Article

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

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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    • "The more specificity of chemo-mechanical methods is probably due to the specific chemical dissolution caused by the active component in these products, combined to the limited mechanical action of a hand instrument more conservatively used.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., &apos;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). Other specific discrepancies in caries removal, as seen for sample 5, where apparently not all carious tissue was removed (Fig. 2(A)) and, for sample 4, where MD in removed volume were slightly higher than the threshold for carious tissue (Fig. 2(C)) are related some factors as follows: in sample 5, some residual enamel originated from the fissures can still be identified, and this could have impaired further subjacent carious dentin removal (arrow, Fig. 1(E)). "
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    ABSTRACT: Physiological oral mechanical forces may play a role on the progression of enamel carious lesions to cavitation. Thus, the aim of this study was to describe, by 3D finite element analysis, stress, and strain patterns in sound and carious enamel after a simulated occlusal load. Micro-CT based models were created and meshed with tetrahedral elements (based on an extracted third molar), namely: a sound (ST) and a carious tooth (CT). For the CT, enamel material properties were assigned according to the micro-CT gray values. Below the threshold corresponding to the enamel lesion (2.5 g/cm(3) ) lower and isotropic elastic modulus was assigned (E = 18 GPa against E1 = 80 GPa, E2 = E3 = 20 GPa for sound enamel). Both models were imported into a FE solver where boundary conditions were assigned and a pressure load (500 MPa) was applied at the occlusal surface. A linear static analysis was performed, considering anisotropy in sound enamel. ST showed a more efficient transfer of maximum principal stress from enamel to the dentin layer, while for the CT, enamel layer was subjected to higher and concentrated loads. Maximum principal strain distributions were seen at the carious enamel surface, especially at the central fossa, correlating to the enamel cavity seen at the original micro-CT model. It is possible to conclude that demineralized enamel compromises appropriate stress transfer from enamel to dentin, contributing to the odds of fracture and cavitation. Enamel fracture over a dentin lesion may happen as one of the normal pathways to caries progression and may act as a confounding factor during clinical diagnostic decisions. Microsc. Res. Tech., 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    No preview · Article · Aug 2015 · Microscopy Research and Technique
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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.
    Full-text · Article · Mar 2015 · Scanning
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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.
    Full-text · Article · Jan 2014 · The Scientific World Journal
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