Hhhe Hamama

Current update of chemomechanical caries removal methods

Chemomechanical caries removal is an excellent method for minimally invasive caries excavation, and the removal agents are either sodium hypochlorite (NaOCl)- or enzyme-based. The NaOCl-based agents include GK-101, GK-101E (Caridex) and Carisolv, and the enzyme-based agents include Papacarie and the experimental material, Biosolv. This review outlines the changes in chemomechanical caries removal methods and focuses on recently published laboratory and clinical studies. The historical development, mechanism of action, excavation time and biological effects on pulp and dental hard tissues are described. Based on existing evidence, the currently available chemomechanical caries removal methods are viable alternatives to conventional rotary instrument methods. Chemomechanical methods could be extremely useful in very anxious, disabled and paediatric patients. It does seem some of these agents would still benefit from quicker excavation times in order to achieve more universal acceptance. However, as a means of conserving the caries-affected dentine, chemomechanical caries removal is possibly much more successful than conventional rotary instrumentation.

Systematic Review and Meta-Analysis of Randomized Clinical Trials on Chemomechanical Caries Removal

OBJECTIVES The aim of this review was to assess the methodologies used in previously published prospective randomized clinical trials on chemomechanical caries removal and to conduct a meta-analysis to quantify the differences in the excavation time between chemomechanical and conventional caries removal methods. METHODS An electronic search was performed using Scopus, PubMed, EBSCO host, and Cochrane Library databases. The following categories were excluded during the assessment process: non-English studies published before 2000, animal studies, review articles, laboratory studies, case reports, and nonrandomized or retrospective clinical trials. The methodologies of the selected clinical trials were assessed. Furthermore, the reviewed clinical trials were subjected to meta-analysis for quantifying the differences in excavation time between the chemomechanical and the conventional caries removal techniques. RESULTS Only 19 randomized clinical trials fit the inclusion criteria of this systematic review. None of the 19 reviewed trials completely fulfilled Delphis ideal criteria for quality assessment of randomized clinical trials. The meta-analysis results revealed that the shortest mean excavation time was recorded for rotary caries excavation (2.99±0.001 minutes), followed by the enzyme-based chemomechanical caries removal method (6.36±0.08 minutes) and the the hand excavation method (atraumatic restorative technique; 6.98±0.17 minutes). The longest caries excavation time was recorded for the sodium hypochlorite-based chemomechanical caries removal method (8.12±0.02 minutes). CONCLUSIONS It was found that none of the current reviewed trials fulfilled all the ideal requirements of clinical trials. Furthermore, the current scientific evidence shows that the sodium hypochlorite-based (Carisolv) chemomechanical caries removal method was more time consuming when compared to the enzyme-based (Papacarie) chemomechanical and the conventional caries removal methods. Further prospective randomized controlled clinical trials evaluating the long-term follow-up of papain-treated permanent teeth are needed.

Effect of silver diamine fluoride and potassium iodide on residual bacteria in dentinal tubules

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.

A new method of evaluation of fracture patterns following microtensile bond strength testing using polarized light microscopy

PURPOSE This work describes a new method using polarized light microscopy to determine the failure modes of fractured beams following microtensile bond strength testing. The outcomes were validated using SEM and EDX elemental analysis. MATERIALS AND METHODS Resin adhesives and resin composites bonded to caries-free dentin samples as well as disks of adhesive and composite were observed with reflected polarized light microscopy (PLM) to obtain standard images. A set of beams fractured in the microtensile bond test were observed with PLM and compared with the standard images to determine failure mode through PLM color matching with the standard dentin, adhesive, or composite images. Samples were analyzed by EDX under SEM and compared with the PLM outcomes. RESULTS Reflected PLM images showed that the fractured surfaces covered with resin-based materials (adhesives or composite) appeared pink in color, in contrast to dentin surfaces, which appeared yellow. EDX mapping together with SEM observation confirmed the results obtained by PLM. CONCLUSION The results of EDX mapping and SEM observation showed that the use of polarized light microscopy is a simple, viable method for differentiation between the resin-covered dentin surfaces for determining fracture pattern analysis after bond testing.

Bonding of Resin-modified glass ionomer-based adhesive to dentine

This journal suppl. entitled: Special Issue: Abstracts of the 2012 FDI Annual World Dental CongressThis journal supplement is the Special Issue: Abstracts of the 2012 FDI Annual World Dental Congress, September 2012This journal supplement is the Special Issue: Abstracts of the 2012 FDI Annual World Dental Congress