Search

Background: Different methods for removing dental carious lesions exist, including conventional rotary caries removal and new advanced technology like polymer-based burs, chemomechanical agents, air abrasion, and laser., Objectives: This study shows the differences in features of dentin (smear layer, patency of dentinal tubules, surface irregularities, intertubular micro porosities, and exposed dentinal tubules) among different types of caries removal techniques., Materials and Methods: An in vitro study was done on 60 primary molars with occlusal class I active caries. Teeth were divided into three groups according to a method of caries removal (G1: chemomechanical, G2: mechanical with a smart bur, and G3: air-abrasion). After complete caries excavation, the teeth were examined under a scanning electronic microscope (SEM) with the power of magnification 4,000x and 8,000x to show the morphological dentinal features with SEM microphotographs. Data obtained was analyzed using the SPSS program where Fisher exact, Kruskal-Wallis and multiple Wilcoxon sum rank tests were used. The level of significance is when the p -value is less than 0.05., Results: Generally, SEM showed the highest ratio of score 1 of smear layer presence, surface irregularities, and microporosity in all groups in both magnifications. The patency of tubules showed the highest ratio of score 1 in G1, scores 2 in both G2 and G3 in magnification 4,000x, while 8,000x there was the highest ratio of its score 1 in G1 and G2 while the G3 has score 2 as the highest score. The exposed dentinal tubules showed the highest ratio in G1 in score 3, in G2 in score 2, and in G3 in score 1 in magnification 4,000x, while 8,000x there was the highest ratio of its score 2 in both G1 and G3 while the G3 has highest score 1. The study with magnification 4,000x showed a significant difference (S) among three groups in exposed dentinal tubules with a p -value (0.012), and there was S between chemomechanical and smart, chemomechanical and air-abrasions groups with a p -value (0.041, 0.001 subsequentially). Other dentin features showed non-significant differences (NS) among or between groups in both magnifications (4,000x, 8,000x)., Conclusions: All groups were effective in removing caries and can successfully treat young, scared or stressed patients. All methods of caries removal produce clinically parametric changes in the residual dentin., Competing Interests: The authors declare there are no competing interests., (©2024 Abdul-Kareem Mahmood et al.)

This paper introduces a novel application of the laser speckle technique in dentistry, focusing on assessing the efficiency of dental excavation methods used to remove decayed tooth structure. The aim is to evaluate the efficiency of two chemo-mechanical agents and the high-speed drill using the laser speckle technique, which offers objective, non-invasive, and real-time evaluation capabilities. Extracted human primary molars with active occlusal carious lesions were sectioned into three parts, with each part allocated to one of three groups: Group 1 (Brix3000 ® ), Group 2 (Papacarie DUO ® ), and Group 3 (High-speed drill mechanical caries removal). Caries removal was performed using the designated agent or method for each group. After caries excavation, speckle imaging using a 632.8 nm laser was conducted. Additionally, SEM was used to acquire micro-photographs of the surface morphology of the treated samples. The findings reveal insights into the comparative efficiency of the three dental excavation agents and methods using the laser speckle technique. The speckle parameters extracted from speckle patterns generated by treated teeth provide valuable information for evaluating the performance of the excavation methods. The scanning electron microscopy images also offer detailed visual evidence to support the analysis. This paper demonstrates the potential of the laser speckle technique for assessing the efficiency of dental excavation methods. The objective, non-invasive, and real-time evaluation provided offers advantages over subjective visual assessment and manual measurements., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

In the current odontological era, carious lesions are removed while tooth tissue is preserved. Most of these ideals are met by chemomechanical caries removal (CMCR) methods, which are easy and comfortable to use, differentiate and eliminate infected tissues, minimize pressure, vibration and heat, and are cost-effective. This study examines the efficacy of commercially available CMCR agents, namely Papacarie®, Carie-Care™ and BRIX3000™, and a conventional hand instrumentation method for caries removal in deciduous molars in terms of time consumption, ease of application, and pain perception. For this randomized clinical trial, 120 children aged 4 to 9 years were selected and randomly allocated to four groups of 30 patients each. Time consumption, ease of application, and pain perception were evaluated at three intervals: pre-, during- and post-caries removal, using Wong-Baker FACES (WBF) Pain Rating Scale and the Face, Legs, Activity, Cry, Consolability (FLACC) scale. The results showed that among the compared materials and conventional hand instrumentation technique, Carie-Care™ was statistically found to be the least time-consuming with a p -value of 0.019, have the least pain perception with a p -value of 0.02, and was clinically the best with respect to manipulation and handling. While all three CMCR agents aid in the removal of carious tissue, Carie-Care™ was the most effective based on time consumption, pain perception and simplicity of administration., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

We aimed to compare subjective (S) vs. objective (O) selective carious tissue removal using hand-excavation versus a self-limiting polymer bur, respectively. A community-based single-blind cluster-randomized controlled superiority trial was performed. This is a 1-year-interim analysis. 115 children (age 7-8 years) with ≥1 vital primary molar with a deep dentin lesion (>1/2 dentin depth) were included (60 S/55 O). The cluster was the child, with eligible molars being treated identically (91 S/86 O). Cavities were prepared and carious tissue on pulpo-proximal walls selectively removed using hand instruments (S), or a self-limiting polymer bur (Polybur P1, Komet). Cavities were restored using glass-hybrid material (Equia Forte, GC). Treatment times and children's satisfaction were recorded. Generalized-linear models (GLM) and multi-level Cox-regression analysis were applied. Initial treatment times were not significantly different between protocols (mean; 95%CI S: 433; 404-462 sec; O: 412; 382-441 sec; p = 0.378/GLM). There was no significant difference in patients' satisfaction (p = 0.164). No pulpal exposures occurred. 113 children were re-examined. Failures occurred in 22/84 O-molars (26.2%) and 26/90 S-molars (28.9%). Pulpal complications occurred in 5(6%) O and 2(2.2%) S molars, respectively. Risk of failure was not significantly associated with the removal protocol, age, sex, dental arch or tooth type (p > 0.05/Cox), but was nearly 5-times higher in multi-surface than single-surface restorations (HR: 4.60; 95% CI: 1.70-12.4). Within the limitations of this interim analysis, there was no significant difference in treatment time, satisfaction and risk of failure between O and S.

Objectives: The marginal quality of ceramic inlays was evaluated after the use of three different instrumental finishing methods in mesio-occluso-distal (mod) cavity boxes in vitro after hydrothermal loading (HTL)., Materials and Methods: Caries-free human molars were divided into three groups. Mod-cavities were conventionally prepared. Box finishing was performed in every group with rotating (RI), sonic (SI), or ultrasonic (USI) instruments. Surface roughness was examined. Twelve mod-cavities remained untreated. Continuous margin quality was evaluated with scanning electron microscopy (SEM). Ceramic inlays were cemented into cavities. After HTL microleakage, marginal and absolute marginal gaps were examined. All data were analyzed statistically., Results: Significant differences were found, between cavity surface roughness of RI and SI groups, the RI and USI groups, but not between microleakage, marginal, absolute marginal gaps after HTL and in proximal marginal quality. No correlations between microleakage and marginal gaps nor between microleakage and surface roughness were found., Conclusion: Mod-cavity proximal box finishing with SI or USI resulted in a higher surface roughness than the use of RI. The type of the finishing method did not influence the marginal quality of ceramic inlays. For the mod-cavity finishing, the use of SI and USI could be an alternative instrumental method to conventional RI methods with a lower risk of iatrogenic damage of the adjacent teeth., Clinical Relevance: This study allows the practitioner to better determine the proper indications and limitations of the sonic and ultrasonic instruments for mod-cavity proximal box finishing.

Introduction: Selective (incomplete/partial) carious tissue removal is suitable for treating deep carious lesions in teeth with vital, asymptomatic pulps. In the periphery of a cavity, removal to hard dentin is performed, while in pulpo-proximal areas, leathery or soft dentin is left to avoid pulp exposure. As the decision of what contains 'soft' or 'leathery' dentin is subjective, using self-limiting burs which help to standardise the hardness of the remaining dentin, has been suggested to increase the reliability of carious tissue removal. The trial compares subjectively measured selective carious tissue removal in deep lesions in primary teeth with objectively measured selective removal with a self-limiting bur (Polybur, Komet)., Methods and Analysis: A community-based single-blind clustered randomised controlled superiority trial nested into a larger evaluation is performed. Recruitment for this trial has been concluded. We have recruited 115 children aged 6-8 years with ≥1 vital primary molar with a deep dentin lesion. The unit of randomisation was the child, with all eligible molars per child treated identically. Treatment was performed in a mobile dental unit. Subjective and objective carious tissue removal was performed at random. Teeth were restored using glass ionomer cement (Equia Forte, GC). Our primary outcome will be the time until complications occur, evaluated via multilevel survival analysis. Secondary outcomes will be the time until extraction is needed, subjective satisfaction of the child with the treatment (measured using a Likert scale) and cost-effectiveness. Re-examination will be performed after 12, 24 and 36 months (the final examination is expected in 2020)., Ethics and Dissemination: This trial has been approved by the Ethics Committee of the Health Sciences of the University of Brasília (CAAE 51310415.0.0000.0030). Trial results will be published in peer-reviewed journals and presented on conferences., Trial Registration Number: NCT02754466., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

A single-blind randomized controlled clinical trial in patients with deep caries and symptoms of reversible pulpitis compared outcomes from a self-limiting excavation protocol using chemomechanical Carisolv gel/operating microscope (self-limiting) versus selective removal to leathery dentin using rotary burs (control). This was followed by pulp protection with mineral trioxide aggregate (MTA) and restoration with glass ionomer cement and resin composite, all in a single visit. The pulp sensibility and periapical health of teeth were assessed after 12 mo, in addition to the differences in bacterial tissue concentration postexcavation. Apical radiolucencies were assessed using cone beam computed tomography/periapical radiographs (CBCT/PAs) taken at baseline 0 mo (M0) and 12 mo (M12). In total, 101 restorations in 86 patients were placed and paired subsurface, and deep (postexcavation) dentin samples were obtained. DNA was extracted and bacteria-specific 16S ribosomal RNA gene quantitative polymerase chain reaction was performed. No significant difference was found in bacterial copy numbers normalized to mass of dentin ("bacterial tissue concentration") between the self-limiting (96.3% reduction) and control protocols (97.1%, P = 0.33). The probability of 12-mo success was 4 times (odds ratio [OR] = 4.33; confidence interval [CI], 1.2-15.6; P = 0.025) higher in the self-limiting protocol compared to the control (conventional excavation technique), with pulp survival rates of 73.3% and 90%, respectively ( P = 0.049). Molars had a 4 times higher probability of success compared to premolars (OR, 4.17; CI, 1.17-14.9; P = 0.028), and symptom severity did not statistically predict outcome (OR, 0.41; CI, 0.12-13.9, P = 0.153). CBCT detected significantly more periapical (PA) lesions than PA radiographs at the baseline visit ( P < 0.001). In conclusion, the self-limiting caries excavation protocol under magnification increased pulp survival rate compared to rotary bur excavation ( ClinicalTrials.gov NCT03071588).

Objective: The aim of this study was to evaluate the influence of cavity preparation with different Er,Cr:YSGG laser handpieces on microleakage of different posterior composite restorations., Methods: Fifty-four extracted intact human premolars were randomly assigned to three groups according to cavity preparation method: Bur Group: high-speed diamond bur (Diatech), MD Group: Er,Cr:YSGG laser Waterlase MD handpiece (Biolase Millennium II), and Turbo Group: Er,Cr:YSGG laser Waterlase MD TURBO handpiece (Biolase Millennium II). One hundred eight Class II slot cavities were prepared on the mesial and distal proximal surfaces of each tooth, and the cavity preparation times required were determined. The groups were then subdivided according to the restorative systems used (n = 12): a conventional methacrylate-based microhybrid composite (Filtek P60+Adper Single Bond 2/3M); a silorane-based resin composite (Filtek Silorane+Silorane System Adhesive/3M); and a nanohybrid methacrylate-based composite (Kalore+G-Bond/GC). The restorative systems were applied according to the manufacturers' recommendations. Following thermocycling (X5000; 5°C-55°C), the teeth were coated with nail varnish except the restoration margins, immersed in 0.5% basic fuchsin dye solution, and sectioned in a mesiodistal direction. Dye penetration was evaluated under a light microscope for occlusal and cervical margins. Data were analyzed with one-way ANOVA and chi-square tests (p < 0.05)., Results: The cavity preparation time (mean ± SD) required for Bur, MD, and Turbo group was 31.25 ± 3.82, 222.94 ± 15.85, and 92.5 ± 7.42 sec, respectively, and the differences among the groups were statistically significant (p < 0.05). Comparing the occlusal and cervical microleakage scores, no statistically significant differences were found among the groups and subgroups (p > 0.05)., Conclusions: Er;Cr:YSGG laser cavity preparation with the Turbo handpiece needed shorter time than the MD handpiece, although it needed longer time than the conventional diamond bur. The use of different handpieces of Er,Cr:YSGG laser did not differ from conventional preparation with diamond bur in terms of microleakage with the tested methacrylate- and silorane-based posterior composite restorative systems.

Purpose: The search for optimizing rehabilitation results with the use of osseointegrated implants has led oral surgeons to look for other technologies that can provide better predictability for treatments; however, effectiveness must be considered as well. This study aimed to compare temperature variation during preparation of implant surgical beds using conventional rotary implant burs versus ultrasonic tips and to study perforation effectiveness by analyzing the functional wear of both systems and the influence of such wear on the overheating of cortical bone., Materials and Methods: This evaluation was made using thermocouples placed in fresh bovine cortical bone (femur) and connected to a data collector so that the recorded temperatures could provide the thermal behavior of both systems after repeated use of the burs and piezoelectric tips, to compare the wear and the loss of cutting efficiency. Scanning electron microscopy (SEM) was used to compare the topography of both systems' perforations. Biostatistics assays were performed comparing both techniques as well., Results: The collected data and images showed that the wear of the burs and tips did not significantly influence the temperature variation, and the greatest variation occurred in the piezoelectric system for preparations of 13-mm depth. The SEM images show a different surface topography between both systems. While the burs cut the bone, showing a smooth surface, the piezoelectric tips condense the bone and present a rough surface., Conclusion: The use of either rotatory burs or piezoelectric tips generates a temperature that does not affect the tissue healing. Burs create a smooth surface, and piezoelectric tips show a more rough and condensed bone surface. The wear of both systems does not have a relevant increase in temperature after the preparation of 30 surgical beds.

Aim: Fissure sealants are effective in preventing caries. The aim of this in vitro study was to evaluate the effects of two different enamel surface preparation techniques for pit and fissure sealing., Materials and Methods: Sixty extracted sound third molars were used. For each tooth, the mesial half of the occlusal fissures was treated with ultrasound diamond tip T1 mounted on an ultrasonic handpiece, while the distal half with conventional diamond bur. The teeth were randomly divided into 2 groups (n = 30/each). Group 1 samples were stored in distilled water at 4 °C. For group 2 samples, sealing of occlusal fissures was performed according to standard procedures. Bucco-lingual cuts parallel to the long axis of the tooth were made in order to separate the two different types of preparations. The effects of the executed procedures were assessed with SEM., Results: Surfaces prepared with ultrasound system showed the presence of residual debris and appeared more irregular than surfaces prepared with traditional bur system. Furthermore, images showed the presence of cracks on the bottom and on the walls of the ultrasound prepared fissures., Conclusion: Conventional bur surface treatment showed a better performance when compared to ultrasound preparation and could probably ensure superior sealant retention.

Purpose: To assess the effect of the erbium:yttrium aluminum garnet (Er:YAG) laser on bond strength of a total-etch adhesive system to the caries-affected dentin on the gingival wall., Materials and Methods: Ten human molars with proximal carious lesions were randomly divided into two groups. In the first group, the carious dentin was removed with a bur, whereas in the second group it was removed with the Er:YAG laser. Carious lesions were excavated with one of these two techniques until laser fluorescence values decreased to 15 in the center of the lesions. The teeth were then restored with a total-etch adhesive system (Adper Single Bond 2) and composite resin (Filtek Z250). Five teeth from each group were sectioned to obtain 1 mm2 stick-shaped microtensile specimens from each tooth. Twenty-five specimens were obtained for each group with using this technique. The data were analyzed in independent-samples t-test (α = 0.05). For each removal technique, one sample was analyzed using scanning electron microscopy., Results: No statistically significant differences were found between the bond strength of the Er:YAG laser and the bur-treated groups (P > 0.05)., Conclusion: The Er:YAG laser treatment did not negatively affect the bonding performance of the total-etch adhesive system to caries-affected dentin on the gingival wall.

Background and Objectives: Conservative caries removal has become an integral part of minimally invasive dentistry (MID). Polymer burs and chemomechanical caries removal are two feasible methods of MID. The objective of this study was to assess and compare the efficacy of polymer bur and chemomechanical caries removal agent clinically and microbiologically for selective removal of infected dentin., Methods: A total of fifty primary second molars with occlusal decay involving dentin were selected from 25 patients aged between 5 and 9 years. They were randomly allocated to Group A (polymer bur group) and Group B (Carie-Care group) for caries removal. Completeness of caries excavation was assessed clinically with the application of caries detector dye. Dentinal samples were collected before and after caries removal and cultured in Luria-Bertani Agar, and total viable count was assessed. All the teeth after caries excavation were restored with Type 2 glass ionomer cement. The data obtained was tabulated and statistically analyzed using paired t-test and Chi-square test., Results: There was a statistically significant reduction in the mean microbial count before and after treatment in polymer bur group and Carie-Care group. The reduction in mean microbial count was found significantly higher in polymer bur group compared to Carie-Care group. There was no significant association was observed between the two groups when efficacy was assessed clinically., Conclusions: Both polymer bur and Carie-Care were efficient caries removal agents when assessed clinically and microbiologically. Polymer bur was found to be more effective than Carie-Care when assessed microbiologically.

Introduction: Recently, we reported that in mandibular molars contracted endodontic cavities (CECs) improved fracture strength compared with traditional endodontic cavities (TECs) but compromised instrumentation efficacy in distal canals. This study assessed the impacts of CECs on instrumentation efficacy and axial strain responses in maxillary molars., Methods: Eighteen extracted intact maxillary molars were imaged with micro-computed tomographic imaging (12-μm voxel), assigned to CEC or TEC groups (n = 9/group), and accessed accordingly. Canals were instrumented (V-Taper2H; SSWhite Dental, Lakewood, NJ) with 2.5% sodium hypochlorite irrigation, reimaged, and the proportion of the modified canal wall determined. Cavities were restored with bonded composite resin (TPH-Spectra-LV; Dentsply International, York, PA). Another 28 similar molars (n = 14/group) with linear strain gauges (Showa Measuring Instruments, Tokyo, Japan) attached to mesiobuccal and palatal roots were subjected to load cycles (50-150 N) in the Instron Universal Testing machine (Instron, Canton, MA), and the axial microstrain was recorded before access and after restoration. These 28 molars and additional 11 intact molars (control) were cyclically fatigued (1 million cycles, 5-50 N, 15 Hz) and subsequently loaded to failure. Data were analyzed by the Wilcoxon rank sum and Kruskal-Wallis tests (α = 0.05)., Results: The overall mean proportion of the modified canal wall did not differ significantly between CECs (49.7% ± 12.0%) and TECs (44.7% ± 9.0%). Relative changes in axial microstrain responses to load varied in both groups. The mean load at failure for CECs (1703 ± 558 N) did not differ significantly from TECs (1384 ± 377 N) and was significantly lower (P < .005) for both groups compared with intact molars (2457 ± 941 N)., Conclusions: In maxillary molars tested in vitro, CECs did not impact instrumentation efficacy and biomechanical responses compared with TECs., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The primary objective of this study was to compare the dentin ablation volume and ablation rate of quantum square pulse (QSP), using two different pulse energy settings plus a new digitally controlled dental laser handpiece (X-Runner), with those of variable square pulse (VSP), using three different pulse durations. The secondary objective was to examine, by scanning electron microscopy (SEM), the surface effects of ablation with the different Er:YAG laser modes on the dentin surfaces., Background Data: The available literature has limited data on the efficiency of different operating modes, pulse durations, and the new digitally controlled handpiece of the Er:YAG laser on human dentin., Materials and Methods: Freshly extracted human molars (n = 72) were divided into two experimental groups (n = 36 each): (1) QSP group, and (2) VSP group. Each group was randomly divided into three subgroups (n = 12 each). In the QSP group, preparations in dentin were performed using 250 and 500 mJ of pulse energy with the conventional handpiece, and with the X-Runner handpiece set at 250 mJ pulse energy. In the VSP group, cavity preparations were performed using three pulse variables: super short pulse (SSP), micro short pulse (MSP), and short pulse (SP). Cavity preparations were made in dentin at time intervals of 1, 2, and 5 sec. A laser triangulation profilometer was used to determine cavity volumes. Surface analysis of the ablated dentin specimens was performed by SEM., Results: For time intervals of 1 and 2 sec, ablated volume and ablation rate for QSP-500 mJ were significantly higher than for all other groups (p < 0.0001). For the 5-sec time interval, X-Runner and QSP-500 mJ were the most efficient in dentin ablation (p < 0.0001). Dentin surfaces were free of smear layer in all groups., Conclusions: The most efficient modes of dentin ablation in the study were the QSP-500 mJ and X-Runner groups. Dentin surfaces were free of smear layer in all groups.

Purpose: To examine the effect that a stainless steel (SS) matrix band has on the depth and distribution of cure of a resin-based composite (RBC) in a simulated Class II cavity., Methods: RBC was cured for 20 seconds in a simulated Class II cavity with and without a SS matrix band, and after 24 hours the specimens were scraped back and ground to expose a vertical central plane where Knoop micro-hardness (KHN) mapping was conducted from 0.05-1.5 mm from the band and in 0.5 mm intervals from the top of the specimens. The effect of different angles of the light guide on the distribution of hardness was also examined., Results: KHN values near the SS matrix band were significantly lower (P < 0.05) than within the bulk of the specimen and were lower than those found without the matrix band. Angles of incidence for the curing light-guide produced changes in the distribution of KHN within the specimens, but particularly near the matrix band, and with a 35° angle of incidence, the depth of cure was significantly different from that of normal incidence of the light.

Purpose: The removal of dentinal caries using the rotary method of excavation is most often associated with pain and anxiety in children. Chemo-mechanical caries removal may eliminate some of the drawbacks of the rotary technique and improve patient comfort. The purpose of this study was to compare the efficiency of the rotary, Carisolv, and Papacarie methods for caries removal in primary teeth, length of time needed, influence on child behavior, pain perception, and treatment preference of the child., Methods: This controlled, split-mouth study with a cross-over design compared three caries removal methods in the primary molars of 50 five- to 12-year-old children., Results: The rotary method was the most efficient and least time-consuming (P<0.001). Pain perception, however, was highest with this method (P<0.05). Papacarie exhibited a higher efficiency and required fewer applications than Carisolv (P<0.01). The Papacarie method was the most preferred, and the rotary method the least-preferred (P<0.05)., Conclusions: Chemo-mechanical caries removal may be a promising alternative treatment procedure, particularly for anxious young patients.

Aim: Study the topographic features of dentin after caries removal with a chemomechanical agent (Papacarie) compared with the conventional drilling method., Study Design: The sample included 7 exfoliated and extracted primary teeth with carious dentin lesions, not reaching the pulp. Each tooth was sectioned longitudinally through the center of the carious lesions into two halves. The teeth were then divided into two groups according to the method of caries removal. Following caries removal, dentin topography and the cut section were examined using the scanning electron microscope., Results: Papacarie produced an irregular, porous, rough and globular dentin appearance. The dentin surfaces were generally free of smear layer, visible bacteria and the dentinal tubules were opened. The dentin cut surfaces showed patent dentinal tubules with open orifices. The drilling method created a smooth and amorphous surface with a continuous smear layer occluding the dentinal tubules. Numerous bacteria were also observed. The cut dentin surfaces showed patent dentinal tubules with their orifices plugged with smear layer., Conclusions: Papacarie produced a rough and porous surface with partial or complete removal of the smear layer and opened dentinal tubules, while the drill produced a smooth surface with uniform smear layer occluding the dentinal tubules.

Aim. This study sought to compare the microleakage of three adhesive systems in the context of Erbium-YAG laser and diamond bur cavity procedures. Cavities were restored with composite resin. Materials and Methods. Standardized Class V cavities were performed in 72 extracted human teeth by means of diamond burs or Er-YAG laser. The samples were randomly divided into six groups of 12, testing three adhesive systems (Clearfil s(3) Bond Plus, Xeno® Select, and Futurabond U) for each method used. Cavities were restored with composite resin before thermocycling (methylene blue 2%, 24 h). The slices were prepared using a microtome. Optical microscope photography was employed to measure the penetration. Results. No statistically significant differences in microleakage were found in the use of bur or laser, nor between adhesive systems. Only statistically significant values were observed comparing enamel with cervical walls (p < 0.001). Conclusion. It can be concluded that the Er:YAG laser is as efficient as diamond bur concerning microleakage values in adhesive restoration procedures, thus constituting an alternative tool for tooth preparation.

Purpose: To compare and evaluate shear bond strength of self-etching adhesives bonded to cavities prepared by diamond bur or Er,Cr:YSGG laser and the effect of prior acid etching on shear bond strength., Materials and Methods: Ninety-six caries-free human premolars were selected and divided into 2 groups depending on mode of cavity preparation (48 teeth each). Cavities were prepared with Er,Cr:YSGG laser in group 1 and diamond burs in an air-turbine handpiece in group 2. Groups 1 and 2 were further subdivided into three subgroups of 8 teeth each, which were bonded with sixth- or seventh-generation adhesives with or without prior acid etching, followed by restoration of all samples with APX Flow. These samples were subjected to shear bond strength testing. In addition, the surface morphology of 24 samples each from groups 1 and 2 was evaluated using SEM. Data were analyzed using the Shapiro-Wilk test, one- and two-way ANOVA, the t-test, and the least significant difference test, which showed that the data were normally distributed (p > 0.05)., Results: The shear bond strength of adhesives in cavities prepared by Er,Cr:YSGG laser was significantly higher than in diamond bur-prepared cavities (p < 0.05). SEM analysis showed a smear-layer-free anfractuous surface on laser-ablated teeth, in contrast to conventional bur-prepared teeth., Conclusions: The Er,Cr:YSGG laser-ablated surface proved to be more receptive for adhesion than those prepared by diamond bur irrespective of the bonding agent used. Seventh-generation adhesives yielded higher shear bond strength than did sixth-generation adhesives. Prior acid etching decreased the shear bond strength of self-etching adhesives.

Background: Restorative dentistry simulation is one of the most challenging applications involving virtual reality and haptics. This paper presents a haptics-based tooth drilling simulator for dental education., Methods: Unlike the existing methods, the force model is based on physical properties which consider the geometrical model of the tool. In order to provide uniform force feedback from tooth layers, a new approach is suggested in which the physical properties of each tooth voxel are subsequently used in calculating the feedback force. We implement a hashing algorithm for collision detection due to its reduced time complexity. The haptics algorithm has been implemented on a graphics processing unit using the CUDA toolbox., Results: In parallel processing, the speed of haptic loop execution is increased almost 8 times., Conclusion: The proposed idea for force calculation leads to a uniform sensation of force. An important feature of the designed system is the capability to run in a real-time fashion., (Copyright © 2015 John Wiley & Sons, Ltd.)

Background: This study examined the effect of operator experience, dominance, tooth position and access, on frequency and extent of iatrogenic damage to approximal tooth surfaces during conventional Class II cavity preparations. The effectiveness of protective devices in minimizing damage was also explored., Methods: 10 students and 10 experienced dentists each prepared 24 Class II cavity preparations in typodont teeth without protection; 10 utilizing stainless steel matrix bands and 10 utilizing protective wedges. The frequency and extent of damage were analysed with respect to the above variables. Subsequently, 20 natural and 20 typodont teeth were utilized to establish the relationship in depth of damage caused by a high-speed diamond bur on typodont versus natural teeth., Results: Dentists caused iatrogenic damage on 74% of approximal surfaces without protection, which fell to 50% and 46% respectively when matrix bands and wedges were used as guards. The corresponding rates of damage for students were 94%, 80% and 44%. There was no difference in depth of damage caused on the two types of teeth when bur was in contact with teeth for a very short time., Conclusions: Greater operator experience and the use of guards reduces iatrogenic damage to proximal surfaces during preparation with high-speed rotary instruments., (© 2015 Australian Dental Association.)

Objectives: The aim of this review was to assess the methodologies used in previously published prospective randomized clinical trials on chemomechanical caries removal and to conduct a meta-analysis to quantify the differences in the excavation time between chemomechanical and conventional caries removal methods., Methods: An electronic search was performed using Scopus, PubMed, EBSCO host, and Cochrane Library databases. The following categories were excluded during the assessment process: non-English studies published before 2000, animal studies, review articles, laboratory studies, case reports, and nonrandomized or retrospective clinical trials. The methodologies of the selected clinical trials were assessed. Furthermore, the reviewed clinical trials were subjected to meta-analysis for quantifying the differences in excavation time between the chemomechanical and the conventional caries removal techniques., Results: Only 19 randomized clinical trials fit the inclusion criteria of this systematic review. None of the 19 reviewed trials completely fulfilled Delphi's ideal criteria for quality assessment of randomized clinical trials. The meta-analysis results revealed that the shortest mean excavation time was recorded for rotary caries excavation (2.99±0.001 minutes), followed by the enzyme-based chemomechanical caries removal method (6.36±0.08 minutes) and the the hand excavation method (atraumatic restorative technique; 6.98±0.17 minutes). The longest caries excavation time was recorded for the sodium hypochlorite-based chemomechanical caries removal method (8.12±0.02 minutes)., Conclusions: It was found that none of the current reviewed trials fulfilled all the ideal requirements of clinical trials. Furthermore, the current scientific evidence shows that the sodium hypochlorite-based (Carisolv) chemomechanical caries removal method was more time consuming when compared to the enzyme-based (Papacarie) chemomechanical and the conventional caries removal methods. Further prospective randomized controlled clinical trials evaluating the long-term follow-up of papain-treated permanent teeth are needed.

Use of magnification, such as 6x to 8x binocular surgical loupes or the surgical operating microscope, combined with co-axial illumination, may facilitate the creation of stable composite resin restorations that are less likely to develop caries, cracks or margin stains over years of service. Microscopes facilitate observation of clinically relevant microscopic visual details, such as microscopic amounts of demineralization or caries at preparation margins; microscopic areas of soft, decayed tooth structure; microscopic amounts of moisture contamination of the preparation during bonding; or microscopic marginal gaps in the composite. Preventing microscope-level errors in composite fabrication can result in a composite restoration that, at initial placement, appears perfect when viewed under 6x to 8x magnification and which also is free of secondary caries, marginal staining or cracks at multi-year follow-up visits.

Aim: The aim of the study was to compare the efficacy of caries removal, time taken and to evaluate the pain threshold experienced by children during various caries removal methods., Methods: One hundred and twenty patients aged between 4 and 14 years requiring dental restorations were selected. Caries removal was completed using an air-rotor, hand instruments, Carisolv and polymer burs. The efficacy, time taken and pain thresholds were evaluated during caries removal by Ericsson et al. scale, visual analogue scale and verbal pain scale, respectively., Statistical Analysis: Data was collected and statistically analysed using one-way analysis of variance followed by Post Hoc comparison by Bonferroni method. The skewed data was analysed amongst groups by applying Kruskal-Wallis test followed by probability adjustment by Mann-Whitney test., Result: These results indicated that the efficacy of caries removal was highest with air-rotor and was least by the hand instrument, whilst Carisolv® was least painful and the most time-consuming method., Conclusions: Caries removal with polymer burs and Carisolv were found to be as effective in caries removal and could be considered as alternatives to painful procedures as air-rotor in management of caries especially in children.

Objective: The purpose of this systematic review and meta-analysis was to evaluate the reliability of the Carisolv system with respect to drilling regarding the full removal of decayed hard tissues in primary dentition. A systematic review of the literature was conducted to identify controlled trails, randomized controlled trials and clinical trials that compared the Carisolv system to the traditional mechanical caries removal in the primary dentition., Materials and Methods: The main relevant databases were searched: MEDLINE via PUBMED, Web of Science and SCOPUS. Complete caries removal, length of working time and need of local anesthesia were the outcomes evaluated., Results: A total of 195 studies were identified and complete analysis of 28 studies was performed; finally, 10 papers were included. The trials included involved a total of 348 patients for 532 treated teeth. There was no significant difference in terms of clinical efficacy between the Carisolv and the rotary instrument (z = 0.68, p = 0.50), whereas the treatment with Carisolv was significantly longer in terms of time with respect to the rotary instruments (z = 10.49, p < 0.01). The chemo mechanical technique reduces the need for local anesthesia, with a difference between two types of treatment near to statistical significance (z = 1.91 p = 0.06)., Conclusions: This systematic review indicates that the clinical efficacy of chemo-mechanical removal with Carisolv seems as reliable as the rotary instruments. However, the results should be interpreted cautiously due to the heterogeneity among study designs and to the shortage of available data. Further large-scale, well-designed randomized controlled trials are needed.

Objectives: Human intrapupal tooth temperature is considered to be similar to that of the body (≈37 °C), although the actual temperature has never been measured. This study evaluated the in vivo, human, basal, coronal intrapulpal temperature of anesthetized upper first premolars., Methods: After approval of the local Ethics Committee was obtained (protocol no. 255,945), upper right and left first premolars requiring extraction for orthodontic reasons from 8 volunteers, ranging from 12 to 30 years old, received infiltrative and intraligamental anesthesia. The teeth (n=15) were isolated using rubber dam and a small, occlusal preparation was made using high-speed handpiece, under constant air-water spray, until a minute pulp exposure was attained. The sterile probe from a wireless, NIST-traceable, temperature acquisition system (Thermes WFI) was inserted directly into the coronal pulp. Once the probe was properly positioned and stable, real-time temperature data were continuously acquired for approximately 25 min. Data (°C) were subjected to 2-tailed, paired t-test (α=0.05), and the 95% confidence intervals for the initial and 25-min mean temperatures were also determined., Results: The initial pulp temperature value (31.8±1.5 °C) was significantly lower than after 25-min (35.3±0.7 °C) (p<0.05). The 95% confidence interval for the initial temperature ranged from 31.0 to 32.6 °C and from 35.0 to 35.7 °C after 25 min. A slow, gradual temperature increase was observed after probe insertion until the pulp temperature reached a plateau, usually after 15 min., Significance: Consistent coronal, human, in vivo temperature values were observed and were slightly, but significantly below that of body core temperature., (Copyright © 2014 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the effect of enzyme-based (Papacárie) and sodium-hypochlorite-based (Carisolv) chemomechanical caries removal methods on bonding of self-etching adhesives to caries-affected dentin, in comparison to the standard rotary-instrument caries removal method., Materials and Methods: Seventy-eight carious permanent molars exhibiting frank cavitation into dentin were used. Forty-eight teeth were randomly divided into three groups, according to the caries excavation methods: (i) Papacárie, (ii) Carisolv and (iii) a round steel bur. After caries removal, each group was subdivided into two groups for two-step (Clearfil SE Bond) or one-step (Clearfil S3 Bond) self-etching adhesive application and resin composite buildups. Bonded specimens were sectioned into beams for microtensile bond strength testing. Bond strength data were analyzed using three-way ANOVA and Tukey's test. For interfacial nanoleakage evaluation using a field-emission scanning electron microscope, caries was similarly removed from the remaining thirty carious molars, bonding was performed as for bond strength testing, and the teeth were sectioned., Results: RESULTS of three-way ANOVA revealed that bond strength was significantly affected by "adhesive" (p<0.001) and "dentin" (p<0.001), but not "caries excavation methods" (p>0.05). The bond strength of the two-step self-etching adhesive was significantly higher than that of the one-step self-etching adhesive (p<0.001). Conversely, the bond strength of self-etching adhesives to sound dentin was significantly higher than to residual caries-affected dentin (p<0.001). Greater silver penetration was observed in the bonded interfaces of residual caries-affected dentin and in interfaces bonded with the one-step self-etching adhesive vs those bonded with the two-step self-etching adhesive., Conclusion: Chemomechanical caries removal did not affect the bonding of self-etching adhesives to caries-affected dentin as compared to caries excavation with rotary instruments.

Aim: This in vitro study was carried out to evaluate the microhardness of enamel adjacent to a glass ionomer cement (GIC) with high fluoride content used as a sealant (Fuji Triage, GC Corp., Japan) after laser, bur or air abrasion treatment procedures., Study Design: 200 freshly extracted non-carious human molars were divided into 10 experimental groups according to the enamel pre-treatment method: A air abrasion (Mach 4.1 Kreativ Inc., USA); AP, Air abrasion + conditioning with 20% polyacrylic acid (GC cavity conditioner); L, Er,Cr:YSGG laser application (Waterlase, Biolase Technology, Inc., San Clemente, USA); LP, Er,Cr:YSGG laser application and fissure conditioning; B, ameloplasty carried out with a diamond bur especially designed for preparing fissures (Komet #8833); BP, ameloplasty + fissure conditioning; P, application of 20% polyacrylic acid and all fissures sealed with GIC; C, no fissure treatment, the material was applied directly to the fissures (control); R, application of 37% orthophosphoric acid and fissures sealed with a resin-based sealant (Fissurit; Voco, Germany) (control); N, no treatment (control). Half of each group of teeth were left in artificial saliva for one month and the rest for three months. The teeth were then sectioned and microhardness was measured using a Vickers test apparatus. Kruskal-Wallis, Mann-Whitney U and Dunn's multiple comparison tests were carried out (5% significance)., Results: After one month results regarding hardness at the base and lateral walls of fissures were significantly higher in groups A, AP, L, LP, B, BP, P and C than in groups R and N (p<0.01), but no difference was seen between the treatment procedures. The results after three months produced similar findings with evenly increased values for all groups., Conclusion: The results of this study showed that the tested GIC with a higher fluoride content seemed to improve the enamel hardness of the fissure enamel and could be regarded as an alternative material in cases where resin sealant applications are questionable.

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., (© 2014 Australian Dental Association.)

Objective: The study was designed to compare changes in pulpal temperature during ablation of dental hard tissue while using two established erbium dental laser systems, a new CO2 laser system, and a conventional high-speed handpiece., Methods: Eighty non-carious human extracted molars were separated into four sample groups of 20 teeth each. Three laser systems were used, respectively, to ablate the occlusal surface of the teeth in three of the groups for 60 seconds each. The high-speed handpiece was used to drill the occlusal surface of the fourth group for 60 seconds. Pulpal temperatures were measured using thermocouples inserted into each tooth's pulpal chamber prior to ablation., Results: None of the average temperature increases approached the threshold of 5.5°C at which pulpal damage begins. On average, the pulpal temperature of teeth ablated with the Waterlase MD system increased the most (3.56°C). The traditional handpiece caused the lowest average temperature increase (1.57°C), followed by the LightWalker DT system (3.20°C) and the Solea CO2 system (3.30°C).

Unlabelled: Infectious diseases endanger all dental personnel during treatment, especially when spatter and aerosols are produced. Therefore, there is a strong need for better infection control principles during all treatments. The purpose of this in-vitro pilot study was to measure the environmental spatter contamination through a fluorescence technique. Scaling was performed using different power-driven devices and high-volume evacuation combined with a newly developed cannula (PS), standard suction cannulas (STS) and saliva ejectors (CDS)., Material and Methods: One sonic (AIR) and two ultrasonic devices (TIG, VEC) were utilized to remove biofilm from 168 artificial teeth in a manikin head. Teeth were scaled for 120s supra- or subgingivally. The spatter contamination of an area of 1.5m2 around the manikin head was assessed., Results and Conclusions: The contaminated area (%) was significantly different for the AIR (median [25th; 75th percentiles]: 2.5 [1.16; 6.05]) versus TIG (0.25 [0.18; 0.88]) and VEC (0.08 [0.06; 0.1]) (p<0.001). Irrespective of the instrument, subgingival scaling led to a less contaminated area (0.18 [0.07; 1.05]) than supragingival scaling (0.34 [0.1; 2.24]) (p < 0.001). High-volume evacuation combined with STS (0.17 [0.07; 1.04]) and PS (0.18 [0.07; 1.14]) reduced the contamination similarly (p=0.302) and was more effective compared to CDS (1.01 [0.12-5.78]) (p<0.001; p=0.002). Beside the limitation of an in-vitro investigation, it can be conclude that only high-volume evacuation with an adequately calibrated cannula is capable of significantly reducing the amount of spatter contamination produced during power-driven scaling.

Purpose: The purpose of this study was to evaluate the influence of prior etching on the sealing of silorane composite restorations in Class V cavity preparations prepared with an Er,Cr:YSGG laser compared to bur preparation in primary teeth., Methods: Standard Class V cavity preparations were prepared on the buccal surfaces of 56 extracted primary canines and randomly divided into four groups of 14 teeth each, according to laser or bur preparation and the use of prior acid etching in the preparation. All cavity preparations were restored with silorane adhesive and silorane composite. After water storage and thermocycling, the specimens were placed in 0.5 percent basic fuchsin dye solution. Dye penetration was evaluated with a stereomicroscope. The data were analyzed with nonparametric tests (P=.05)., Results: Laser preparation and prior etching in bur-prepared cavity preparation had no significant effect on enamel sealing (P>.05), but significantly increased microleakage at the dentin margin (P<.001 and P=.001, respectively). Prior etching in laser-prepared cavity preparations significantly improved sealing at the enamel and dentin margins (P=.009 and P=.003, respectively)., Conclusions: Prior acid etching may be necessary to ensure good marginal sealing when laser preparation is used. However, this step is not required when bur cutting is used in primary teeth.

Purpose: Most studies of cavity preparation using Er:YAG lasers have employed permanent teeth. This study's purpose was to compare the cutting efficiency of an Er:YAG laser versus diamond burs in primary and permanent teeth in order to measure thermal effects on the pulp and evaluate lased surfaces using scanning electron microscopy (SEM)., Methods: A total of 80 primary and permanent teeth were used. Crater depths and mass loss were measured after delivering laser pulses at varying energies onto sound or carious enamel or dentin using the Key-3 laser. Control samples were cut using diamond burs in an air turbine handpiece. Thermal changes were measured using miniature thermocouples placed into the pulp chamber. Lased surfaces were evaluated using SEM., Results: Laser ablation crater-like defects were deeper in dentin than enamel at the same pulse energy. Greater ablation rates for dentin and enamel and significantly more efficient removal of carious tooth structure by laser was present in primary teeth. Temperature rises in the pulp did not exceed the 5.5 degrees Celsius threshold in any teeth during laser ablation., Conclusions: The Er:YAG laser is an efficient device for cavity preparations in primary teeth, with no unacceptable increases in temperature detected in this model.

Goal of contemporary dentistry is to decrease the patient's discomfort during treatment. Dentists aim to achieve maximum with the newly developed dental materials as well as with new cavity preparation techniques in the shortest time span. Since the development of the first constructed borer (drilling machine) for caries removal, the preparation techniques have considerably changed. The progress of dental materials as well as the cavity preparation techniques has led us to contemporary carbide tungsten and diamond borers that are used with obligatory water cooling. The innovation within this field represents newly developed polymer borers that can detect the difference between carious lesions and healthy tooth structure. In this way the cavity preparation may be performed without damaging dental healthy tissue. This is possible owing to their hardness which is lower than the hardness of intact dentin. Polymer borer preparation is painless with less vibration, while the increase in temperature is negligible. Lasers have been used in clinical dentistry since 1980s so it can be said that they represent a new technology. The function of lasers is based on ablation which requires water. Erbium lasers have shown the highest potential with their ability to produce effective ablation of hard dental tissues. Laser application in dentistry requires special training as well as some protective measures. Laser advantages, compared to traditional preparation techniques, involve the absence of vibration, painless preparation, possibility of preparation without anesthetic and easier patient's adjustment to dental intervention which is of importance, especially in pediatric dentistry.

This study evaluated the performance of dental students versus prosthodontics residents on a simulated caries removal exercise using a newly designed, 3D immersive haptic simulator. The intent of this study was to provide an initial assessment of the simulator's construct validity, which in the context of this experiment was defined as its ability to detect a statistically significant performance difference between novice dental students (n=12) and experienced prosthodontics residents (n=14). Both groups received equivalent calibration training on the simulator and repeated the same caries removal exercise three times. Novice and experienced subjects' average performance differed significantly on the caries removal exercise with respect to the percentage of carious lesion removed and volume of surrounding sound tooth structure removed (p<0.05). Experienced subjects removed a greater portion of the carious lesion, but also a greater volume of the surrounding tooth structure. Efficiency, defined as percentage of carious lesion removed over drilling time, improved significantly over the course of the experiment for both novice and experienced subjects (p<0.001). Within the limitations of this study, experienced subjects removed a greater portion of carious lesion on a 3D immersive haptic simulator. These results are a first step in establishing the validity of this device.

The concept of minimal intervention in oral medicine is based on advances in biological sciences applied to the dental organ. Many cultural barriers, economic as well as technical, have thwarted the application of micro-invasive conservative techniques by the general practitioner. Emerging technologies do not remove all obstacles but promote the integration of less invasive techniques in daily practice. Sono-abrasion is a technique for the selective preparation of enamel and dentine offering excellent efficacy, quality and safety. The authors describe the therapeutic principles, the choice of instrumentation and its mode of action and discuss its interest in adhesive restorative dentistry. The illustrated clinical situations focus on the preservation and optimisation of tissue bonding for both initial lesions and advanced lesions.

Unlabelled: The aim of this study is to investigate different instruments for finishing composite restorations, as well as examining different surfaces and interfaces of the same restoration. The null hypothesis is represented by the fact that there are no significant differences on roughness of composite restorations finishing between tungsten carbide and diamond burs, furthermore the null hypothesis is that there are no significant differences on roughness between finishing on composite surfaces (C), compositeenamel (CE) and composite-dentin (CD) interfaces. The study was performed on 28 teeth, and class V cavities were prepared on the extracted teeth. Restorations were done in Filtek XTE nanofilled composite (3M Espe) in a standardized method, to then be finished. A comparison was made in the phase 1 between tungsten carbide burs (16 blades), diamond burs (46 μm), with a similar shape by the same manufacturer (Komet). Each surface received 5 bur applications. Consequently, an analysis with a profilometer was performed. Phase 2 involved further confrontation of ulterior finishing with ultrafine tungsten carbide burs (30 blades) and with extra and ultrafine diamond burs (25 and 8 μm) (the same shape as previously mentioned). A second analysis was then performed with a profilometer. All measurements were taken on C surfaces, CE and CD interfaces. Statistical analyses were carried out with c2 test (a = 0.05)., Conclusions: The finishing procedures with fine grit or toothing burs gave a better smoothness with tungsten carbide burs compared to diamond burs. While with the ultrafine grit no significant differences were noted between tungsten carbide and diamond burs on the CE and CD interfaces, the diamond bur left less superficial roughness on the C surfaces. With regards to the superficial roughness of the different areas of restoration, it can be concluded that: minor roughness was detected on C surfaces, while the CD interface had the most superficial roughness, regardless of whether the diamond burs or tungsten carbide burs were used. This study shows some statistical differences that could not be clinically perceivable. The clinical relevance could be resumed as follows: the fine tungsten carbide burs provided less roughness compared to a fine diamond bur. There were no differences between the ultrafine tungsten carbide and diamond burs. The less favourable interface to be finished is CD, compared to the CE interface and C surfaces.

Aim: The aim of the present study was to determine the success rate after 12 months of follow-up in a series of cases in which chemo-mechanical caries removal (CMCR) was performed with Papacarie(TM), followed by restoration with glass ionomer cement., Background: The development of conservative techniques for carious tissue removal and improvements in dental restoration materials have allowed better preservation of dental structures in the treatment of decayed teeth. Chemo-mechanical caries removal (CMCR) is a conservative atraumatic treatment option. Papacarie(TM) is a papain-based material developed to act only on the carious dentin, allowing its easy removal with a blunt curette., Case Report: The study involved a total of 84 deciduous posterior teeth with occlusal dentinal caries. Only teeth without risk of pulp exposure were studied. After a period of 12 months, the restorations were evaluated based on criteria employed in previous studies. The radiographic evaluation revealed resorption and calcification of the affected teeth. The data were submitted to descriptive statistical analysis with the aid of the XLSTAT program. The success rate was 88.1% and 98.8% based on the clinical and radiographic evaluations, respectively. The difference between the success and failure rates was statistically significant (p < 0.0001)., Conclusion: Papacarie(TM) is an effective product for CMCR on occlusal dentinal tissue in deciduous teeth, demonstrating a high clinical and radiographic success rate after 12 months of follow-up.

Purpose: To evaluate the influence of long-term water storage and thermocycling on the shear bond strength of a glass-ionomer cement to Er:YAG-irradiated and bur-prepared dentin., Materials and Methods: Fifteen bovine incisors were selected and the roots removed. Crowns were sectioned into four pieces, resulting in 60 samples that were individually embedded in polyester resin (n = 15) and ground to plane the enamel and expose the dentin. The bonding site was delimited and samples were randomly assigned according to the method of cavity preparation: Er:YAG laser (250 mJ/4 Hz) or high-speed handpiece (diamond bur #2096). Samples were fixed to a metallic device, where glass-ionomer cement (GIC) cylinders were prepared. Subsequently, they were subdivided according to the duration of water storage (WS) and number of thermocycles (TCs) - 24 h WS/no TCs and 6 months WS/12,000 TCs - and subjected to a shear bond strength test (500 N at 0.5 mm/min)., Results: The duration of water storage and number of thermocycles tested had no statistically significant effect on the shear bond strength to laser-irradiated dentin (p > 0.05). For bur-prepared substrate, the long-term degradation process promoted a decrease in shear bond strength values (p < 0.05)., Conclusion: Long-term water storage and thermocycling did not affect shear bond strength of glass-ionomer cement bonded to Er:YAG laser-prepared dentin.

Purpose: To evaluate and compare the use of micro-computed tomography (microCT) to investigate the mineral concentration of the treated dentin surface after caries removal with fluorescence-aided caries excavation (FACE) and conventional excavation., Methods: 20 extracted human teeth with dentin caries were bisected through the lesion center into two halves which were distributed to a FACE and a conventional excavation group. Tungsten-carbide round burs were used for both groups. Each specimen was investigated with microCT after excavation. The obtained images of all the specimens were evaluated using Image J. Based on the grey values, the linear attenuation coefficients were calculated. Four resin-embedded solid hydroxyapatite phantoms with the gradually increased mineral concentration were used to obtain a calibration curve and equation. Finally, the mineral concentration values of the superficial dentin of each specimen after removal and sound dentin were calculated. The data were compared with the Student's t-test., Results: The statistical results showed that the linear attenuation coefficient (LAC) of the treated surface was significantly lower (P < 0.0001) in the FACE group with a mean value of 2.13 +/- 0.33 cm9-1). The value of the conventional excavation group was 2.98 +/- 0.19 cm(-1). The LAC of sound dentin was 3.89 +/- 0.10 cm(-1). By using the calibration equation, the calculated mineral concentration of the superficial dentin after caries removal were 0.68 +/- 0.14 g/cm3 in the FACE group and 1.05 +/- 0.08 g/cm3 in the conventional excavation group. The mineral concentration of sound dentin was 1.44 +/- 0.04 g/cm3. The mineral concentration of the superficial dentin after caries removal in the FACE group was about 47% of that of sound dentin, while the value in the conventional excavation group was approximately 73% of that of sound dentin. Under the conditions of this in vitro study, the results of the microCT evaluation may imply that FACE was more conservative than conventional excavation.

The aim of this in vitro study was to optimise clinical parameters and the energy density of Er:YAG laser-conditioned dentin for class V fillings. Shear tests in three test series were conducted with 24 freshly extracted human third molars as samples for each series. For every sample, two orofacial and two approximal dentin surfaces were prepared. The study design included different laser energies, a thin vs a thick bond layer, the influence of adhesives as well as one-time- vs two-time treatment. The best results with Er:YAG-conditioned dentin were obtained with fluences just above the ablation threshold (5.3 J/cm(2)) in combination with a self-etch adhesive, a thin bond layer and when bond and composite were two-time cured. Dentin conditioned this way reached an averaged bond strength of 23.32 MPa (SD 5.3) and 24.37 MPa (SD 6.06) for two independent test surfaces while showing no statistical significance to conventional dentin adhesion and two-time treatment with averaged bond strength of 24.93 MPa (SD 11.51). Significant reduction of bond strength with Er:YAG-conditioned dentin was obtained when using either a thick bond layer, twice the laser energy (fluence 10.6 J/cm(2)) or with no dentin adhesive. The discussion showed clearly that in altered (sclerotic) dentin, e.g. for class V fillings of elderly patients, bond strengths in conventional dentin adhesion are constantly reduced due to the change of the responsibles, bond giving dentin structures, whereas for Er:YAG-conditioned dentin, the only way to get an optimal microretentive bond pattern is a laser fluence just above the ablation threshold of sclerotic dentin.

Purpose: To evaluate the influence of resin cements and aging on cuspal deflection, fracture resistance, and mode of failure of endodontically treated teeth restored with composite resin inlays., Materials and Methods: Seventy-two maxillary premolars were divided into 6 groups: 1: sound teeth as control (C); 2: preparations without restoration (WR); 3: inlays luted with RelyX ARC (ARC); 4: inlays luted with RelyX Unicem (RLXU); 5: inlays luted with Maxcem Elite (MCE); 6: inlays luted with SeT (ST). Groups 2 to 6 received mesio-occlusal-distal preparations and endodontic treatment. Stone casts were made for groups 3 to 6. Composite resin inlays were built over each cast and luted with the resin cements. A 200-N load was applied on the occlusal aspect and the cuspal deflection was measured using a micrometer before and after 500,000 cycles of fatigue loading (200 N; 500,000 cycles). The specimens were then submitted to an axial load until failure., Results: The median cuspal deflection (µm) and median fracture resistance (N) were calculated and statistically analyzed using Kruskal-Wallis and Mann-Whitney tests (p < 0.01). Values followed by the same letter represent no statistically significant difference. Cuspal deflection before cyclic loading: C = 3 µma; ARC = 4 µmab; RLXU= 5 µmab; MCE = 21 µmb; ST = 51 µmbc; WR = 69 µmc. Cuspal deflection after cyclic loading: ARC = 6 µma; RLXU = 19 µmab; MCE = 33 µmb; ST = 62 µmb. Fracture resistance in N: C = 1902a; ARC = 980b; RLXU = 670c; MCE = 533c; ST = 601c; WR = 526c. According to the Wilcoxon test, there was no statistical difference between the cuspal deflection before and after cyclic loading only for ARC (p = 0.015). There was a predominance of recovery fractures for the restored groups., Conclusion: Composite resin inlays luted with RelyX ARC maintained cuspal deflection stability and showed higher fracture resistance of the teeth than did inlays luted with the other cements tested.

Statement of Problem: The loss of tooth structure can increase cuspal flexure, thereby reducing the fracture resistance of the tooth, or open the tooth-restoration interface, leading to microleakage., Purpose: The purpose of this study was to evaluate tooth strain in teeth with different cavity preparations after loading and unloading., Material and Methods: Ten intact human maxillary premolars were selected and embedded in epoxy resin molds. Constantan strain gauges were used and tested as an intact tooth (group I), occlusal cavity (group O), mesio-occlusal cavity (group MO), and finally mesio-occluso-distal cavity (group MOD). All teeth were subjected to gradual nondestructive occlusal loading and unloading (50 N, 70 N, 90 N, 110 N, 130 N, 50 N, 0 N) in a servohydraulic testing machine. All data were analyzed statistically by performing a repeated measures ANOVA with load and cavity as factors to compare the relevant mean strains, and a Bonferroni post hoc test was performed for multiple comparisons (α=.05)., Results: The repeated measures ANOVA did not provide any evidence of an interaction between load and cavity but indicated a significant difference in the mean strains both between the loads (P<.001) and between the cavity groups (P<.001)., Conclusions: MOD cavities presented statistically significantly higher values of strain than MO, O, or intact teeth, and a significant increase in the values of mean strain for all cavities was observed, even with intact teeth, when nondestructive occlusal loading was increased., (Copyright © 2013 Editorial Council for the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Aim: To observe the effects of glass-ionomer cement (GIC) lining on the risk of pulpal complications in deep occlusal cavities with resin-based restorations., Methods: Fifty-three patients, aged 18-30 years, who had one or two deep occlusal carious lesions (≥3 mm in depth) in molars, were recruited. Dental caries were removed, and the prepared cavity was restored with resin composite using one of two restorative procedures: (a) without GIC lining; and (b) with (resin-modified) GIC lining. Restored teeth were evaluated for any pulpal complications (subjective symptoms, objective signs or loss of tooth vitality) at 1 month (baseline), 1 year, and 2 years after restoration., Results: After excluding shallow cavities, 31 restorations without GIC lining, and 31 restorations with GIC lining, were placed and recalled at baseline without any pulpal complications. At the 1- and 2-year recalls, six patients who had restorations in group 1, and 13 in group 2, had dropped out. None of the remaining teeth in the two groups exhibited pulpal complications at either recall period, regardless of GIC lining placement., Conclusions: The absence of GIC lining does not increase the risk of pulpal complications in deep occlusal cavities restored with resin-based restorations in either the short or long term., (© 2013 Wiley Publishing Asia Pty Ltd.)

Aim: The aim of this in vitro study is to evaluate the effects of three different caries removal techniques on the microtensile bond strength of adhesive materials to caries-affected dentin., Materials and Methods: Thirty primary molar teeth were used. The teeth were randomly divided into three groups according to the caries removal technique employed: conventional steel bur (group 1); Er:YAG laser (group 2); chemomechanical method (group 3). Each group was divided into two subgroups according to bonding agents: one-step self-etch adhesive and etch-and-rinse adhesive. The teeth were restored with composite resin. Vertical sticks were obtained and subjected to tensile stress. Data were analyzed by two-way analysis of variance (ANOVA), Tukey's test and an independent samples t-test., Results: The values for the laser groups were significantly lower than those of the bur groups for both bonding agents (p<0.05). There were no significant differences between the bur and chemomechanical groups (p > 0.05)., Conclusion: Bur and chemomechanical techniques in primary teeth were found more successful. Similar results were found according to the adhesives used for each caries removal techniques.