Comparison of the Effectiveness of Chemo-mechanical and Traditional Caries Removal Methods in Primary Teeth Using Micro-Computed Tomography

Purpose: The purpose of this study was to evaluate dentin mineral density before and after caries removal with the traditional caries removal technique and chemo-mechanical method, with or without the use of caries detection dye. Our null hypothesis was that the chemo-mechanical method with minimally invasive treatment would achieve an effect similar to that of conservative pediatric dentistry treatment. Materials & Methods: Forty-eight medium-sized, interfacial decayed primary molar teeth without pulpal perforation were selected. Two groups were formed by Papacarie Duo and conventional method; then four sub-groups were formed by two caries detection dye applied or not applied groups, twelve teeth were randomly divided into each group. The teeth were then treated with chemo mechanical and traditional caries removal approach. Teeth were scanned with the same voxel sizes using micro-computed tomography images to figure out the difference dentin mineral density and to calculate the removed dentinal volume after chemo-mechanical or traditional method application. Results: The results showed increase of cavity volume in the chemo-mechanical and traditional method groups. No significant difference was found for cavity volume and dentinal carious volume in both groups (p>0.05). The mineral density values of demineralized dentin were between 0.52-0.66 g/cm3 before caries removal, and 1.39-1.59 g/cm3 after removing caries. These values were found to be within the range of healthy dentin mineral density values again without any significant difference between groups (p>0.05). Conclusion: In conclusion, chemo-mechanical methods can be used effectively for removing the caries in the primary molar teeth similar to conservative treatments.

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

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.

The Use of Hall’s Technique Preformed Metal Crown (HTPMC) by Pediatric Dentists in Malaysia

Introduction. Hall’s technique preformed metal crown (HTPMC) has been used widely by pediatric dentists in developed countries as a new approach for managing decayed primary molars without local anesthesia, caries removal, and tooth preparation. Currently, inadequate information is available regarding the implementation of this technique (HTPMC) in Malaysia. This study is aimed at evaluating the implementation of HTPMC by Malaysia’s pediatric dentists and identify the co-occurrence frequencies of the HTPMC implementation with the respondents’ demographic profile. Materials and Methods. A cross-sectional questionnaire-based research was conducted among 65 pediatric dentists in Malaysia. Online questionnaires were distributed to the pediatric dentists employed at public hospitals (MOH) and universities in Malaysia. Result. It was found that over half of the respondents (65.6%) employed HTPMC. The analysis of the co-occurrence network frequency revealed that a high frequency of female pediatric dentists who were within the age group of 31-40 years old had fulfilled their postgraduation overseas and was employed in the university mainly applied HTPMC. Conclusion. The application of HTPMC among respondent pediatric dentists in Malaysia was high. However, most respondents considered HTPMC a treatment option only to manage carious primary molar rather than a treatment of choice.

Minimally Invasive Therapies for the Management of Dental Caries—A Literature Review

In recent years, due to a better understanding of the caries pathology and advances in dental materials, the utilization of non-invasive and minimally invasive techniques that delay/obviate the need for traditional restorations has started gaining momentum. This literature review focuses on some of these approaches, including fluoride varnish, silver diamine fluoride, resin sealants, resin infiltration, chemomechanical caries removal and atraumatic restorative treatment, in the context of their chemistries, indications for use, clinical efficacy, factors determining efficacy and limitations. Additionally, we discuss strategies currently being explored to enhance the antimicrobial properties of these treatment modalities to expand the scope of their application.