Abordagem conservadora de lesões cariosas profundas: uma revisão de literatura / Conservative approach to deep carious lesions: a literature review

O presente trabalho tem como objetivo realizar uma revisão de literatura e discutir os mais atuais conceitos sobre abordagem conservadora de lesões cariosas profundas, facilitando o manejo clínico. Para que essa abordagem conservadora seja implementada, é imprescindível que se conheça a composição estrutural e funcional do biofilme para, assim, entender a evolução da doença cárie que acomete a estrutura dentária. No entanto, quando se trata de um dente com lesão de cárie ativa com grande comprometimento de esmalte e dentina, procedimentos operatórios mais invasivos e restauradores podem ser necessários, mesmo que fundamentados na maior preservação possível de estrutura dentária. As evidências mais atuais encontradas na literatura recomendam a remoção seletiva do tecido cariado que consiste na dentina infectada, ou seja, clinicamente amolecida, e restauração definitiva na mesma sessão. Portanto, desde que o dente apresente vitalidade pulpar clinicamente confirmada, acredita-se que a preservação estratégica da dentina, poderá aumentar as chances de sucesso no tratamento, evitando possível exposição da polpa dentária. Adicionalmente, ao optar por práticas conservadoras no contexto da Odontologia de mínima intervenção, resultará em um significativo aumento na longevidade das restaurações sempre associando promoção de saúde ao paciente(AU)

This paper aims to conduct a literature review and discuss the most current concepts on conservative approach to deep carious lesions in permanent posterior teeth, facilitating clinical management. For this conservative approach to be implemented, it is essential to know the structural and functional composition of the biofilm in order to understand the evolution of the caries disease that affects the dental structure. However, when it comes to a tooth with an active caries lesion with major enamel and dentin compromise, more invasive and restorative surgical procedures may be necessary, even if based on the greatest possible preservation of the dental structure. The most current findings in the literature recommend the selective removal of carious tissue consisting of infected dentin, that is, clinically softened, and definitive restoration in the same session. Therefore, as long as the tooth has clinically confirmed pulp vitality, it is believed that the strategic preservation of dentin may increase the chances of successful treatment, avoiding possible exposure of the dental pulp. Additionally, when opting for conservative practices in the context of Minimally Invasive Dentistry, it will result in a significant increase in the longevity of restorations, always associating health promotion to the patient(AU)

Ultrasound device as a minimally invasive approach for caries dentin removal

Abstract The aim of this study was to evaluate the efficacy of an ultrasound device and the dentin surface morphology after removal of the caries dentin lesions by removal rate and scanning electron microscopy (SEM). The Knoop hardness test on the bovine dentin blocks (n = 20, 4x4x2mm) was performed to standardize the samples and only those with 38 ± 2 KHN were included. The dentin blocks were submitted to induction of artificial caries lesions, using the bacterial model. Strains of Streptococcus mutans and Lactobacillus acidophilus were used for 7 days. The caries dentin lesion was removed for 1 min, according to two methods: G1 - carbide bur under low-speed rotation (control group) and G2 - ultrasound device under refrigeration. For the removal rate, the samples were weighed 3 times: T0 (before induction), T1 (after induction) and T2 (after removal). Morphology evaluation of the residual dentin surface was performed by SEM. Data normality was verified by Shapiro-Wilk test (p ≥ 0.240). T-test for independent samples was applied to evaluate the removal rate. A significance level of 5% was adopted. G2 provided lower removal rate than G1 (G1: 3.68 mg and G2 = 2.26 mg). SEM images showed different morphological characteristics between the groups. G2 showed absent of smear layer, while G1 showed a visible smear layer over the surface. We concluded that ultrasound device provides minimally invasive removal with residual dentin exhibiting open dentin tubules and no smear layer formation and no bacteria, which infer the removal of the infected tissue.

Resumo O objetivo deste estudo foi avaliar a eficácia de um dispositivo ultrassônico e a morfologia da superfície dentinária após a remoção da dentina cariada por meio da taxa de remoção e imagens de microscopia eletrônica de varredura (MEV). Foi realizado o teste de dureza Knoop nas amostras de dentina bovina (n = 20, 4x4x2mm) afim de padronizar as amostras e foram incluídas apenas aquelas com 38 ± 2 KHN. As amostras de dentina foram submetidas à indução de lesões artificiais de cárie, utilizando-se modelo biológico contendo cepas de Streptococcus mutans e Lactobacillus acidophilus durante por 7 dias. As lesões foram removidas por 1 min, de acordo com dois métodos: G1 - fresa esférica sob baixa rotação (grupo controle) e G2 - dispositivo ultrassônico sob refrigeração. Para a taxa de remoção, as amostras foram pesadas em três tempos: T0 (antes da indução), T1 (após a indução) e T2 (após a remoção). A avaliação morfológica da superfície residual da dentina foi realizada por MEV. A normalidade dos dados foi verificada pelo teste de Shapiro-Wilk (p ≥ 0,240). Teste T para amostras independentes foi aplicado para avaliar a taxa de remoção. Foi adotado nível de significância de 5%. G2 apresentou menor taxa de remoção que G1 (G1: 3,68 mg e G2 = 2,26 mg). As imagens de MEV mostraram características morfológicas diferentes entre os grupos. G2 mostrou ausência de smear layer, enquanto G1 mostrou grande quantidade de smear layer sobre a superfície. Com base neste estudo in vitro, o dispositivo de ultrassom promoveu remoção minimamente invasiva e dentina residual exibindo túbulos dentinários abertos e mínima formação de smear layer.

Efficacy evaluation of pepsin enzyme-based gel in chemo-mechanical caries removal on primary anterior teeth: a randomized controlled clinical study / Avaliação da eficácia do gel à base de enzima pepsina na remoção químico-mecânica da cárie em dentes anteriores decíduos: um estudo clínico controlado randomizado

Objective: To evaluate the efficacy of a new pepsin enzyme-based gel compared with Carisolv as a CMCR agent. Clinical and radiographical evaluations of recurrent caries were made 3 and 6 months after treatment. Material and Methods: A split-mouth designed randomized controlled clinical study was carried out on 40 primary anterior teeth of children aged between 4-7 years. Pepsin enzyme-based gel and Carisolv solution were applied to carious lesions until complete removal of caries. The efficacy of both agents was evaluated by the number of application times to remove all caries. Recurrent caries were evaluated clinically and radiographically after 3 and 6 months of treatment. Results: Results showed no statistically significant differences in the efficacy of caries removal by the number of application times (P = 0.919). Concerning recurrent caries, clinical and radiographical evaluation after three and six months showed no statistically significant differences between the two groups (P = 0.574, P = 0.547, respectively). Conclusion: Pepsin enzyme-based gel can be considered similar to Carisolv gel regarding its efficacy as a CMCR agent for small carious lesions on primary anterior teeth in children aged 4-7 years old. (AU)

Objetivo: avaliar a eficácia de um novo gel a base de enzima pepsina comparada com o Carisolv como um agente na remoção químico-mecânica da cárie. Avaliações clínicas e radiográficas de cárie recorrente foram feitas em 3 e 6 meses apos o tratamento. Material e Métodos: um estudo clínico controlado randomizado de boca-dividida foi realizado em 40 dentes deciduos anteriores de crianças com idade entre 4-7 anos. Gel à base de enzima pepsina e a soluçao de Carisolv foram aplicados sobre a lesão cariosa até a completa remoção da carie. A eficácia de ambos agentes foi avaliada pelo número de tempo de aplicações para a remoção de todo tecido cariado. Cárie recorrente foi avaliada clinicamente e radiograficamente após 3 e 6 meses de tratamento. Resultados: Não houve diferença significativa na eficácia de remoção de cárie pelo número de tempo de aplicação (P = 0.919). Em relação à cárie recorrente, avaliação clínica e radiográfica apos 3 e 6 meses mostraram que não houve diferença estatisticamente significante entre os 2 grupos (P = 0.574, P = 0.547, respectivamente). Conclusão: o gel à base de enzima pepsina pode ser considerado similar ao gel Carisolv em relação a sua eficácia como um agente químico-mecânico na remoção da cárie para lesões cariosas pequenas em dentes anteriores decíduos em crianças entre 4-7 anos de idade.(AU)

Remoción selectiva comparado con remoción total para caries dentinarias profundas / Selective removal compared to complete removal for deep carious lesions

INTRODUCCIÓN La caries dental ha sido convencionalmente manejada mediante la remoción no selectiva del tejido carioso (remoción total), sin embargo, los efectos adversos de este procedimiento han promovido la utilización de técnicas de remoción de caries conservadoras (remoción selectiva), pero aún existe controversia respecto a su efectividad. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metaanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos siete revisiones sistemáticas que en conjunto incluyeron siete estudios primarios, todos ellos correspondientes a ensayos aleatorizados. Concluimos que la remoción selectiva de caries podría disminuir la necesidad de tratamiento de endodoncia y el riesgo de exposición pulpar en dientes con caries profundas, pero la certeza de la evidencia es baja. No existe claridad de que la remoción selectiva de caries disminuya el riesgo de aparición de signos y síntomas de patología pulpar y el riesgo de fracaso de las restauraciones ya que la certeza de la evidencia es muy baja.

INTRODUCTION Dental caries have been conventionally managed by non-selective removal of carious tissue (total complete removal); however, the adverse effects of this procedure have promoted the use of conservative caries removal techniques (selective removal), but there is still controversy regarding its effectiveness. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including seven studies overall, of which all were randomized trials. We concluded that selective caries removal may decrease the need for root canal treatment and the risk of pulp exposure in teeth with deep caries, but the certainty of the evidence is low. It is not clear whether the selective removal of caries reduces the risk of appearance of signs and symptoms of pulp disease and the risk of restorations failure, as the certainty of the evidence is very low.

Effect of Er: YAG laser irradiation on the bonding strength of permanent teeth / 口腔疾病防治

@#The concept of “minimally invasive dentistry” aims to provide conservative treatment of cavities in which sound dentin is removed. Because the Er: YAG laser can selectively remove caries, the smear layer is removed, dentin tubules are exposed after the preparation of substrate conditioning, and its advantages of precision, safety and painlessness are deeply valued. At the same time, the bonding strength between the prepared dentin surface and the filling material is different due to the different parameters of the Er: YAG laser. In this paper, the principle of dentin bonding, the mechanism of Er: YAG laser action, after treatment of dentin with different parameters (power, energy density, pulse duration, and irradiation distance), whether there is thermal damage to pulp tissue, the ultramicro morphology of dentin surface, the bonding properties of different bonding systems and the filling materials between irradiated hard tissues were reviewed. An appropriate parameter range (power ≤ 10 Hz, energy density ≤ 60 mJ, and pulse duration ≤ 50 μs) combined with water spray cooling will not cause thermal damage to the pulp tissue, while the higher power, energy density and pulse duration of laser treatment for dentin will lead to melting, carbonization, cracks, narrowing of the gap between collagen fibers, etc., which will limit the penetration of adhesives and have a negative impact on bonding. However, whether the adhesive systems based on the smear layer are suitable for dentin after laser treatment needs to be further explored.

Effects of papain-based gel used for caries removal on macrophages and dental pulp cells

Abstract Papain-based gel is used for chemical-mechanical caries removal and present antimicrobial and anti-inflammatory activities. However, its effects on dental pulp cells and on macrophages remains largely unknown. Therefore, the aim of this study was to investigate whether the papain-based gel Papacárie Duo® acts as an immunomodulator in lipopolysaccharide (LPS)-activated macrophages and its effects on dental pulp cells . J774.1 macrophage and OD-21 dental pulp cells were stimulated with 0.5% and 5% of Papacárie Duo®, following pre-treatment or not with LPS. After 24 h, a lactate dehydrogenase assay was used to measure cytotoxicity, a tetrazolium-based colorimetric assay (MTT) was used to measure cell viability, and qRT-PCR was used to analyze relative gene expression of Ptgs2, Il10, Tnf, Mmp9, Runx2, Ibsp and Spp1. Papacárie Duo® was cytotoxic and reduced cell viability at 5% but not at 0.5% in both cultures. In macrophages, Papacárie Duo® increased the expression Il10 and LPS-induced Ptgs2, but it did not affect Tnf or Mmp9. In OD-21 cells, Papacárie Duo® inhibited Runx2 and Ibsp expression, but stimulated Spp1 expression. Papain-based gel presented a concentration dependent cytotoxicity, without affecting cell viability, for dental pulp cells and macrophages. Interestingly, the gel presented an inhibitory effect on pulp cell differentiation but modulated the activation of macrophages stimulated with LPS. We speculate that in dental pulp tissue, Papacárie Duo® would impair reparative dentinogenesis but could activate macrophages to perform their role in defense and inflammation.

Resumo O gel à base de papaína é utilizando para remoção químico-mecânica do tecido cariado e apresenta propriedades antimicrobianas e anti-inflamatórias Entretanto, seu efeito sobre as células da polpa dentárias e macrófagos é desconhecido. Portanto, o objetivo deste estudo foi investigar o efeito de um gel de papaína (Papacárie Duo®) em células indiferenciadas da polpa dentária e a capacidade de induzir a ativação e síntese de mediadores inflamatórios por macrófagos estimulados com lipopolissacarídeo bacteriano (LPS). O gel de papaína foi diluído nas concentrações de 0,5 e 5%. Células indiferenciadas da polpa dentária OD-21 e macrófagos J774.1 foram mantidos em cultura com os diferentes estímulos por um período de estimulação de 24 h para realização do teste de citotoxicidade (Ensaio LDH) e para avaliação da viabilidade celular (Ensaio Colorimétrico MTT). A seguir foi realizada avaliação da expressão gênica relativa dos genes Ibsp, Runx2 e Spp1 em células OD-21; e dos genes Il10, Mmp9, Ptgs2 e Tnf em células J774.1, pelo método de transcrição reversa e reação em cadeia de polimerase em tempo real (qRT-PCR), após estimulação pelo período de 24 h. O extrato do gel diluído a 5% foi citotóxico às células da polpa dental, reduziu a viabilidade celular, inibiu a expressão de Runx2 e Ibsp e estimulou a expressão de Spp1. Em macrófagos, o extrato do gel foi citotóxico e reduziu a viabilidade celular na concentração de 5%. O LPS inibiu a viabilidade celular na presença ou não do extrato do gel, sem apresentar citotoxicidade. O extrato do gel induziu a expressão de Ptgs2 e Il10, sem alterar Tnf e Mmp9. O extrato do gel de papaína foi citotóxico, dependente da concentração, tanto em células da polpa dentária como em macrófagos, sem alterar a viabilidade celular. Interessantemente, apresentou efeito inibitório na diferenciação de células da polpa dentária e modulou a ativação de macrófagos estimulados com LPS. No tecido pulpar, o Papacárie Duo® poderia impedir a dentinogênese de reparação, porém ativar macrófagos para desempenhar seu papel na inflamação e defesa.

Supervivencia de restauraciones adhesivas en cavidades preparadas con dos técnicas de remoción de caries / Survival of adhesive restorations in cavities prepared with two caries removal techniques

Objetivo: evaluar la supervivencia de las restauraciones adhesivas sobre cavidades preparadas con remoción parcial de caries o remoción total de caries. Métodos: se planteó un ensayo clínico aleatorizado, doble ciego. La muestra estuvo constituida por 107 piezas dentarias de 32 niños de 4 a 8 años de edad, que cumplieron los criterios de inclusión y exclusión previamente determinados, con cavidades profundas que abarcaban una o dos superficies dentales, las cuales fueron tratadas mediante remoción parcial de caries o remoción total de caries. Las evaluaciones fueron realizadas cada 6 meses durante 2 años, desde el punto de vista radiográfico y clínico. De manera complementaria los menores y sus responsables recibieron motivación, capacitación, acompañamiento y dispositivos de aseo bucal de forma permanente. Los datos obtenidos fueron sometidos a análisis estadístico de supervivencia de Kaplan-Meier y para la diferencia de tratamientos se utilizó la prueba Log Rank. Se realizó un análisis con tabla de supervivencia incluyendo los dos tratamientos a los 6, 12, 18 y 24 meses. Resultados: no se encontró diferencia significativa entre las técnicas de remoción total y parcial de caries (p= 0,61). El análisis mostró que los porcentajes de supervivencia fueron de 95 por ciento a los 6 meses, 88 por ciento a los 12 meses, 81 por ciento a los 18 meses y 55 por ciento a los 24 meses. Conclusiones: la utilización de remoción parcial o total de caries para la preparación de cavidades demostró no tener diferencias significativas. Para futuros estudios en los que se analice la supervivencia de las restauraciones se deberá considerar una pérdida de participantes del 30 por ciento(AU)

Objective: Evaluate the survival of adhesive restorations in cavities prepared with partial or total caries removal. Methods: A randomized double-blind clinical trial was conducted. The sample was composed of 107 teeth of 32 children aged 4-8 years who met the inclusion and exclusion criteria set for the trial. These children had deep cavities that covered one or two dental surfaces, which were treated by partial or total caries removal. Radiographic and clinical evaluations were performed every six months for two years. The children involved in the trial and the adults in charge of them also received motivation sessions, training, support and oral hygiene devices on a permanent basis. The data obtained were subjected to Kaplan-Meier survival statistical analysis, and the Log Rank test was used to determine the difference between the treatments. Survival table analysis was performed which included the two treatments at 6, 12, 18 and 24 months. Results: No significant difference was found between total and partial caries removal techniques (p= 0.61). Survival percentages were found to be 95 percent at 6 months, 88 percent at 12 months, 81 prcent at 18 months and 55 prcent at 24 months. Conclusions: No significant difference was found between the use of partial and total caries removal for cavity preparation. Further studies about restoration survival should consider a 30 percent dropout rate(AU)

Microbial load after selective and complete caries removal in permanent molars: a randomized clinical trial

Abstract The aim of this randomized clinical trial was to compare the remaining microbial load after treatments based on complete and selective caries removal and sealing. Patients with active carious lesions in a permanent molar were randomly allocated into 2 groups: a test group (selective caries removal-SCR; n=18) and a control group (complete caries removal - CCR; n=18). Dentin samples were collected following the excavation and three months after sealing. Streptococcus species, Streptococcus mutans, Lactobacillus species, and total viable microorganisms were cultured to count the viable cells and frequency of species isolation. CCR resulted in significant lower total viable microorganisms counts (p≤0.001), Streptococcus species (p≤0.001) and Lactobacillus species (p≤0.001) initially. However, after sealing, a decrease in total viable microorganisms, Streptococcus species, and Lactobacillus species in the SCR resulted in no difference between the groups after 3 months. In conclusion, selective caries removal is as effective as complete caries removal in reducing dentin bacterial load 3 months after sealing.

Resumo O objetivo deste ensaio clínico randomizado foi comparar os microrganismos remanescentes após tratamentos baseados em remoção total de tecido cariado e selamento e a remoção seletiva de tecido cariado e selamento. Pacientes com lesões de cárie ativas em molares permanentes foram divididos aleatoriamente em dois grupos: grupo teste (remoção seletiva de tecido cariado-SCR; n=18), e grupo de controle (remoção total de tecido cariado-CCR; n=18). Amostras de dentina foram obtidas após a remoção da tecido cariado e após 3 meses de selamento das cavidades. Streptococcus spp., Streptococcus mutans, Lactobacillus spp. e microrganismos viáveis totais foram cultivados para contagem de células e frequência de isolamento de espécies. CCR resultou em menores contagens totais de microorganismos viáveis (p≤0,001), Streptococcus spp. (p≤0,001) e Lactobacillus spp. (p≤0,001) inicialmente. Entretanto, após o selamento, uma redução significativa nas contagens totais de microrganismos viáveis, Streptococcus spp. e Lactobacillus spp. resultou em nenhuma diferença entre os grupos após 3 meses. Conclui-se que a remoção seletiva de cárie é tão seletiva quanto a remoção completa de cárie na redução da infecção dentinária após três meses com selamento da lesão.

New treatment method for pain and reduction of local anesthesia use in deep caries

Chemo-mechanical caries removal methods are known to be more effective compared with conventional methods in pain reduction. Carie-care™, a chemo-mechanical caries removal agent, was introduced in 2010 but a systematic review of its efficacy has not yet been performed. The purpose of this study was to investigate the effectiveness of Carie-care™ on the outcomes of treatment of caries in children and adolescents. The primary outcome was pain while the secondary outcomes included complete caries removal (CCR), time, need for local anesthesia and behavioral response changes. A Comprehensive literature search was performed in PubMed, EMBASE, and the Cochrane Library up to 30 September 2018. The following keywords were used in the search: ‘chemo-mechanical caries removal agent’, ‘dental caries’, ‘Carie-care’, ‘chemo-mechanical caries removal’, ‘chemo-mechanical caries excavation’, other related keywords, and their combinations. From 942 studies identified, 16 were analyzed. Finally, 4 studies met the eligibility criteria and 260 teeth in 120 children and adolescents were included in this review. This review showed that Carie-care™ reduces pain during caries treatment but requires a longer time for effective treatment than conventional methods. Local anesthesia was not required in the Chemo-mechanical caries removal (CMCR) group. In addition, dental anxiety decreased compared to the control group, and co-operation was more positive. Therefore, it may be a useful alternative to conventional methods in children and adolescents, but further verification through additional studies is needed.

Vital Pulp Therapies in Clinical Practice: Findings from a Survey with Dentist in Southern Brazil

Studies based on dentists' clinical practice possess vital relevance to understand factors leading the clinicians to choose by a specific technique over another. This study investigated which clinical conduct therapies are adopted by dentists in front of deep caries. Was evaluated how the place of work, post-graduate training and years since complete graduation influenced their decisions. A cross-sectional study was performed using a self-applied questionnaire with dentists (n=276) in Southern Brazil. Information regarding post-graduation training (specialization, master's or PhD), clinical experience (years since completing graduation) and place of work were investigated. The information regarding pulp vital therapies (materials for direct pulp capping; techniques for caries removal in deep cavities and strategies for indirect pulp capping) were collected by specific questions. Data were submitted to descriptive analysis and Exact Fischer Test. Response rate was 68% (187). The majority of dentists selected the calcium hydroxide (CH) as first material for direct (86.3%) and indirect (80.3%) pulp protection. Partial caries removal was reported by 61.9% of dentists. Less experienced clinical dentists choose partial caries removal more frequently (p=0.009), if compared with dentists graduated 10 years and up ago. The use of MTA was more common among professionals working at academic environment. Besides, MTA was not mentioned by professionals working exclusively in the public health service (p=0.003). In conclusion, the time since graduation influenced the clinical conduct related to caries removal. The choice of liner materials was influenced by dentists' workplace.

Resumo Estudos baseados na prática clínica de dentistas possuem relevância vital para o entendimento dos fatores que influenciam os clínicos na escolha de uma técnica específica em detrimento de outra. Este estudo investigou quais condutas clínicas são adotadas por dentistas frente a lesões profundas de cárie. Foi avaliado como o local de trabalho, curso de pós-graduação e tempo desde a graduação influenciaram suas decisões clínicas. Foi conduzido um estudo transversal utilizando questionários auto- aplicados à dentistas no sul do Brasil (n=276). Informações relacionadas a educação continuada (especialização, mestrado ou doutorado), experiência clínica (anos desde a graduação) e local de trabalho foram investigadas. As informações sobre terapias vitais da polpa (materiais para capeamento pulpar direto, técnicas para remoção de carie em cavidades profundas e estratégias para capeamento pulpar indireto) foram coletadas por meio de perguntas específicas. Os dados foram submetidos à análise descritiva e teste exato de Fisher. A taxa de resposta foi de 68% (187). A maioria dos dentistas selecionam o hidróxido de cálcio (HC) como primeiro material para proteção pulpar direta (86,3%) e indireta (80,3%). Remoção parcial de tecido cariado foi relatado por 61,9% dos clínicos. Dentistas com menor experiência clínica optaram pela remoção parcial de tecido cariado com mais frequência (p=0,009), quando comparados a dentistas graduados há mais de 10 anos. O uso do MTA foi mais comum entre os profissionais que trabalham em ambiente acadêmico. Além disso, o MTA não foi mencionado pelos profissionais que trabalham exclusivamente no serviço público de saúde (p=0,003). O tempo desde a graduação influenciou a conduta clínica relacionada à remoção de cárie. A escolha de materiais para proteção pulpar foi influenciada pelo local de trabalho dos dentistas.

Papacarie: A Chemomechanical Caries Removal Agent.

Chemomechanical caries removal (CMCR) is a noninvasive technique eliminating infected dentine via a chemical agent. Th e objective of CMCR is to eliminate the outer layer or infected dentin, leaving the aff ected layer or partly demineralized dentin, which can be remineralized and repaired. As this process based on minimally invasive dentistry, it not only removes infected tissues, also preserves healthy dental structure, avoiding pulp irritation and patient discomfort. Th is is a method of caries removal based on dissolution. Instead of drilling, this method uses a chemical agent assisted by an a traumatic mechanical force to remove soft carious structure. Th e chemomechanical method for caries removal is most outstanding among other alternative methods. Th is paper reviews one of the chemomechanical removal agent, Papacarie.

Influencia del método de remoción de caries en la fuerza de adhesión a dentina afectada / Influence of caries removal method on bond strength to dentin affected

La técnica de adhesión en dentina es una técnica poco predecible y se agudiza aun más cuando la dentina ha sido afectada por caries ya que las alteraciones histológicas disminuyen la posibilidad de esta unión; no obstante la variación en la técnica de remoción del tejido cariado pudiera influir de manera independiente en la unión. El objetivo de esta investigación es determinar la influencia del método de remoción del tejido cariado en la resistencia adhesiva en micro tracción (µTBS) de resina compuesta unida a dentina humana afectada por caries. Se utilizaron 15 molares humanos afectados por caries y de manera aleatoria simple se dividieron en tres grupos (G1,G2,G3), luego se realizó un corte con disco de diamante (KG Sorensen® /Brasil) perpendicular al eje mayor del diente exponiendo la mayor cantidad de dentina afectada, el G1 fue sometido a remoción con Aire abrasivo de oxido de aluminio de 50 µm a una presión de 40 PSI (Microjato®, Bio-art /Brasil), al G2 se le eliminó la caries con fresa redonda de carburo N° 6 a baja velocidad (KG Sorensen® /Brasil)y al G3 se le eliminó con el método Químico/Mecánico (PAPACARIE ® /Brasil y Cucharita para dentina), la eliminación fue corroborada con fluorescencia laser (DIAGNOdent®, Kavo /Germany), posteriormente se aplicó la técnica de grabado total siguiendo las indicaciones del fabricante para adhesivo Excite ®( Ivoclar Vivadent Inc. /USA), y se restauraron 6 mm oclusales con resina compuesta Brilliant Enamel New Line® (Coltène-Whaledent /Germany.), luego se seccionaron con una sierra de precisión ISOMET 1000® (Buehler /USA) y se obtuvieron muestras de 1x1x10 mm , a continuación las muestras se prepararon para la prueba de micro tracción en la máquina de prueba universales AGS-J (Shimadzu /Japan) a una velocidad de desplazamiento de 0,5mm por min. Los datos fueron recolectados en hoja de cálculo Excel y analizados con un ANOVA de 1 Vía, en un nivel (µBts), el valor de p quedo preestablecido en p?0,05

The dentin adhesion technique is a quite unpredictable one and it is enhanced when the dentin has been affected because histological alterations reduce the chance for this union; however, the variation in the removal technique of caries-affected tissue could have an independent influence on the union. Aim: to determine the influence of the method of caries-affected tissue removal on the adhesive resistance in micro-tensile (µTBS) of composite bonded to human dentin affected by caries. Methods: 15 human molars affected by caries were randomly assigned into three groups (G1, G2, and G3). Then, one cut with a diamond disc (KG Sorensen® /Brasil) was performed perpendicular to the major axis of the teeth exposing the larger amount on affected dentin. G1 condition was removal with abrasive air of aluminum oxide of 50 µm at a 40 PSI (Microjato®, Bio-art /Brasil) pressure. G2 had caries removal with carbide round drill N° 6 at a low speed (KG Sorensen® /Brasil). Finally, for G3 caries was removed with the Chemical/Mechanical method (PAPACARIE ® /Brasil and spoon excavator). The elimination was corroborated by laser fluorescence (DIAGNODENT®, Kavo /Germany); later, the total etching technique was performed by following the manufacturer instructions for Excite ® (Ivoclar Vivadent Inc. /USA) and 6 oclusal mm were restored with composite Brilliant Enamel New Line® (Coltène-Whaledent /Germany.), then they were cut with a precision saw ISOMET 1000® (Buehler /USA) and 1x1x10 mm samples were obtained. The samples were prepared for the micro traction test in the universal testing machine AGS-J (Shimadzu /Japan) a speed of 0,5mm per minute. Data were recorded in Microsoft Excel and a one way ANOVA was performed for one level (µBts), the p value was established at p?0,05. Results: the mean µBts in MPa for each group and the standard deviation (±SD) was as follows: G1= 21,7 (8,6) G2=19,70 (10,5) G3=22,2 (9,7)

A comparative study of the clinical efficiency of chemomechanical caries removal using Carisolv® and Papacarie® - A papain gel.

Objectives: The purpose of this study was to compare the clinical efficiency of chemomechanical caries removal using Carisolv® and Papacarie® - a papain gel. Materials and Methods: The Carisolv® system for caries removal, consisting of a solvent gel and a specially designed hand instrument, was compared to Papacarie - a papain gel. The outcome variables were: time taken for complete caries removal and volume of carious tissue excavated. Forty patients in the age-group of 20-40 years, having Black's class I dentinal caries with cavity entrance size of ≥3 mm in the molars, were enrolled for the study. The time taken for the complete removal of caries was measured using a stopwatch. Pre- and post-excavation single-step putty/wash elastomeric impression was recorded using addition silicone impression material. Subsequently, casts were poured and measured under a traveling microscope. The total volume of caries excavated was computed using the formula π (d/2)2 h. The difference between the two groups in clinical efficiency and volume excavated was statistically analyzed using the Student's unpaired 't' test. Results: The time for caries removal with Carisolv® and Papacarie® were, respectively, 11.67 ± 3.25 minutes and 10.48 ± 2.96 minutes (P>.05). The mean volume of carious tissue removed with Papacarie® (135.99 ± 66.43 mm 3 ) was higher than that with Carisolv® (126.33 ± 53.56 mm 3 ); however, the difference was not significant. Conclusion: Carisolv® and Papacarie® have similar clinically efficiency as chemomechanical agents for dentinal caries removal.

Comparative clinical evaluation of chemomechanical caries removal agent Papacarie® with conventional method among rural population in India: in vivo study

The use of minimally invasive procedures and attention to patient comfort are of great importance, especially for dental treatment in young children. This has led to the development of chemomechanical methods for caries removal. Aim: To evaluate and compare the antimicrobial efficacy, efficacy in terms of time consumption and pain perception of chemomechanical caries removal agent Papacarie® and conventional method of caries removal. Methods: Subjects for this study were chosen from children admitted to dental clinic for restorative procedures. Forty children (age 4-8 years) with early childhood caries were included in this study. Two primary teeth with comparable degrees of carious destruction were chosen in each child for caries removal with either Papacarie® or rotary instruments. The time taken for caries removal was measured using stopwatch. Pain response during caries removal was evaluated using the Wong Baker Face Pain Scale. Dentin samples of both groups were taken prior to, and after caries removal for microbiological analysis. Results The time taken for caries removal in chemomechanical caries removal method was three times longer than the conventional method. Pain score during chemomechanical method of caries removal was 1.525 as compared with 6.65 when conventional method was used. The antimicrobial efficacy of chemomechanical caries removal was significantly similar to conventional method. Conclusions: Papacarie® can be an effective clinical alternative treatment for the removal of occlusal dentinal caries in cavitated primary molars.

Effect of carisolv and papacárie on theresin-dentin bond strength in sound andcaries-affected primary molars

Aim: This study evaluated the influence of different chemomechanical caries removal techniqueson the bond strength of an adhesive system to caries-affected and healthy dentin. Methods:Thirty healthy teeth were randomly divided into three groups: Group 1 (control): no cariesremoval technique was applied; Group 2: chemomechanical technique using Carisolv®; andGroup 3: chemomechanical technique using Papacárie®Twenty caries-affected teeth were divided .into two groups: Group 4: chemomechanical technique using Carisolv; and Group 5:chemomechanical technique using Papacárie. The teeth received the application of an etch-andrinse adhesive system, were restored with composite resin, and then sectioned to obtain 4 hourglassshaped slabs from each specimen, which were subjected to a microtensile bond strength test. Datawere analyzed statistically by ANOVA and Tukey’s test (a=0.05). Results: G1 (13.387 ± 6.1074),G2 (18.123 ± 3.2611) and G3 (12.781 ± 4.5652) presented statistically significant higher meanbond strength values than the other groups (p<0.05), but did not differ significantly from each other(p>0.05). G4 (6.228 ± 5.3435) and G5 (6.482 ± 3.2076) presented the lowest mean bondstrength values and were statistically similar to each other (p>0.05). Conclusions: Neither of thechemomechanical caries removal methods interfered in the resin-dentin bond strength. However,lower tensile bond strength was found to caries-affected dentin.

Clinical evaluation of caries removal with a chemo-mechanical Carisolv method / 实用口腔医学杂志

Objective:To compare the caries removal efficiency of Carisolv with that of drilling in deciduous teeth.Methods:Thirty-two children,aged from 6 to 9 years,with symmetric coronal medium or deep caries in deciduous teeth,were involved in the clinical study.According to a split-mouth design,in each patient,caries tissue was removed by using a round bur on one side,and Carisolv on the other side.After caries removal,the teeth were restored with composite resin.Patients were asked to fill in a postoperative questionnaire,including patient acceptance of technique preference.6 months after operation the restorations were checked.Results:The time(min) for Carisolv caries removal and for drilling method were 4.33?1.25 and 2.58?0.82 respectively(P0.05).Conclusion:Carisolv is a time-consuming technique,but the majority of patients accepte Carisolv because of less pain.Carisolv may have no effect on the incidence of marginal microleakage and secondary caries.

Effects of Carisolv caries removal method on dentin bonding strength / 实用口腔医学杂志

Objective: To study the effects of Carisolv caries removal method on dentin bonding strength. Methods:Thirty extracted human third molars with moderate occlusal caries were used. Each molar was split into two parts, one part was prepared by Carisolv method and another was prepared by the low-speed burs. Then samples were randomly divided into three groups. Three adhesive systems were used: Prime&Bond NT +Dyract AP compomer、Uni-Etch +One-step plus+Renew resin composite and Prompt-L-Pop +Z100 resin composite. Microtensile bonding strength(MTBS) of the three adhesive systems were tested. Results:The MTBS of the three adhensive systems were (17.22?7.95) MPa, (25.40?8.44) MPa, (17.66?8.33) MPa in Carisolv group, and were (16.01?7.43) MPa, (23.45?7.55) MPa, (16.26?7.97) MPa in burs group. There was no significant difference between the two caries removal methods.Conclusion:Carisolv caries removal method has no side effects on dentin bonding strength of the three adhesive systems.

Experimental study of the effect of Carisolv in caries removal on dentin bonding interface / 实用口腔医学杂志

Objective: To study the effect of Carisolv in caries removal on dentin bonding surface.Methods:24 extracted third molars with moderate carious were randomly divided into four groups. Each cavity was split into two parts, one part was prepared by Carisolv and the other by high-speed bur. Then samples were processed as follows: samples in group A were not treated, those in group B were treated with 320 ml/L phosphoric acid, SEM was used to observe the morphology of dentin surface of the samples in group A and B. Samples in group C were restored with Dyract AP and those in group D with resin for the observation of the microstructure of dentin-filling bonding interfaces.Results:In group A, rough surface without obvious smear layer was exhibited and dentinal tubules were clearly open after Carisolv preparation; after bur preparation, dentin surfaces were covered with a thick smear layer and no opening of tubules was visible. In group B, after treatment with 320 ml/L phosphoric acid, the smear layer was removed and dentinal tubules were exposed after either Carisolv or bur preparation, but tube stoppers were visible in the samples prepared by bur. In group C, resin tags were observed only in the samples after Carisolv preparation. In group D,dentin surfaces and lengths of the resin tags did not show remarkable difference after Carisolv or bur preparation, but more lateral branch connection between resin tags appeared in the samples prepared by Carisolv than by bur.Conclusion:The dentin prepared by Carisolv favors bonding between dentin and resin/compomer and has the advantage of restoring with compomer.