Chemo-mechanical dentine caries removal with Carisolv using a rotating brush.

AIM: The aim of this study was to assess the efficacy of removing dentine caries using carbide burs, Carisolv with hand instruments and Carisolv in combination with a new mechanical excavation method using a rotating brush. METHODS: 36 extracted permanent teeth, with dentine caries, were assigned into 3 groups according to caries removal technique. Caries removal was monitored by checking the properties of the dentine with a dental explorer. After embedding and sectioning (400 microm), remaining caries was assessed by using a caries detector. In microscope images (7x) of the samples, the mean stain depth of the remaining carious tissue per tooth was calculated by AnalySIS computer software. RESULTS: Four to 8 applications (mean time = 10.9 min) of Carisolv were necessary for caries removal with the new method using rotating brushes. The mean thickness of residual dentine caries by this procedure (226 microm, +/- 136) was higher than the one using Carisolv with hand instruments (57 microm, +/- 39) or carbide burs (32 microm, +/- 20). Even in areas with good access to the lesion, an unacceptable amount of residual caries was observed. CONCLUSION: Thus, it seems that Carisolv using rotating brushes does not reach the degree of caries removal reached by additional mechanical abrasion of Carisolv using hand instruments or conventional rotating carbide burs.     

乳牙化学去龋法的细菌学研究

目的：比较化学去龋法和机械去龋法清除细菌的效果。方法：选取40个龋坏深至牙本质的乳磨牙，中龋或深龋，随机分为化学法去龋组和机械法去龋组，每组20个牙，去龋前后使用无菌挖匙对龋坏牙本质进行取样，分别在4种不同的培养基上进行厌氧培养和计数。结果：两种方法去龋后，除机械法去龋组放线菌外，两种方法其他细菌数显著减少，有统计学意义（P〈0．05），化学法去龋组比机械法去龋组的总菌数量减少更显著（p〈0．05）。结论：化学去龋法比机械去龋法清除乳牙龋坏细菌效果好。     

In vitro comparison of the efficacy of Carisolv and conventional rotary instrument in caries removal

summary The purpose of this in vitro study was to compare the efficacy of a new chemomechanical caries removal agent, Carisolv^TM (MediTeam AB, Sävedalen, Sweden), with conventional slow‐speed rotary instrument (bur). Fourteen extracted human molar teeth with deep dentine caries and no enamel coverage were selected for the study. Their laser fluorescence values were over 30 (DIAGNOdent^®; KaVo, Biberach, Germany). After the teeth were sectioned through the centre of the carious lesion, one half was removed with conventional drilling (bur); the other half was removed with Carisolv gel. Removal of carious dentine was continued until the lesion was deemed caries‐free by visual and tactile criteria. The preparation time for each caries removal technique was also noted. The two halves of each tooth were fixed in 10% buffered‐formaldehyde for 1 week. They were then decalcified, dehydrated and embedded in paraffin blocks for histological studies. After taking serial sections of 5 μm thickness, sections were mounted on glass slides, deparaffinized, dehydrated and stained with toluidine blue for observation under a light microscope. Each section was examined for the presence of bacteria. Complete removal of caries was achieved in 13 (93%) of 14 conventionally prepared teeth, and 5 (36%) of 14 chemomechanically prepared teeth (P < 0·05). Mean (±SD) time for caries removal was 272 s (±53·3) with Carisolv, and 116 s (±49·4) with drilling. The results of this study suggest that conventional rotary instrument (bur) was more effective than Carisolv in removal of carious tissue and also takes shorter time.     

Chemical and topographical analyses of dentine surfaces after Carisolv treatment

OBJECTIVES: The aim of this study was to characterise the surface chemistry of cavities after chemomechanical caries excavation, and also to measure the surface topography after caries removal with Carisolv or burs, followed by acid etching. METHODS: Fourier transform (FT)-Raman spectroscopy was used to study the relative amounts of organic material and minerals of sound enamel, dentine, and cavities, after caries excavation. Fourier transform infrared spectroscopy (FTIR) and laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) were used for detection of Carisolv substances (i.e. mainly sodium hypochlorite, amino acids, and the gelling agent carboxymethyl cellulose). In total, 19 carious and 11 sound extracted teeth were used for the chemical analyses. Topographic examination of 30 carious extracted teeth was performed with a contact profilometer. RESULTS: The relative amounts of organic material and minerals did not significantly differ between sound dentine and the cavities after caries removal with burs or Carisolv. The FTIR analyses indicated extremely small amounts of Carisolv substances at the cavity surface, but the LA-ICP-MS analyses did not confirm those findings. Furthermore, the topographical parameters did not significantly differ between etched cavities after caries removal using burs or Carisolv. CONCLUSIONS: The chemical and topographical analyses in the present study imply that any differences between the cavities after caries excavation with burs or with Carisolv are insignificant.     

Morphological study of demineralized dentine after caries removal using two different methods

BACKGROUND: Caries-affected dentine is the usual substrate bonded to in everyday clinical practice. The first step for most of the current dentine adhesive systems is etching or conditioning. It is therefore important to understand the effect of etchant/conditioner on caries-affected dentine. METHODS: Twelve extracted carious permanent molars were examined. Six teeth had caries removed using burs after staining with a caries detector dye, and caries from the other six was removed using Carisolv. After caries removal, three teeth from each group were left untreated. The remaining teeth were sectioned to obtain two normal dentine samples and two caries-affected dentine samples from each tooth. One half of the normal dentine samples and one half of the caries-affected dentine samples were treated with 35 per cent phosphoric acid, and the remaining samples were treated with 20 per cent polyacrylic acid/3 per cent aluminium chloride. The samples were observed using field emission scanning electron microscopy (FE-SEM). RESULTS: Phosphoric acid treated samples showed more obvious intertubular dentine microporosity and greater depth of demineralization in caries-affected dentine. Polyacrylic acid treated samples showed some residual smear layer. However, the peritubular and intertubular collagen network was easily observed in Carisolv treated dentine. The depth of demineralization was not as distinct as that of the phosphoric treated samples. CONCLUSIONS: From this study it was shown that etched 'normal' dentine and etched caries-affected dentine had different surface appearances. Furthermore, the two caries removal techniques resulted in different caries-affected dentine surfaces after acid treatment that may influence the longevity of bonds from adhesive restorative materials.     

Carisolv在乳磨牙龋治疗中效能的体外研究

目的比较Carisolv和传统手机在乳磨牙龋病治疗中去龋后窝洞表面微形态、充填后微渗漏情况及微拉伸粘接强度。方法 96颗离体龋坏乳磨牙,随机分成2组,分别用Carisolv和手机去龋,用扫描电镜观察窝洞表面形态,微渗漏发生情况,并测试微拉伸粘接强度。结果 Carisolv去龋组的牙本质表面牙本质小管口清晰可见,充填后微渗漏的发生与手机去龋组有统计学意义（Z=4.831,P〈0.05）,2组充填后的牙本质粘接强度差异无统计学意义（t=1.89,P〉0.05）。结论 Carisolv能有效去除玷污层,显著减少术后微渗漏的发生,对牙本质粘接强度无显著影响。     

An in vitro investigation of penetration depth of dentine bonding agents into carious dentine

The aim of the present in vitro study was to determine the penetration depth of dentine bonding agents into carious dentine as a possible strategy in caries treatment of deep lesions. Forty-eight extracted carious teeth were used for the experiments and divided in four groups. In a split-tooth design, one half of each tooth was treated without caries excavation, and the second half after caries excavation. In group 1 the teeth were treated with Prime & Bond 2.0 without phosphoric acid etching, and in group 2 with phosphoric acid etching. In group 3, the teeth were treated with All-Bond 2 without phosphoric acid etching, and in group 4 with phosphoric acid etching. Bonding agents were marked with an orange dye prior to application. The composition of the bonding agents had no significant influence on penetration depths. The mean thickness of the outer, necrotic caries zone in unexcavated specimens was 117 microm (+/-126). Bonding agents penetrated significantly deeper into unexcavated carious dentine (mean 124 +/- 76 microm) compared with excavated dentine (11 +/- 14 microm) and sound dentine (3 +/- 4 microm). Acid etching significantly reduced the thickness of the outer caries zone, and the penetration depth of the bonding agents into unexcavated carious specimens by approximately 50%, and increased it into sound dentine. The results indicate that dentine bonding agents could completely penetrate the unexcavated outer carious dentine in 90% of specimens. Further studies are required to determine whether further caries activity is arrested after treatment with dentine bonding procedures.     

伢典化学与机械去龋法的光镜研究

目的：通过对伢典和传统牙钻去除牙本质龋后的磨片观察，评价伢典的去龋效果。方法：选取龋损已到牙本质的离体牙9个，分为对照组、机械组、伢典组3组，每组3个牙。对照组不处理，机械组用传统牙钻去龋，伢典组用伢典去龋。然后磨制成磨片，在光学显微镜下观察去龋效果。结果：对照组能观察到明显的龋损病理组织结构。伢典组、牙钻组的龋损组织被完全去除。结论：伢典能有效去除龋损组织。     

伢典化学机械去龋法的扫描电镜研究

目的：利用扫描电镜技术观察伢典和传统车针去龋后窝洞表面的微观形态。方法：选取累及牙本质深层龋坏的离体牙9颗，分为对照组，机械组，伢典组3组，每组3颗。用扫描电镜观察窝洞表面形态。结果：对照组表面有很多碎屑、残渣等，无牙本质小管完整形态。传统车针组的牙本质表面有不规则的颗粒和碎片，有玷污层形成。牙本质小管口堵塞。伢典组的牙本质表面没有玷污层，牙本质小管口清晰可见。结论：伢典能有效去除玷污层。     

A morphological and micro-tensile bond strength evaluation of a single-bottle adhesive to caries-affected human dentine after four different caries removal techniques

OBJECTIVES: This study evaluated the influence of different caries removal techniques (conventional bur; chemomechanical removal/Carisolv()-MediTeam; a sonic preparation system/SonicsysMicro-Kavo and air abrasion/PrepStar-Danville Engineering) on microtensile bond strength to caries-affected human dentine. METHODS: Occlusal surfaces of extracted human permanent third molars with coronal dentine caries extending approximately halfway through the dentine was ground perpendicular to the long axis of the tooth to expose a flat surface of normal dentine surrounding the carious lesion with laser fluorescence values of approximately 30 (DIAGNODent), KaVo). Carious lesions were excavated with one of the four techniques until laser fluorescence values decreased to 15 in the center of the lesions. An ethanol-based dentine adhesive (Single Bond, 3M) was used to bond composite resin (P60, 3M) to the substrate. Vertical slices (n=11/group), approximately 0.8 mm thick were made through the caries-affected portions of each tooth, perpendicular to the bonding surface. Specimens were subjected to tensile stress at a crosshead speed of 1 mm/min. Data were analyzed by Kruskal-Wallis test. SEM investigation was performed for the qualitative evaluation of resin-dentine hybridization. RESULTS: The microtensile bond strengths were as follows (mean+/-SD in MPa): 6.4+/-5.3 (bur), 8.4+/-3.3 (Carisolv), 8.5+/-5.9 (Sonicsys Micro), and 8.8+/-8.8 (air abrasion). Statistical analysis did not show significant differences between any of the treatment modalities (p=0.160). Tensile fracture was cohesive within caries-affected dentine in all specimens. CONCLUSIONS: The four different caries removal techniques used within this study did not influence the bond strength of the tested dentine adhesive to caries-affected human dentine.     

Carisolv化学机械去龋临床应用效果的初步评价

目的评价Carisolv化学机械去龋临床应用效果。方法选取100个中、深龋恒牙等分为2组,实验组用Carisolv化学机械法去龋,对照组用慢速球钻去龋,记录去龋时间、医患双方对患者术中疼痛反应的评价等。结果2组去龋时间分别是(6.17±1.92)min、(2.83±0.93)min,以Carisolv组为长(P<0.01);去龋术中疼痛感以Carisolv组较小(P<0.01)。结论Cari-solv化学机械去龋法是龋病治疗中一个可供选择的方法。     

Efficiency of the polymer bur SmartPrep compared with conventional tungsten carbide bud bur in dentin caries excavation

SmartPrep is a rotating instrument for dentin caries excavation made from a special polymer. The manufacturer's product information stated that SmartPrep removes carious dentin selectively. This in vitro study compared the efficiency of SmartPrep with conventional tungsten carbide bud burs. Fifty extracted teeth were split in the center of a carious lesion. The 100 specimens were randomly divided into five groups. Five dentists were asked to excavate 10 teeth each: one half with SmartPrep and the corresponding half with conventional bud burs. The time needed for the caries excavation was measured. Subsequently, histological specimens were produced from all cavities and analyzed by light-microscope after Mallory-Azan-staining. The thickness of the remaining caries was measured (< 1 mm or > 1 mm). The time expended was analyzed using the paired t-test. The results were analyzed for the remaining caries and thickness of the carious layer for every tooth, using the non-parametric Wilcoxon test for combined random samples. A binary logistical regression was performed to determine the influence of the three variables (tooth, sections or bur) on the criteria "caries" or "carious layer thickness (> 1 mm)." The average time to excavate a cavity with SmartPrep was 208.1 seconds, and it was 228.32 seconds with conventional bud burs. The difference between the recorded times was not statistically significant (p > 0.05). In 37 of 50 teeth, the number of carious sections was higher in the SmartPrep group than in the bud bur group. In nine teeth, the quantity of carious sections was higher in the bud bur group than in the SmartPrep group. Four teeth showed no difference in the number of carious sections. The results were statistically significantly different (p < 0.001). In 30 teeth, the number of carious sections with a carious layer thicker than 1 mm was higher in the SmartPrep group compared with the bud bur group. In nine teeth, the number of carious sections was higher in the bud bur group than in the SmartPrep group. Eleven teeth showed no difference in thickness of the carious dentin layer. These results were statistically significantly different (p = 0.003). Binary logistical regression showed that only the variable "bur" (bud bur or SmartPrep) influenced the results concerning the criterion "caries" (p < 0.001).     

Micro-computed tomographic evaluation of a new enzyme solution for caries removal in deciduous teeth

This study evaluated a new enzyme solution (SFC-V) for dentin caries removal, and obtained results were compared with Carisolv. Both solutions were used with a prototype plastic instrument - this being a modified technique for Carisolv. Five carious deciduous teeth were sectioned, and both treatments were applied alternately to each half. Micro-CT observations showed that both treatments resulted in removal of the outer demineralized dentin layer: 28.6% for SFC-V and 28.2% for Carisolv. As for the remaining demineralized dentin, thicknesses of 0.27 microm (SFC-V) and 0.31microm (Carisolv) were observed with no statistically significant differences. FE-SEM analysis revealed that the use of Carisolv resulted in a rougher surface; whereas after SFC-V enzymatic treatment, an organized dentin collagen network with open tubules and few signs of bacteria were observed. In summary, the experimental enzymatic solution and the modified Carisolv treatment removed comparable amounts of carious dentin but with differing resultant surface morphologies.     

Performance of four dentine excavation methods in deciduous teeth

This in vitro study aimed to assess the speed and caries removal effectiveness of four different new and conventional dentine excavation methods. Eighty deciduous molars were assigned to four groups. Teeth were sectioned longitudinally through the lesion centre. Images of one half per tooth were captured by light microscope and confocal laser scanning microscopy (CLSM) to assess the caries extension. The halves were then reassembled and caries removed using round carbide bur (group 1), Er:YAG laser (group 2), hand excavator (group 3) and a polymer bur (group 4). The time needed for the whole excavation in each tooth was registered. After excavation, the halves were photographed by light microscope. Caries extension obtained from CLSM images were superimposed on the post-excavation images, allowing comparison between caries extension and removal. The regions where caries and preparation limits coincided, as well as the areas of over- and underpreparation, were measured. Steel bur was the fastest method, followed by the polymer bur, hand excavator and laser. Steel bur exhibited also the largest overpreparation area, followed by laser, hand excavator and polymer bur. The largest underpreparation area was found using polymer bur, followed by laser, hand excavator and steel bur. Hand excavator presented the longest coincidence line, followed by polymer and steel burs and laser. Overall, hand excavator seemed to be the most suitable method for carious dentine excavation in deciduous teeth, combining good excavation time with effective caries removal.     

Scanning electron microscopic observations of human dentine after mechanical caries excavation

OBJECTIVES: The structural integrity and surface characteristics of dentine remaining after caries excavation may be relevant to the subsequent bonding of adhesive restorative materials to the prepared cavity. This in vitro investigation aimed to analyse the different surface characteristics of the dentine cavity floor created after preparation using five different mechanical and chemo-mechanical methods of excavation: hand excavation, slow-speed bur, sono-abrasion, air-abrasion and Carisolv gel. METHODS: Ten cavities were prepared using each excavation method in extracted teeth with occlusal carious lesions. Epoxy resin replicas of the 50 cavities were manufactured from silicone impressions and then analysed using secondary electron scanning electron microscopy (SEM) to ascertain the surface characteristics of the dentine at the cavity floor. RESULTS AND CONCLUSIONS: Results from the 50 cavities examined suggested that each alternative excavation technique produced a different and characteristic dentine surface. Carisolv gel was the only method examined that consistently removed the smear layer during excavation to leave exposed dentine tubules at the end of cavity preparation.     

The nature of the remaining dentin surface following application of Carisolv solution

PURPOSE: To evaluate the effect of Carisolv solution on the topography and surface hardness of dentin. METHODS: Two separate studies were carried out. Atomic force microscopy (AFM) was employed to visualize dentin surface topography on slices of previously extracted non-carious and carious teeth following the passive application of Carisolv gel for 30- and 60-second periods. A Wallace hardness instrument was used to measure the dentin surface hardness following active caries removal with Carisolv gel and the specially designed instruments. Conventional caries removal with dental burs and non-carious dentin acted as controls for the latter study. RESULTS: AFM revealed that the passive application of Carisolv gel resulted in smoother surfaces than observed on carious and non-carious dentin. There was a statistically significant difference between the mean hardness values for non-carious and Carisolv-treated dentin (P< 0.05). There was no statistically significant difference between the non-carious and bur-treated dentin nor the Carisolv and bur-treated dentin.     

In vitro effectiveness of a chemo-mechanical method for caries removal.

AIM: The aim of the study was to assess the efficacy of chemo-mechanical method for caries removal based on histological analysis and scanning electron microscopy of dentine samples. METHODS: Forty-five freshly extracted human deciduous and permanent teeth with dentinal caries were used in this in vitro study. The teeth were allocated to two different technique groups. Chemo- mechanical caries removal using Carisolv was performed in 30 teeth and in 15 teeth caries was removed using conventional rotary instruments. The caries status of dentine was judged according to clinical criteria (probing and visual inspection). After caries removal had been completed, teeth were sectioned through the prepared cavities and the two halves of each tooth were processed for light microscopy and scanning electron microscopy. Light microscope was used to examine the specimens for the presence of bacteria in dentine tubules. Scanning electron microscope was used to determine surface characteristics of the cavity floor after caries removal. RESULTS: All examined dentine surfaces were clinically caries free. Regarding the presence of bacteria, 53% of chemo- mechanically prepared teeth and 87% of conventionally prepared teeth were bacteria-free (p>0.05). Efficacy of both methods was confirmed using scanning electron microscope, but different dentine topography was recorded after chemo-mechanical and conventional caries removal. Conclusion: Based on histological and scanning electron microscope analyses it could be concluded that this chemo-mechanical method is efficient in the removal of carious dentine.     

Chemochemical caries removal: a review of the techniques and latest developments

Chemomechanical caries removal involves the chemical softening of carious dentine followed by its removal by gentle excavation. The reagent involved is generated by mixing amino acids with sodium hypochlorite; N-monochloroamino acids are formed which selectively degrade demineralised collagen in carious dentine. The procedure requires 5-15 minutes but avoids the painful removal of sound dentine thereby reducing the need for local anaesthesia. It is well suited to the treatment of deciduous teeth, dental phobics and medically compromised patients. The dentine surface formed is highly irregular and well suited to bonding with composite resin or glass ionomer. When complete caries removal is achieved, the dentine remaining is sound and properly mineralised. The system was originally marketed in the USA in the 1980's as Caridex. Large volumes of solution and a special applicator system were required. A new system, Carisolv, has recently been launched on to the market. This comes as a gel, requires volumes of 0.2-1.0 ml and is accompanied by specially designed instruments.     

Chemo-mechanical caries removal: a review of the techniques and latest developments

Chemo-mechanical caries removal involves the chemical softening of carious dentine followed by its removal by gentle excavation. The reagent involved is generated by mixing amino acids with sodium hypochlorite; N-monochloroamino acids are formed which selectively degrade demineralised collagen in carious dentine. The procedure requires 5-15 minutes but avoids the painful removal of sound dentine thereby reducing the need for local anaesthesia. It is well suited to the treatment of deciduous teeth, dental phobics and medically compromised patients. The dentine surface formed is highly irregular and well suited to bonding with composite resin or glass ionomer. When complete caries removal is achieved, the dentine remaining is sound and properly mineralised. The system was originally marketed in the USA in the 1980's as Caridex. Large volumes of solution and a special applicator system were required. A new system, Carisolv, has recently been launched on to the market. This comes as a gel, requires volumes of 0.2-1.0 ml and is accompanied by specially designed instruments.     

The influence of CarisolvTM on enamel and dentine surface topography

The purpose of the present study was to investigate the surface topography of healthy enamel and dentine before and after application of a new chemomechanical system for caries removal, Carisolv. The same surfaces were investigated with respect to the influence of phosphoric acid, plus carious dentine after removal with either Carisolv or burrs. One-hundred freshly extracted teeth were used. Surface topography was measured in two different ways in order to characterize the surfaces at different levels of resolution, atomic force microscopy (AFM) and a contact stylus profilometer. Somewhat conflicting data were obtained with the two measuring techniques. When surfaces were investigated over a small area (AFM), healthy enamel seemed unaffected by Carisolv, while healthy dentine became smoother. Etching enamel with phosphoric acid resulted in a rougher surface, while no effect was detected on etched healthy dentine. Caries removal using Carisolv resulted in a smoother surface compared with conventional caries removal. When the surfaces were monitored with the contact profilometer, no effect of Carisolv could be detected on healthy enamel or dentine. Phosphoric acid etching, in contrast, increased the surface roughness of both enamel and dentine. When compared with conventional caries removal technique, caries removal with Carisolv did increase the surface roughness.