Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
this topics involves detail discussion of varous chemical and mechanical agents for caries removal and their recent advances
Typology: Study notes
1 / 21
This page cannot be seen from the preview
Don't miss anything!
FACE(Fluorescence-aided Caries Excavation) ACCESS CAVITY PREPARATION BURS CONCLUSION REFERENCES
So damaged tissue that should be removed during caries excavation The principle of chemomechanical caries removal : use of a solution to chemically alter carious tooth tissue to further soften it, thus facilitating its easier removal. The softened dentine is then mechanically removed using a hand instrument. Early attempts were introduced in the 1970s using various agents such as Ethylene diamine tetra-acetic acid (EDTA), Collagenase Sodium dodecyl sulfate. More recently, other agents have become available; the best known is Carisolv (Mediteam, Go€teborg, Sweden). CLASSIFICATION Sodium hypochlorite (NaOCl)- GK GK-101E (Caridex) Carisolv
Cariemove Enzyme-based agents Papacarie Biosolv Carie-Care™ Brix 3000: Sodium hypochlorite (NaOCl) based CMCR agents The first studies on CMCR were done using a 5% NaOCl solution (Dhamija and Pundir, 2016). However, NaOCl alone was aggressive to sound dental tissues, which induced the addition of a buffer solution (sodium chloride , sodium hydroxide, and glycine), generating a new formula (GK-101) (Hamama, Yiu and Burrow, 2014). GK- Introduced in 1972, United States and (FDA) approved it in the same year. GK-101 consisted of two solutions GK-101 required a special delivery system consisting of : The delivery tip was applied to the carious lesion with minimal pressure via a paintbrush- like motion, Mechanism of action: Caries Excavation time: A study revealed that GK-101 dental caries excavation time was 8.5 min. and the using of burs still an important subsequent step to finish the excavated cavities. Biological effects on pulpal tissues: Laboratory studies results revealed that the GK-101 had no side effect on the platelet count, white or red cells of blood
The clinical usage and acceptance of both GK-101 and GK-101E solutions was very limited because neither showed a significant improvement in caries excavation compared with the conventional caries removal methods. Carisolv Introduced as Carisolv in January 1998 by Medi Team. Carisolv is only commercially available NaOCl based CMCR. The Carisolv was originally red in color in the form of two syringes, Mechanism of action The chemical structure and the mechanism of action of Carisolv was similar to Caridex, except that the mono aminobutyric acid was replaced by three different amino acids. The amino acids were shown to react with different moieties of carious lesions. In 2004, Carisolv was modified by Reducing the amino acid to half concentration, Doubling the concentration of sodium hypochlorite Removing the red coloring agent. It became in the form of multi-mix syringe that contains all ingredients. Recently, a cooperative arrangement took place between the bur manufacturer,Komet (Komet, Dental-Gbr Brasseler GmbH & Co, Lemgo, Germany) and the Carisolv manufacturer to establish the ‘New Carisolv’ system TM. The new system contains two types of slow-speed bur, designed for removing the softened Carisolv-treated carious dentine. The aim is to significantly reduce the caries excavation time, while ensuring that over excavation is avoided. Biological effects of Carisolv on the dental hard tissue and pulp: Many studies revealed that Carisolv gel had no side effect on the dental pulp tissue, and some of the studies reported that Carisolv has an action similar to Ca(OH)2 pulp capping materials.
Carisolv had a haemostatic and a bactericidal effects on dental pulp, An in vitro study revealed that the Calcium: phosphate ratio of dentin after Carisolv caries tissue removal did not significantly differ from that of sound dentin. This might revealed that Carisolv is an efficient in removing the infected carious dental tissue. Carisolv caries excavation time Two studies demonstrated the original Carisolv gel exhibited prolonged caries excavation times; Fure and Lingstrom compared the caries excavation time of the original and new Carisolv gels and reported there was no significant difference in moderately-sized carious lesions; (new gel 6.7 min vs original gel: 7.6 min ; p > 0.05). Conversely, in deep lesions, the new gel exhibited a shorter mean excavation time compared with the original gel. Other uses of Carisolv Carisolv gel can be used for other purposes not related to caries excavation, e.g treatment of oral ulcers periodontal therapy cleaning of organic debris prior to application of pit and fissure sealants, plaque removal and root canal irrigation. CARIEMOVE It is one of NaOCl based CMCR (Fig.1), there was lack of sufficient literature about it and its effectiveness in caries removal. II. Enzyme-based chemomechanical caries removal agents: Papacarie Bussadori et al. (2003) introduced Papacarie CMCR gel.
It is developed by Uni-Biotech Pharmaceuticals Private Limited in India. The main active ingredient from papaya extract, chloramines and dye. Also, the gel contains percentages of essential oils such as clove oil, which has mild anesthetic and anti-inflammatory action. The preparation also contains a gelling agent to prevent the gel to be spill over when applied (Venkataraghavan et al. , 2013). Effectiveness of cariecare in caries excavation and Microhardness of dentin following cariecare caries removal: A previous research was conducted to evaluate the efficiency and efficacy of caries removal using Papacarie and Carie-Care, revealed that they were conservative techniques in caries removal, but Papacarie was more efficient in bacteria reduction from the infected carious lesion in lesser time(Sahana et al. , 2016). An in vitro study examined the effect of Carie-Care (CMCR) agent on dentin microhardness, and showed that the Carie-Care caused a change in normal and treated carious dentin microhardness (Ramamoorthi, Nivedhitha and Vanajassun, 2013). 3.Biosolv: Biosolv introduced in 2006 is an enzyme based CMCR agent. It consists of pepsin enzyme in a phosphoric acid and sodium biophosphate (A. D. A. Neves et al. , 2011). Biosolv instruments: Biosolv manufacturers recommended a specific plastic instruments. These special plastic instruments hardness is between infected and sound dental tissues hardness. Mechanism of action It was supposed that the phosphoric component can affect the mineral contents of carious dentine, whereas allowing pepsin enzyme to destruct the degraded fibers of collagen. Meanwhile, these softened dental tissues can be removed easily without effect on sound dental tissues. Biosolv effectiveness in caries excavation: Banerjee et al. revealed that there were more caries-infected dentine tissues remained after Biosolv CMCR comparing with Carisolv CMCR and hand excavation techniques
They related this to the buffering effect of dentin which counteracts with the function of the enzyme. On the contrary , the acidity of biosolv is the reason why it has an aggressive effect as it affect both sound and infected dental tissue(A. A. Neves et al. , 2011). 4.Brix 3000: Brix 3000 was the recent enzyme-based CMCR agents. This CMCR gel introduced in 2012 by Brix Medical science, Argentina. The unique features of this product were the papain concentration which was increased in each 10% to 3000 U/mg, and the Encapsulated Buffer Emulsion technology. So, the Brix 3000 gel has the ideal pH to immobilize the enzymes, that enhance the proteolytic effect on the collagen fibrils in the carious dental tissues, As well , Brix 3000 didn’t contain chloramines, and this enhance its toxicological safety features(Inamdar et al. , 2020). Caries excavation time of Brix An invitro study evaluated the time required to caries removal with Brix 3000 ,conventional rotary method and sodium hypochlorite gel in deciduous molars, showed that the conventional rotary required less time compared to NaOCl gel and Brix 3000, although no difference was reported between NaOCl gel and Brix 3000 (Alkhouli et al. , 2020). Another in vivo study aimed to evaluate the time required to Brix 3000 caries removal compared with Carie Care gel and smart burs, the authors concluded that caries excavation time was lesser in Brix3000 group than Cariecare and smart burs(Inamdar et al. , 2020). Conventional caries removal Mechanical rotating caries excavation Rose-head burrs Classical mechanical instrument for the removal of carious dentine. Rose-head burrs are circular, toothed all around (spirally),
The plastic cutting blades wear away immediately when they come in contact with harder material and become unusable. The instruments are self-limiting and intended for single use only. SmartPrep instruments are available in the three ISO sizes 010, 014 and 018. Used in slow moving angle pieces at rpm of between 500 min-1 and 800 min-1. In comparison to rose-head burrs, adhesion coefficients of various dentine adhesives were sometimes significantly lower at the surface of the dentine when SmartPrep instruments had been used for excavation. In-house controlled tests have shown, that SmartPrep was not always able to completely remove carious dentine (Dammaschke et al. 2005). Ceramic burs The CeraBurs (Komet-Brasseler; Lemgo, Germany) are all-ceramic round burs made of alumina-yttria stabilized zirconia and are available in different diameter sizes. The manufacturer claims that besides its high cutting efficiency in infected, soft dentin. the use of this instrument for caries removal replaces both the explorer and the excavation spoon by simultaneously providing tactile sensation, self-evidently reducing preparation time.
Mechanical non-rotating caries excavation Excavators The basic shape of these traditional instruments extends from spoon-like dentine to plate- shaped pulp excavators. Most excavators have diametrically opposed, double ends with one anti-clockwise and one clockwise cutting tool section. In cross section the sharp-edged arc of a circle can usually be seen. Advantages the low procurement cost and the simple and gentle ease of use. There is no vibration and no thermal irritation. However, even here pain can be caused as a result of pressure especially on the odontoblast processes. Disadvantages Excavators made of carbide is that these cannot be re-sharpened The use of excavators cannot be recommended wholeheartedly. Excavation is a relatively long-winded process. Air abrasion devices The historical development of air abrasion devices in the US can be traced back to R. B. Black (1945).
Modern air abrasion devices may be able to remove dental discolorations, cleanse fissures and pits prior to sealing and roughen surfaces in preparation for an application of a composite adhesive agent, but they are unable to attain a quality standard comparable to that which can be achieved with conventional cavity preparation techniques. Similarly it is not possible either to talk of effective caries removal, as the powder particles show no effect on softened dentine, whereby hard tissue is easily cut away by the kinetic energy. SONO-ABRASION ‘ A recent development from the original ultrasonics mentioned above is the use of high- frequency, sonic, air-scalers with modified abrasive tips – a technique known as ‘sono- abrasion’. Recently, oscillating instruments have aroused ,The Sonicflex System (KaVo, Biberach, Germany), a new development of the sonically abrasive preparation process. Sonicflex is a modified airscaler, which is connected to the dentist’s unit via a turbine connection. Oscillation occurs in the sonic range below 6.5 kHz The tips describe an elliptical motion with a transclinically between 0.08 – 0.15 mm and a longitudinal movement of between 0.055 – 0.135 mm. They are diamond coated on one side using 40 μm grit diamond (figure 3) and are cooled using water irrigant at a flow rate of between 20–30 mL /min. The operational air pressure for cavity finishing should be around 3.5 bar (ie the nominal pressure at the coupling). Sonicsys micro diamond-coated hemispherical cutting tips Advantage
The minimally invasive character of the way they function. Disadvantages. The unpleasant noise during treatment as well as the hitherto lack of test results with regard to their effectiveness Lasers Since the development of the first ruby laser by Maiman in 1960, researchers postulated that it could be applied to cutting both hard and soft tissues in the mouth. However, early studies found that the ruby laser produced significant heat that caused damage to the dental pulp. The field of lasers has developed considerably and many new types of laser are available to cut dental hard tissues. Lasers that are currently being investigated for more selective hard tissue ablation include: Er:YAG (erbium: yttrium-aluminium garnet) and Nd:YAG (neodymium: YAG) Carbon dioxide lasers (CO2) — IR emission Excimer lasers (ArF (argon:freon) XeCl (xenon: chlorine) — UV emission Dye-enhanced laser ablation –— exogenous dye, indocyanine green in conjunction with a diode laser. UV emission of excimer lasers (377 nm) has the potential to be more selective in the ablation of carious dentine and there may be a possible use of dye-enhanced laser ablation to develop this selectivity further. In addition to caries removal, studies have shown that, in the presence of a suitable photo-sensitiser, low-power laser light has the ability to destroy Streptococcus mutans. Lasers have also been used to cut and seal dentine tubules, reducing the possibility of postoperative sensitivity. Fluorescence-aided Caries Excavation (“FACE”)
The best way to ensure maximum life for the natural teeth is to respect the sound dental tissues and protect it from damage by using minimally intervention techniques in the restorative dentistry. References Murdoch-Kinch CA, McLean ME. Minimally invasive dentistry.J Am Dent Assoc 2003;134:87–95. Dhamija, N. and Pundir, P. (2016) ‘A Review on Agents for Chemo-mechanical Caries Removal’, Scholars Journal of Dental Sciences (SJDS). Banerjee A, Kidd E A M, Watson T F. Scanning electron microscopic observations of human dentine after mechanical caries excavation. J Dent : in press Bjørndal, L. et al. (2019) ‘Management of deep caries and the exposed pulp’, International Endodontic Journal. Hamama, H., Yiu, C. and Burrow, M. (2014) ‘Current update of chemomechanical caries removal methods’, Australian Dental Journal , 59(4), pp. 446–456. Venkataraghavan, K. et al. (2013) ‘Chemomechanical Caries Removal: A Review & Study of an Indigen-ously Developed Agent (Carie Care (TM) Gel) In Children.’, Journal of international oral health : JIOH , 5(4), pp. 84–90. Chatterjee, A. N. et al. (2020) ‘Chemomechanical Caries Removal with Respect to COVID-19 in Dentistry’, International Journal of Research and Review. Schutzbank SG, Galaini J, Kronman JH, Goldman M, Clark RE. A comparative in vitro study of GK-101 and GK-101E in caries removal. J Dent Res 1978;57:861–864. Burns T, Wilson M, Pearson G J. Effect of dentine and collagen on the lethal photosensitisation of Streptococcus mutans.Caries Res 1995; 29 : 192-197. Yip HK, Stevenson AG, Beeley JA. An improved reagent for chemomechanical caries removal in permanent and deciduous teeth: an in vitro study. J Dent 1995;23:197– Ericson D, Zimmerman M, Raber H, Gotrick B, Bornstein R, Thorell J. Clinical evaluation of efficacy and safety of a new method for chemo-mechanical removal of caries. A multi-centre study. Caries Res 1999;33:171– Albrektsson T. Tissue preservation in caries treatment. London: Quintessence, 2001:159.
Fure S, Lingstro¨m P. Evaluation of the chemomechanical removal of dentine caries in vivo with a new modified Carisolv gel. Clin Oral Investig 2004;8:139– Abdelaziz E, Badran A, Allam G. Chemomechanical Caries Removal Agents and Their Applications in Pediatric Dentistry. Advanced Dental Journal. 2022 Jan 1;4(1):11-8. Rao, D., Panwar, S. and Narula, H. (2020) ‘An in-vivo comparative evaluation of the efficacy of two different papain based chemo-mechanical caries removalagents in primary molars’, International Journal of Scientific Research , 9(3), pp. 43–45. Hamama H, Yiu C, Burrow M, King N. Chemical, morphological and microhardness changes of dentine after chemomechanical caries removal. Aust Dent J 2013;58:283– Singh, S. et al. (2011) ‘Comparative clinical evaluation of chemomechanical caries removal agent papacarie with conventional method among rural population in india - in vivo study’, Brazilian Journal of Oral Sciences. Sahana, S. et al. (2016) ‘Effectiveness of chemomechanical caries removal agents Papacarie ® and Carie-CareTM in primary molars: An in vitro study’, Journal of International Society of Preventive and Community Dentistry , 6(7), p. 17. Neves, A. D. A. et al. (2011) ‘Caries-removal effectiveness and minimal-invasiveness potential of caries-excavation techniques: A micro-CT investigation’, Journal of Dentistry , 39(2), pp. 154–162. Inamdar, M. et al. (2020) ‘Comparative evaluation of BRIX3000, CARIE CARE, and SMART BURS in caries excavation: An in vivo study’, Journal of Conservative Dentistry , 23(2), p. 163. Alkhouli, M. M. et al. (2020) ‘Comparing the efficacies of two chemo-mechanical caries removal agents (2.25% sodium hypochlorite gel and brix 3000), in caries removal and patient cooperation: A randomized controlled clinical trial’, Journal of Dentistry. Elsevier Ltd, 93(December 2019), p. 103280 Dammaschke T, Rodenberg T, Schäfer E, Ott K (2005), Vergleich der Effektivität von SmartPrep mit herkömmlichen Rosenbohrern bei der Exkavation der Dentinkaries, Dtsch Zahnärztl Z 60:203- Black RB (1945), Technique for nonmechanical preparation of cavities and prophylaxis, J Am Dent Assoc 32, 955-
