeling process of the dentin matrix.
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Affiliation(s)
- Eunice Kuhn
- Department of Dentistry, School of Dentistry, Ponta Grossa State University, Ponta Grossa, Brazil
| | - Alessandra Reis
- Department of Dentistry, School of Dentistry, Ponta Grossa State University, Ponta Grossa, Brazil
| | - Eduardo Bauml Campagnoli
- Department of Dentistry, School of Dentistry, Ponta Grossa State University, Ponta Grossa, Brazil
| | | | | | - Denise Stadler Wambier
- Department of Dentistry, School of Dentistry, Ponta Grossa State University, Ponta Grossa, Brazil
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Chibinski A, Gomes J, Camargo K, Reis A, Wambier D. Bone Sialoprotein, Matrix Metalloproteinases and Type I Collagen Expression after Sealing Infected Caries Dentin in Primary Teeth. Caries Res 2014; 48:312-9. [DOI: 10.1159/000355302] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 08/15/2013] [Indexed: 11/19/2022] Open
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Failure of incompletely excavated teeth—A systematic review. J Dent 2013; 41:569-80. [DOI: 10.1016/j.jdent.2013.05.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/04/2013] [Accepted: 05/04/2013] [Indexed: 11/22/2022] Open
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Katz CRT, de Andrade MDRB, Lira SS, Ramos Vieira ÉL, Heimer MV. The concepts of minimally invasive dentistry and its impact on clinical practice: a survey with a group of Brazilian professionals. Int Dent J 2013; 63:85-90. [DOI: 10.1111/idj.12018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Maltz M, Jardim JJ, Mestrinho HD, Yamaguti PM, Podestá K, Moura MS, de Paula LM. Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results. Caries Res 2012. [PMID: 23207420 DOI: 10.1159/000344013] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIM The aim of this study was to evaluate the effectiveness of partial removal of carious dentine and restoration in a single session (PDR) and stepwise excavation (SW), both of which are treatments for deep carious lesions, in Public Health Services in Brazil. METHODS INCLUSION CRITERIA patients ≥6 years old, permanent molars with deep caries lesions (having a radiolucency halfway or more into dentine) and pulp vitality but absence of spontaneous pain, positive percussion test, and periapical alterations. The subjects received either PDR (test group) or SW (control group). The radiological and clinical exams were performed after a mean time of 18 months. OUTCOMES success was defined as pulp sensitivity to cold test and absence of periapical alterations. RESULTS Of the 299 treatments performed, 146 were SW and 153 were PDR; 122 were amalgam restorations and 168 resin-composite restorations. There were no differences between the groups regarding the baseline characteristics (i.e. age, gender and family income). After 18 months, 212 evaluations were performed, which indicated 99 and 86% success rates in the PDR and SW groups, respectively (p = 0.016). Reasons for failure were: PDR - 1 pulpitis; SW - 8 pulpitis; 1 osteitis; 4 necrosis; 1 endodontic treatment. None of the baseline variables were significantly associated with the outcomes. CONCLUSION The retention of carious dentine does not interfere in pulp vitality. Data from this 18-month study suggest that the procedure of reopening the cavity to remove the residual infected dentine is not necessary.
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Affiliation(s)
- M Maltz
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Maltz M, Henz SL, de Oliveira EF, Jardim JJ. Conventional caries removal and sealed caries in permanent teeth: a microbiological evaluation. J Dent 2012; 40:776-82. [PMID: 22664566 DOI: 10.1016/j.jdent.2012.05.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 05/23/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare microbiological infection after conventional carious dentine removal with incomplete carious dentine removal and sealing. METHODS Eighty-seven patients (12-50 years of age) under treatment at the Dental Clinics of the Federal University of Rio Grande do Sul (UFRGS), Brazil, participated in the study. The patients presented 90 posterior permanent teeth with primary caries. The lesions were coronal, active, and reached at least the middle third of the dentine. None of the teeth exhibited spontaneous pain, sensitivity to percussion or apical pathology (detected through radiographic exams). Pulp sensibility was confirmed by the cold test. The lesions were divided into 2 experimental groups: complete caries removal (CCR) based on hardness criteria (n=60 lesions) and incomplete caries removal (ICR) and sealing (n=32 lesions). Microbiological samples were obtained from the initial demineralized dentine, after CCR and after ICR-Seal. RESULTS The number of anaerobic and aerobic bacteria, lactobacilli, and mutans streptococci decreased at the end of treatment (p<0.05). Significantly less anaerobic bacteria (p<0.01), aerobic bacteria (p=0.02), and mutans streptococci (p<0.01) growth was observed after ICR-Seal compared to CCR. The difference in lactobacilli was insignificant (p=0.08). The amount of bacteria detected after conventional caries removal was higher than that which remained in sealed caries lesions. CONCLUSIONS The results suggest it is not necessary to remove all carious dentine before the restoration is placed because over time, sealing of carious dentine results in lower levels of infection than traditional dentine caries removal. CLINICAL SIGNIFICANCE The results of this study indicate that sealed carious dentine was less infected than the remaining dentine left after conventional caries removal and sealing. Our results support treatment of deep carious lesions in one session with incomplete removal of carious dentine.
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Affiliation(s)
- M Maltz
- Faculty of Odontology, Federal University of Rio Grande do Sul, Brazil.
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Gupta A, Sinha N, Logani A, Shah N. An ex vivo study to evaluate the remineralizing and antimicrobial efficacy of silver diamine fluoride and glass ionomer cement type VII for their proposed use as indirect pulp capping materials - Part I. J Conserv Dent 2011; 14:113-6. [PMID: 21814348 PMCID: PMC3146099 DOI: 10.4103/0972-0707.82603] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 12/28/2010] [Accepted: 01/29/2011] [Indexed: 11/04/2022] Open
Abstract
AIM Indirect pulp capping (IPC) preserves the pulp vitality by disinfecting and remineralizing remaining carious dentin. In the present study, glass ionomer (GC, FUJI VII) and silver diamine fluoride (SDF) were tested and compared to calcium hydroxide for their antimicrobial efficacy and remineralizing potential. MATERIALS AND METHODS Dentin disks prepared from 45 freshly extracted first premolars were divided into three groups (n = 15). Each disk was cut into two equal parts, in which one half formed the control. Thirty dentin samples were used for ion estimation and the other 15 for microhardness testing. Atomic absorption spectrophotometry, colorimetric and potentiometric titration analyses were performed for calcium, phosphate and fluoride ion detection, respectively. The antimicrobial efficacy was analyzed using pure culture of Streptococcus mutans and mixed flora. RESULTS Increase in the levels of calcium and phosphate ions was the highest in calcium hydroxide group. Both SDF and GC VII groups showed significant increase in fluoride ion levels. Samples treated with GC VII showed maximum increase in micro hardness. The highest zone of bacterial inhibition was found with SDF group. CONCLUSIONS This in vitro study documented the remineralizing, re-hardening and antimicrobial efficacy of both SDF and GC VII and hence can act as effective IPC materials.
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Affiliation(s)
- A Gupta
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Weber CM, Alves LS, Maltz M. Treatment decisions for deep carious lesions in the Public Health Service in Southern Brazil. J Public Health Dent 2011; 71:265-70. [DOI: 10.1111/j.1752-7325.2011.00258.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alves LS, Fontanella V, Damo AC, Ferreira de Oliveira E, Maltz M. Qualitative and quantitative radiographic assessment of sealed carious dentin: a 10-year prospective study. ACTA ACUST UNITED AC 2010; 109:135-41. [PMID: 20123388 DOI: 10.1016/j.tripleo.2009.08.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 08/11/2009] [Accepted: 08/11/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to assess radiographic outcomes after partial carious dentin removal performed in deep caries lesions over a 10-year period. STUDY DESIGN Baseline image was compared to 3 follow-up radiographs (at 6-7 months, 3 years, and 10 years). Tertiary dentin deposition and lesion depth were qualitatively assessed. Radiographic density changes in the radiolucent zone (RZ) beneath the restoration were quantitatively compared to the control areas (CA) using digital subtraction radiography (Friedman repeated-measures analysis of variance). RESULTS A total of 13 teeth were evaluated. In most cases, lesion depth remained unchanged or decreased (12/13) and tertiary dentin formation was observed (10/13) after the 10-year follow-up. Differences between RZ and CA at the 6- to 7-month and 3-year follow-up periods were similar but significantly lower than those at the 10-year assessment. CONCLUSIONS Sealing of carious dentin arrested the caries process, promoted deposition of tertiary dentin, and induced mineral gain in the radiolucent zone.
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Affiliation(s)
- Luana Severo Alves
- Department of Social and Preventive Dentistry, Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Duque C, Negrini TDC, Sacono NT, Spolidorio DMP, de Souza Costa CA, Hebling J. Clinical and microbiological performance of resin-modified glass-ionomer liners after incomplete dentine caries removal. Clin Oral Investig 2009; 13:465-71. [PMID: 19548010 DOI: 10.1007/s00784-009-0304-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 06/08/2009] [Indexed: 11/29/2022]
Abstract
The aims of this study were to evaluate clinically and microbiologically the effects of two resin-modified glass-ionomer cements (RMGICs) used as liners after incomplete dentine caries removal and to identify Streptococcus mutans and Streptococcus sobrinus strains isolated from dentine samples, before and after indirect pulp treatment. Twenty-seven primary molars with deep carious lesions, but without signs and symptoms of irreversible pulpitis, were submitted to indirect pulp treatment. Treatment consisted of incomplete excavation of the carious dentine, application of one of the RMGICs (Vitrebond or Fuji Lining LC) or calcium hydroxide cement (Dycal), and sealing for 3 months. Clinical evaluation (consistency, color, and wetness of dentine) and carious dentine collects were performed before temporary sealing and after the experimental period. Microbiological samples were cultivated in specific media for subsequent counting of mutans streptococci (MS) and lactobacilli (LB). MS colonies were selected for identification of S. mutans and S. sobrinus by polymerase chain reaction. After 3 months, the remaining dentine was hard and dry, and there was a significant decrease in the number of MS and LB, in all groups, although complete elimination was not achieved in 33% and 26% of the teeth for MS and LB, respectively. From 243 MS colonies selected, 216 (88.9%) were identified as S. mutans and only 2 (0.8%) as S. sobrinus. The use of resin-modified glass-ionomer liners after incomplete caries removal, as well as a calcium hydroxide cement, promoted significant reduction of the viable residual cariogenic bacteria in addition to favorable clinical changes in the remaining carious dentine.
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Affiliation(s)
- Cristiane Duque
- Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University (UNESP), Rua Humaitá, 1680, Araraquara, São Paulo, Brazil
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Fagundes TC, Barata TJE, Prakki A, Bresciani E, Pereira JC. Indirect pulp treatment in a permanent molar: case reort of 4-year follow-up. J Appl Oral Sci 2009; 17:70-4. [PMID: 19148410 PMCID: PMC4327618 DOI: 10.1590/s1678-77572009000100014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 09/15/2008] [Indexed: 11/22/2022] Open
Abstract
This case report describes the Indirect Pulp Treatment (IPT) of deep caries lesion in a permanent molar. A 16-year-old male patient reported discomfort associated with thermal stimulation on the permanent mandibular left first molar. The radiographs revealed a deep distal caries lesion, very close to the pulp, absence of radiolucencies in the periapical region, and absence of periodontal space thickening. Pulp sensitivity was confirmed by thermal pulp vitality tests. Based on the main complaint and the clinical and radiographic examinations, the treatment plan was established to preserve pulp vitality. Clinical procedures consisted of removing the infected dentin and lining the caries-affected dentin with calcium hydroxide paste. The tooth was provisionally sealed for approximately 60 days. After this period, tooth vitality was confirmed, the remaining carious dentin was removed, and the tooth was restored. At 4-year follow-up, no clinical or radiographic pathological findings were found.
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Affiliation(s)
- Ticiane Cestari Fagundes
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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Hauser-Gerspach I, Pfäffli-Savtchenko V, Dähnhardt JE, Meyer J, Lussi A. Comparison of the immediate effects of gaseous ozone and chlorhexidine gel on bacteria in cavitated carious lesions in children in vivo. Clin Oral Investig 2008; 13:287-91. [DOI: 10.1007/s00784-008-0234-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 10/22/2008] [Accepted: 10/31/2008] [Indexed: 11/28/2022]
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Abstract
Formocresol pulpotomy (FP) in the United States is most frequently used to treat asymptomatic caries near the pulp in primary teeth. Indirect pulp therapy (IPT) is also indicated and has a significantly higher long-term success. Pulpotomy is thought to be indicated for primary teeth with carious pulp exposures, but research shows the majority of such teeth are nonvital or questionable for treatment with vital pulp therapy. IPT has a significantly higher success in treating all primary first molars, but especially those with reversible pulpitis compared with FP. The purpose of this article was to review the dental literature and new research in vital pulp therapy to determine the following: (1) Is a pulpotomy indicated for a true carious pulp exposure? (2) Is there a diagnostic method to reliably identify teeth that are candidates for vital pulp therapy? (3) Is primary tooth pulpotomy out of date, and should indirect pulp therapy replace pulpotomy?
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Affiliation(s)
- James A Coll
- Department of Pediatric Dentistry, University of Maryland Dental School, Baltimore, Maryland, USA.
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Treatment of deep carious lesions by complete excavation or partial removal: a critical review. J Am Dent Assoc 2008; 139:705-12. [PMID: 18519994 DOI: 10.14219/jada.archive.2008.0252] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The classical approach to treatment of deep carious lesions approaching the pulp mandates removing all infected and affected dentin. Several studies call this approach into question. TYPES OF STUDIES REVIEWED A search of five electronic databases using selected key words to identify studies relating to partial versus complete removal of carious lesions yielded 1,059 reports, of which the authors judged 23 to be relevant. Three articles reported the results of randomized controlled trials. RESULTS The results of three randomized controlled trials, one of which followed up patients for 10 years, provide strong evidence for the advisability of leaving behind infected dentin, the removal of which would put the pulp at risk of exposure. Several additional studies have demonstrated that cariogenic bacteria, once isolated from their source of nutrition by a restoration of sufficient integrity, either die or remain dormant and thus pose no risk to the health of the dentition. CLINICAL IMPLICATIONS There is substantial evidence that removing all vestiges of infected dentin from lesions approaching the pulp is not required for caries management.
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A clinical and microbiological comparative study of deep carious lesion treatment in deciduous and young permanent molars. Clin Oral Investig 2008; 12:369-78. [DOI: 10.1007/s00784-008-0208-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 05/19/2008] [Indexed: 10/22/2022]
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Cavity size difference after caries removal by a fluorescence-controlled Er:YAG laser and by conventional bur treatment. Clin Oral Investig 2008; 12:311-8. [DOI: 10.1007/s00784-008-0203-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 04/29/2008] [Indexed: 11/25/2022]
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Krause F, Braun A, Lotz G, Kneist S, Jepsen S, Eberhard J. Evaluation of selective caries removal in deciduous teeth by a fluorescence feedback-controlled Er:YAG laser in vivo. Clin Oral Investig 2008; 12:209-15. [PMID: 18224360 DOI: 10.1007/s00784-007-0169-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Accepted: 11/26/2007] [Indexed: 11/24/2022]
Abstract
This study investigated the ability and efficacy of an Er:YAG laser with a fluorescence feedback system for caries removal in deciduous teeth. Seventy-nine carious lesions were excavated using a fluorescence-controlled Er:YAG laser. Endpoint of treatment was defined by emission of fluorescence from the dentine surface below the pre-selected threshold level of 7 units and the subsequent termination of Er:YAG laser radiation. Dentine samples were obtained from the cavity floor, and viable counts of both Streptococcus mutans and Lactobacilli, expressed as colony forming units (log CFU), were evaluated. Preparation time was recorded to assess efficacy of the treatment procedure. S. mutans and/or Lactobacilli were found in 25 out of 79 lesions. Regarding the counts for S. mutans and Lactobacilli, the median log CFU was 0 (min, 0; max, 5.5) and 0 (min, 0; max, 6), respectively, with 2.4% of all samples yielding more than 100 CFU S. mutans and 4.8% yielding more than 100 CFU Lactobacilli. In 8 out of 79 cases, laser excavated cavities were not judged being caries-free using the conventional tactile criterion for assessing caries tissue. Focussing on these teeth, the median log CFU was 0 (min, 0; max, 0.5) for S. mutans and 0 (min, 0; max, 1.6) for Lactobacilli. The mean time for treatment was 2.3+/-1.2 min. Of the children, 93.8% rated the laser treatment to be comfortable. The study indicates that the fluorescence feedback-controlled Er:YAG laser might be an appropriate device for caries removal in children using the suggested threshold level of 7 units.
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Affiliation(s)
- Felix Krause
- Department of Operative Dentistry and Periodontology, University of Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany.
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Maltz M, Oliveira EF, Fontanella V, Carminatti G. Deep caries lesions after incomplete dentine caries removal: 40-month follow-up study. Caries Res 2007; 41:493-6. [PMID: 17921671 DOI: 10.1159/000109349] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 07/30/2007] [Indexed: 11/19/2022] Open
Abstract
Radiographic changes after indirect pulp capping (32 teeth in 27 patients) were studied for up to 36-45 months. Radiolucent zone (RZ) depth and tertiary dentine formation were assessed qualitatively and changes in radiographic density (by image subtraction) in RZ and control areas (CA) were estimated. During follow-up there were 1 pulp necrosis, 1 pulp exposure, 3 fractures and 3 withdrawals. Twelve cases showed decreased RZ depth and 4 displayed tertiary dentine. No changes with time in density of CA or RZ, or in the difference between them, were observed. It is concluded that indirect pulp capping arrests lesion progression, suggesting that complete dentine caries removal is not essential for caries control.
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Affiliation(s)
- M Maltz
- Department of Social and Preventive Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Donovan TE, Becker W, Brodine AH, Burgess JO, Cronin RJ, Summitt JB. Annual review of selected dental literature: Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2007; 98:36-67. [PMID: 17631173 DOI: 10.1016/s0022-3913(07)60036-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Terence E Donovan
- Department of Operative Dentistry, University of North Carolina, School of Dentistry, Chapel Hill, NC 27599-7450, USA.
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Peters MC, Flamenbaum MH, Eboda NN, Feigal RJ, Inglehart MR. Chemomechanical caries removal in children: efficacy and efficiency. J Am Dent Assoc 2007; 137:1658-66; quiz 1729-30. [PMID: 17138710 DOI: 10.14219/jada.archive.2006.0111] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Mathilde C Peters
- Department of Cardiology and Restorative Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, USA.
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