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.
- [Show abstract] [Hide abstract]
ABSTRACT: Background Dental problems in early childhood can have a very significant effect not only on the oral health of young children but on their quality of life and that of their families. Added to this are the long term risks they carry into the permanent dentition.Aim To review current literature on the management of early childhood caries and its influence on wider oral and general health.Results Recent studies suggest that the risks for dental caries, periodontal disease, malocclusion and other general health problems including overweight and obesity may be increased in children who have had early childhood caries. Traditional restoration of damaged primary teeth has been shown to have only moderate outcomes depending on the techniques and materials used and the ability of children to cooperate because of age or other factors.Conclusions More recent interesting approaches that seal enamel caries, only partially remove carious dentine or attempt to entirely seal carious dentine lesions merit not only discussion but also longer term investigation. With increasing demands on health funding, dentistry must look at how the most appropriate care can be provided to allow children to reach adulthood with healthy permanent dentitions - something that less than half the population currently achieve.British dental journal official journal of the British Dental Association: BDJ online 06/2013; 214(11):E27. · 1.09 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE: The aim of this study was to evaluate the effect of sealant placement on the detection of caries by a fluorescent camera (FC), the Spectra caries detector. MATERIALS AND METHODS: In a laboratory study, FC images and readings were obtained from 31 extracted teeth, before and following application of clear sealants (Shofu Clear or Delton unfilled), or opaque sealants (3M Clinpro or Delton FS). Teeth were then sectioned and examined for enamel or dentine caries. Using each tooth's true caries diagnosis, the sensitivity and specificity of the FC measurements in detecting dentine caries was calculated. In the clinical study, FC readings were obtained from 41 molars in children prior to and following application of clear sealants. RESULTS: Following application of Shofu or Delton unfilled there were reductions in the mean FC readings of 10% (p=0.5) and 8.2% (p=0.009) respectively. Application of two opaque sealants, 3M or Delton FS significantly reduced mean FC readings 16.2% and 20.8% (p<0.5) respectively. Although the carious lesions could still be observed in FC images from teeth with opaque sealants there was a significant loss of sensitivity in detecting dentinal caries. Clear sealant application caused an insignificant loss of detection sensitivity. Following application of clear sealants to children's molars there was a small (4.01%) but significant (p< 0.01) reduction in FC readings recorded from these teeth. CONCLUSIONS: The FC can detect caries under clear sealants with little loss of sensitivity. Although lesions can be seen through opaque sealants, loss of sensitivity precludes accurate lesion assessment.Journal of dentistry 05/2013; · 3.20 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVES: When treating deep caries, one- and two-step incomplete caries removal reduce the risk of pulpal exposure. However, it is currently unclear if incompletely excavated teeth fail due to pulpal or rather non-pulpal complications. The present study systematically analysed how incompletely excavated teeth fail, and if certain tooth- or treatment-related factors may influence risk of failure. Data: Clinical studies investigating clinical or radiologic failure after incomplete excavation of deep caries (depth >1/2 dentin thickness) were evaluated. Weighted annual failure rates (AFRs) were used to analyse frequency and mode of failures. Sub-analyses compared risk of failure in different groups of possible influencing factors. Sources: Electronic databases were screened and studies cross-referenced. Language was restricted to English and German. Grey literature was not evaluated. RESULTS: 19 studies with a median (Q25/75) follow-up of 24 (12/48) months were included. AFR was 3.8 (1.4/4.4)%. Eleven studies reported pulpal complications being the major reason for failure, and only 2 studies found more non-pulpal than pulpal failures. Sub-analyses found significantly lower risk of failure for teeth after one- compared with two-step excavation (Odds ratio [95% CI] = 0.21 [0.08, 0.55]) and teeth with single- compared with multi-surface cavities (0.33 [0.16, 0.67]). Risk of bias differed widely between studies, and evidence levels were graded as very low. CONCLUSIONS: After incomplete removal of deep caries, pulpal failure was more common. One- compared with two-step excavation reduces risk of failure, and factors like number of restored surfaces seem to but influence failure, but limited evidence permits drawing definitive conclusions. Clinical Significance: Growing evidence indicates that one-step incomplete excavation seems suitable to treat deep caries lesions, and might have advantages compared to two-step incomplete or complete caries removal. However, it is too early to recommend certain clinical strategies.Journal of Dentistry 05/2013; · 3.20 Impact Factor