Conventional caries removal and sealed caries in permanent teeth: A microbiological evaluation
ABSTRACT The aim of this study was to compare microbiological infection after conventional carious dentine removal with incomplete carious dentine removal and sealing.
Eighty-seven patients (12-50 years of age) under treatment at the Dental Clinics of the Federal University of Rio Grande do Sul (UFRGS), Brazil, participated in the study. The patients presented 90 posterior permanent teeth with primary caries. The lesions were coronal, active, and reached at least the middle third of the dentine. None of the teeth exhibited spontaneous pain, sensitivity to percussion or apical pathology (detected through radiographic exams). Pulp sensibility was confirmed by the cold test. The lesions were divided into 2 experimental groups: complete caries removal (CCR) based on hardness criteria (n=60 lesions) and incomplete caries removal (ICR) and sealing (n=32 lesions). Microbiological samples were obtained from the initial demineralized dentine, after CCR and after ICR-Seal.
The number of anaerobic and aerobic bacteria, lactobacilli, and mutans streptococci decreased at the end of treatment (p<0.05). Significantly less anaerobic bacteria (p<0.01), aerobic bacteria (p=0.02), and mutans streptococci (p<0.01) growth was observed after ICR-Seal compared to CCR. The difference in lactobacilli was insignificant (p=0.08). The amount of bacteria detected after conventional caries removal was higher than that which remained in sealed caries lesions.
The results suggest it is not necessary to remove all carious dentine before the restoration is placed because over time, sealing of carious dentine results in lower levels of infection than traditional dentine caries removal.
The results of this study indicate that sealed carious dentine was less infected than the remaining dentine left after conventional caries removal and sealing. Our results support treatment of deep carious lesions in one session with incomplete removal of carious dentine.
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ABSTRACT: Aim: Quality assessment of stainless steel crowns (SSCs) placed in primary molars of high caries risk children after 1, 3 and 5 years of service time. Material and methods: Out of 1149 SSCs placed 1, 3 or 5 years before the evaluation period in 558 children, 428 (37.2%) SSCs were clinically evaluated in 171 (30.6%) children aged between 1.1 and 8.6 years. Marginal adaptation, extension and proximal contacts of SSCs, plaque and gingival bleeding at SSC were assessed. Caries experience was recorded by WHO standards. Results: Caries experience was 7.8 dmft/18.4 dmfs before treatment. The overall success rate of SSCs was 97.2%, regardless of the extent of carious lesions or pulp treatment of the tooth. Loss of SSCs (1.9%), pathological tooth mobility (0.7%) and perforation of the crown (0.2%) were scored as clinical failures. The majority of SSCs had sealed margins and the marginal extension reached sub-gingival level. Open proximal contacts occurred mesially and distally (21.7%, 20%). All qualitative defects increased with service time. Secondary caries was not diagnosed. Of the SSCs, 46.4% were free of dental plaque. Gingival bleeding after probing was observed in 72.1% of all SSCs. Gingivitis was significantly associated with increased dmft-values (OR = 1.108, 95%CI: 1.03-1.19) and plaque at SSCs (OR = 0.29, 95% CI: 0.18-0.47). Children with migration background exhibited significantly more often insufficient oral hygiene and higher rates of gingival bleeding and caries experience than did German children. Conclusions: SSCs are clinically successful restorations in primary molars of high caries risk children. High caries prevalence and insufficient oral hygiene were greater determining factors for the occurrence of gingivitis than the quality of the SSCs.Journal of Dentistry 06/2014; 42:1 3 9 6 – 1 4 0 3. DOI:10.1016/j.jdent.2014.06.009 · 2.84 Impact Factor
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ABSTRACT: Dental caries is a common disease all over the world, despite the fact that it can be both effectively prevented as well as treated. It is driven by acids produced by oral microorganisms as a consequence of their metabolism of dietary carbohydrates. Given enough acid challenge, eventually the enamel barrier will be broken down, and the carious lesion will extend into underlying hard tissue, forming a macroscopic cavity in the dentine. In comparison to plaque biofilm on enamel, this dentine carious lesion will form a vastly different environment for the residing microorganisms. The environment will influence the types and numbers of microorganisms that will be able to colonize the dentine caries lesion. The overall aims for this thesis is to enumerate and further study microorganisms found in established dentine caries lesions, and also to illuminate how host-derived proteolytic enzymes might contribute to this degradation, in order to better understand the caries process in dentine, but also to find incitements for new methods to influence the natural progression of caries lesions. In Paper I, the number of remaining viable microorganisms after completed excavation using two different excavation methods were investigated. Samples of carious dentine tissue was collected before and after excavation, and cultivated on different agar media in different atmospheres. Analysis was performed by counting the number of colony forming units (cfu). Key findings: Numbers of remaining microorganisms after excavation was low for both methods, but some microorganisms always remained in the cavity floors even when the cavities were judged as ”caries free” using normal clinical criteria. In Paper II, the acid tolerant microbiota in established dentine caries lesions were investigated. Samples were taken as in Paper I, but on three levels (superficial, center of lesion, cavity floor). The samples were cultivated in anaerobic conditions on solid pH-selective agar media of different acidity. Key findings: Each investigated lesion harbored a unique microbiota, both in terms of species composition and numbers of microorganisms. This indicate that various combinations of aciduric microorganisms can colonize, survive in and probably also propagate dentine carious lesions. We also found that solid pH-selective agars successfully can be used to select acid tolerant microorganisms in caries lesions. This would preserve their phenotypic traits for further study. In Paper III, the relation between salivary levels of matrix metalloproteinase-8 (MMP-8), salivary levels of tissue inhibitor of MMP (TIMP-1) and presence of manifest caries lesions in a large number of subjects was investigated. Saliva samples were collected and analyzed for concentrations of MMP-8, TIMP-1 and total protein using immunofluorometric assay, enzyme linked immunosorbent assay and Bradford assay, respectively. Key findings: Subjects with manifest caries lesions had significantly elevated levels of salivary MMP-8 compared to subjects without caries lesions. TIMP-1 was not significant in any case. In Paper IV, a new method for generating bioactive demineralized dentine matrix substrate (DDM) was developed, using a dialysis system and two different demineralization approaches (acetic acid (AA) or EDTA). The generated DDM was subsequently analyzed for presence of type 1 collagen, active MMP-8 and hydroxyproline (HYP) levels using SDS-PAGE, ELISA or immunofluorescence assay. Key findings: Both demineralization methods produced a substrate rich in collagen and with preserved MMP-8 activity. The report presents new knowledge on the composition of the acid tolerant dentine caries microbiota from three levels in dentine carious lesions and on the efficacy of operative caries removal on the numbers of viable microorganisms in the caries free cavity using two different operative methods. Moreover, the basic mechanisms behind collagen degradation in the dentine caries process are studied from both a clinical and laboratory perspective. The report provides a reference for further studies on dentine caries microbiology and dentine caries collagen degradation mechanisms, both of which are only known in part.10/2014, Degree: Doctor of Odontology, Supervisor: Dan Ericson
Journal of the American Dental Association (1939) 06/2014; 145(6):574-576. DOI:10.14219/jada.2014.8 · 1.82 Impact Factor