Dental caries is a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues. Caries can occur throughout life, both in primary and permanent dentitions, and can damage the tooth crown and, in later life, exposed root surfaces. The balance between pathological and protective factors influences the initiation and progression of caries. This interplay between factors underpins the classification of individuals and groups into caries risk categories, allowing an increasingly tailored approach to care. Dental caries is an unevenly distributed, preventable disease with considerable economic and quality-of-life burdens. The daily use of fluoride toothpaste is seen as the main reason for the overall decline of caries worldwide over recent decades. This Primer aims to provide a global overview of caries, acknowledging the historical era dominated by restoration of tooth decay by surgical means, but focuses on current, progressive and more holistic long-term, patient-centred, tooth-preserving preventive care.
The long-term durability of bonds between adhesive resins and dentin is of significant importance for the longevity of bonded restorations. We carried out an in vivo one-year study to evaluate the durability of resin-dentin bonds in the oral cavity, as well as to test the hypothesis that the adhesive interface would show morphological changes in vivo over time. Very shallow saucer-shaped dentin cavities were prepared in 12 intact teeth of one Japanese monkey (Macaca fuscata) under general anesthesia. The cavities were restored with Clearfil Liner Bond II and Clearfil Photo Posterior resin composite. The teeth were extracted at three different times: immediately, and 180 and 360 days after placement of the restorations. One day after the monkey was killed, specimens of the three time periods were subjected to the micro-tensile bond test at a crosshead speed of 1 mm/min. The surfaces of the failed bonds were observed under a field emission scanning electron microscope (FE-SEM). Bond strength measurements in this study were successfully performed and were stable at approximately 19 MPa during the one-year testing. Scanning electron microscopic observations of the failed surfaces revealed, at the top of the hybrid layer and within the adhesive resin, porosity which increased over time. Long-term bonds can be assessed in vivo by the combined evaluation of the microtensile bond strength and SEM morphological examination of the adhesive interface.
Tensile bond strength measurements are commonly used for the evaluation of dentin adhesive systems. Most tests are performed using extracted non-carious human or bovine dentin. However, the adhesion of resins to caries-affected dentin is still unclear. The objectives of this study were to test the hypothesis that bonding to caries-affected dentin is inferior to bonding to normal dentin, and that the quality of the hybrid layer plays a major role in creating good adhesion. We used a micro-tensile bond strength test to compare test bond strengths made to either caries-affected dentin or normal dentin, using three commercial adhesive systems (All Bond 2, Scotchbond Multi-Purpose, and Clearfil Liner Bond II). For scanning electron microscopy, the polished interfaces between the adhesive bond and dentin were subjected to brief exposure to 10% phosphoric acid solution and 5% sodium hypochlorite, so that the quality of the hybrid layers could be observed. Bonding to normal dentin with either All Bond 2 (26.9 +/- 8.8 MPa) or Clearfil Liner Bond II (29.5 +/- 10.9 MPa) showed tensile bond strengths higher than those to caries-affected dentin (13.0 +/- 3.6 MPa and 14.0 +/- 4.3 MPa, respectively). The tensile bond strengths obtained with Scotchbond Multi-Purpose were similar in normal and caries-affected dentin (20.3 +/- 5.5 MPa and 18.5 +/- 4.0 MPa, respectively). The hybrid layers created by All Bond 2 in normal dentin and by Clearfil Liner Bond II in normal or caries-affected dentin showed phosphoric acid and sodium hypochlorite resistance, whereas the hybrid layers created by All Bond 2 in caries-affected dentin and those created by Scotchbond Multi-Purpose to normal and caries-affected dentin showed partial susceptibility to the acid and sodium hypochlorite treatment. The results indicate that the strength of adhesion to dentin depends upon both the adhesive system used and the type of dentin. Moreover, the quality of the hybrid layer may not always contribute significantly to tensile bond strength.
Effective ablation of dental hard tissues by means of the erbium-doped:yttrium-aluminum garnet (Er:YAG) laser has been reported recently, and its application to caries removal and cavity preparation has been expected. However, few studies have investigated the capability of the Er:YAG laser to treat caries. In the present study, the effectiveness of caries removal by using an Er:YAG laser in vitro was compared with that of conventional mechanical treatment. Thirty-one extracted human teeth with root caries were used. Half of the caries in each tooth was treated with the Er:YAG laser, and the other was removed with a conventional bur or was left untreated as a control. Laser treatment was performed by means of a combination of contact and non-contact irradiation modes with cooling water spray, with a new fiber delivery and contact probe system. Conventional bur treatment was conducted by means of a low-speed micromotor. Measurements of the time required for caries removal, histopathological observations of decalcified serial sections, scanning electron microscope (SEM) observations, and hardness measurements of the treated cavity-floor dentin were performed for each treatment. Due to the careful irradiation technique, a longer treatment time was required for the complete removal of carious dentin by the Er:YAG laser. However, the Er:YAG laser ablated carious dentin effectively with minimal thermal damage to the surrounding intact dentin, and removed infected and softened carious dentin to the same degree as the bur treatment. In addition, a lower degree of vibration was noted with the Er:YAG laser treatment. The SEM examination revealed characteristic micro-irregularities of the lased dentin surface. Our results show that the Er:YAG laser system is promising as a new technical modality for caries treatment.
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