RECENT METHODS OFCARIES REMOVAL

1. 1

2.  Total no. of slides: 144
 No. of illustrations: 48
 Total time of presentation :90 min
2

3.  REFERENCES
 INTRODUCTION
 DEFINITION OF DENTAL CARIES
 CLASSIFICATION OF TECHNIQUES
HAND PIECE,BURS
SMART PREP BURS,
HAND EXCAVATION
AIR ABRASION
AIR POLISHING
ULTRASONIC INSTRUMENTATION
3

4. SONO ABRASION
CHEMOMECHANICAL CARIES REMOVAL
FACE
LASERS
 CONCLUSION
4

5. 1. STURDEVANT’S Art and science of Operative
dentistry 5th edition
2. Minimally invasive dentistry :The management
of caries.N.Wilson
3. Current concepts and techniques for caries
excavation and adhesion to residual dentinJ
Adhes Dent 2011;13; 7-22.
4. Dentine caries excavation: a review of current
clinical tecniques. British dental journal
2000;188;476-482.
5.Current concepts in cariology DCNA 2010;54(3)
5

6. 6.In vitro Evaluation of Five Alternative Methods of Carious Dentine
Excavation.Caries Research 2000;34(2)
7.Scanning electron microscopic observations of human dentine
after mechanical caries excavation. Journal of Dentistry
2000;28; 179–186.
8.A SEM of different caries removal tecniques on human dentin.
Oper Dent 2002;27(4);360-6.
9. Performance of four dentine excavation methods in deciduous
teeth. Caries Res 2006;40:117-123.
Efficacy of 4 caries excavtion methods compared .Oper Dent
2006;31;5
6

7. 10.In vitro comparison of ceramic burs and
conventional tungsten carbide bud burs in
dentin caries excavation.Quintessence Int
2008;39:495-499.
11.In Vivo Comparison of Reduction in Bacterial
Countafter Caries Excavation with 3 Different
Techniques .J Dent Child 2011;78:31-5
12.Microhardness as a predictor of sound and
carious dentine removal using alumina air
abrasion. CariesRes 2006;40:292-295
7

8. 13.An in vitro investigation of the effect and
retention of bioactive glass air-abrasive on
sound and carious dentine.
J Dent 2008;36:214-218.
14.Comparative evaluation of the efficacy of
chemomechanical caries removal
agent(Papacarie) and conventional method
of caries removal: An in vitro study J Indian
soc Pedod Prevent Dent 2010 ; 2 ( 28 )73
8

9. 15.Selective caries removal with air abrasion.
Oper Dent 1998;23:236-243.
16.Efficacy of chemo-mechanical method
(carisolv) of caries removal with that of
hand cutting and rotary cutting
instruments. Annals and essences of
dentistry Dec 2011.
17.Effectiveness and Efficiency of
Chemomechanical Carious Dentin Removal.
Braz Dent J (2006) 17(1): 63-67
9

10. 18.Self-limiting caries therapy with
proteolytic agents. Am J Dent 2008;21:303-
312.
19.Human teeth with and without dental
caries studied by visible luminescent
spectroscopy. J Dent Res 1981;60:120-122
20.Diagnodent: An optical method for caries
detection. J Dent Res 2004;83:80-83.
21.Residual caries detection using visible
fluorescence. Caries Res 2002;36:315-319
10

11. 22.Fluorescence-aided caries excavation
(FACE) compared toconventional method.
Oper Dent 2003;28:341-345.
23.Quantity of remaining bacteria and cavity size
after excavation with FACE, caries detector dye and
conventional excavation in vitro.
OperDent2007;32:236-241
24.Essentials of preventive and community dentistry.
3rd edition Soben Peter.
25.Walsh LJ. The current status of laser applications
in dentistry. Austr Dent J 2003;48:146-155
11

12.  Dental caries is an infectious microbiologic
disease of the teeth that results in localized
dissolution and destruction of calcified
tissues. -Sturdevant
12

13.  Caries removal or rather treatment of the
infected dentine, is best defined by outcome
criteria, i.e., procedures that lead to local
arrestment of the carious process.
 GV Black, in 1893—the principle of
“extension for prevention”
13

14.  Term “caries excavation” was defined as a
synonym for “cavity preparation”, which in
turn consisted of
“mechanical treatment of the injuries to the
teeth produced by dental caries, as would
best fit the remaining part of the tooth to
receive a filling”
14

15.  Stability form
 Retention form
15

16. CATEGORY TECHNIQUE
Mechanical, rotary Hand piece , burs
Mechanical, non rotary Hand excavators, air-abrasion ,air
polishing, ultrasonics , sono-
abrasion
Chemo-mechanical Caridex,carisolv,enzymes
Photo ablation lasers
16

17.  Controlled selective rotary excavation
Torque controlled motors
Carisolv power drive
Polymer burs
 Smart prep burs
 Ceramic burs
Fluorescence aided caries excavation
17

18.  Conventional Excavation with Burs
 Carbon-steel or tungsten-carbide burs
18

19.  Enamel pit and fissure caries- No.1 or No.2
round bur.
 Carious dentin – round steel excavating burs
in a low speed contra-angled hand piece
19

20.  A sharp round steel bur- large as lesion
 Burs with a positive rake angle -used to cut
softer, weaker substances, such as soft
carious dentin.
20

21.  Microscopic tungsten-carbide particles are
held together in a matrix of cobalt or nickel
at the head (working end) of the bur.
 head- typical spiral-like cutting edges with
or without additional cross cuts to improve
cutting efficiency.
21

22. 22

23.  Greater number of flutes than carbide bur.
 Smoother cutting action
 Operator is provided with a better tactile
sense.
 same caries-removing properties as
tungsten-carbide burs
 less expensive,
 but they are much more prone to corrosion
and dulling
23

24. 24

25.  A light force with wiping motion- to
discriminate between carious and normal
dentin .
 start carious dentin excavation from the
periphery towards the center of the lesion in
order to minimize the risk of infection in case
of accidental pulp exposure.
25

26.  Tungsten-carbide or carbon-steel burs in
low-speed contra-angle handpieces are the
most efficient method to excavate carious
lesions in terms of time, and are therefore
 still the most widely used caries-excavation
method.
Performance of four dentine excavation methods in deciduous
teeth. Caries Res 2006;40:117-123
26

27.  When studied by SEM,this method leaves a
homogeneous smear layer with more or less
uniform roughness, and dentinal tubules
visibly obstructed with smear plugs.
A scanning electron microscopic study of different caries
removal techniques on human dentin. Oper Dent
2002;27:360-366.
27

28. 28

29. Polymer burs:
 A “plastic” bur was made of a polyamide/
imide (PAI) polymer, possessing slightly lower
mechanical properties than sound dentin.
 hard enough to remove decayed dentin,
 stops at- hard healthy dentin
29

30.  self limiting –
 The blade design was developed to remove
dentin by locally depressing the carious
tissue and pushing it forward along the
surface until it ruptures and is carried out of
the cavity
30

31. SmartPrep, SSWhite Burs; Lakewood, NJ, USA)
 PEKK
 Hardness -50 KHN
 Higher than carious dentin (0 to 30 KHN)
 Lower than sound dentin (70 to 90 KHN)
31

32.  available in 3 sizes #2, #4, #6,
 smaller than their carbide round bur
counterparts
 low speed i.e. 500-800 rpm , without water
spray.
 used with very light air brush type stroke.
32

33. Their cutting edges were not spiralled but
straight.
 Disadvantage:
To excavate caries from the center to the
periphery in order to avoid contact with
sound tooth tissue, the bur would
be prematurely and irreversibly damaged
33

34.  More residual caries – smart prep burs.
 Micro tensile bond strength to carious
dentin- excavated with smart prep burs-
lower.
 TEM
34

35.  SmartBurs
 In primary teeth, resulted in the highest
coincidence between the caries removal
endpoint obtained by auto-fluorescence of
carious dentin and the actual degree of caries
removal.
 surface hardness of the SmartBurs (26.6 KHN)
 arrested carious dentin (39.2 KHN)
35

36. 36

37.  The CeraBurs are all-ceramic round burs
made of alumina-yttria stabilized zirconia.
 high cutting efficiency in infected, soft
dentin.
 replaces both the explorer and the spoon
excavator by simultaneously providing tactile
sensation, reducing preparation time.
37

38. CeraBurs with different diameters.
From left to right: 10-,
14-, 18-, and 23-mm diameter.
38

39. In vitro investigation of the caries-removal
efficiency and efficacy did not show any
significant difference between the ceramic
and conventional tungsten-carbide burs.
In vitro comparison of ceramic burs and conventional tungsten
carbide bud burs in dentin caries excavation.
Quintessence Int 2008;39:495-499.
39

40.  Caries removal with a carbide bur, polymer
bur, and spoon excavator produced
significant reduction in viable count of both
Streptococcus mutans and lactobacilli.
 Carbide burs, however, produced greater
reduction in the viable count of bacteria
followed by polymer bur and spoon
excavator.
In Vivo Comparison of Reduction in Bacterial Countafter Caries
Excavation with 3 Different Techniques (J Dent Child
2011;78:31-5)
40

41.  Mechanical Non-rotary:
 Hand excavators
 Air abrasion
 Air polishing
 Ultrasonic instrumentation
 Sono-abrasion
41

42.  Spoon excavator and enamel hatchets –
excavation of caries
 Sharp excavators are effective and will
reduce the force required for caries removal.
42

43. 43

44. Advantages:
 Long term observations have shown adequate
tissue removal
 Over excavation is unlikely
 Accepted procedure especially in pedodontics
and anxious patient
 Does not require any expensive equipment
Disadvantages:
 High pressure causes pain
44

45.  Banerjee, Kidd and Watson in 2000 –
conventional hand excavation appeared to offer
the best combination of efficiency and
effectiveness for carious dentine excavation.
In vitro Evaluation of Five Alternative Methods of Carious Dentine
Excavation Caries Res 2000;34:144–150
.
45

46.  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.
46

47. 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.
Performance of Four Dentine Excavation Methods in
Deciduous Teeth Caries Res 2006;40:117-123
47

48. 48

49. Procedure based on excavating carious cavities
in teeth using hand instruments only and
subsequent restoration with adhesive filling
material (glass-ionomer).
 innovative,
 largely pain-free,
 minimal intervention approach of
treating decayed teeth
49

50. 50

51. The reasons for using hand instruments :
 - it makes restorative care accessible for all
population groups,
 requires minimal cavity preparation that
conserves sound tooth tissues
 causes less trauma to the teeth,
 - the low cost of hand instruments compared
to electrically driven dental equipment,
51

52.  the limitation of pain that reduces the need
for local anaesthesia to a minimum and
reduces psychological trauma
 - simplified infection control.
 Hand instruments can easily be cleaned and
sterilized after every patient
52

53.  The reasons for using glass-ionomer are
 GIC sticks chemically to both enamel and
dentine, the need to cut sound tooth tissue to
prepare cavity is reduced,
 - fluoride is released
 - it is rather similar to hard oral tissues and
does not inflame the pulp or gingiva.
53

54.  - there is a cavity involving the dentine, and
 - that cavity is accessible to hand
instruments.
54

55.  swelling (abscess) or fistula (opening from
abscess to the oral cavity,
 - the pulp exposed,
 - teeth have been painful for a long time and
there may be chronic inflammation of the
pulp,
 - there is an obvious carious cavity, but the
opening is inaccessible to hand instruments
55

56.  Mouth mirror
 Explorer
 A pair of tweezers
 Spoon excavators
 Enamel hatchet
 Carver
 Mixing pad and spatula
56

57. 1.Place cotton wool rolls alongside the tooth to
be treated.
2.Remove plaque from tooth surface with wet
cotton wool pellets.
3.Dry the tooth surface with dry cotton wool
pellets.
4.If necessary make the entrance of the cavity
wider with a dental hatchet.
5.Remove the carious dentin with excavators
starting at the enamel dentin junction.
57

58. 6.Fracture off unsupported thin enamel with the
hatchet. Make sure the enamel does not contain
any carious spots.
7.Clean the cavity with wet and dry cotton wool
pellets.
8.Remove the caries near the pulp carefully.
9.Clean the cavity again with cotton wool pellets.
10.Check the relation of the tooth to be restored
with the opposing teeth by asking the patient to
bite.
11.Complete the procedure by drying the cavity
with dry cotton pellets.
58

59.  Dr. Robert B. Black was the first to study air-
abrasives technology in dentistry in 1943.
 In 1951, S.S.White introduced the first air-
abrasive system – Airdent
59

60.  The principle employed by the airdent unit
utilizes kinetic energy or inertia as a rapid
and not unpleasant means of removing tooth
structure by incorporating a fine abrasive
material in a high velocity gaseous propellent.
 EK= ½ m v2
60

61.  Air abrasion is not a completely painless
method of cavity preparation;
It eliminates
 vibration,
 bone-conducted noise,
 pressure and heat.
 The traumatic influence on tooth structure
and periodontal tissue is reduced to a
minimum.
61

62.  Unit
 Foot control
 Hand piece- consists of a handle, a shaft – an
adjustable contra-angle (ball and socket) and
a tip or nozzle in a 90 relationship to the
shaft.
62

63. 63

64.  Basic principles of air-abrasive:
 Air abrasive depends for its action on a
fine stream of suitable gas carrying a
controlled quantity of small abrasive particles
Abrasive Materials:
 Al2O3 – For cutting tooth substance
 CaMgCO3 – Dolomite – oral prophylaxis
64

65. US FDA approval for clinical use of 27.5 
alumina particles
 It possess a hardness of 9 on Moh’s scale
and its particles possess sharp edges and
pointed corners when properly prepared.
65

66. Propellants:
 CO2 was found to possess certain advantage
for this purpose.
 Practically free from moisture
 Non-toxic in low concentrations
 Convenient and almost universally available
 The pressure of the liquid CO2 varies from
700 to 1300 pounds per square inch.
 This pressure is reduced to app.115 pounds
in the line and
 80 to 45 pounds at the nozzle.
66

67. 67

68.  A nozzle tip distance of 1mm- the angulation
is zero
 At 2 mm total angulation - 7.
 At 5mm it is 13.
 At 10 mm it is 23
 and at 15mm it is 35.
68

69. Action of air abrasive is influenced by factors
 propellant pressure
 type and particle size of the abrasive used,
 abrasive mixture
 nozzle bore and length,
 nozzle distance from the enamel surface
 nozzle angulation.
69

70. No.561chrome plated dental bur =6 mg of
enamel _ 30 sec at 1725 rpm , pressure of 2
pounds.
 Al2O3 _ 80 psi—a nozzle of 0.018 inch
inside diameter and nozzle tip distance of 7
to 13 mm -90,
air abrasive is capable of removing 30 mg of
enamel in 30 seconds.
70

71.  Hand piece Control:
 The operator must develop close co-
ordination between the eye, hand and foot.
 no tactile relation between the instrument
and tooth being operated on,
visual sense.
Thus, good eye sight and good lighting are
imperative for this technique.
71

72. Hand piece grasp:
 Air abrasive hand piece is held lightly in the
pen grasp .
 No pushing or pulling is necessary .
 3rd or 4th finger is generally used not as a
brace but as a rest for steadying the
instrument.
72

73.  Nozzle angulation must be correlated with
nozzle tip distance.
 Greater the nozzle tip distance the greater
will be the angulation
73

74.  Straight line cut:
 high degree of definition is desired.
 This type of cut utilizes close nozzle
distances and is precise and narrow.
Angle cut:
 greater nozzle distance, together with the
required nozzle angulation.
 As the nozzle distance from the substance
being cut increases, the angle of the walls
increases proportionately.
74

75. Advantages of angle cut–
 greater cutting speed and
 less visual interference
75

76. Limitations of air abrasive system—
 abrasive particles cause inhalational
problems.
 no tactile guidance
 difficult to remove the existing restoration
 High cost
 When the abrasive particles strikes the
surface of the mirror, it becomes frosted.
 Might damage the cavosurface sound tooth
enamel.
76

77.  The major drawback of air-abrasion
excavation of carious dentin is that sound
dentin is more efficiently removed than
carious dentin.
Microhardness as a predictor of sound and carious dentine
removal using alumina air abrasion. CariesRes 2006;40:292-
295.
77

78. High Speed Drills Air Abrasion
Rotary bur cause micro
fractures
No micro fractures
Excessive destruction of
tooth structure
Less destruction of tooth
structure
Heat, vibration,bone
conducted noise-patient
discomfort
Heatless, vibration less,
minimal sound
Patient Anxiety Patient friendly
78

79.  Spherical glass beads
 Polycarbonate resin-crushed powder removed
artificially softened dentin more selectively
without cutting sound dentin or enamel.
Selective caries removal with air abrasion. Oper Dent
1998;23:236-243.
79

80.  A mixture of alumina and hydroxyapatite
in a volume ratio of 3:1, with particle sizes
ranging from 3 to 60 μm, was shown to be as
efficient as conventional hand excavation
with dental spoons.
Banerjee A, Kidd EA, Watson TF. In vitro evaluation of five
alternative methods of carious dentine excavation. Caries Res
2000;34:144-150.
80

81.  Bioactive glass powder (Bioglass, Novamin
Technology;Alachua, USA) with a particle
diameter between 25 and 32μm was also
explored.
 Risk of unnecessary sound dentin removal
was reduced because of the difference in
cutting rate between sound and carious
dentin.
An in vitro investigation of the effect and retention of bioactive
glass air-abrasive on sound and carious dentine.
J Dent 2008;36:214-218.
81

82. 82

83.  Water soluble sodium bicarbonate and
tricalcium phosphate
 0.08% by weight
 to improve the flow characteristics
 air pressure,
 concentric water jet.
 As the abrasive is water soluble it does not
escape too far from the operating field.
83

84.  Razoog and Koka in 1994,
 increasing the air-pressure beyond 90 psi
actually reduced the abrasiveness of the
microprophy system.
 This was due to a phenomenon -choked flow.
 as the air pressure exceeds the critical pressure,
the mass flow of particles will reduce thus
limiting the system’s abrasiveness.
84

85. 85

86. Commercially recommended use of this
technique is to
 remove surface enamel stains,
 plaque and calculus
 overzealous use - remove healthy tooth
structure
 removal of carious dentine at the end of
cavity preparation.
86

87.  Nielson et al. in 1950s
 Magnetostrictive instrument with a 25 kHz
oscillating frequency.
 Thick aluminium oxide and water slurry,
created by the cutting action.
Mechanism of action
Kinetic energy of water molecules being
transferred to the tooth surface via the
abrasive through the high speed oscillations
of the cutting tip.
87

88. Nielson attempted to analyse the results
from altering
 the pressure applied,
 the length of use of the instrument,
 the powder water ratio in the slurry,
 the nature of the material
 cut and the type of abrasive used.
88

89. SONIC OSCILLATION
(SONOABRASION)
89

90.  Removal of carious dentin using high
frequency ,sonic air scaler with modified
abrasive tips
First Design
•Sonic micro unit designed by Dr.Hugo Unterbrink and
Mosele
•Based on Soniflex 2000L and 2000N Air scaler Hand
piece
•Oscillations - < 6.5 KHZ
90

91.  Tips- elliptical motion - transverse distance
of between 0.08 to 0.15 mm
 longitudinal movement of between 0.55 –
0.135mm
 tips are diamond coated on one side using
40  grit diamond
 Cooled using water irrigant at a flow rate of
between 20-30 ml/min.
 The operational air pressure -3.5 bar.
91

92. A lengthways
halved torpedo
shape
9.5mm
long,1.3mm wide
A small hemisphere
1.5 mm diameter
A large
hemisphere 2.2mm
diameter
92

93. 93

94.  Torque Applied – 2N
 More pressure - dampens oscillations –
cutting efficiency reduced.
Indications
•Carious dentin removal
•Finishing cavity preparations
More studies needed to prove its efficiency
94

95. Advantage
 less over preparation than with rotary
instruments
 smaller access cavity is possible.
Disadvantage
 unclear completeness of excavation
95

96. 96

97. CHEMO MECHANICAL
CARIES REMOVAL (CMCR)
Chemical softening of carious dentin followed
by its removal by gentle excavation
97

98. Dentin
Inorganic – 70% Organic matrix - 20 % H2O – 10 %
18 % Collagen 2 % Non Collagen
Proline + Glycine - Polypeptides – Tropocollagen - Fibril
• Chlorination of Partially Degraded Collagen (Conversion of Hydroxyproline
to Pyrrole-2-carboxylic acid)
98

99. CMCR limits
 the removal of sound tooth structure,
 the cutting of open dentinal tubules,
 pulpal irritation
 pain
99

100. Goldman and Kronman
Na0Cl + Sorenson’s Buffer
(Glycine ,NaOH,NaCl)
N Mono Chloro Glycine
(GK 1019)
Glycine replaced by
Amino Butyric
acid
N-Mono Chloro DL2 amino
butyric acid
(NMAB) –GK 101E
10
0

101.  Chlorination of Partially Degraded Collagen
(Conversion of Hydroxyproline to Pyrrole-
2-carboxylic acid)
 Cleavage by Oxidation of glycine residues –
Disruption of collagen – more friable
collagen- removed.
10
1

102.  Solution 1: 1% NaOCl
 Solution 2: glycine+amino butyric acid+
NaCl+NaOH
 pH = 11
 Delivery system- reservoir,
heater and pump,
handpiece,
applicator tips
10
2

103. 10
3

104. 10
4

105.  Advantages: avoids painful procedure
reduced need for L.A.
conservation of tooth structure
dental phobics
deciduous teeth
10
5

106.  Rotary & hand instruments were still needed
 Large volumes of solution
 Slow
 Long term studies were lacking
 Short shelf life
 Special delivery system was needed
10
6

107. carisolv
10
7

108. 2 Syringes
NaOCl
Pink Viscous gel ( Lysine,
Leucine, Glutamic Acid
+Carboxymethyl cellulose +
Erythrosine )
Max Volume of Gel – 0.2 – 1 ml
Cloudy - frosty
‘A silent revolution’
10
8

109. Multi mix
10
9

110. singlemix
11
0

111. 11
2

112.  operative steps in chemomechanical caries
excavation include:
 (1) application of the solution,
 (2) scrapping off the carious dentin with
possible change of instrument size,
(3)rinsing, and
(4) repetition of the procedures until all caries
is removed.
Time required 10-15 min
Volume required 0.2 -1 ml
11
3

113. 11
4

114. 11
5

115.  Carisolv power drive is a faster and easier way of
working with carisolv.
 Advantages:-
 It has unique torque limitations and this helps to
protect the healthy dentine.
 It works at very low speed, thereby minimizing
noise and pain.
 Power drive is used with special star bur – 1.0, 1.5,
2.0. These burs work with power drive or a low
speed handpiece of maximum 300 rpm.
11
6

116. 11
7

117. CARIDEX CARISOLV
SOL I 1% NaOCl 0.5 % NaOCl
SOL II 0.1MAminobutyric acid
glyciene
0.1M NaCl,0.1 M NaOH
0.1M glutamic acid / leucine /
lysine, NaCl, NaOH
Dye - Erythrocyin
pH 11 11
Physical Nature Liquid gel
Volume 100-500ml 0.2 – 1ml
Time required 10-15 mins 10-15 mins
Instruments Applicator tips Specially designed
Active time 1 Hr 20 mins
11
8

118.  Painless
 No need of local anesthesia
 Conservation of sound tooth structure
 Reduced risk of pulp exposure
 Well suited for anxious
 Better than Caridex
LIMITATION
•Rotary and hand instruments may
still be needed
11
9

119.  Complete removal of caries was achieved
significantly in both the methods,( Papacarie,
with conventional slow-speed rotary
instrument(bur)
 there was less marked destruction of dentinal
tubules in chemomechanical caries removal
method by Papacarie.
Comparative evaluation of the efficacy ofchemomechanical
caries removal agent(Papacarie) and conventional method of
caries removal: An in vitro study J INDIAN SOC PEDOD PREVENT DENT
2010( 28 )|
12
0

120. Removal of carious dentin with Carisolv is
highly effective than that of Hand Excavation,
but slightly less than round carbide bur.
It may be because of carisolv which removes
only the infected dentin and not the affected
dentin.
Efficacy of chemo-mechanical method (carisolv) of caries
removal with that of hand cutting and rotary cutting
instruments. Annals and essences of dentistry Dec 2011
12
1

121.  Chemomechanical excavation using Carisolv
gel was the slowest technique.
 hand excavation presented higher efficiency
and effectiveness than chemomechanical
excavation.
Effectiveness and Efficiency of Chemomechanical Carious
Dentin Removal. Braz Dent J (2006) 17(1): 63-67
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122. 12
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123.  Pepsin in a phosphoric acid/sodium
biphosphate buffer- alternative to CMCR.
 phosphoric acid dissolves the inorganic
component of carious dentin.
 pepsin - organic part of the carious biomass
denatured collagen
Self-limiting caries therapy with proteolytic agents. Am J Dent
2008;21:303-312
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124.  Advantage:
more specific by digesting only denatured
collagen (after the triple-helix integrity is
lost) than the sodium hypochlorite-based
agents.
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125. 12
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126. In 1989 Goldsberg and Keil
Achromobacter collagenase- did not affect the
sound layers of dentin beneath the lesion.
In 1996 Norbo, Brown and Jan -Enzyme
Pronase –non specific proteolytic enzyme –
Streptomyces griseus
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127.  This technique was developed as a direct
method to clinically differentiate between
infected and affected carious dentin.
 Changes in tooth fluorescence detects early
tooth surface caries.
 Lennon et al. in 2002 studied the residual
caries detection using visible fluorescence.
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128.  Based on the fact that several oral
microorganisms produce orange-red
fluorophores as by-products of their
metabolism (porphyrins), infected carious
tissue will fluoresce especially in the red
fraction of the visible spectrum due to the
presence of proto- and meso-porphyrins.
Human teeth with and without dental caries studied by visible
luminescent spectroscopy. J Dent Res 1981;60:120-122
Diagnodent: An optical method for caries detection.
J Dent Res 2004;83:80-83.
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129. Carious dental tissue fluorescences more
intensely in the red portion of the visible
spectrum (>540 nm) than the sound dentine.
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130.  Violet light (370-420 nm) –
 The operator can observe the cavity through
a 530 nm – high pass filter.
 Areas exhibiting orange-red fluorescence –
caries -- removed by appropriate size bur.
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131.  Compared to Caries Detector or the visual-
tactile method for establishing the caries
removal endpoint, the FACE method showed
the highest sensitivity, specificity, percentage
correct score, and predictive values for
residual caries detection, as evaluated using
confocal microscopy.
 Residual caries detection using visible fluorescence. Caries
Res 2002;36:315-319
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132.  There was a significant reduction in the number
of samples presenting residual bacteria after
excavation with FACE, when compared to Carisolv
or bur excavation guided by Caries Detector(1)
 Histological examination after staining with
ethidium bromide revealed fewer samples
presenting bacteria in dentin when the FACE
method was used than was the case with
conventional bur excavation(2)
1.Efficiency of 4caries excavation methods compared. Oper Dent
2006;31:551-555.
2.Fluorescence-aided caries excavation (FACE) compared
toconventional method. Oper Dent 2003;28:341-345.
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133.  Advantages:
 very efficient, with less time needed to
excavate caries and without a need to change
instruments, apply chemical agents, or to test
the cavity with an explorer.
 FACE was apparently not associated with an
increased cavity size or overexcavation.
Efficiency of 4 caries excavation methods compared. Oper
Dent 2006;31:551-555
Quantity of remaining bacteria and cavity size after
excavation with FACE, caries detector dye and
conventional excavation in vitro.
OperDent2007;32:236-241.
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134. LASER THERAPY
135

135. Light Amplification by Stimulated Emission of
Radiation
In 1960, Theodore Maiman developed the first
working laser device which emitted a deep red-
coloured beam from a ruby crystal applied to
cutting both hard and soft tissues in the mouth
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136. Efficacy of laser depends on
•Pulse energy
•Optical properties of incident tissue
•Wavelength characteristics
Applications
•Selective Hard Ablation
•Selective Carious Dentin Removal
•Destroy S.Mutans
•Sealing of Fissures
•Adjunctive treatment in caries prophylaxis
•Modify structures of dentin and enamel
tissue
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137. Ablation:
The absorption differences between
carious and healthy dentin were the highest at
blue spectral range
 0.4J/cm2 but below 1.8J/cm2.
 The laser energy must be delivered uniformly
to the lesion surface.
 Murray et al. –
remaining dentine thickness should be at least
0.5 mm to avoid pulp injury.
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138.  CO2 lasers and Nd :YAG produce surface
changes in enamel such as roughness,
cracking, fissuring, melting and
recrystallisation.
 generate markedly elevated surface and
pulpal temperature.
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139.  ArF excimer lasers have been reported to
remove dental caries.
 Krypton F excimer laser has been shown to
cut dentin;
 however enamel is resistant to effective
ablation.
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Walsh LJ. The current status of laser applications in
dentistry. Austr Dent J 2003;48:146-155

140.  CO2 laser irradiation inhibits the progression
of caries like lesion up to 85%.
 Er : YAG -40%
 Er, Cr : YSGG - 60% caries reduction
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141.  Er : YAG lasers, Er : YSGG and Er, Cr : YSGG
lasers operate at wavelengths of 2940, 2790
and 2780 nm.
 These wavelengths correspond to the peak
absorption range of water in the infra red
spectrum.
 The efficiency of ablation is greatest for the
Er : YAG laser.
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142.  Er-based laser systems - popping sound.
MECHANISM OF ACTION
 A laser powered hydrokinetic system delivers
photons into an air-water spray matrix with
resultant microexplosive forces on water
droplets.
The mechanism of hard tissue cutting is based on
this process.
 This system with its accompanying air water
spray has been shown to cut enamel, dentine,
cementum and bone efficiently and clearly
without any deleterious thermal effects on dental
pulp.
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143. 14
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144. 14
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