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目的应用扫描电镜观察传统高速牙钻法、空气喷砂法、CarisolvTM化学机械法去龋后牙本质表面玷污层,肉眼观察窝洞洞底表面。方法将2006年3月至2006年6月南昌大学附属口腔医院收集的新近拔除伴中度龋坏的15颗患牙,依据去龋方法的不同分为3组:传统高速牙钻组、空气喷砂组和CarisolvTM化学机械组。去龋后肉眼观察窝洞洞底表面,并用扫描电镜对牙本质表面玷污层进行观察。结果3种方法均可有效去龋。传统高速牙钻组去龋后窝洞洞底牙本质表面平整、光亮而且透明;空气喷砂组牙本质表面粗糙、凹凸不平;CarisolvTM化学机械组牙本质表面光泽较暗。扫描电镜下观察,CarisolvTM化学机械组去龋后牙本质小管附近玷污层少,牙本质小管栓塞率仅为4.4%,明显低于其他2组(P均<0.05);空气喷砂组牙本质小管清晰可见,周围玷污层仅有少量分布;传统高速牙钻组牙本质小管清晰度较差,周围玷污层大量分布,牙本质小管栓塞率明显高于其他2组(P均<0.05)。结论CarisolvTM化学机械法能有效去龋,清除牙本质玷污层。     

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。     

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.     

Evaluation of micro-tensile bond strength of caries-affected human dentine after three different caries removal techniques

Objective

This study evaluated the effect that different techniques for removing dental caries had on the strength of the microtensile bond to caries-affected human dentine created by three bonding agents.

Materials and methods

Forty-five human molar teeth containing carious lesions were randomly divided into three groups according to the technique that would be used to remove the caries: a conventional bur, an Er:YAG laser or a chemo-mechanical Carisolv^® gel (n = 15). Next, each of the three removal-technique groups was divided into three subgroups according to the bonding agents that would be used: Clearfil^® SE Bond, G-Bond^®, or Adper^® Single Bond 2 (n = 5). Three 1 mm² stick-shaped microtensile specimens from each tooth were prepared with a slow-speed diamond saw sectioning machine fitted with a diamond-rim blade (n = 15 specimens). For each removal technique one dentine sample was analysed using scanning electron microscopy.

Results

There were statistically significant differences in the resulting tensile strength of the bond among the techniques used to remove the caries and there were also statistically significant differences in the strength of the bond among the adhesive systems used. The etch-and-rinse adhesive system was the most affected by the technique used to remove the caries; of the three techniques tested, the chemo-mechanical removal technique worked best with the two-step self etch adhesive system.

Conclusion

The bond strength values of the etch-and-rinse adhesive system were affected by the caries removal techniques used in the present study. However, in the one- and two-step self etch adhesive systems, bond strength values were not affected by the caries removal techniques applied. While a chemo-mechanical caries removal technique, similar to Carisolv^®, may be suggested with self etch adhesive systems, in caries removal techniques with laser, etch-and-rinse systems might be preferred.

Clinical significance

Caries removal methods may lead to differences in the characteristics of dentine surface. Dentine ultra structure generally affects the bonding of adhesive materials commonly used in restorative dentistry. Whereas etch-and-rinse system, like the ones used in the present study, are affected by these changes, the self etch systems are not affected. Hence, clinicians may opt for caries removal methods and systems appropriate for each patient and practice.     

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.     

Evaluation of selective caries removal by a fluorescence feedback-controlled Er:YAG laser in vitro

AIM: To establish a fluorescence threshold level that could guide a therapeutic Er:YAG laser through a caries lesion to determine a therapeutic endpoint of caries removal. MATERIALS AND METHODS: A total of 65 extracted human teeth, 35 with dentine caries and 30 healthy, were used for this study. An Er:YAG laser system that emitted at a wavelength of 2.94 microm was used. The laser was equipped with a laser fluorescence feedback system, excitation wavelength 655 nm, to control the irradiation by the Er:YAG laser. The evaluated threshold levels of the fluorescence feedback system were 3, 7, 8, 10, 12, 15 and 20. After treatment the teeth were prepared for histological staining according to the method of Brown and Brenn for the identification of bacteria. The specimens were subjected to a quantitative evaluation of residual bacteria on the treated dentine surface. In addition, the internal fluorescence of dentine and potential fluorescence changes of dentine after laser irradiation were evaluated. Results: About 80% of the irradiated dentine surface showed residual bacteria with threshold levels of 20, 15, 12, and 10. Residual bacteria were not found with threshold levels of 7 and 3. The study revealed a significant increase in dentine fluorescence after laser irradiation. Conclusion: The results of the present in vitro study indicate that a fluorescence threshold level of 7 or 8 units can guide an Er:YAG laser to a complete removal of carious dentine.     

Does mechanical pressure force bacteria into the dentinal tubules of carious and non-carious teeth--an exploratory study.

BACKGROUND: Although many researchers have confirmed bacterial migration within dentine, no evidence was found to show whether bacteria can be easily forced into dentine during caries treatment. OBJECTIVES: This exploratory study was to see if bacteria could be easily forced into dentinal tubules of carious and non-carious teeth using hand excavation and air pressure. METHODS: Two (2) carious and ten (10) non-carious teeth were used. Class I (Black's Classification) cavities were created using rotary instruments in the non-carious teeth, while the carious teeth were excavated using hand instruments to remove the caries. The cavity of one carious tooth was etched and in the other tooth was not. Five (5) of the non-carious tooth cavities were etched, of which, one tooth was also disinfected. The remaining five non-carious teeth were not etched and included one tooth that was disinfected. Bacterial cultures of S. mutans, E. coli and Veilonella were placed in the prepared cavities and hand excavators and air pressure were used in an attempt to force bacteria down into the dentinal tubules. Thereafter, the teeth were fixed, decalcified and prepared for electron or light microscopy. RESULTS: One etched, and one etched and disinfected non-carious tooth showed bacteria in the dentinal tubules. One carious tooth (etched) showed bacterial presence in the dentinal tubules. CONCLUSION: This study shows that it is difficult to force bacteria into dentinal tubules using hand excavation (as in the Atraumatic Restorative Treatment technique) so a definitive study is not indicated.     

微创技术治疗乳磨牙龋的临床评价

目的:评价Carisolv化学机械法微创技术对乳牙牙本质龋的临床疗效。方法:选择65例同颌同名乳磨牙诊断为牙本质龋的儿童,共148个患牙,采用自身对照方法,对同一个体的患牙随机分为两组进行治疗,一组采用Carisolv化学机械法去龋,一组采用牙钻法去龋,两组病例均用玻璃离子体充填,经6个月、1年观察,比较临床治疗效果。结果:两种治疗方法在修复体的完整性、边缘缺损及修复体脱落等方面比较,均无统计学差异(P>0.05)。结论:微创去龋技术可以消除儿童对牙科治疗的恐惧感,减少疼痛,去腐效果与传统牙钻去腐效果相同,可以在儿童龋病治疗中广泛应用。     

An in vitro investigation of microtensile bond strengths of two dentine adhesives to caries-affected dentine

OBJECTIVES: To compare the micro-tensile bond strengths of two different adhesive systems (ABF (Clearfil Protect Bond), Kuraray Medical Inc., Tokyo, Japan) and Prime & Bond NT (PBNT, Dentsply, Konstanz, Germany) bonded to caries-affected dentine retained after chemo-mechanical caries removal using Carisolv gel, with that retained after excavation using conventional hand instrumentation. METHOD: Twenty, adult, human extracted carious teeth were used in this split tooth study with bur-cut cavities in sound dentine acting as controls. After clinical caries excavation, the occlusal cavities in each experimental group were restored with either bonding system plus composite. Matchstick-shaped samples through the bond interfaces were sectioned and microtensile bond strengths recorded. Scanning electron microscopy (SEM) was used to ascertain the mode of failure at the restoration-dentine interface. RESULTS: Statistical analysis of the bond strength data showed that for the ABF group, there was no difference in bond strengths between the controls and Carisolv group but these values were significantly higher than those for the hand-excavated samples. PBNT samples showed no significant differences in any of the three test groups, with wider ranging data sets. SEM analysis indicated a variety of failures at the interface including cohesive failures within the caries-affected dentine itself. CONCLUSIONS: From the data generated by this study it could be concluded that microtensile bond strengths of PBNT/composite restorations to caries-affected dentine in clinical cavities were statistically comparable to those to sound dentine. In the ABF/composite restored group (self-etched), the use of conventional hand excavation appeared to weaken the bond strength to the remaining caries-affected dentine. However, the use of Carisolv gel excavation did not compromise bond strengths to caries-affected dentine in either group tested.     

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.     

Clinical, histological and microbiological study of hand-excavated carious dentine in extracted permanent teeth.

Changes in cultivable flora in dentine samples collected before and after hand excavation were examined in association with clinical status of the cavity surface, light microscopy and scanning electron microscopy (SEM). Thirty-five extracted permanent molar teeth with an occlusal caries lesion were excavated with hand instruments according to the atraumatic restorative treatment (ART) approach. Excavation pressure, dentine colour and consistency were recorded at the dentine-enamel junction (DEJ) prior to carious dentine removal and at the cavity floor after the final excavation; a microbiological sample of dentine was taken at both stages. Twelve restored teeth; six with positive and six with negative bacterial growth on the second sample, were selected for light microscopy and SEM. The hand-excavation removed tooth structure was soft, irreversibly damaged, dark and highly infected. Hand excavation reached dentine of increased hardness with a more normal colour to provide a sound structural base for restoration. Light and SEM examination of the cavity floor showed infected dentinal tubules in all 12 teeth examined. Linear logistic analysis showed a statistical association between light-yellow dentine on the cavity floor and an absence of bacterial growth (P = 0.006). This short-term in vitro study showed that caries-producing bacteria remained in dentine close to the cavity floor in 26/35 teeth despite clinical observations that indicated a suitably prepared cavity floor.     

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.     

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.     

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.     

Removal of caries using only hand instruments: a comparison of mechanical and chemo-mechanical methods

The aim of this study was to evaluate the efficacy, comfort and efficiency of removing dentin caries using only hand instruments. The Carisolv system for caries removal consisting of a solvent gel and a set of specially designed hand instruments (chemo-mechanical) was compared to the use of conventional spoon excavators (mechanical). This was a clinical randomised controlled trial where the two techniques were compared in the same individual. The outcome variables were: complete caries removal; pain during caries removal; anaesthesia requested by the patient during caries removal; time taken to remove caries. Sixty-six individuals, each with a pair of similar cavities in permanent teeth were selected. After caries removal, a 'blinded' evaluator assessed the clinical status of the cavity, with the use of a probe. The times for caries removal of the chemo-mechanical and mechanical methods were respectively: 9.2+/-3.8 and 8.6+/-3.8 min (p>0.05). There were 4 cavities arguably presenting signs of caries after cavity preparation in the 66 cavities treated with the mechanical method and 7 in the 66 chemo-mechanical cavities (p>0,05). Some pain/discomfort was reported by 21 (32%) participants when the chemo-mechanical method was used, compared with 43 (65%) when the mechanical method was used (p<0.05). During the chemo-mechanical and the mechanical treatment, 2 (3%) and 5 (8%) patients, respectively, requested local anaesthesia (p>0.05). The chemo-mechanical method appeared to be more comfortable for most patients.     

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.     

Dye-assisted diode laser ablation of carious enamel and dentine

Carious dentine and enamel from extracted human teeth were ablated using a semiconductor diode laser in conjunction with an applied dye, indocyanine green. This technique offers selective ablation with minimal risk of thermal damage to surrounding dental tissues because uptake of the dye and its irradiation by the laser together control the ablation. In this study, various laser powers and dye concentrations were used to ablate previously extracted human teeth with moderate caries. The mass of material ablated and the temperature rise in the pulp and at the surface were recorded, and the ablated surface was examined by microscopy. The ablation was efficient and the rise in the pulp temperature slight. Ablation efficiency and surface temperature were both found to increase with laser irradiance and with dye concentration. No surface cracks or fissures were seen in electron microscope examination and the hardness of the laser-treated surfaces was comparable to that of healthy tissue. The dye-assisted laser ablation technique offers considerable potential for clinical caries removal and dentine, enamel and pulp sterilization, whilst leaving healthy tissue intact. The diode laser can deliver its energy via simple optical fibre and is cheaper and much smaller than the conventional high power lasers used in other studies.     

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.     

Discrimination of morphological findings in dentine from osteogenesis imperfecta patients using combinations of polarized light microscopy, microradiography and scanning electron microscopy

Objectives . The aim of this study was to investigate the morphological appearance of dentine in teeth from individuals with osteogenesis imperfecta type I, III and IV using different histological techniques, and to correlate morphological findings to different types of osteogenesis imperfecta.
Sample and methods . Extracted or exfoliated primary and permanent teeth were collected from 15 patients with the osteogenesis imperfecta diagnoses I, III or IV, with or without the additional diagnosis dentinogenesis imperfecta. Ground and decalcified sections were prepared from the teeth. Histo-morphological studies of the dentine were performed utilizing light and polarized light microscopy, microradiography and scanning electron microscopy.
Results . Characteristic findings were irregular tubules, remnants of capillary inclusions and obliterated pulps. All types of osteogenesis imperfecta exhibited similar types of dentine aberrations, but patients with type III or IV had a higher frequency of aberrations when compared to type I.
Conclusions . The combination of either polarized light microscopy or micro-radiography, together with scanning electron microscopy, gave the most amount of morphological information from dentine samples. In addition, aberrations in dentine structure were more clearly observable. Light microscopy was not critical for the analyses.     

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.