Conventional caries removal and sealed caries in permanent teeth: A microbiological evaluation

Faculty of Odontology, Federal University of Rio Grande do Sul, Brazil.
Journal of dentistry (Impact Factor: 2.75). 06/2012; 40(9):776-82. DOI: 10.1016/j.jdent.2012.05.011
Source: PubMed


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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    • "Regarding the results showing some carious tissue at the cavity bottom for some samples (Table II), it is important to stress that the threshold for carious tissue used in the present study is originally obtained from in vitro measurements of mechanical properties of different zones of carious dentin (Pugach et al., 2009) and may not fully represent the more clinically relevant threshold of " infected dentin " (Kuboki et al., '77). Moreover, some carious tissues eventually left at the bottom of a sealed cavity do not pose harm to longterm pulp vitality, as shown by recently controlled clinical trials (Alves et al., 2010; Maltz et al., 2012). "
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    ABSTRACT: The aim of this study was to access the effectiveness and specificity of a papain-based chemo-mechanical caries-removal agent in providing minimum residual caries after cavity preparation. In order to do it, extracted carious molars were selected and scanned in a micro-CT before and after caries-removal procedures with the papain-based gel. Similar parameters for acquisition and reconstruction of the image stacks were used between the scans. After classification of the dentin substrate based on mineral density intervals and establishment of a carious tissue threshold, volumetric parameters related to effectiveness (mineral density of removed dentin volume and residual dentin tissue) and specificity (relation between carious dentin in removed volume and initial caries) of this caries-removal agent were obtained. In general, removed dentin volume was similar or higher than the initial carious volume, indicating that the method was able to effectively remove dentin tissue. Samples with an almost perfect accuracy in carious dentin removal also showed an increased removal of caries-affected tissue. On the contrary, less or no affected dentin was removed in samples where some carious tissue was left in residual dentin. Mineral density values in residual dentin were always higher or similar to the threshold for mineral density values in carious dentin. In conclusion, the papain-based gel was effective in removing carious dentin up to a conservative in vitro threshold. Lesion characteristics, such as activity and morphology of enamel lesion, may also influence caries-removal properties of the method. SCANNING 9999:XX-XX, 2015. © 2015 Wiley Periodicals, Inc. © Wiley Periodicals, Inc.
    Scanning 03/2015; 37(4). DOI:10.1002/sca.21206 · 1.89 Impact Factor
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    • "Although a limited number of microorganisms persist under restorations a few months after the PDR and sealing [2] [3] [11] [12], some cariogenic bacteria may be found within the remaining microorganisms, such as mutans streptococci, which is currently found on sealed carious dentin [10] [11] [12] [13] [14] [15] [16] [17]. "
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    ABSTRACT: The aim of this study was to compare the genotypic diversity and virulence traits of Streptococcus mutans isolated from carious dentin before and after partial dentin caries removal (PDR) and sealing. Carious dentin samples were obtained three months before and after the PDR and cavity sealing. Up to seven isolates of each morphological type of S. mutans were selected and strain identity was confirmed using gtfB primer. Genotyping was performed by arbitrary primer-PCR (AP-PCR). Acidogenesis and acidurance of the genotypes were evaluated as virulence traits. A paired t-test and a Wilcoxon test were used to compare the virulence of genotypes. A total of 48 representative S. mutans isolates were genotyped (31 before and 17 after the sealing). At least one of the genotypes found before the sealing was also found on dentin after the sealing. The number of genotypes found before the sealing ranged from 2 to 3 and after the sealing from 1 to 2 genotypes. No difference was observed in the acidogenesis and acidurance between genotypes isolated before and after the sealing. In conclusion, genotypic diversity of S. mutans decreased after the PDR and sealing, but the virulence traits of S. mutans remained unchangeable.
    The Scientific World Journal 01/2014; 2014:165201. DOI:10.1155/2014/165201 · 1.73 Impact Factor
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    • "Total caries excavation assumes soft and demineralized dentine removal to provide a well-mineralized dentine base for restoration and preventing further cariogenic activity by removing bacteria. However, it has been shown that remaining dentine was more infected after total caries excavation compared with partial caries excavation covered with calcium hydroxide based material and sealed for 6–7 months [8]. Moreover, total caries excavation has demonstrated a high risk of pulpal exposure and lower success rate than stepwise excavation [9]. "
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    ABSTRACT: Objective: To investigate preferred treatment methods of deep carious lesions in mature permanent teeth among dentists in Northern Norway. Materials and methods: The survey included all 437 general dental practitioners in Northern Norway working in the private or the public dental health service. The participants received an invitation with a radiograph and a clinical picture of a deep carious lesion in a mature permanent tooth and a questionnaire asking about demographic characteristics and their preferred treatment methods related to different clinical deep caries diagnoses. Results: The response rate was 56%. There was an over-representation of publicly employed dentists among the respondents; otherwise no systematic bias related to non-responders was detected. In the absence of carious exposure and no symptoms, total caries excavation was the preferred treatment method (49%) followed by stepwise excavation (45%). In cases of deep caries and no exposure with symptoms, the preferences were equally distributed between root canal treatment (39%) and stepwise excavation (38%). In the presence of carious exposure but no symptoms, the preferred treatment method was direct pulp capping (51%) and in carious exposure with symptoms root canal treatment was the preferred treatment method (91%). Conclusions: There is no uniform treatment method of deep carious lesions among dentists in Northern Norway.
    Acta odontologica Scandinavica 03/2013; 71(6). DOI:10.3109/00016357.2013.775338 · 1.03 Impact Factor
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