Minimally Invasive Selective Caries Removal put into Practice

Dental Update ◽  
2020 ◽  
Vol 47 (10) ◽  
pp. 841-847
Author(s):  
Bhupinder Dawett ◽  
Sarah Young ◽  
Chris Deery ◽  
Avijit Banerjee
Keyword(s):  
Dental Caries ◽  
Minimally Invasive ◽  
Oral Care ◽  
Health Resources ◽  
Operative Strategy ◽  
Carious Lesions ◽  
Deep Carious Lesions ◽  
Caries Removal ◽  
The Uk ◽  
Selective Caries Removal

Dental caries remains a significant health problem globally, causing morbidity in those affected and consuming health resources. The management of caries consumes considerable finances both for individuals and the public purse. The scientific understanding of the dental caries process has evolved considerably over the last four decades with a move towards a minimum intervention oral care (MIOC) approach to managing patients. The minimally invasive operative intervention that retains demineralised, caries-affected dentine under a well-sealed restoration in order to avoid instrumentation close to the pulp, has shown clinical efficacy in treating individual teeth, as part of the MIOC framework. However, implementation of the selective caries removal approach in deep lesions is still not thought to be practised routinely by clinicians both globally, and in the UK. This article discusses some of the issues that may account for this and describes a case study using this operative strategy. CPD/Clinical Relevance: Restoring deep carious lesions can be a challenge, but using selective caries removal approaches will help minimise the adverse effects of pulp trauma.

scholarly journals Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jan E. Clarkson ◽  
Craig R. Ramsay ◽  
David Ricketts ◽  
Avijit Banerjee ◽  
Chris Deery ◽  
...  
Keyword(s):  
Dental Health ◽  
Controlled Clinical Trial ◽  
Trial Registry ◽  
Posterior Teeth ◽  
Carious Lesions ◽  
Randomised Controlled Clinical Trial ◽  
Deep Carious Lesions ◽  
Caries Removal ◽  
Randomised Controlled ◽  
Selective Caries Removal

Abstract Background Dental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth. Method This is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes. Discussion SCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making. Trial Registration Trial registry: ISRCTN. Trial registration number: ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search.

scholarly journals A Comparative Study on the Efficacy between Minimally Invasive Caries Removal Technique involving Carisolv and Traditional Mechanical Caries Removal in Treating Dental Caries in Children

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Jiaying Song
Keyword(s):  
Dental Caries ◽  
Minimally Invasive ◽  
Recovery Time ◽  
Control Group ◽  
Observation Group ◽  
Research Subjects ◽  
Removal Method ◽  
Caries Removal ◽  
The Difference ◽  
Removal Technique

Objective: To explore the curative effect of Carisolv, a minimally invasive caries removal technique and traditional mechanical caries removal treatment on children's dental caries. Methods: A total of 97 children with dental caries who were treated in the Department of Stomatology in Affiliated Hospital of Chifeng University, Chifeng from September 2017 to May 2019 were selected and recruited as the research subjects. They were divided into two groups by random number table method. Forty-nine individuals were assigned in the control group while the remaining 48 individuals in the observation group. The control group was treated with traditional mechanical caries removal method, and the observation group was treated with minimally invasive caries removal technique, i.e. Carisolv. Both groups were followed up for six months. The degree of pain, recovery time of dental function and complications after six months of treatment were observed in the two groups of children. Results: During the treatment, compared with the control group, the children in the observation group experienced lower degree of pain and had shorter recovery time of dental function. After six months of treatment, the incidence of complications in the observation group was lower than that in the control group. The difference was statistically significant (P<0.05). Conclusion: Compared with traditional mechanical caries removal method, Carisolv, a minimally invasive caries removal technique could reduce the pain of children during the treatment process, shorten the time to restore dental function, reduce the occurrence of complications, and had a better therapeutic effect in treating children’s dental caries.

scholarly journals Penetration of Silver Diamine Fluoride in Deep Carious Lesions of Human Permanent Teeth: An In Vitro Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Jutharat Manuschai ◽  
Supitcha Talungchit ◽  
Supawadee Naorungroj
Keyword(s):  
Permanent Teeth ◽  
Carious Lesion ◽  
Micro Ct ◽  
Silver Diamine Fluoride ◽  
Carious Lesions ◽  
Significant Difference ◽  
Group A ◽  
Deep Carious Lesions ◽  
Caries Removal ◽  
Group B

Background. When silver diamine fluoride (SDF) is used in conjunction with conservative caries removal in deep carious lesions, the distribution depth of silver is critical for safety and effectiveness. Objective. The purpose of this study is to determine the effect of selected caries removal on silver penetration when 38% SDF is applied to deep carious lesions in permanent teeth. Methods. Extracted permanent teeth with caries extending to the inner third of the dentin were used (N = 18). The periphery of the carious lesion was completely removed to the dentinoenamel junction (DEJ). In group A (n = 9), no further removal of carious tissue was performed, leaving necrotic dentin inner to the DEJ, whereas in group B (n = 9) superficial necrotic dentin was completely removed until leathery, slightly moist, reasonably soft dentin remained. SDF was applied for 3 minutes in both groups. Microcomputer tomography (micro-CT) and field emission scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (FESEM-EDS) were used to measure mineral density and silver distribution. The silver penetration depth/lesion depth (PD/LD) ratio was calculated for each sample. The Mann–Whitney U test was used to compare differences between the two groups. Results. The micro-CT analysis showed that the PD/LD ratios of group B (1.07–2.29) were marginally greater than those of group A (1.00–1.31). However, a statistically significant difference was not observed ( p value = 0.5078). When stratified by remaining dentin thickness (RDT), the PD/LD ratios of group B were still greater than those of group A only when RDT was >500 µm. The FESEM-EDS analysis indicated that silver particles precipitated throughout the entire thickness of the carious lesions. Conclusion. Applying SDF on a deep carious lesion and leaving the necrotic dentin pulpally did not affect silver penetration. However, the extent to which silver penetrates the remaining dentin beneath the lesions is dependent on the amount and characteristics of that dentin.

Partial caries removal: a conservative option for the treatment of deep carious lesions

2012 ◽  
pp. S11-0
Author(s):  
AM Lopez-Seijo ◽  
D Da Silva-Goncalves ◽  
A Monedero-Fernandez ◽  
L Ceballos ◽  
MV. Fuentes
Keyword(s):  
Carious Lesions ◽  
Deep Carious Lesions ◽  
Caries Removal ◽  
Partial Caries Removal

Caries removal strategies for deep carious lesions in primary teeth: Systematic review

2020 ◽  
Vol 30 (4) ◽  
pp. 392-404
Author(s):  
Elody Aïem ◽  
Clara Joseph ◽  
Anaïs Garcia ◽  
Violaine Smaïl‐Faugeron ◽  
Michèle Muller‐Bolla
Keyword(s):  
Systematic Review ◽  
Primary Teeth ◽  
Carious Lesions ◽  
Deep Carious Lesions ◽  
Caries Removal

Randomized Clinical Trial to Evaluate MTA Indirect Pulp Capping in Deep Caries Lesions After 24-Months

2017 ◽  
Vol 42 (5) ◽  
pp. 470-477 ◽  
Author(s):  
U Koc Vural ◽  
A Kiremitci ◽  
S Gokalp
Keyword(s):  
Mineral Trioxide Aggregate ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Pulp Capping ◽  
Permanent Molar ◽  
Carious Lesions ◽  
Deep Carious Lesions ◽  
Caries Removal ◽  
Removal Technique ◽  
Caries Lesions

SUMMARY Objective: This clinical study aimed to assess the efficacies of mineral trioxide aggregate (MTA) and calcium hydroxide [Ca(OH)2] in the treatment of deep carious lesions by the direct complete caries removal technique. Methods and Materials: A total of 100 permanent molar/premolar teeth were capped with either Ca(OH)2 (n=49) or MTA (n=51) and restored with composite resin in 73 patients. Periapical radiographs were acquired prior to the treatment as well as at six, 12, and 24 months posttreatment. Two calibrated examiners performed the clinical and radiographic assessment of the periapical pathology and pulpal symptoms. Intergroup comparisons of the observed values were performed using the Fisher exact test. Significance was predetermined at α = 0.05. Results: The recall rates were 100% at six and 12 months posttreatment and 98.6% at 24 months posttreatment. Four teeth capped with Ca(OH)2 (two each at six and 12 months posttreatment) and two capped with MTA (one each at 12 and 24 months posttreatment) received endodontic emergency treatment because of symptoms of irreversible pulpitis, which were clinically and/or radiographically established. There were no significant differences in pulp vitality between the two pulp-capping agents at six, 12, or 24 months posttreatment (p=0.238, p=0.606, and p=0.427, respectively). Conclusions: Both pulp-capping materials were found to be clinically acceptable at 24 months posttreatment.

scholarly journals The Use of Resinous Infiltrants for the Management of Incipient Carious Lesions: a Literature Review

2019 ◽  
Vol 21 (4) ◽  
pp. 358
Author(s):  
Jéssica Delazari Ferreira ◽  
Mariana Dias Flor-Ribeiro ◽  
Giselle Maria Marchi ◽  
Flávia Bittencourt Pazinatto
Keyword(s):  
Dental Caries ◽  
Literature Review ◽  
Minimally Invasive ◽  
Scientific Evidence ◽  
Minimally Invasive Treatment ◽  
Invasive Treatment ◽  
Tooth Remineralization ◽  
Carious Lesions ◽  
Long Term Studies

AbstractThe objective of this work was to analyze scientific evidence from a literature review pertaining to the effectiveness of resinous infiltrants for minimally invasive treatment of incipient carious lesions. Studies published between 2002 and 2019 were queried from the following databases: Capes, PubMed, Medline, BBO, Lilacs and SciELO. The search keywords included "Dental Caries", "Tooth Remineralization", "Dental Leakage". Most of the studies found resin-infiltrating treatment to be a viable option for the minimally invasive treatment of incipient carious lesions; this treatment was able to fulfill the primary expected effects: inhibition of carious progression and the lesions esthetic improvement. However, some issues need to be clarified to improve the safety of this treatment because it can be recommended in clinical practice. In conclusion, the use of resinous infiltrants has been reported as promising for the treatment of incipient carious lesions. However, there is a need for long-term studies to confirm the effectiveness of this treatment to determine its applicability for clinical use. Keywords: Dental Caries. Dental Leakage. Tooth Remineralization. ResumoO objetivo desse trabalho foi analisar evidências científicas, por meio de uma revisão de literatura, sobre a eficácia do uso de infiltrantes resinosos para o tratamento minimamente invasivo de lesões cariosas incipientes. A seleção do material literário utilizado foi realizada por pesquisa sobre o tema nas bases de dados: portal de periódicos Capes, PubMed, Medline, BBO, Lilacs e SciELO, abrangendo prioritariamente, o período de 2002 a 2019. Para busca nas bases de dados foram utilizadas palavras-chave como “Cárie Dentária”, “Remineralização Dentária”, “Infiltração Dentária”, assim como suas correspondentes na língua inglesa.  A maioria dos estudos encontrados aponta o tratamento infiltrante resinoso como uma opção viável para o tratamento minimamente invasivo de lesões cariosas incipientes sendo capaz de cumprir os principais efeitos esperados: inibição da progressão cariosa e melhoria estética das lesões. Entretanto, alguns impasses necessitam ser esclarecidos para que o tratamento seja recomendado com mais segurança na prática clínica. Conclui-se que o uso de infiltrantes resinosos tem sido relatado como promissor para o tratamento de lesões cariosas incipientes, contudo há necessidade de novas pesquisas e estudos a longo prazo para confirmar sua eficácia em todos aspectos desejáveis para seu uso clínico. Palavras-chave: Cárie Dentária. Infiltração Dentária. Remineralização Dentária.

scholarly journals Attitudes And Behavior Of Dentists Regarding Management Of Deep Carious Lesion

2019 ◽  
Vol 09 (03) ◽  
pp. 206-209
Author(s):  
Umeed Javaid ◽  
Shama Asghar ◽  
Kulsoom Fatima Rizvi
Keyword(s):  
Cross Sectional ◽  
Academic Qualification ◽  
Carious Lesions ◽  
Clinical Scenarios ◽  
Deep Carious Lesions ◽  
Deep Carious Lesion ◽  
Caries Removal ◽  
And Behavior ◽  
Attitudes And Behavior ◽  
Caries Excavation

Objective: To assess the attitude and behavior of dentists for the management of deep carious lesions. Study Design and Setting: It was a cross sectional based study conducted at six dental institutes of Karachi from both government and private sectors. Methodology: The included participants were the dental graduates and post graduates working in different specialties of dentistry. Whereas graduates and post graduates not affiliated with any institution were excluded from the study. The Questionnaire comprises of two parts, first part was composed of participant’s demographic details and academic qualification, while the second part comprised of clinical scenarios regarding management of deep carious lesions. Results: From the 250 distributed questionnaires, 218 dentists returned the questionnaire giving a satisfactory response rate of 87.2%. There were 28% male and 72%% female dentists. The majority of dentists were aged between 25-35 years old. Complete caries removal was the management of choice by 72.5% of dentists for deep carious lesions. Conclusion: Complete caries removal was the most preferred treatment modality when the risk of dental pulpal exposure associated with caries excavation is low. However when the risk is high, step-wise excavation was preferred procedure by half of the participants.

Effectively Managing Dental Caries: Prevention and Disease Ownership

2013 ◽  
Vol 2 (3) ◽  
pp. 26-29 ◽  
Author(s):  
Paul Brunton
Keyword(s):  
Dental Caries ◽  
Digital Technology ◽  
Caries Prevention ◽  
Operative Intervention ◽  
White Spot ◽  
White Spot Lesions ◽  
Carious Lesions ◽  
Caries Removal

• Better prevention will result in smaller carious lesions being diagnosed at an earlier stage • White spot lesions are amenable to being repaired using biomimetic technologies • Digital technology will improve diagnosis but will also assist practitioners in the monitoring of lesions • When operative intervention is indicated it will be of a minimal nature. Following validation, newer techniques for caries removal will become the norm

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