Evaluation of Papacarie®, Carie-Care™, BRIX3000™ and conventional hand instrumentation for caries removal in primary teeth: a randomized control study

In the current odontological era, carious lesions are removed while tooth tissue is preserved. Most of these ideals are met by chemomechanical caries removal (CMCR) methods, which are easy and comfortable to use, differentiate and eliminate infected tissues, minimize pressure, vibration and heat, and are cost-effective. This study examines the efficacy of commercially available CMCR agents, namely Papacarie®, Carie-Care™ and BRIX3000™, and a conventional hand instrumentation method for caries removal in deciduous molars in terms of time consumption, ease of application, and pain perception. For this randomized clinical trial, 120 children aged 4 to 9 years were selected and randomly allocated to four groups of 30 patients each. Time consumption, ease of application, and pain perception were evaluated at three intervals: pre-, during- and post-caries removal, using Wong-Baker FACES (WBF) Pain Rating Scale and the Face, Legs, Activity, Cry, Consolability (FLACC) scale. The results showed that among the compared materials and conventional hand instrumentation technique, Carie-Care™ was statistically found to be the least time-consuming with a p-value of 0.019, have the least pain perception with a p-value of 0.02, and was clinically the best with respect to manipulation and handling. While all three CMCR agents aid in the removal of carious tissue, Carie-Care™ was the most effective based on time consumption, pain perception and simplicity of administration.

Volumetric analysis after caries excavation with caries detecting dyes and chemomechanical caries removal agents using 3D scanner-a randomised clinical trial

AIM

This research aimed to use an extra-oral 3D scanner for conducting volumetric analysis after caries excavation using caries-detecting dyes and chemomechanical caries removal agents in individuals with occlusal and proximal carious lesions.

METHODS

Patients with occlusal (A1, A2, A3) and proximal carious lesions (B1, B2, B3) were treated with the conventional rotary technique, caries detecting dyes (CDD) and chemomechanical caries removal (CMCR) method on 90 teeth (n = 45 for each). Group A1, B1: Excavation was performed using diamond points. Group A2, B2: CDD (Sable Seek™ caries indicator, Ultradent) was applied and left for 10 s, and then the cavity was rinsed and dried. For caries removal, diamond points or excavators were used. Group A3 and B3: BRIX3000 papain gel was applied with a micro-brush for 20 s and was activated for 2 min, and then the carious tissue was removed with a sharp spoon excavator. Post-excavation cavity volume analysis was performed using a 3D scanner. The time required and the verbal pain score (VPS) for pain were scored during excavation. Post-restoration evaluation was performed at 1, 3, and 6 months FDI (Federation Dentaire Internationale) criteria.

RESULTS

Comparison of age, time and volume with study groups were made using Independent Sample' t' test and one-way analysis of variance (ANOVA) for two and more than two groups, respectively. Using Cohen's Kappa Statistics, evaluators 1 and 2 agreed on caries removal status aesthetic, functional and biological properties at different follow-ups. The chi-square test revealed that the rotary groups [A1(2.5 ± 0.4 min) B1(4.0 ± 0.4 min)] had significantly less (p = 0.000) mean procedural time than CDD [A2(4.5 ± 0.4 min) B2(5.7 ± 0.4 min)] and CMCR [A3(5.4 ± 0.7 min) B3(6.2 ± 0.6 min)] groups. The CMCR group showed better patient acceptance and less pain during caries excavation than the rotary and CDD groups. CMCR group showed significantly less mean caries excavated volume(p = 0.000). Evaluation of restoration after 1-, 3-, and 6-month intervals was acceptable for all the groups.

CONCLUSION

Brix3000 helps effectively remove denatured teeth with less pain or sensitivity. The time required for caries removal was lowest in the rotary method and highest in the brix3000 group, while the volume of caries removed was the lowest for brix3000 and highest for the rotary group.

Clinical and Microbiological Assessment of Carisolv and Polymer Bur for Selective Caries Removal in Primary Molars

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.

Comparative Evaluation of Chemo-mechanical and Rotary-mechanical Methods in Removal of Caries with Respect to Time Consumption and Pain Perception in Pediatrc Dental Patients

Aim and objective

Materials and methods

The Carisolv system for caries removal, consisting of a solvent gel and a specially designed hand instrument, as compared to the conventional method of caries removal, i.e., Airotor. Sixty patients in the age-group of 6–14 years, having Black's class I dentinal caries with the cavity in the molars, were enrolled for the study.

Results

The time for caries removal with Carisolv and Airotor was, respectively, 7.17 ± 1.57 and 8.00 ± 1.56 minutes. Thus, the mean time taken was also significantly higher in group II as compared to group I (t = 4.805; p < 0.001).

How to cite this article

Katiyar A, Gupta S, Gupta K, et al. Comparative Evaluation of Chemo-mechanical and Rotary-mechanical Methods in Removal of Caries with Respect to Time Consumption and Pain Perception in Pediatrc Dental Patients. Int J Clin Pediatr Dent 2021;14(1):115–119.

Pediatric Dentistry during Coronavirus Disease-2019 Pandemic: A Paradigm Shift in Treatment Options

Coronavirus disease-2019 (COVID-19) pandemic has affected the world in an aggressive manner and the healthcare fraternity has been at the forefront in this fight. Dental professionals are at a larger risk to get afflicted owing to the proximity to the oral cavity. Along with other verticals of dentistry, pediatric dentistry too has to adapt quickly keeping in mind the newer protocols so as to limit the increase of the global epidemic and the commencement of cross-infections. The purpose of this article is to present different treatment options for a pediatric dentist so as to achieve positive dental outcomes.

Comparing the Efficacy of Three Minimally Invasive Techniques on Demineralized Dentin in Primary Teeth and Evaluating Its Residual Dentin and Microhardness Levels: An In Vitro Study

Aim

This study aims to compare the caries removal efficacy of three minimally invasive techniques and to analyze qualitatively under stereomicroscopy and quantitatively using Vickers hardness test.

Materials and methods

Thirty non-carious anterior primary teeth were selected and subjected to demineralization and the same was confirmed using RadioVisioGraphy (RVG). Samples were divided into three groups: Bromelain gel, smart bur, and atraumatic restorative technique (ART). Caries removal was carried out for a time period of 2 minutes. The remaining demineralized dentin was measured using stereomicroscopy. Random dentin blocks were prepared and a microhardness test was conducted.

Statistical analysis

Data were subjected to statistical analysis by one-way analysis of variance (ANOVA) test.

Results

Stereomicroscopic analysis revealed bromelain gel and smart burs to be superior to ART. Bromelain gel was found to have comparable microhardness levels as healthy dentin. Statistically significant (p < 0.001) results were obtained.

Conclusion

In terms of caries removal and microhardness, bromelain gel was highly efficient when compared to other groups.

Clinical significance

Fear and anxiety of children and parents about conventional drills led to the emerging trends of minimally invasive restorative dentistry. This research indicated the use of bromelain gel and smart bur in the process of caries removal and that bromelain was more efficient when compared to other groups.

How to cite this article

Abinaya R, Nagar P, Urs Pallavi, et al. Comparing the Efficacy of Three Minimally Invasive Techniques on Demineralized Dentin in Primary Teeth and Evaluating Its Residual Dentin and Microhardness Levels: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(6):585–589.

Bromelain vs Papain Gel for Caries Removal in Primary Teeth

AIM

The aim of the study was to evaluate and compare bromelain with papain as the chemomechanical caries removal agent in relation to their efficacy.

MATERIALS AND METHODS

Thirty extracted primary molars with active carious lesion extending into dentin were selected. The samples were randomly divided into groups by sectioning the samples into two halves. Group I-cavity prepared using papain gel; group II-cavity prepared using bromelain gel. Time taken for caries removal in both the groups (I and II) was recorded with the help of a stopwatch. Following caries removal, the amount of remaining demineralized dentin was measured with the help of stereomicroscope and weld check (biological image analysis) software.

RESULTS

t test is used to evaluate the significance of study parameters on continuous scale between two groups on metric parameters. The mean of residual carious dentin thickness obtained from the group II (bromelain) was 36.74 μm, which was much lower than that obtained from group I (papain) with a mean of 73.84 μm. The mean time taken in the group II (bromelain) was 335.30 seconds which was nearly equal to the mean time of group I (papain) of 352.33 seconds.

CONCLUSION

The amount of remaining demineralized dentin was found to be lower in bromelain group than the papain group and time taken for the carious dentin removal was almost found similar in both bromelain and papain groups. It may be concluded that bromelain was more effective in amount of caries removal than papain.

CLINICAL SIGNIFICANCE

Chemomechanical caries removal with the organic gels pose a great benefit as they are less invasive and has low side effects and cost-effective. How to cite this article: Reddy VK, Nagar P, Reddy S, et al. Bromelain vs Papain Gel for Caries Removal in Primary Teeth. J Contemp Dent Pract 2019;20(11):1345-1349.

Dentin Topographic Features following Chemomechanical Caries Removal in Primary Teeth

AIM

Study the topographic features of dentin after caries removal with a chemomechanical agent (Papacarie) compared with the conventional drilling method.

STUDY DESIGN

The sample included 7 exfoliated and extracted primary teeth with carious dentin lesions, not reaching the pulp. Each tooth was sectioned longitudinally through the center of the carious lesions into two halves. The teeth were then divided into two groups according to the method of caries removal. Following caries removal, dentin topography and the cut section were examined using the scanning electron microscope.

RESULTS

Papacarie produced an irregular, porous, rough and globular dentin appearance. The dentin surfaces were generally free of smear layer, visible bacteria and the dentinal tubules were opened. The dentin cut surfaces showed patent dentinal tubules with open orifices. The drilling method created a smooth and amorphous surface with a continuous smear layer occluding the dentinal tubules. Numerous bacteria were also observed. The cut dentin surfaces showed patent dentinal tubules with their orifices plugged with smear layer.

CONCLUSIONS

Papacarie produced a rough and porous surface with partial or complete removal of the smear layer and opened dentinal tubules, while the drill produced a smooth surface with uniform smear layer occluding the dentinal tubules.

Efficacy and tolerance of papain gel with conventional drilling method: a clinico-microbiological study

BACKGROUND

Conventional methods of caries removal are commonly associated with pain, fear and discomfort. Chemomechanical methods were introduced to instill a positive dental attitude. Agents like GK-101, Caridex, Carisolv did not prove effective alternatives owing to their high cost, need of special instruments and taste of chlorine. A new chemomechanical agent, Papacarie®, has been introduced to overcome these deficiencies.

OBJECTIVE

This study was aimed to compare the effectiveness and tolerance of Papacárie® with the conventional method.

METHOD

25 children with at least two primary teeth with broad cavitated occlusal or cervical lesion were selected. One carious tooth from each patient was randomly treated with each of Papacarie® and conventional drilling method, one after the other. Time taken for caries excavation, child's pain perception, change in anxiety levels, microbial flora and child's preference of treatment were recorded separately for both the methods.

RESULT

Although the mean time taken for caries removal by the Papacarie® method was slightly longer (P≯0.05) but it led to reduction in pain and anxiety (p<0.05). The viable bacterial counts were significantly reduced by either of the two methods (P <0�0001). More patients preferred Papacarie® over conventional method of treatment (P<0.05).

CONCLUSION

Papacárie® method seems to be a better alternative to conventional method of caries removal.

Recent vs Conventional Methods of Caries Removal: A Comparative in vivo Study in Pediatric Patients

Aims: To compare the three different methods of caries removal, conventional method using Airotor and chemomechanical method using Carisolv and Papacarie.

Settings and design: The patients with multiple carious teeth were selected either in the deciduous dentition or mixed dentition. Ninety primary molars were selected from 30 children (10 males and 20 females) between the age group 6 and 9 years.

Materials and methods: After caries excavation, cavities were evaluated for caries removal or clinical efficacy by the tactile and visual criteria, microbiological efficacy, time taken for the procedure. Patient acceptability toward the treatment was also checked with the help of a visual analog scale (VAS). The observations thus obtained were subjected to statistical analysis using analysis of variance (ANOVA), Mann-Whitney U-test and Kruskal-Wallis test.

Results: The clinical efficacy of caries removal was highest with Airotor while the microbiological efficacy of caries removal was almost comparable with Airotor, Carisolv and Papacarie caries removal methods. The time taken to remove caries by Airotor method was observed to be least while the patient acceptance was found to be highest with Papacarie method.

How to cite this article: Chowdhry S, Saha S, Samadi F, Jaiswal JN, Garg A, Chowdhry P. Recent vs Conventional Methods of Caries Removal: A Comparative in vivo Study in Pediatric Patients. Int J Clin Pediatr Dent 2015;8(1):6-11.

Comparative Evaluation of Microleakage in Conventional and RMGIC Restorations following Conventional and Chemomechanical Caries Removal: An in vitro Study

Background: Conventional caries removal involves use of high-speed handpiece. Current concepts of caries excavation in cavitated lesions consist of manual excavators. Principles of minimal invasive approach indicate the need to excavate only carious tissue.

Aim: The aim of this study was to compare the microleakage in conventional and resin modified glass ionomer cement restorations following conventional and chemomechanical caries removal.

Design: Hundred class I carious human mandibular first molar s were collected and divided into two groups: I and II (50 each). Each group was further divided into subgroups, i.e. (IA, IB and IIA, IIB). Caries was completely removed using conventional method in group one and chemomechanically in group two. The teeth in group IA, IIA are restored with conventional glass ionomer comment (GIC) and in group IB, IIB restored with resign-modified glass ionomer comments (RMGIC), followed by fnishing and polishing. Subsequently, the specimens were thermocycled and then placed in dye solution. The teeth were sectioned through the restorations and evaluated for microleakage scores using a stereomicroscope. The data were analyzed using Mann-Whitney U-test.

Results: Statistical analysis showed no significant difference in microleakage between the conventional GIC and RMGIC following conventional and chemomechanical caries removal method.

Conclusion: Carisolv is minimally invasive and an effective alternative treatment for the removal of occlusal caries.

How to cite this article: Pavuluri C, Nuvvula S, Kamatham RL, Nirmala SVSG. Comparative Evaluation of Microleakage in Conventional and RMGIC Restorations following Conventional and Chemomechanical Caries Removal: An in vitro Study. Int J Clin Pediatr Dent 2014;7(3):172-175.

Minimal intervention dentistry - a new frontier in clinical dentistry

Minimally invasive procedures are the new paradigm in health care. Everything from heart bypasses to gall bladder, surgeries are being performed with these dynamic new techniques. Dentistry is joining this exciting revolution as well. Minimally invasive dentistry adopts a philosophy that integrates prevention, remineralisation and minimal intervention for the placement and replacement of restorations. Minimally invasive dentistry reaches the treatment objective using the least invasive surgical approach, with the removal of the minimal amount of healthy tissues. This paper reviews in brief the concept of minimal intervention in dentistry.

Evaluation of the Efficiency and Effectiveness of Three Minimally Invasive Methods of Caries Removal: An in vitro Study

BACKGROUND

Many chemomechanical caries removal (CMCR) agents have been introduced and marketed since 1970s, with each new one being better and effective than the previously introduced. Papacarie and Carisolv are new systems in the field of CMCR techniques. These are reportedly minimally invasive methods of removing carious dentin while preserving sound dentin.

AIM

To compare the Efficiency (time taken for caries removal) and effectiveness (Knoop hardness number of the remaining dentin) of caries removal by three minimally invasive methods, i.e. hand excavation and chemomechanical caries removal using Carisolv and Papacarie.

MATERIALS AND METHODS

Thirty recently extracted human permanent molars with occlusal carious lesions were divided randomly in three equal groups and bisected through the middle of the lesion mesiodistally and excavated by two methods on each tooth.

RESULTS

Statistically significant difference was present among three methods with respect to time and knoop hardness values (KHN) of the remaining dentin.

CONCLUSION

The Efficiency of Hand method is better compared to CMCR techniques and effectiveness of CMCR techniques is better than Hand method in terms of dentin preservation so the chances of maintaining vitality of the pulp will be enhanced. How to cite this article: Boob AR, Manjula M, Reddy ER, Srilaxmi N, Rani T. Evaluation of the Efficiency and Effectiveness of Three Minimally Invasive Methods of Caries Removal: An in vitro Study. Int J Clin Pediatr Dent 2014;7(1):11-18.

Effect of two different chemomechanical caries removal agents on dentin microhardness: An in vitro study

Aim:

The aim of this in vitro study was to evaluate the effect of two different chemomechanical caries removal (CMCR) agents on dentin microhardness.

Materials and Methods:

In this study, the crown portion of ten carious-free and ten caries-affected teeth were selected. In carious-free samples, the teeth were decoronated at the level of cemento – enamel junction. Only the crown portion of the teeth was selected. Occlusal one-third of the crowns were cross-sectioned and discarded to expose the dentin, and it was divided into two groups, five teeth in each group. Then, they were further sectioned longitudinally through the centre. In one group, no agent was applied on one half and Carisolv was applied on other half. In another group, no agent was applied on one-half and Carie-Care was applied on the other half for 1 min. In carious samples, the crowns were sectioned through the centre of carious lesion. Carisolv was applied on one-half and Carie-Care was applied on the other half. After using CMCR agents, surface hardness of dentin was examined using Vickers hardness number (VHN).

Statistical Analysis and Results:

The data were analyzed using t-test and one-way analysis of variance (ANOVA). There were no significant difference among normal dentin (62.91 ± 2.76), Carisolv-treated normal dentin (61.72 ± 2.89), and Carie-Care-treated normal dentin (61.90 ± 3.19). In carious samples, the results of Carisolv-treated dentin (58.57 ± 2.62) was not statistically significantly different from those of the Carie-Care-treated dentin (56.77 ± 4.41).

Conclusion:

In conclusion, neither of the CMCR methods caused a significant change in the microhardness of normal dentin and the treated carious dentin.

Comparison of Marginal Microleakage of Glass Ionomer Restorations in Primary Molars Prepared by Chemo-mechanical Caries Removal (CMCR), Erbium: Yttrium Aluminum-Garnet (Er:YAG) Laser and Atraumatic Restorative Technique (ART)

Background: It is important to emphasize that the aspects of pretreatment techniques, as well as the composition and mechanism of adhesion, may decisively influence the effectiveness of the restorative materials in sealing cavity margins and preventing marginal leakage.

Aims: This study assessed the in vitro influence of surface preparation techniques on the microleakage of glass ionomer restorations in primary teeth.

Materials and methods: The study groups were divided into three different techniques: (1) The chemomechanical caries removal (CMCR) method using the Apacaries gel, (2) the erbium:yttrium aluminum-garnet (Er:YAG) laser method and (3) the atraumatic restorative technique (ART). The teeth restored with a glass ionomer restorative material (Fuji IX GP capsule, GC Corporation, Tokyo, Japan). The dye penetration was measured in micrometers using a polarized light microscope and specific computer software.

Results: The results showed that the mean microleakage level after was lowest with the CMCR method using Apacaries gel and highest with the Er:YAG laser. There was a statistically significant difference regarding the mean microleakage level between the group with the CMCR method using Apacaries gel and the Er:YAG laser.

Conclusion: Marginal leakage was significantly higher with preparations made using the Er:YAG laser than with the CMCR method using Apacaries gel and spoon excavator (p < 0.05).

How to cite this article: Juntavee A, Juntavee N, Peerapattana J, Nualkaew N, Sutthisawat S. Comparison of Marginal Microleakage of Glass Ionomer Restorations in Primary Molars Prepared by Chemomechanical Caries Removal (CMCR), Erbium: Yttrium Aluminum-Garnet (Er:YAG) Laser and Atraumatic Restorative Technique (ART). Int J Clin Pediatr Dent 2013;6(2):75-79.

Antimicrobial efficacy of an indigenously prepared caries removing gel

Objective:

The aim of this study was to assess the anti-microbial efficacy of an indigenously prepared caries removing gel, in primary molars.

Materials and Methods:

Twenty teeth with broad occlusal cavitated lesions that fulfilled the clinical and radiographic criteria formed the study group. These teeth were subjected to chemomechanical method of caries removal, using an indigenously prepared caries removing gel. Prior to and following caries removal, the dentin samples were analyzed for total viable count and lactobacilli count.

Results:

The percentage of reduction in the total viable count was 92.4% and in the lactobacilli count it was 94.1%, which was statistically highly significant.

Conclusion:

Removal of carious tissue with a caries removing gel, a natural plant extract, proved to be efficient, easy to perform, and comfortable for the patient.