Comparison of the Effectiveness of Chemo-mechanical and Traditional Caries Removal Methods in Primary Teeth Using Micro-Computed Tomography

Year 2021, Volume: 48 Issue: 3, 101 - 107, 31.12.2021

Melike Turgut Coşgun Firdevs Tulga Öz Mert Ocak Kaan Orhan

https://doi.org/10.52037/eads.2021.0032

Abstract

Objective: The purpose of this study was to evaluate dentin mineral density before and after caries removal with the traditional caries removal technique and chemo mechanical method, with or without the use of caries detection dye. Our null hypothesis was that the chemo mechanical method with minimally invasive treatment would achieve an effect similar to that of conservative pediatric dentistry treatment. Forty-eight extracted human primary molar were used in this study.
Materials and Methods: The two main study groups underwent treatment with the chemo mechanical and traditional methods. The teeth were then treated with chemo mechanical and traditional caries removal approach. Teeth were scanned with the same voxel sizes using micro-CT images to figure out the difference dentin mineral density and to calculate the removed (excavated) dentinal volume after chemo mechanical or traditional method application.
Results: The results showed increase of cavity volume in the chemo mechanical and traditional method groups. No significant difference was found for cavity volume and dentinal carious volume in both groups (p˃0,05). The mineral density values of demineralized dentin were between 0.52-0.66 g/cm3 before caries removal, and 1.39-1.59 g/cm3 after removing caries. These values were found to be within the range of healthy dentin mineral density values again without any significant difference between groups (p˃0,05).
Conclusions: In conclusion, chemo mechanical can be used effectively for removing the caries in the primary molar teeth similar to conservative treatments.

Keywords

residual caries, caries removing techniques, micro-CT, Papacarie

Project Number

16H0234001

References

• 1. Featherstone JD. The science and practice of caries prevention. J Am Dent Assoc 2000; 131(7): 887-899.
• 2. Featherstone JD, Doméjean S. Minimal intervention dentistry: part 1. From compulsive restorative dentistry to rational therapeutic strategies. Br Dent J 2012; 213(9): 441-445.
• 3. Zero DT, Zandona AF, Vail MM, Spolnik KJ. Dental caries and pulpal disease. Dent Clin North Am 2011; 55(1): 29-46.
• 4. Ericson D, Kidd E, Mccomb D, Mjor I, Noack MJ. Minimally invasive dentistry—concepts and techniques in cariology. Oral Health Prev Dent 2003; 1(1): 59-72.
• 5. Burke FJ. From extension for prevention to prevention of extension: (minimal intervention dentistry). Dent Update 2003; 30(9): 492-502.
• 6. Hamama HH, Yiu CK, Burrow MF, Kıng NM. Chemical, morphological and microhardness changes of dentine after chemomechanical caries removal. Aust Dent 2013; 58(3): 283-292.
• 7. Peters MC, McLean ME. Minimally invasive operative care. I. Minimal intervention and concepts for minimally invasive cavity preparations. J Adhes Dent 2000; 3(1): 7-16.
• 8. Mount GJ, Hume WR. A revised classification of carious lesions by site and size. Quintessence Int 1997; 28(5): 301-303.
• 9. Banerjee A, Watson Tf, Kidd EA. Dentine caries excavation: a review of current clinical techniques. Br Dent J 2000; 188(9):476–482.
• 10. Neves AA, Coutinho E, Cardoso MV, Jaecques SV, Van Meerbeek B. Micro-CT based quantitative evaluation of caries excavation. Dental Materials 2010; 26(6): 579–588.
• 11. Kidd EA, Joyston-Bechal S, Smith M, Allan R, Howe L, Smith SR. The use of a caries detector dye in cavity preparation. Br Dent J 1989; 167(4): 132-134.
• 12. El-Tekeya M, El-Habashy L, Mokhles N, El-Kimary E. Effectiveness of 2 chemomechanical caries removal methods on residual bacteria in dentin of primary teeth. Pediatric dentistry 2012; 34(4):325-330.
• 13. Innes NP, Stirrups DR, Evans DJ, Hall N, Leggate M. A novel technique using preformed metal crowns for managing carious primary molars in general practice -a retrospective analysis. Br Dent J 2006; 200(8): 451-454.
• 14. Kidd E. Should deciduous teeth be restored? Reflections of a cariologist. Dental update 2012; 39(3): 159-166.
• 15. Lennon AM. Fluorescence-aided caries excavation (FACE) compared to conventional method. Operative dentistry, 2003; 28(4): 341-345.
• 16. Azrak B, Callaway A, Grundheber A, Stender E, Willershausen B. Comparison of the efficacy of chemomechanical caries removal (Carisolv ‘) with that of conventional excavation in reducing the cariogenic flora. Int J Paediatr Dent 2004; 14(3):182–191.
• 17. Beeley JA, Yip HK, Stevenson AG. Chemochemical caries removal: a review of the techniques and latest developments. Br Dent J 2000; 188(8):427–430.
• 18. Zhang X, Tu R, Yin W, Zhou X, Li X, Hu D. Micro‐computerized tomography assessment of fluorescence aided caries excavation (FACE) technology: comparison with three other caries removal techniques. Aust Dent J 2013; 58(4): 461-467.
• 19. Bussadori SK, Martins MD, Fernandes KP, Guesdes CC, Motta LJ, Reda SH, Santos EM. Evaluation of in vitro biocompatibility of new product for chemical-mechanical caries removal – Papacarie. Pesq Bras Odontoped Clin Integr 2005; 5(3): 253-259.
• 20.Bussadori SK, Castro LC, Galvão AC. Papain gel: a new chemo- mechanical caries removal agent. J Clin Pediatr Dent 2006; 30(2): 115-119.
• 21. Bussadori SK, Guedes CC, Bachiega JC, Santis TO, Motta LJ. Clinical and radiographic study of chemical- mechanical removal of caries using Papacarie: 24- month follow up. J Clin Pediatr Dent 2011 35(3): 251–254.
• 22. Mhatre S, Sinha S, Bijle MNA, Thanawala EA. Chemo-Mechanical Method Of Caries Removal: A Brief Review. Journal of Clinical Dental Science 2011; 2(2): 52-57.
• 23. Maragakis GM, Hahn P, Hellwig E. Chemomechanical caries removal: a comprehensive review of the literature. Int Dent J 2001; 51(4):291–299.
• 24. Neboda C, Anthonappa RP, Engineer D, King NM, Abbott PV. Root canal morphology of hypomineralised first permanent molars using micro-CT. Eur Arch Paediatr Dent 2019; 1-12.
• 25. Neves ADA, Coutinho E, De Munck J, Van Meerbeek B. Caries-removal effectiveness and minimal-invasiveness potential of caries-excavation techniques: a micro-CT investigation. J Dent 2011; 39(2): 154-162.
• 26. Neves AB, Bergstrom TG, Fonseca-Gonçalves A, Dos Santos TMP, Lopes RT, De Almeida Neves A. Mineral density changes in bovine carious dentin after treatment with bioactive dental cements: a comparative micro-CT study. Clin Oral Investig 2019; 23(4): 1865-1870.
• 27. Pires PM, Dos Santos TP, Fonseca-Gonçalves A, Pithon MM, Lopes RT, De Almeida Neves, A. A dual energy micro-CT methodology for visualization and quantification of biofilm formation and dentin demineralization. Arch Oral Biol 2018; 85: 10-15.
• 28. 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(4): 236-240.
• 29. Mount GJ. A new paradigm for operative dentistry. J Conserv Dent 2008; 11(1): 3.
• 30. Feldkamp LA, Goldstein SA, Parfitt MA, Parfitt MA, Jesion G, Kleerekoper M. The direct examination of three‐dimensional bone architecture in vitro by computed tomography. J Bone Miner Res 1989; 4(1):3–11.
• 31. Ganesh M, Parikh D. Chemomechanical caries removal (CMCR). Agents: Review and clinical application in primary teeth. J Dent Oral Hyg 2011; 3(3): 34-45.
• 32. Martens LC. Laser physics and a review of laser applications in dentistry for children. Eur Arch Paediatr Dent 2011; 12(2): 61-67.
• 33. Flückiger L, Waltimo T, Stich H, Lussi A. Comparison of chemomechanical caries removal using CarisolvTM or conventional hand excavation in deciduous teeth in vitro. J Dent 2005; 33(2): 87-90.
• 34.Thomas AR, Nagraj SK, Mani R, Haribabu R. Comparative evaluation of the efficiency of caries removal using various minimally invasive techniques with conventional rotary instruments using cone beam computed tomography: An in vitro study. J Int Oral Health 2020; 12(3): 253.
• 35. 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.
• 36. Alegría Coahuila FDG, Nieto Martínez DL, Lara Carrillo E, Sánchez Rayón L. Acceptance of chemical-mechanical caries removal by four-to six-year-old patients seen in 2018. Archivos de Investigación Materno Infantil 2019; 10(1): 22-29.
• 37.Swain MV, Xue J. State of the art of Micro-CT applications in dental research. International Journal of Oral Sciences 2009; 1(4):177–88.
• 38. Miyajima H, Ishimoto T, Ma S, Chen J, Nakano T, Imazato S. In vitro assessment of a calcium-fluoroaluminosilicate glass-based desensitizer for the prevention of root surface demineralization. Dent Mater J 2016; 35(3): 399-407.
• 39. Djomehri SI, Candell S, Case T, Browning A, Marshall GW, Yun W, Ho SP. Mineral density volume gradients in normal and diseased human tissues. PLoS One 2015 10(4):e0121611.
• 40. Hamama HH, Yiu CK, Burrow MF. Caries management: A journey between Black's principals and minimally invasive concepts. Int J Dent Oral Sci 2015; 2(8): 120-125.
• 41. Clementino-Luedemann, TNR, Kunzelmann KH. Mineral concentration of natural human teeth by a commercial micro-CT. Dent Mater J 2006; 25(1): 113-119.
• 42. Hahn SK, Jung-Wook K, Lee SH, Chong-Chul K, Hahn SH, Jang KT. Micro-computed tomographic assessment of chemomechanical caries removal. Caries Research 2004; 38(1): 75-78.