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Al-Wakeel RE, Hamama HH, Farahat DS, El-Negoly SA. Microhardness and elemental analysis of ion-releasing restoration/ dentin interface following enzymatic chemomechanical caries excavation. BMC Oral Health 2024; 24:581. [PMID: 38764034 PMCID: PMC11103859 DOI: 10.1186/s12903-024-04304-8] [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: 02/25/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND This study was conducted to compare chemical, elemental and surface properties of sound and carious dentin after application of two restorative materials resin-modified glassionomer claimed to be bioactive and glass hybrid restorative material after enzymatic chemomechanical caries removal (CMCR) agent. METHODS Forty carious and twenty non-carious human permanent molars were used. Molars were randomly distributed into three main groups: Group 1 (negative control) - sound molars, Group 2 (positive control) - molars were left without caries removal and Group 3 (Test Group) caries excavated with enzymatic based CMCR agent. After caries excavation and restoration application, all specimens were prepared Vickers microhardness test (VHN), for elemental analysis using Energy Dispersive Xray (EDX) mapping and finally chemical analysis using Micro-Raman microscopy. RESULTS Vickers microhardness values of dentin with the claimed bioactive GIC specimens was statistically higher than with glass hybrid GIC specimens. EDX analysis at the junction estimated: Calcium and Phosphorus of the glass hybrid GIC showed insignificantly higher mean valued than that of the bioactive GIC. Silica and Aluminum mean values at the junction were significantly higher with bioactive GIC specimens than glass hybrid GIC specimen. Micro-raman spectroscopy revealed that bioactive GIC specimens showed higher frequencies of v 1 PO 4, which indicated high level of remineralization. CONCLUSIONS It was concluded that ion-releasing bioactive resin-based restorative material had increased the microhardness and remineralization rate of carries affected and sound dentin. In addition, enzymatic caries excavation with papain-based CMCR agent has no adverse effect on dentin substrate.
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Affiliation(s)
- Rana E Al-Wakeel
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura City, Egypt
| | - Hamdi H Hamama
- Department of Conservative Dentistry, Faculty of Dentistry, Mansoura University, Mansoura City, Egypt.
| | - Dina S Farahat
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura City, Egypt
- Faculty of Dentistry, New-Mansoura University, New-Mansoura City, Egypt
| | - S A El-Negoly
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura City, Egypt
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Wu YT, Lu PW, Lin CA, Chang LY, Jaihao C, Peng TY, Lee WF, Teng NC, Lee SY, Dwivedi RP, Negi P, Yang JC. Development of a zinc chloride-based chemo-mechanical system for potential minimally invasive dental caries removal system. J Dent Sci 2024; 19:919-928. [PMID: 38618085 PMCID: PMC11010630 DOI: 10.1016/j.jds.2023.08.004] [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: 07/07/2023] [Revised: 08/01/2023] [Indexed: 04/16/2024] Open
Abstract
Background/purpose The chemo-mechanical caries-removal technique is known to offer advantages of selective dentin caries treatment while leaving healthy dental tissues intact. However, current sodium hypochlorite based reagents usually excessively damage dentin collagen. Therefore, the purpose of this study was to develop a novel chemo-mechanical caries-removal system to preserve the collagen network for subsequent prosthetic restorations. Materials and methods The calfskin-derived collagen was chosen as a model system to investigate the dissolution behavior of collagen under different operating conditions of chemical-ultrasonic treatment systems. The molecular weight, triple-helix structure, the morphology, and functional group of collagen after treatment were investigated. Results Various concentrations of sodium hypochlorite or zinc chloride together with ultrasonic machinery were chosen to investigate. The outcomes of circular dichroism (CD) spectra demonstrated stability of the triple-helix structure after treatment of a zinc chloride solution. In addition, two apparent bands at molecular weights (MWs) of 130 and 121 kDa evidenced the stability of collagen network. The positive 222 nm and 195 nm negative CD absorption band indicated the existence of a triple-helix structure for type I collagen. The preservation of the morphology and functional group of the collagen network on the etched dentin surface were investigated by in vitro dentin decalcification model. Conclusion Unlike NaOCl, the 5 wt% zinc chloride solution combined with ultra-sonication showed dissolution rather than denature as well as degradation of the dentin collagen network. Additional in vivo evaluations are needed to verify its usefulness in clinical applications.
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Affiliation(s)
- Yu-Tzu Wu
- Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Po-Wen Lu
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, New Taipei, Taiwan
| | - Chih-An Lin
- Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Liang-Yu Chang
- Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Chonlachat Jaihao
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Yu Peng
- School of Dentistry, Taipei Medical University, Taipei, Taiwan
| | - Wei-Fang Lee
- School of Dental Technology, Taipei Medical University, Taipei, Taiwan
| | - Nai-Chia Teng
- School of Dentistry, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Yang Lee
- School of Dentistry, Taipei Medical University, Taipei, Taiwan
| | - Ram Prakash Dwivedi
- School of Electrical and Computer Science Engineering, Shoolini University, Himachal Pradesh, India
| | - Poonam Negi
- School of Pharmaceutical Sciences, Biotechnology and Management Sciences, Shoolini University, Himachal Pradesh, India
| | - Jen-Chang Yang
- Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan
- International Ph.D. Program in Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- Research Center of Biomedical Device, Taipei Medical University, Taipei, Taiwan
- Research Center of Digital Oral Science and Technology, Taipei Medical University, Taipei, Taiwan
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Govind S, Jena A, Kamilla SK, Mohanty N, Kader MA, Luke AM, Alessa NA, Assiry AA, Karobari MI. Analyzing working time and efficient caries removal using a novel bioactive caries detecting dye and air polisher prophy for caries excavation: randomised clinical trial. Clin Oral Investig 2024; 28:214. [PMID: 38485869 DOI: 10.1007/s00784-024-05609-2] [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: 12/20/2023] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES This study aims to analyze the working time consumed during caries excavation and pain perception while using a novel Bioactive caries-detecting dye solution (BCD), an Air Polisher Prophy and a combination. MATERIALS AND METHODS Four groups (in each group, n = 20 permanent teeth) were selected from 60 people between 17 and 40 years of age. The study included teeth with occlusal dentinal caries in the molars with cavity entrance sizes of less than 2 mm (clinically and radiographically). Randomization software was used to assign patients to various groups. Group A: Conventional Rotary Drilling, Group B: BCD + Mechanical Excavation (Spoon Excavator), Group C: Air Polisher Prophy, and Group D: BCD + Air Polisher Prophy 0.5 mL BCD was applied with a micro brush to the carious tooth surface for 40 s in groups B and D. After that, radiographs were performed to see if the radiopaque extension was visible. For mechanical caries extraction, a spoon excavator was used for group B, and an air polisher prophy was employed for group D. For mechanical caries extraction, a spoon excavator was utilized for group B. An air polisher prophy was employed for group D. Multiple applications of the BCD were used in the event of residual caries. Working time and pain experienced during caries excavation were registered using the Verbal Pain Scale (VPS) (score 0-4), and caries removal was clinically graded using the modified Scale (score 0-5). RESULTS The time taken was Group A, Group D, Group B, and Group C, according to statistical analysis using ANOVA and the Post Hoc Test (275.02, 403.8, 461.98, 615.41 s, respectively). Group A had the highest mean VPS (1.85), whereas Group B had the most minor pain (0.6), followed by Group D (1.2) and Group C (0.6). (1.45). Group C (2.35), followed by groups D (1.75), B (1.30), and A (1.30), had ineffective caries eradication (0.90). (p < 0.05). CONCLUSIONS compared to group C, groups B and D took less time and had less/no pain while excavating caries. Compared to traditional mechanized caries removal methods, the chemo-chemical BCD can diagnose and aid in successful caries removal with minimal pain. CLINICAL RELEVANCE The outcomes of the present study demonstrated that the chemo-chemical bioactive caries detecting dye solution has the potential to identify and help in effective caries removal before mechanized caries removal methods.
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Affiliation(s)
- Shashirekha Govind
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha' O'Anusandhan (Deemed to Be) University, Bhubaneswar, Odisha, India.
| | - Amit Jena
- Department of Conservative Dentistry and Endodontics, Sriram Chandra Bhanja Dental College & Hospital Cuttack, Cuttack, Odisha, 753007, India
| | - Sushanta Kumar Kamilla
- Department of Physics, And Head S'O'A IPR Cell Semiconductor Research Laboratory, Siksha'O' Anusandhan (Deemed to Be) University, Odisha, Bhubaneswar, India
| | - Neeta Mohanty
- Department of Oral Pathology, Institute of Dental Sciences, Siksha'O'Anusandhan (Deemed to Be) University, Bhubaneswar, Odisha, India
| | - Mohammed Abdul Kader
- Department Restorative Dental Science, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Alexander Maniangat Luke
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, UAE
- Center for Medical and Bio-Allied Health Sciences Research (CMBAHSR), Ajman University, Ajman, UAE
| | - Noura Abdulaziz Alessa
- Department of Pediatric Dentistry and Orthodontics, Dental college, King Saud University, Riyadh, Saudi Arabia
| | - Ali A Assiry
- Preventive Dental Science Department, Faculty of Dentistry, Najran University, Najran, Saudi Arabia
| | - Mohmed Isaqali Karobari
- Dental Research Unit, Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical And Technical Sciences, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu, 602105, India.
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Dhanvijay A, Kubde R, Shenoi P, Badole G, Shahu S. Assessment of Smear Layer Formation After Caries Removal Using Erbium Laser and Papain-Based Chemo-Mechanical Caries Removal Agent: An In Vitro Scanning Electron Microscopy Study. Cureus 2023; 15:e47999. [PMID: 38034221 PMCID: PMC10686783 DOI: 10.7759/cureus.47999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction With the advancement in the field of adhesive dentistry, there has been a significant and groundbreaking shift toward the adoption of minimally invasive caries removal techniques where substrate modification is known to enhance adhesive bonding. The smear layer has always been controversial, as its modification helps in bonding, but if contaminated with bacteria, it compromises the formation of a satisfactory marginal seal. Thus, the recognition of the role played by the smear layer highlights the importance of the type of caries removal method employed. Hence, the aim of the present study was to assess and compare smear layer formation after caries removal using an erbium laser and chemo-mechanical caries removal agent by scanning electron microscopy. Methods The study involved the evaluation of 30 extracted human molars with occlusal caries. Based on the method of caries excavation, the samples were allocated into two separate groups: group 1 - caries removed using erbium laser (Waterlase, Biolase, Lake Forest, CA); group 2 - caries removed using papain-based chemo-mechanical caries removal agent (Carie Fix, Dengen Dental, Bahadurgarh, India). To assess the smear layer, the samples underwent examination using a scanning electron microscope at 1500x and 3000x magnification after removal of caries. Statistical analysis was done using SPSS version 22 software (IBM Corp., Armonk, NY). Mann-Whitney test was used to compare the mean smear layer (nonparametric) between both groups. Results Group 1 (Er:YAG laser) showed significantly greater removal of the smear layer than group 2 (papain-based chemo-mechanical caries removal agent) on the excavated caries surfaces (p < 0.001). In group 1, the dentinal tubules exhibited greater patency when compared to the partial patency observed in group 2. Conclusion Both techniques for caries removal were effective; however, the Er:YAG laser method was determined to be more efficient in comparison to the chemo-mechanical agent. These caries removal methods can be considered the future of minimally invasive dentistry.
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Affiliation(s)
- Aditi Dhanvijay
- Department of Conservative Dentistry and Endodontics, Vidya Shikshan Prasarak Mandal (VSPM) Dental College and Research Centre, Nagpur, IND
| | - Rajesh Kubde
- Department of Conservative Dentistry and Endodontics, Vidya Shikshan Prasarak Mandal (VSPM) Dental College and Research Centre, Nagpur, IND
| | - Pratima Shenoi
- Department of Conservative Dentistry and Endodontics, Vidya Shikshan Prasarak Mandal (VSPM) Dental College and Research Centre, Nagpur, IND
| | - Gautam Badole
- Department of Conservative Dentistry and Endodontics, Vidya Shikshan Prasarak Mandal (VSPM) Dental College and Research Centre, Nagpur, IND
| | - Shriya Shahu
- Department of Conservative Dentistry and Endodontics, Vidya Shikshan Prasarak Mandal (VSPM) Dental College and Research Centre, Nagpur, IND
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Govind S, Jena A, Kamilla SK, Mohanty N, Mallikarjuna RM, Nalawade T, Saraf S, Khaldi NA, Jahdhami SA, Shivagange V. Diagnosis and Assessment of Dental Caries Using Novel Bioactive Caries Detecting Dye Solution. Biomedicines 2023; 11:biomedicines11020500. [PMID: 36831036 PMCID: PMC9953294 DOI: 10.3390/biomedicines11020500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The goal of materials should be early caries detection, removal of carious lesions, and reduction of dentin hypersensitivity. Thus, the study aims to determine the efficacy of a bioactive caries detecting dye (BCD) for the diagnosing and mechanical removal of occlusal and proximal dental caries. METHODS Patients with occlusal (A1, A2) and proximal carious lesions (B1, B2) were treated with the rotary technique and BCD solution on 120 teeth (n = 60 for each). Group 1: Excavation was performed using diamond points. Group 2: 0.5 mL of BCD solution was scrubbed for 20 sec and excavation was performed with a sharp spoon excavator. Post-excavation cavity volume analysis was performed using a 3D scanner. The time required, VAS for pain, VAS for facial expression, and sound eye motor scoring were scored during excavation. Post-restoration evaluation was performed at 3, 6, and 12 months (FDI criteria). RESULTS The chi-square test revealed that the A1 (197.90 30.97 s) and B1 (273.06 69.95 s) had significantly less mean procedural time than the A2 (292.13 44.87 s) and B2 (411.86 88.34 s). BCD (A2, B2) group showed good patient acceptance, less pain during caries excavation VAS (p = 0.001, FACE (p = 0.001), and SEM (p < 0.001) analysis than the rotary group. There was a statistically insignificant difference between groups immediately (p = 0.235), (p = 0.475) and after 24 h (p = 0.561), (p = 0.688). Color score, hardness of excavated surface, and caries removal score for occlusal and proximal groups showed insignificant differences between the groups. BCD group showed significantly less mean caries excavated volume for the occlusal group (p = 0.003) as compared to the proximal group (p = 0.417) evaluated by 3D scanner. Evaluation of restoration after 3-, 6-, and 12 months intervals (Occlusal caries group (p = 0.247), (p = 0.330), and (0.489) and Proximal caries group (p = 0.299), (p = 0.594), and (0.494)) was acceptable for both the groups. CONCLUSION BCD helps in identification of dental caries clinically, radiographically, and in effective removal of denatured teeth with less pain or sensitivity.
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Affiliation(s)
- Shashirekha Govind
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed to be) University, Bhubaneswar 751003, India
- Correspondence: ; Tel.: +91-933-845-7955
| | - Amit Jena
- Department of Conservative Dentistry and Endodontics, Sriram Chandra Bhanja Dental College & Hospital, Cuttack 753007, India
| | - Sushanta Kumar Kamilla
- Department of Physics, Institute of Technical Education and Research, Siksha ‘O’ Anusandhan (Deemed to be) University, Bhubaneswar 751003, India
| | - Neeta Mohanty
- Department of Oral Pathology and Microbiology, Institute of Dental Sciences, Siksha ‘O’Anusandhan (Deemed to be) University, Bhubaneswar 751003, India
| | - Rachappa M. Mallikarjuna
- Department of Paediatric Dentistry, Child Dental Health, Oman Dental College, Mina Al Fahal, Muscat, Wattayah 116, Oman
| | - Triveni Nalawade
- Department of Paediatric Dentistry, Child Dental Health, Oman Dental College, Mina Al Fahal, Muscat, Wattayah 116, Oman
| | - Sanjay Saraf
- Department of Oral Biology and Oral Pathology, Oman Dental College, Mina Al Fahal, Muscat, Wattayah 116, Oman
| | - Naseer Al Khaldi
- Consultant Prosthodontist, Al-Nahdha Hospital, Al Khuwair, Muscat 133, Oman
| | - Salma Al Jahdhami
- Specialist, Oral and Maxillofacial Surgeon, Al-Nahdha Hospital, Al Khuwair, Muscat 133, Oman
| | - Vinay Shivagange
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Chennai 600077, India
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Chemomechanical Caries Removal Methods: A Literature Review. Saudi Dent J 2023; 35:233-243. [PMID: 37091279 PMCID: PMC10114597 DOI: 10.1016/j.sdentj.2023.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Aim To provide dental practitioners and researchers with a comprehensive review of the historical development, chemical composition, mechanisms of action, advantages, and drawbacks of different chemomechanical caries removal (CMCR) agents. Methods An electronic search was performed for all articles published on CMCR agents in various databases, including the Web of Science, PubMed, Cochrane, Scopus, and Google Scholar bibliographic databases, from January 1, 1975, to July 31, 2022. Results Records were identified using the following search terms: Brix3000, Carie-Care, Caridex, Carisolv, chemomechanical caries removal, conventional surgical method, and Papacárie. A total of 171 articles were screened based on the titles and abstracts, of which 126 were deemed eligible for inclusion after duplicates were removed. Following a manual search of the reference list, eight articles were added. Articles were then excluded for other reasons, such as being written before 1975, being written in a language other than English, and the non-availability of the full text. Overall, 120 articles were included in the analysis (literature reviews [n = 27], systematic reviews [n = 8], research articles [n = 82], case reports [n = 3]). Conclusion CMCR is a potential method of caries control in the future as an alternative to the conventional surgical approach in standard dentistry applications. It is more widely accepted, less painful, and has comparable efficacy to the conventional surgical method. Clinical significance A continuous trend among manufacturers has been observed since 1975 to reduce the drawbacks of CMCR agents. Moreover, evidence-based minimally invasive techniques, including CMCR agents that require minimal or no aerosol-generating procedures, are preferred while measures to control the spread of coronavirus disease are in force.
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Souza TFD, Martins ML, Jural LA, Maciel IP, Magno MB, Coqueiro RDS, Pithon MM, Leal SC, Fonseca-Gonçalves A, Maia LC. Did the Use of Minimum Interventions for Caries Management Change during the COVID-19 Pandemic? A Cross-Sectional Study. Caries Res 2023; 57:459-469. [PMID: 36623490 DOI: 10.1159/000528837] [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: 07/05/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
The aim of this study was to evaluate changes in the frequency of use of minimum intervention (MI) techniques for caries management during the COVID-19 pandemic. A questionnaire was applied through the SurveyMonkeyTM platform to evaluate changes in the dentist's frequency of use of noninvasive, microinvasive, minimally invasive, and mixed interventions, nonaerosol or aerosol productive, to manage dental caries before and during COVID-19 pandemic. Differences in the use of MI techniques were analyzed by Wilcoxon test, and the effect size (ES) was calculated. An α = 0.05 was adopted. A total of 781 dentists answered the questionnaire; most of them were female (76.4%), with 30s (76.4%), graduated over 10-24 years ago (38%) in public dental schools (62%), graduated in southwest of Brazil (38%), that work in clinical environment (66.8%) and in private jobs (53.4%). During COVID-19, among the sample, 91 respondents were not working. In relation to the noninvasive techniques, only the use of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) decreased during the COVID-19 pandemic (p < 0.01; ES = 0.11). The frequency of sealants to repair defective restorations was the only microinvasive technique that increased during the pandemic (p < 0.01; ES = 0.03). Among the minimally invasive techniques, the use of atraumatic restorative treatment increased significantly (p < 0.01; ES = 0.06), while the use of air abrasion decreased (p = 0.02; ES = 0.04) during COVID-19 pandemic. Moreover, nonrestorative cavity control (mixed intervention) increased during pandemic period (p < 0.001; ES = 0.11). Although the results demonstrated differences in the use of some procedures, a very small magnitude of the effect was perceived, demonstrating that the influence of COVID-19 pandemic was very little, if any, in the use of MI techniques for caries management. Moreover, the use of MI strategies was already well established between Brazilian dentists before the pandemic period.
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Affiliation(s)
- Tainá Fontes de Souza
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil,
| | - Mariana Leonel Martins
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Lucas Alves Jural
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Isadora Passos Maciel
- Department of Dentistry, School of Health Sciences, Universidade de Brasília (UnB), Brasília, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Matheus Melo Pithon
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Department of Health I, Universidade Estadual Do Sudoeste Da Bahia (UESB), Jequié, Brazil
| | - Soraya Coelho Leal
- Department of Dentistry, School of Health Sciences, Universidade de Brasília (UnB), Brasília, Brazil
| | - Andréa Fonseca-Gonçalves
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Santos VCED, Maquera-Huacho PM, Imbriani MJM, Minhaco VMTR, Spolidorio DMP. Effects of BlueM® against Streptococcus mutans biofilm and its virulence gene expression. Braz Dent J 2023; 34:19-28. [PMID: 36888841 PMCID: PMC10027103 DOI: 10.1590/0103-6440202305133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/21/2022] [Indexed: 03/08/2023] Open
Abstract
This study evaluated the antimicrobial capacity of BlueM® mouthwash against the bacterium Streptococcus mutans and its influence on gbpA gene expression as well as its cytotoxic effect on fibroblast cells. BlueM® showed antimicrobial activity, with MIC and MBC values of 0.005% and 0.01%, respectively. The MBIC was 6.25% for S. mutans. CFU count and confocal microscopy revealed significant effect of BlueM® on S. mutans biofilm pre-formed on dentin surfaces. Interestingly, the analysis of gbpA gene expression indicated a decrease in gene expression after 15 min of treatment with BlueM® at a concentration of 25%. Moreover, BlueM® exhibited low levels of cytotoxicity. In conclusion, our results showed the antimicrobial effectiveness of BlueM® against S. mutans, its ability to modulate the expression of the gbpA gene and its low cytotoxicity. This study supports the therapeutic potential of BlueM® as an alternative agent for the control of oral biofilm.
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Affiliation(s)
| | | | - Maria Júlia Mancim Imbriani
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University(Unesp), Araraquara, SP, Brazil
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil
| | - Vivian M Tellaroli Rodrigues Minhaco
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University(Unesp), Araraquara, SP, Brazil
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil
| | - Denise M Palomari Spolidorio
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University(Unesp), Araraquara, SP, Brazil
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Ferreira LDAQ, Diniz IMA, Peixoto RTRDC, Gomes NA, Caneschi CDS, Spineli LM, Martins CC. Efficacy of antiseptics and chemomechanical methods for dentin caries lesions: A systematic review with GRADE approach. FRONTIERS IN ORAL HEALTH 2023; 4:1110634. [PMID: 36908693 PMCID: PMC9992646 DOI: 10.3389/froh.2023.1110634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
Objectives Selective caries removal aims to remove carious tissue in deep dentin lesions. However, a discussion stands on the value of antiseptics and chemomechanical adjuvant methods to reduce the bacterial load on residual caries lesions. This systematic review has addressed two main clinical questions to compare the antimicrobial efficacy of available methods using (1) antiseptic or (2) chemomechanical agents before restoring dentin carious lesions. Methods We included randomized and non-randomized controlled trials (RCTs/ NRCTs). We searched eight databases from inception to October 2021. Paired reviewers independently screened studies, extracted data, and assessed the risk of bias. The primary outcome was the reduction in the number of total bacterial in dentin, whereas secondary outcomes were reduction in the number of Lactobacillus and Streptococcus. We used the ratio of ratio of post-treatment to baseline means between two interventions in the logarithmic scale as a proper effect measure. Certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation approach. Results We included 14 RCTs and 9 NRCTs, with nine interventions. Regardless the method, the number of bacteria at baseline was similar or exceeded that after the intervention, particularly in NRCTs. The evidence was inconclusive for most comparisons. Among antiseptic agents, chlorhexidine (CHX) resulted in an average of 1.14 times [95% confidence interval (CI): 1.08-1.21] more total bacterial than photodynamic therapy in RCTs. Among NRCTS, the natural agents resulted in five times more total bacterial than CHX (95% CI: 2-11). For chemomechanical methods, the control resulted in eight times (95% CI: 4-17) more total bacterial than Carisolv (SHAA). Conclusions The certainty of the evidence was very low for all comparisons showing uncertainty whether one treatment could be more effective than another for dentin disinfection. So far, exclusively removing soft carious dentin would be enough to reduce the bacterial count.
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Affiliation(s)
| | - Ivana Márcia Alves Diniz
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Natália Aparecida Gomes
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Camila de Sousa Caneschi
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Loukia Maria Spineli
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Carolina Castro Martins
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Choudhary K, Gouraha A, Sharma M, Sharma P, Tiwari M, Chouksey A. Clinical and Microbiological Evaluation of the Chemomechanical Caries Removal Agents in Primary Molars. Cureus 2022; 14:e31422. [DOI: 10.7759/cureus.31422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022] Open
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11
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Influence of the chemomechanical and mechanical carious tissue removal on the risk of restorative failure: a systematic review and meta-analysis. Clin Oral Investig 2022; 26:6457-6467. [DOI: 10.1007/s00784-022-04695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022]
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12
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Zou J, Du Q, Ge L, Wang J, Wang X, Li Y, Song G, Zhao W, Chen X, Jiang B, Mei Y, Huang Y, Deng S, Zhang H, Li Y, Zhou X. Expert consensus on early childhood caries management. Int J Oral Sci 2022; 14:35. [PMID: 35835750 PMCID: PMC9283525 DOI: 10.1038/s41368-022-00186-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 02/05/2023] Open
Abstract
Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.
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Affiliation(s)
- Jing Zou
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qin Du
- Department of Stomatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lihong Ge
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jun Wang
- Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Department of Pediatric Dentistry, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xiaojing Wang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shanxi Key Laboratory of Military Stomatology, Department of Pediatric Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Yuqing Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Guangtai Song
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Wei Zhao
- Department of Pediatric Dentistry, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat‑Sen University, Guangzhou, China
| | - Xu Chen
- Department of Pediatric Dentistry, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Beizhan Jiang
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Yufeng Mei
- Department of Pediatric Dentistry, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Yang Huang
- Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, China
| | - Shuli Deng
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Hongmei Zhang
- Department of Pediatric Dentistry, The Affiliated Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
| | - Yanhong Li
- Department of Pediatric and Preventive Dentistry, The Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Bratu DC, Nikolajevic-Stoican N, Popa G, Pop SI, Dragoș B, Luca MM. A Bibliometric Analysis (2010-2020) of the Dental Scientific Literature on Chemo-Mechanical Methods of Caries Removal Using Carisolv and BRIX3000. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060788. [PMID: 35744051 PMCID: PMC9231379 DOI: 10.3390/medicina58060788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
Reports in the literature have proposed and analyzed several minimally invasive techniques for caries removal in recent decades. In light of recent events surrounding the ongoing epidemiological context, concerns have been raised regarding the generation of aerosols during dental procedures. The aim of our research was to provide an overview of the scientific literature on the topic of chemo-mechanical caries removal (CMCR) methods, focusing on two products (Carisolv, BRIX3000), commercially available in Europe. A bibliometric analysis was used to investigate the scientific articles included in Web of Science (WoS) Core Collection database, published from January 2010 to December 2020. We analyzed the co-occurrence of all keywords (Author Keywords and the KeyWords Plus section), co-authorship and co-citation, using the free software VOSviewer. Our bibliometric analysis revealed a worldwide interest in the subject of chemo-mechanical methods of caries removal, which has transcended the area of pediatric dentistry. The analyzed studies have been conducted mainly in high-income countries that have developed sanitary policies regarding prevention and early treatment of carious lesions as a health priority.
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Affiliation(s)
- Dana Cristina Bratu
- Department of Orthodontics and Dento-Facial Orthopedics, Orthodontic Research Center, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
| | - Nicoleta Nikolajevic-Stoican
- Department of Pediatric Dentistry, Pediatric Dentistry Research Center, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (N.N.-S.); (M.-M.L.)
| | - George Popa
- Department of Orthodontics and Dento-Facial Orthopedics, Orthodontic Research Center, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Correspondence: (G.P.); (S.I.P.)
| | - Silvia Izabella Pop
- Department of Orthodontics, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
- Correspondence: (G.P.); (S.I.P.)
| | - Bianca Dragoș
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 9 Revolutiei 1989 Avenue, 300070 Timisoara, Romania;
| | - Magda-Mihaela Luca
- Department of Pediatric Dentistry, Pediatric Dentistry Research Center, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (N.N.-S.); (M.-M.L.)
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Lee YL, Li KC, Yiu CKY, Boyd DH, Ekambaram M. Evaluation of developmentally hypomineralised enamel after surface pretreatment with Papacarie Duo gel and different etching modes: an in vitro SEM and AFM study. Eur Arch Paediatr Dent 2022; 23:117-131. [PMID: 34586616 DOI: 10.1007/s40368-021-00671-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/24/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE This study aimed at investigating the surface morphology and nanotopography of normal enamel (NE) and developmentally hypomineralised enamel (HE) when subjected to various pretreatment protocols under scanning electron microscopy (SEM) and atomic force microscopy (AFM). METHODS Sixteen NE, 16 creamy/white (CW) HE and 16 yellow/brown (YB) HE specimens sectioned from extracted hypomineralised first permanent molars (FPMs) were included in this study. They were randomly distributed into 12 experimental groups (n = 4). Each group involved the following: (1) deproteinisation with Papacarie Duo® gel or no deproteinisation, and (2) the use of Scotchbond™ Universal Adhesive (Scotchbond) in self-etch (SE) mode or 37% phosphoric acid etchant. Subsequently, the surface morphology and nanotopography of pretreated enamel specimens were evaluated under SEM and AFM, respectively. RESULTS SEM observation showed that deproteinisation with Papacarie Duo® gel before phosphoric acid etching led to favourable etching patterns. This was consistent across all groups irrespective of the type of enamel specimen and the severity of hypomineralisation. In contrast, AFM results identified three factors that influenced surface parameters: (1) type of enamel specimen, (2) severity of hypomineralisation and (3) etching mode. YB HE recorded higher surface roughness values than CW HE and NE when subjected to the same pretreatment protocol. Deproteinisation and the application of Scotchbond in SE mode led to minimal topographic changes; however, acid etching was associated with an increase in surface roughness. CONCLUSION Deproteinisation with Papacarie Duo® gel followed by acid etching contributed to improved etching patterns on HE.
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Affiliation(s)
- Y-L Lee
- Discipline of Paediatric Dentistry, Department of Oral Sciences, Faculty of Dentistry, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - K C Li
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - C K Y Yiu
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong (SAR), People's Republic of China
| | - D H Boyd
- Discipline of Paediatric Dentistry, Department of Oral Sciences, Faculty of Dentistry, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - M Ekambaram
- Discipline of Paediatric Dentistry, Department of Oral Sciences, Faculty of Dentistry, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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Jiang CM, Duangthip D, Auychai P, Chiba M, Folayan MO, Hamama HHH, Kamnoedboon P, Lyons K, Matangkasombut O, Mathu-Muju KR, Mathur VP, Mei ML, Morgan M, Poolthong S, Rahul M, Srinivasan M, Takahashi T, Yaklai S, Zhang S, Zou XC, Chu CH, Lo ECM. Changes in Oral Health Policies and Guidelines During the COVID-19 Pandemic. FRONTIERS IN ORAL HEALTH 2022; 2:668444. [PMID: 35048011 PMCID: PMC8757803 DOI: 10.3389/froh.2021.668444] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to describe the changes in oral health policies and guidelines in response to the Coronavirus disease 2019 (COVID-19) pandemic in different countries and regions around the world. Information on oral health policies and guidelines from 9 countries (Canada, China including Hong Kong, Egypt, India, Japan, New Zealand, Nigeria, Switzerland, and Thailand) were summarized, and sources of the information were mostly the national or regional health authorities and/or dental council/associations. The changes made to the oral health guidelines depended on the severity of the COVID-19 pandemic. This included suspension of non-emergency dental care services at the peak of the COVID-19 outbreak, and easing the restrictions on non-essential and elective dental care when the pandemic became under control. The COVID-19 risk mitigation strategies include strict adherence to infection control practices (use of hand sanitizers, facemask and maintaining social distancing), reducing the amount of aerosol production in the dental setting, and managing the quality of air in the dental treatment rooms by reducing the use of air conditioners and improving air exchange. The COVID-19 pandemic has shown a major impact on dental practice. Dental professionals are trying to adapt to the new norms, while the medium to long-term impact of COVID-19 on dentistry needs further investigation.
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Affiliation(s)
- Chloe Meng Jiang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | | | - Prim Auychai
- Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Mirei Chiba
- Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | | | | | | | - Karl Lyons
- Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | | | | | - Vijay Prakash Mathur
- Department of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - May Lei Mei
- Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Mike Morgan
- Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Suchit Poolthong
- Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Morankar Rahul
- Department of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Murali Srinivasan
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Tetsu Takahashi
- Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Sanicha Yaklai
- Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Shinan Zhang
- Affiliated Stomatological Hospital, School of Stomatology, Kunming Medical University, Kunming, China
| | - Xin Chun Zou
- Affiliated Stomatological Hospital, School of Stomatology, Kunming Medical University, Kunming, China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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16
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Souza TF, Martins ML, Magno MB, Vicente-Gomila JM, Fonseca-Gonçalves A, Maia LC. Worldwide research trends on the use of chemical-mechanical caries removal products over the years: a critical review. Eur Arch Paediatr Dent 2022; 23:869-883. [PMID: 35831699 PMCID: PMC9281217 DOI: 10.1007/s40368-022-00726-6] [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: 12/22/2021] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chemical-mechanical caries removal (CMCR) products are in constant evolution and were recommended during the COVID-19 pandemic as substitutes for conventional caries removal. AIM Characterize the worldwide scientific literature about CMCR products, over the years, by means of a critical review. DESIGN Electronic search was performed on Medline/PubMed, Scopus, Web of Science, Cochrane Library, Lilacs, and Embase up to November 2020. Year, journal, country of authors, and type of study were the data extracted from the retrieved studies. Additional data of the clinical studies and systematic reviews were investigated. RESULTS 2221 records were identified, 397 selected. 2011-2020 period concentrates higher number of publications (n = 169), in the Journal of Dental Research (n = 51), developed in Brazil (n = 45) and India (n = 44). Most studies were in vitro (n = 211) and clinical trials (n = 101). Carisolv™ (n = 48) and Papacarie Duo Gel™ (n = 33) were the most used products, prescript in isolated usage (n = 101), and compared with drills (n = 77). CMCR were more studied in primary teeth (n = 78), receiving glass ionomer cement (GIC) (n = 51) as restorative material. The most evaluated outcomes were time spent (n = 48) and pain (n = 41). Clinical application of CMCR takes more time than other techniques, but can also reduce patient anxiety, pain, and need for anesthesia. CONCLUSION In vitro and clinical studies with CMCR products have been increasing, mostly carried out in developing countries, evaluating Carisolv™ and Papacarie Duo Gel™. Clinical studies tend to evaluate the time spent and pain compared to drills for removing caries in primary teeth, posteriorly restored with GIC. CMCR clinical application reduces anxiety, pain, and need for anesthesia, despite increase treatments' time.
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Affiliation(s)
- T. F. Souza
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325-Cidade Universitária, Rio de Janeiro, RJ CEP 21941-971 Brazil
| | - M. L. Martins
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325-Cidade Universitária, Rio de Janeiro, RJ CEP 21941-971 Brazil
| | - M. B. Magno
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325-Cidade Universitária, Rio de Janeiro, RJ CEP 21941-971 Brazil
| | - J. M. Vicente-Gomila
- Department of Corporate Management, ESIC Business and Marketing School, Pozuelo, Madrid, Spain
| | - A. Fonseca-Gonçalves
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325-Cidade Universitária, Rio de Janeiro, RJ CEP 21941-971 Brazil
| | - L. C. Maia
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325-Cidade Universitária, Rio de Janeiro, RJ CEP 21941-971 Brazil
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17
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Asal MA, Abdellatif AM, Hammouda HE. Clinical and Microbiological Assessment of Carisolv and Polymer Bur for Selective Caries Removal in Primary Molars. Int J Clin Pediatr Dent 2021; 14:357-363. [PMID: 34720507 PMCID: PMC8543989 DOI: 10.5005/jp-journals-10005-1956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective To assess the efficacy of the new Carisolv system and Polymer bur (SmartbursII®) for selective caries removal in primary molars clinically and microbiologically, compared with the conventional mechanical method. Materials and methods Sixty children with class I active carious lesions were selected. The children were randomly allocated to three groups (n = 20) according to the caries removal method. Under rubber dam isolation, dentin samples were taken before and after caries removal for microbial culture. Time spent in each technique was recorded. The clinical efficacy of caries removal was verified using caries detector dye. Patient satisfaction toward the treatment was evaluated using a facial image scale. Results The median of caries detector dye scores was significantly lower in the conventional group compared to others (p value < 0.05). The mean time for caries removal was the longest with Carisolv (p value < 0.05). The median of facial image scale scores was significantly higher in the conventional group compared with others (p value < 0.05). The mean total viable bacterial count after caries removal was significantly higher in polymer bur group compared with others (p value < 0.05). While, there was no significant difference between Carisolv and conventional groups (p value > 0.05). Conclusion The clinical efficacy of caries removal was highest with the mechanical method. Carisolv took the longest time for caries removal. Patient satisfaction was higher with Carisolv and polymer bur than the mechanical method. The antimicrobial efficacy of Carisolv and the mechanical method was higher than the polymer bur. Clinical significance Carisolv is a viable alternative to the mechanical method in the management of dental caries, especially in children. Further studies are needed to assess the efficacy of caries removal by SmartbursII®. How to cite this article Asal MA, Abdellatif AM, Hammouda HE. Clinical and Microbiological Assessment of Carisolv and Polymer Bur for Selective Caries Removal in Primary Molars. Int J Clin Pediatr Dent 2021;14(3):357–363.
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Affiliation(s)
- Mohamed A Asal
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Abeer M Abdellatif
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Hossam E Hammouda
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Mansoura University, Mansoura, Dakahlia, Egypt
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18
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Adham MM, El Kashlan MK, Abdelaziz WE, Rashad AS. The impact of minimally invasive restorative techniques on perception of dental pain among pregnant women: a randomized controlled clinical trial. BMC Oral Health 2021; 21:76. [PMID: 33602209 PMCID: PMC7891028 DOI: 10.1186/s12903-021-01432-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The public dental care sector is striving to fulfill the preventive and restorative needs of Egyptians, including pregnant women, who may not receive timely care due to misconceptions about dental treatment during pregnancy. Because of this, they are likely to suffer dental pain, with higher risk of infection affecting their offsprings. AIM OF THE STUDY To compare the effectiveness of chemo-mechanical caries removal using Papacarie-Duo and Atraumatic Restorative Treatment (ART) in reducing dental pain among pregnant women. MATERIALS AND METHODS A randomized controlled clinical trial was conducted, in 2019, and included 162 pregnant women visiting family health centers in Alexandria, Egypt, with dental pain due to dental caries not extending to pulp. Patients were randomly assigned to Papacarie-Duo group (n = 82) and ART group (n = 80) after stratification by number of treated surfaces. The outcome variables were reduction in pain assessed using Visual Analogue Scale (VAS), satisfaction with treatment, and time taken for dental caries removal. T test/ Mann Whitney U test were used to compare groups and Freidman test was used to compare change across time. RESULTS Pain reduction was significantly greater in the Papacarie-Duo than the ART group (81.55% and 69.43%, P = 0.001). Patients in the Papacarie-Duo group were significantly more satisfied with treatment than those in the ART, immediately after treatment (mean = 9.60 and 8.00, P = < 0.01) and after 6 months (mean = 9.63 and 8.16, P = < 0.01). Significantly less excavation time was recorded in the Papacarie-Duo group than in the ART group (mean = 10.38 and 11.56 min, P = < 0.01). CONCLUSION Chemo-mechanical caries removal using Papacarie-Duo is more effective in reducing dental pain, in pregnant women, and is associated with more satisfaction and less excavation time than ART. TRIAL REGISTRATION ID NCT04573608 ( https://clinicaltrials.gov/ ); 5/10/2020, retrospective registration.
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Affiliation(s)
- May M Adham
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champolion St., Azarita, Alexandria, 21527, Egypt.
| | - Mona K El Kashlan
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champolion St., Azarita, Alexandria, 21527, Egypt
| | - Wafaa E Abdelaziz
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champolion St., Azarita, Alexandria, 21527, Egypt
| | - Ahmed S Rashad
- Department of Economics, Faculty of Commerce, Damanhour University, Damanhour, Egypt
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Efficacy and Patient's Acceptance of Alternative Methods for Caries Removal-a Systematic Review. J Clin Med 2020; 9:jcm9113407. [PMID: 33114249 PMCID: PMC7690910 DOI: 10.3390/jcm9113407] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 12/21/2022] Open
Abstract
Dental caries is a disease of dental hard tissues, considered the most common non-communicable disease worldwide. Conventional treatments for caries removal are often associated with pain and fear, so different therapeutic approaches have been developed towards more conservative and pleasant treatments. This systematic review aimed to assess the efficacy and patient's acceptance of alternative methods for caries removal compared to conventional methods. The Cochrane Library, Embase, Medline/Pubmed, Web of Science, and Clinical Trials databases were searched. Clinical trials of primary dental caries treated with alternative methods were included. The last search was performed on 5 August 2020. The Population, Intervention, Comparison, and Outcome (PICO) strategy was followed. Thirty-seven clinical trials were included, reporting caries removal using alternative (chemomechanical-Brix 3000, Carie-care, Carisolv and Papacarie, laser-Er:YAG (Erbium-doped Yttrium Aluminium Garnet) and Er,Cr:YSGG (Erbium, Chromium-doped Yttrium, Scandium, Gallium and Garnet), and a system combining air and sono-abrasion-Vector® System) and conventional methods. Alternative methods tended to prolong treatment time and lessen anesthesia need. All treatments were effective in reducing cariogenic flora, and the restoration's performance did not differ significantly. Chemomechanical solutions seemed to be the best option towards minimally invasive treatments, with good control during application and action and good treatment experiences for patients. Papacarie was demonstrated to be an effective method for caries removal with less pain, and superior acceptance by patients when compared to conventional treatments.
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20
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Shashirekha G, Jena A, Mohanty N, Kamilla SK. Novel bioactive caries-detecting dye solution: Cytotoxicity, antimicrobial activity, scanning electron microscope, and stereomicroscopic analysis in diagnosis of dental caries. J Conserv Dent 2020; 23:79-85. [PMID: 33223647 PMCID: PMC7657426 DOI: 10.4103/jcd.jcd_154_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 12/01/2022] Open
Abstract
Aim The aim was (1) to study the cytotoxicity of novel Bioactive Caries-detecting Dye solution (BCD) and its antimicrobial activity against Streptococcus mutans, Lactobacillus acidophilus, Actinomyces naeslundii, and Candida albicans and (2) comparative assessment of BCD and Carie-Care for efficient removal of caries (stereomicroscope) and dentin tubule occlusion (scanning electron microscope [SEM]). Materials and Methods For BCD cytotoxic study (direct contact method), colorimetric MTT assay, and cell line study(L929 mouse fibroblast NCTC clone 929 strain L) was performed. Xenetix 350, chitosan, nanohydroxyapatite (nHA), BCD, and Carie-Care solutions were subjected to the antimicrobial activity through blood agar well diffusion method, and the minimum inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were determined. On 20 extracted human carious teeth a comparative pilot study was done for BCD (Group A, n = 10) and Carie-Care (Group B, n = 10), and evaluated visually and radiographically. After mechanical excavation of caries with a spoon excavator, teeth sectioned longitudinally and stereomicroscopically were evaluated (8x–40x) by two observers. The percentage of dentinal tubule occlusion was evaluated with SEM for both solutions. Statistical kappa analysis of agreement was 0.7–0.8 (P < 0.01). Mann–Whitney test ranks and Wilcoxon signed-rank test (P = 0.01) were applied. Results Cytotoxicity test revealed BCD to be nontoxic and biocompatible. Antimicrobial tests (zone of inhibition) showed BCD > chitosan > chlorhexidine > Carie-Care > Xenetix 350 > nHA. MIC and MBC values suggested chlorhexidine > BCD > Carie-Care. Stereomicroscopic analysis showed effective mechanical removal of caries in BCD without residual dye in the dentinal tubules as compared to Carie-Care. Dentinal tubule occlusion (SEM analysis) was 80%–85% for BCD and 10% for Carie-Care. Conclusions Profound synergistic effect for BCD was observed with advantage of radiographic assessment.
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Affiliation(s)
- Govind Shashirekha
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, India
| | - Amit Jena
- Department of Conservative Dentistry and Endodontics, Sriram Chandra Bhanja Dental College and Hospital, Cuttack, Odisha, India
| | - Neeta Mohanty
- Department of Oral Pathology and Microbiolgy, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, India
| | - Sushanta Kumar Kamilla
- Department of Physics, Institute of Technical Education and Research, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, India
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Kusumasari C, Abdou A, Tichy A, Hatayama T, Hosaka K, Foxton RM, Wada T, Sumi Y, Nakajima M, Tagami J. Effect of smear layer deproteinization with chemo-mechanical caries removal agents on sealing performances of self-etch adhesives. J Dent 2020; 94:103300. [DOI: 10.1016/j.jdent.2020.103300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 01/27/2023] Open
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AlHumaid J. Efficacy and Efficiency of Papacarie versus Conventional Method in Caries Removal in Primary Teeth: An SEM Study. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 8:41-45. [PMID: 31929777 PMCID: PMC6945313 DOI: 10.4103/sjmms.sjmms_104_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/14/2018] [Accepted: 03/05/2019] [Indexed: 11/04/2022]
Abstract
Background Chemomechanical methods such as Papacarie were developed as alternate dental caries removal methods to overcome major disadvantages of the conventional drilling technique. However, few studies have demonstrated the efficacy of Papacarie for caries removal using scanning electron microscope (SEM). Objectives The purpose of this study was to compare the efficacy and efficiency of Papacarie and the conventional bur method in caries removal from primary teeth. Materials and Methods In this in vitro study, 30 freshly extracted, human primary molars with dentinal caries were obtained from the outpatient clinics at the Dental Hospital of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Each tooth was sectioned mesiodistally into two halves through the center of the lesion, and each half was randomly subjected to caries removal by Papacarie (Group I) and excavation using the conventional bur method (Group II). Time taken (efficiency) for removal of caries was noted using a stopwatch. Samples were then examined under SEM for presence of bacterial colonies (efficacy). For efficiency, data were analyzed using chi-square, and for efficacy, using t-test. Results There was no significant difference in the presence of bacteria in both groups under SEM (Papacarie = 23.3%; conventional method = 16.7%; P = 0.52). However, significantly more time was taken for caries removal with Papacarie (mean = 351.56 s) than with the conventional bur method (mean = 158.41 s) (P < 0.0001). Conclusion Papacarie is as effective in removing dentinal bacteria as the conventional caries removal method but is less efficient, as the time taken for excavation was longer.
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Affiliation(s)
- Jehan AlHumaid
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
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AlHumaid J, Al-Harbi F, El Tantawi M, Elembaby A. X-ray microtomography assessment of Carisolv and Papacarie effect on dentin mineral density and amount of removed tissue. Acta Odontol Scand 2018; 76:236-240. [PMID: 29161950 DOI: 10.1080/00016357.2017.1406614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of the present study was to directly compare Carisolv and Papacarie regarding the volume of removed tissue (RT) and dentin mineral density (DMD) after excavation. MATERIALS AND METHODS Twenty permanent molars were randomized into two groups where caries was excavated using Carisolv or Papacarie followed by removal of softened tissue by a blunt instrument. X-ray microtomography was used to scan teeth before and after excavation generating two- and three-dimensional images that were used to calculate the percentage of RT relative to baseline tooth tissue volume and DMD that was categorized into sound dentin (>1.11 g/cm3) and residual caries (≤1.11 g/cm3). The two groups were compared using t-test Fisher exact test. RESULTS DMD was higher after Papacarie than Carisolv (mean = 1.70 and 1.14, p = .14) with higher percentage of cases with sound dentin (70 and 60%, p = 1.00). The percentage of RT was lower after Papacarie than Carisolv (7.40 and 8.95%, p = .31) with 22.95% less RT in cases that ended with sound dentin after excavation. CONCLUSIONS There was higher DMD, more sound dentin and less RT when Papacarie was used compared to Carisolv.
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Affiliation(s)
- Jehan AlHumaid
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fahad Al-Harbi
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Maha El Tantawi
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abeer Elembaby
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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24
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Comparison of deproteinization agents on bonding to developmentally hypomineralized enamel. J Dent 2017; 67:94-101. [DOI: 10.1016/j.jdent.2017.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/26/2017] [Accepted: 10/10/2017] [Indexed: 11/22/2022] Open
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Abstract
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.
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Kumar KVKS, Prasad MG, Sandeep RV, Reddy SP, Divya D, Pratyusha K. Chemomechanical caries removal method versus mechanical caries removal methods in clinical and community-based setting: A comparative in vivo study. Eur J Dent 2016; 10:386-391. [PMID: 27403059 PMCID: PMC4926594 DOI: 10.4103/1305-7456.184151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To compare the effectiveness of various caries removal techniques in mandibular primary molars using Smart Burs, atraumatic restorative technique (ART) (mechanical caries removal) and Carie-care (chemomechanical caries removal [CMCR]) among primary school children in clinical and community-based settings. Materials and Methods: A total of 80 carious primary mandibular molars were selected for the study from the dental clinic and community. They were equally assigned to four groups according to caries removal technique and also by the operating site. In Group 1, caries was removed using Carie-care in the dental clinic and in Group 2, with Smart Burs in the dental clinic. In Group 3, caries was removed using Carie-care in the field and in Group 4, with the ART in the field. The time taken for caries removal, the efficacy of caries removal and patient acceptance were evaluated with different caries removal techniques. Statistical Analysis: The obtained data were subjected to statistical analysis by ANOVA test. Results: In clinical settings, Carie-care was time-consuming but was more efficient with increased acceptance than Smart Burs and the result was found to be significant statistically (P < 0.05). In community-based settings, Carie-care was more efficient, less time consuming, and showed an increased acceptance when compared to atraumatic restorative treatment and the result was found to be significant statistically (P < 0.05). Conclusions: The CMCR technique was superior to the mechanical caries removal technique in primary teeth among school children in terms of time, efficacy, and acceptance in both clinical- and community-based settings.
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Affiliation(s)
- K V K Santosh Kumar
- Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College and Hospital, Eluru, Andhra Pradesh, India
| | - M Ghanashyam Prasad
- Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College and Hospital, Eluru, Andhra Pradesh, India
| | - R Venkata Sandeep
- Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College and Hospital, Eluru, Andhra Pradesh, India
| | - S Pavani Reddy
- Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College and Hospital, Eluru, Andhra Pradesh, India
| | - D Divya
- Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College and Hospital, Eluru, Andhra Pradesh, India
| | - K Pratyusha
- Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College and Hospital, Eluru, Andhra Pradesh, India
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Hamama HH, Yiu CK, Burrow MF. Effect of silver diamine fluoride and potassium iodide on residual bacteria in dentinal tubules. Aust Dent J 2015; 60:80-7. [PMID: 25721282 DOI: 10.1111/adj.12276] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study evaluated the antimicrobial effect of a silver diamine fluoride (SDF)/potassium iodide (KI) product (Riva Star) on the viability of intratubular bacteria. METHODS Forty-five dentine discs prepared from caries-free maxillary premolars were randomly divided into nine groups. Group 1 (negative control) contained non-infected sound dentine discs. The remaining discs were infected with Streptococcus mutans suspension and received dentine treatments as follows: Group 2 (positive control), discs were left untreated; Group 3 SDF/KI (Riva Star); Group 4 chlorhexidine (CHX); Group 5 CHX+SDF/KI; Group 6 Carisolv; Group 7 Carisolv+SDF/KI; Group 8 Papacarie, and Group 9 Papacarie+SDF/KI. The discs were then fractured into two halves, stained with fluorescent LIVE/DEAD stain and observed using confocal laser scanning microscopy. RESULTS SDF/KI exhibited a potent antibacterial effect, as represented by a significantly higher percentage of dead bacteria, in comparison with Carisolv and Papacarie (p<0.05). The application of SDF/KI following Carisolv and Papacarie chemomechanical caries removel gels significantly reduced the viability of intra-tubular bacteria in these groups. CONCLUSIONS The use of the silver diamine fluoride/potassium iodide product is effective in reducing the numbers of S. mutans in dentinal tubules infected with this organism.
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Affiliation(s)
- H H Hamama
- Clinical Assistant Professor in Operative Dentistry, Faculty of Dentistry, Mansoura University, Egypt
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