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.     

Bonding of single-component adhesives to dentin following chemomechanical caries removal

PURPOSE: To determine the effect of chemomechanical caries removal on the bonding quality of contemporary single-component adhesives to dentin. MATERIALS AND METHODS: N-monochloro-DL-2-aminobutyrate solution (NMAB) and Carisolv gel were used to chemomechanically remove dentin caries in 60 extracted human molars. Caries removal with rotating instruments served as the control. Two single-component adhesive systems, Syntac Single Component and Excite, were applied to bond the hybrid composite Tetric Ceram to the treated dentin surfaces. The prepared samples were sectioned for microtensile bond strength testing and SEM examination of the bonding interfaces. The debonding patterns of the fractured samples were also assessed. RESULTS: No statistically significant differences were found between the bond strengths of either adhesive to the conventionally and the NMAB-treated dentin (p > 0.05). However, the Carisolv-treated dentin yielded significantly higher (p > 0.05) bond strength values with both adhesives compared to those on dentin prepared with rotating instruments. No statistical difference could be discerned between the 2 adhesive systems (p > 0.05), nor was the interaction between the 2 variables under investigation (method of caries removal and the type of adhesive) statistically significant (p = 0.7712). SEM images indicated unspecific effects of the tested variables on both the thickness of the hybrid layer and the length of the resin tags. CONCLUSION: Under the conditions of this study, using the Carisolv chemomechanical caries removal system to prepare dentin surfaces enhanced the dentin/adhesive bond strength. In addition, the chemical nature of the adhesive systems seems to have no effect on the values of bond strength.     

Comparison of chemomechanical caries removal using Carisolv or conventional hand excavation in deciduous teeth in vitro

OBJECTIVES: The purpose of the present study was to compare the efficacy of chemomechanical caries removal (Carisolv) to conventional hand excavation in deciduous teeth. METHODS: Twenty-two freshly extracted teeth with varying degree of caries were treated using both of these methods. One part of each caries lesion was prepared using the Carisolv method and the other part using conventional hand excavation. The third (middle) part was left untreated to serve as control. Histological preparations of each tooth were then made and examined in order to compare the quality of the preparations. Length and area of residual caries, microhardness of the dentine in each group and time needed for preparation were analysed. RESULTS: The results showed that there was no significant difference in the amount of residual caries in the cavity walls treated using the two methods. CONCLUSIONS: The Carisolv method was significantly more time consuming than conventional preparation using hand excavator. However, both methods removed caries efficiently.     

Effectiveness and efficiency of chemomechanical carious dentin removal

The aims of this in vitro study were both to determine the time necessary for removal of carious dentin (efficiency) and the Knoop Hardness Number (KHN) of the remaining dentin (effectiveness), using a chemomechanical method (Carisolv) or hand excavation. Thirty human molars were bisected through occlusal carious lesions into two equal halves. Each half was randomly excavated by hand in circular movements with a spoon excavator or using Carisolv gel according to the manufacturer's instructions. The duration of carious dentin removal was recorded. Tooth sections were resin-embedded, ground flat and polished. Dentin KHN was determined at distances of 100, 200, 300, 400 and 500 microm from the cavity floor. Data were analyzed by Wilcoxon's test (alpha= 0.01), ANOVA and Student's t test (alpha= 0.05). The median of the time necessary for chemomechanical excavation was significantly greater than for hand excavation. KHN means (+/- SD) at 100, 200, 300, 400, 500 microm for chemomechanical method were, respectively: 15.6 (+/- 4.96), 18.0 (+/- 6.22), 21.3 (+/- 9.30), 24.3 (+/- 9.25), 28.5 (+/- 11.80); and for hand excavation were: 21.2 (+/- 10.26), 23.4 (+/- 9.49), 28.2 (+/- 11.62), 31.0 (+/- 12.17), 34.3 (+/- 11.95). It may be concluded that hand excavation presented higher efficiency and effectiveness than chemomechanical excavation.     

A chemomechanical method for caries removal

Over recent years the dental profession has shifted towards practising preventive dentistry and adopting more conservative and tooth-preserving procedures. Such progression is considered to be a response to the decline in the level of dental caries and advances in materials science. This shift in caries management will no doubt continue over the coming decades, based on rational clinical and scientific principles. Chemomechanical caries removal involves the application of a solution that selectively softens the carious dentine, thus facilitating its removal. This limits the removal of sound tooth structure, the cutting of open dentinal tubules, pulpal irritation and pain compared with conventional mechanical methods.     

Current update of chemomechanical caries removal methods

Chemomechanical caries removal is an excellent method for minimally invasive caries excavation, and the removal agents are either sodium hypochlorite (NaOCl)‐ or enzyme‐based. The NaOCl‐based agents include GK‐101, GK‐101E (Caridex) and Carisolv, and the enzyme‐based agents include Papacarie and the experimental material, Biosolv. This review outlines the changes in chemomechanical caries removal methods and focuses on recently published laboratory and clinical studies. The historical development, mechanism of action, excavation time and biological effects on pulp and dental hard tissues are described. Based on existing evidence, the currently available chemomechanical caries removal methods are viable alternatives to conventional rotary instrument methods. Chemomechanical methods could be extremely useful in very anxious, disabled and paediatric patients. It does seem some of these agents would still benefit from quicker excavation times in order to achieve more universal acceptance. However, as a means of conserving the caries‐affected dentine, chemomechanical caries removal is possibly much more successful than conventional rotary instrumentation.     

化学机械去龋对牙本质粘结效果的电镜观察

目的扫描电镜观察化学机械去龋对牙本质粘结效果的影响。方法观察比较化学机械去龋和慢速球钻去龋后牙本质表面以及牙本质和4种粘结系统粘结界面的超微结构。结果与球钻去龋相比，化学机械去龋后的牙本质表面玷污层少，牙本质和Prime＆Bond　NT（PB）＋复合体的粘结界面出现树脂突结构，和Adper　Prompt-L-Pop（AP）＋树脂的粘结界面中树脂突更密集，混合层更致密、均一。结论从超微结构上看，化学机械去龋技术有利于牙本质的粘结。     

First-choice treatment alternatives for caries removal using the chemomechanical method.

Modern dentistry aims to preserve tooth structure using minimally invasive procedures. Chemomechanical removal of caries is a new method with the advantage of selective removal of severely demineralized dentin. In addition, the method enhances the clinician's ability to diagnose caries. Ensuring chairside caries diagnosis and removal, based on biologic principle, helps to preserve as much healthy tissue as possible. However, while this method is most comfortable for the patient, treatment time is prolonged. In most cases, the method has to be used in combination with a conventional bur. Also, caries lesions in which removal of enamel or a restoration is needed cannot be treated exclusively using the chemomechanical method. This article describes the mechanism of action of the chemomechanical method (CarisolvTM) for caries removal. Indications for use of the chemomechanical method as a first-choice treatment are presented. Clinical cases in which this new approach provides a significant clinical advantage are also described.     

Comparison of mechanical and chemomechanical methods of caries removal in deciduous and permanent teeth: A SEM study

Background: Mechanical method of caries removal is associated with the removal of sound tooth structure, production of pain, heat, annoying sounds, and vibrations. Chemomechanical caries removal method is based on removal of only carious dentin leaving sound dentin intact. Aim: The aim of this study was to compare the efficacy of mechanical and chemomechanical methods of caries removal in deciduous and permanent teeth. Study Design: A total of 30 carious teeth including 15 deciduous and 15 permanent teeth having dentinal caries selected randomly and cut into two halves through center of the lesion, were subjected to caries removal by mechanical (Group A), and chemomechanical methods (Group B). Time taken for removal of caries was noted with stopwatch. Samples were prepared and seen under the scanning electron microscope for the presence of bacterial colonies. Data were analyzed using statistical package for social sciences (SPSS) Software. Results: No significant difference was found for the presence of bacterial colonies in both groups of deciduous and permanent teeth; however, time taken for caries removal by the chemomechanical method was twice than the mechanical method. Conclusion: despite the insignificant presence of bacterial colonies and twice time taken as compared to mechanical method, chemomechanical method was easy to introduce, was painless, did not form smear layer and conserved the sound tooth structure.     

Primary teeth caries removal using the Carisolv chemomechanical method: a clinical trial

PURPOSE: The purpose of this controlled clinical trial was to compare the working time for caries removal in primary teeth, the need for local anesthesia and patient cooperation, when the chemomechanical Carisolv or the conventional mechanical method were used. METHODS: The sample consisted of primary teeth of children who had occlusal or buccal carious lesions into dentin. High speed and/or low speed were used as the conventional mechanical method of caries removal. The efficiency in caries removal was judged on the basis of clinical criteria. Length of working time, need of local anesthesia, and level of patient cooperation were recorded for both methods. Statistical analysis was performed using the student's t test and chi-square test. RESULTS: Working time with the chemomechanical method was much more prolonged than with the mechanical method (P < .001), but it did not negatively affect children's cooperation. Furthermore, the chemomechanical method reduced the need for administration of local anesthesia for Class V cavity preparations. CONCLUSIONS: The chemomechanical method, although more prolonged, is effective in caries removal in primary teeth, does not influence children's cooperation and may reduce the need of local anesthesia in Class V restorations.     

化学机械去腐技术对儿童牙科畏惧症的影响

目的 比较Carisolv化学机械去腐和传统车针去腐2种方法治疗龋齿儿童牙科畏惧症发病率的情况.方法 随机选择我院儿科就诊患者302人年龄3-14岁,分别采用Carisolv化学机械去腐和传统车针去腐2种方法治疗龋齿,由经治医生根据儿童在治疗过程中的反应进行牙科畏惧症分级判定,治疗后以问卷形式调查治疗中疼痛程度,方法倾向.结果 Carisolv化学机械去腐组牙科畏惧症发病率(22.96%)低于车针组(37.72%),特别是在牙科畏惧症高发的3-9岁患儿中发病率与车针去腐组相比较具有显著性差异(P＜0.01).Carisolv化学机械去腐与车针去腐比较疼痛更轻微具有显著性差异(P＜0.01).结论 Carisolv化学机械去腐法能减少低龄儿童牙科畏惧症发病率,提高患儿的依从性,从而获得良好的临床治疗效果.     

伢典化学机械去龋法的粘结性能研究

目的：利用健康离体牛牙,评价伢典对健康牙本质与复合树脂间剪切粘结强度的影响。方法：选取新鲜拔除的牛切牙28颗,磨除唇面釉质,暴露牙本质,分为4组,即空白对照组,酸蚀组,伢典处理组,伢典处理＋酸蚀组。分为不做预处理组,37%磷酸酸蚀组,伢典处理牙本质表面3min组,伢典处理牙本质表面3min后再用37%磷酸酸蚀处理组。在牙本质表面粘结形成直径5mm,高3mm的光固化树脂圆柱体。37℃水浴24h后,以1mm/min的加载速度进行剪切粘结强度测试。结果：伢典处理后的健康牙本质的剪切粘结强度大于不做预处理的健康牙本质。伢典处理不影响酸蚀效果。结论：伢典对复合树脂与健康牙本质间的粘结强度没有显著影响。     

The status of a chemomechanical caries removal system in dental education

A survey on the status of a chemomechanical caries removal system was mailed to the operative dentistry departments of each dental school in the United States and Canada. Eighty-eight percent of the respondents reported they were not presently teaching this technique. The most frequent reasons given for noninclusion in their curriculum were a lack of available clinical data and a variety of specific objections primarily related to limited applicability. Very few schools presently anticipate teaching this technique in the near future, and those that do are basing their final decision upon outcomes of further research. Consensus opinion indicated that additional studies and more definitive information would be required before final judgement could be made regarding the clinical value of this modality.     

Evaluation of the chemomechanical removal of dentine caries in vivo with a new modified Carisolv gel

Carisolv is a minimally invasive method for softening and removing dentine caries. A new, modified Carisolv gel has been developed in order to optimise the efficiency if its chemical caries dissolution. The aim of the present study was to compare the caries removal efficiency of the original gel with that of the new gel, which contains almost double the concentration of sodium hypochlorite. Ten dentists treated 202 cavities in 170 patients; 104 cavities were randomised to the new gel and 98 to the original gel. Their mean treatment times for caries removal were 6.7±4.1 min and 7.6±4.2 min, respectively (P>0.05). In close-to-pulp lesions, constituting 32% of the cavities, the mean times for caries removal were 9.0±7.0 min and 11.6±4.4 min for the new and original gels, respectively (P<0.01). Questionnaires revealed that 81% of the patients preferred chemomechanical treatment to drilling. In conclusion, the improved efficiency of the modified Carisolv gel did reduce the time for caries removal in deep lesions. However, it still needs more time than conventional drilling.