Determination of residual dentine caries after conventional mechanical and chemomechanical caries removal with Carisolv

The aim of the study was to assess the efficacy of removing dentine caries chemomechanically with Carisolv and with round burs. In 24 extracted permanent teeth each, caries removal with Carisolv or rotating round burs was monitored by checking the hardness of the dentine with a dental explorer and stopped at 12 teeth in each group when either (a) a leather-hard texture was reached or (b) a sharp scratching sound was heard. After embedding and sectioning (400 microm), caries activity of the remaining dentine was assessed using methyl red dye. In microscope images (7x) of the samples, the mean depth of the pink (caries-active, pH<5.5) and yellow (pH>5.5) staining of each carious lesion was calculated. Using a round bur, the depth of caries-active and -inactive lesions was significantly greater when a leather-hard texture (51-58 microm) was reached than when a sharp scratching sound was reached (19-25 microm, t-test, P<0.05). For teeth treated with Carisolv, only the depth of the caries-inactive dentine differed significantly. Regardless of the clinical criterion for caries removal, Carisolv treatment resulted in higher mean depths of caries-active dentine (71-78 microm) than conventional caries removal using the round bur (19-51 microm), while the mean depths of the caries-inactive dentine differed minimally. Thus, caries removal with Carisolv leaves up to a mean of 50 microm more carious dentine than round 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。     

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。     

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.     

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。     

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.     

Clinical evaluation of chemomechanical and mechanical caries removal: status of the restorations at 3, 6, 9 and 12 months

In this study, the clinical efficacy of Carisolv™ system and the hand excavation method in the removal of occlusal dentine caries of primary molar teeth was evaluated. Both Carisolv system and hand excavation method were applied for the removal of caries on different teeth of the same children. After the removal of the caries, Dyract AP materials were used to restore the teeth. The clinical follow-up was made every 3 months within a year. The clinical evaluations of restorations were carried out in accordance with US Public Health Service (USPHS) criteria. To determine whether there was any statistical difference between the groups, chi-square analysis was used. During both excavation methods, pain occurrence and the need for anesthesia and the time spent were all recorded. The time spent for the removal of caries in Carisolv system and in hand excavation method was 9.03±4.14 min (mean±SD) and 7.34±3.41 min (mean±SD), respectively (P>0.05). At the end of 1 year, differences between Carisolv and hand excavation groups in terms of marginal adaptation and secondary caries were found to be statistically insignificant (P>0.05). During the removal of caries, certain children complained about pain both in Carisolv system and hand excavation method (7.1 and 35.7%, respectively). As a result, it can be argued that Carisolv system is effective in the removal of caries and causes minimum level pain occurrence. Compared to hand excavation, Carisolv system seems to be a promising restorative approach to remove occlusal caries in primary molar teeth. Studies of longer duration are needed to confirm these findings.     

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.     

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。     

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。     

How to make choice of the carious removal methods,Carisolv or traditional drilling? A meta‐analysis

Despite Carisolv has been used to remove carious dentine for 14 years, it still has not reached consensus regarding its effectiveness and efficacy. We undertook a systematic review and meta‐analysis of published randomised controlled trials (RCTs) to assess the effectiveness and efficacy of the chemomechanical caries removal (CMCR) system – Carisolv. A systematic electronic literature search was conducted to identify RCTs comparing the use of Carisolv with a control (rotary instruments) in patients with dental caries. Results were expressed as risk ratios (RRs) or mean differences with accompanying 95% confidence intervals (CIs). The outcome measurement included the complete caries removal rate (CCR: the number of cases with complete caries removal in study and control groups after different treatment), the treatment time (min) and the use of local anaesthesia. The meta‐analysis was performed with the fixed‐effect or random‐effect model according to the heterogeneity. Six studies involving 578 teeth met our inclusion criteria. There was no statistically significant difference in CCR between Carisolv group and rotary instruments group; in Carisolv group, the treatment time (min) was significantly longer no matter whether the caries was located in coronal or root area, while the use of local anaesthesia was less. Compared with rotary instruments, Carisolv did not show increased CCR. Carisolv reduced the use of local anaesthesia although it took longer treatment time. However, the results should be interpreted cautiously due to the heterogeneity among study designs. Further large‐scale, well‐designed RCTs are needed.     

Clinical evaluation of Carisolv in the chemico-mechanical removal of carious dentin.

The Chemo-mechanical caries removal technique involves the application of chemical agents, to cause a selective softening of the carious dentine and facilitate removal by gentle excavation. Carisolv is one such new chemical agent used in this minimal invasive technique of carious dentine removal. The present study was, therefore, undertaken to evaluate the efficacy of Carisolv in the chemo-mechanical removal of carious dentine, the time taken for caries removal, the perception of the treatment by the patient, and to evaluate the restorations, radiographically. Accordingly, fifty primary and permanent molars with dentinal carious lesions were excavated using this technique of caries removal. The chemo-mechanical caries removal technique using Carisolv proved to be an effective atraumatic treatment modality with potential interest for use in clinical pediatric dentistry.     

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.     

Clinical evaluation of a chemomechanical method for caries removal in children and adolescents

Objective. The purpose of this study was to make a clinical comparison of the chemomechanical method for caries removal and the conventional rotary instruments technique when used in children and adolescents. Material and Methods. The study comprised 120 patients aged 3–17 years randomized into two groups: caries were removed chemomechanically in 60 patients and 60 patients received conventional treatment with rotary instruments. The outcome variables were: clinically complete caries removal, pain during caries removal, need for local anesthesia, treatment time, preferences of patients, and clinical success of the restorations during the 12-month evaluation period. Results. Complete caries removal was achieved in 92% of chemomechanically treated teeth and in all teeth treated with rotary instruments (p>0.05). The chemomechanical method significantly reduced the need for local anesthesia (p<0.001). Eighty-five percent of patients treated with Carisolv and 47% treated with rotary instruments were satisfied with the treatment (p<0.05). The mean time for chemomechanical caries removal was 11.2±3.3 min and 5.2±2.8 min for caries removal with rotary instruments (p<0.001). At the end of the 12-month evaluation period, there was no observed influence of the caries removal method on the survival of the restorations. Conclusions. The chemomechanical caries removal technique is an adequate alternative to the conventional rotary instruments method and is advantageous in pediatric dentistry.     

Microhardness and Ca:P ratio of carious and Carisolv treated caries-affected dentine using an ultra-micro-indentation system and energy dispersive analysis of x-rays--a pilot study

BACKGROUND: This study aimed to evaluate microhardness and chemical analysis of carious and caries-affected dentine. The hypothesis tested was that calcium:phosphorous (Ca:P) ratios correlate with microhardness values. METHODS: Four carious human third molars were sectioned through the caries lesion in the mesiodistal longitudinal plane. One half of each lesion underwent carious dentine removal using Carisolv gel. The cut surfaces were polished, microhardness tested using an Ultra-Micro-Indentation System (UMIS) and elemental analysis performed using energy dispersive analysis of x-rays (EDAX). RESULTS: The microhardness of carious dentine decreased gradually towards the cavity floor, but that for caries-affected dentine showed more variation with depth, having a mean hardness of (0.63 +/- 0.18) GPa. Ca:P ratios of carious dentine varied among the four specimens. The mean Ca:P ratio of caries-affected dentine was 1:2.03 +/- 0.08. The hypothesis was accepted for active lesions. CONCLUSIONS: The use of Carisolv to excavate carious tissue can be as effective as rotary instrumentation.     

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.     

In vitro evaluation of five alternative methods of carious dentine excavation

This in-vitro, split-tooth study aimed to evaluate the efficiency (time taken) and effectiveness (quantity of dentine removed) of four techniques of carious dentine excavation (bur, air-abrasion, sono-abrasion and Carisolv gel) compared to conventional hand excavation. Eighty freshly extracted human molars were assigned to four experimental groups (n = 20), sectioned longitudinally through occlusal lesions and pre-excavation colour photomicrographs obtained. Using the natural autofluorescence of carious dentine (detected using confocal laser scanning microscopy) as an objective and reproducible guide, carious dentine removal was assessed in each half of the split tooth sample, comparing hand excavation to the test method. The time taken to reach a cavity floor that was hard to a dental probe was noted and final colour photomicrographs were taken. From the results, it was concluded that bur excavation was quickest but overprepared cavities relative to the autofluorescent signature, whereas Carisolv excavation was slowest but removed adequate quantities of tissue. Sono-abrasion tended to underprepare whereas air-abrasion was more comparable to hand excavation in both the time and amounts of dentine removed. Conventional hand excavation appeared to offer the best combination of efficiency and effectiveness for carious dentine excavation within the parameters used in this study.     

Cavity size difference after caries removal by a fluorescence-controlled Er:YAG laser and by conventional bur treatment

To determine the extensions of cavities prepared conventionally by bur or by a fluorescence-controlled Er:YAG laser. Sixty-five human teeth with dentine caries were bisected through the caries lesion and were treated by a fluorescence-controlled Er:YAG laser in a non-contact or a contact mode or by a rotary bur. The specimens were subjected to histological staining and a quantitative evaluation of cavity area (mm²) by computer-assisted alignment. Data were tested for statistical significant differences by the Wilcoxon test (p < 0.05). Twenty-three out of 29 cavities were smaller after caries removal with the non-contact laser compared to the bur. For a threshold level of seven, a cavity size difference of 1.63 (1.86) mm² was calculated compared to a cavity size difference of 5.35 (5.05) mm² after bur excavation. The differences were statistically significant (p = 0.029). No significant differences were observed between the cavity size differences after excavation with the non-contact or the contact laser handpiece. Residual bacteria within the cavity floor were found only in low numbers after all treatments. The present in vitro study indicates that caries removal by a fluorescence-controlled Er:YAG laser using a threshold level of seven resulted in less dentine loss than preparations by a bur.     

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.     

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.