Performance of Four Dentine Excavation Methods in Deciduous Teeth

Abstract

This in vitro study aimed to assess the speed and caries removal effectiveness of four different new and conventional dentine excavation methods. Eighty deciduous molars were assigned to four groups. Teeth were sectioned longitudinally through the lesion centre. Images of one half per tooth were captured by light microscope and confocal laser scanning microscopy (CLSM) to assess the caries extension. The halves were then reassembled and caries removed using round carbide bur (group 1), Er:YAG laser (group 2), hand excavator (group 3) and a polymer bur (group 4). The time needed for the whole excavation in each tooth was registered. After excavation, the halves were photographed by light microscope. Caries extension obtained from CLSM images were superimposed on the post-excavation images, allowing comparison between caries extension and removal. The regions where caries and preparation limits coincided, as well as the areas of over- and underpreparation, were measured. Steel bur was the fastest method, followed by the polymer bur, hand excavator and laser. Steel bur exhibited also the largest overpreparation area, followed by laser, hand excavator and polymer bur. The largest underpreparation area was found using polymer bur, followed by laser, hand excavator and steel bur. Hand excavator presented the longest coincidence line, followed by polymer and steel burs and laser. Overall, hand excavator seemed to be the most suitable method for carious dentine excavation in deciduous teeth, combining good excavation time with effective caries removal.

Effect of different root caries treatments on the sealing ability of conventional glass ionomer cement restorations

“…In contrast, the Er,Cr:YSGG laser, regardless of the applied energy density, resulted in an uncontrolled, random pattern, with deep over-prepared areas and wide under-prepared zones in the same cavity, in agreement with previous studies [7,35]. According to Celiberti et al, it is very difficult to give accurate guidelines for sound and hard dentin differentiation [35]. This issue is very prone to subjectivity and very dependent on the operator's perception and experience.…”

“…This finding suggests that ART removes more dental tissue than laser or bur treatment. Other have evaluated several methods of dentin caries removal and, unlike the results obtained in the present study, found that hand excavation is more conservative than the conventional bur technique [35,36]. The manual pressure during excavation and the objective of achieving a cavity with the least amount of infected tissue may have been responsible for this increased removal of dental tissue.…”

“…Considered the most invasive method for caries treatment [35], the operator was aware that this method removes more dental tissue than necessary and, for this reason took more care during the procedure, for example in decreasing the pressure in the target tissue to reduce dentin removal and to avoid over-preparation. In contrast, the Er,Cr:YSGG laser, regardless of the applied energy density, resulted in an uncontrolled, random pattern, with deep over-prepared areas and wide under-prepared zones in the same cavity, in agreement with previous studies [7,35]. According to Celiberti et al, it is very difficult to give accurate guidelines for sound and hard dentin differentiation [35].…”

Effectiveness of different removal methods of artificially demineralized dentin

“…Some previous research on caries removal methods used natural lesions in human dentin 4,6,16,[17][18][19] . However, when natural lesions are used, it is difficult to standardize all of the variables that occur among samples 20 .…”

“…Rotatory instruments, such as steel and carbide burs, are the most widely used caries-excavation methods 3 , and are considered the most efficient methods to remove caries in terms of time 16 . However, the use of burs tends to over-excavate dentin as the removal endpoint is based on a subjective visualtactile examination of dental tissues 16 .…”