In vitroRemineralization of Caries-affected Dentin after Selective Carious Tissue Removal

Abstract

Aim: This study aimed to evaluate the mineral deposition and microhardness within the retained caries-affected dentin (CAD) after excavation with Carisolv™ gel or rotary burs. Materials and methods:Totally 20 extracted human carious molars, with caries extending into the middle third of dentin, were sectioned mesiodistally. The carious tissue in each hemi-section was excavated with gel or bur and restored with a mineral trioxide aggregate (MTA) base and resin composite. Five sound posterior teeth were hemi-sected to serve as a control. Twenty-five hemi-sections were stored in distilled water (DW) and the other 25 were stored in simulated body fluid (SBF). Each sample was scanned and tested using Raman spectroscopy and Knoop microhardness respectively, at the MTA-dentin interface at day 1 and 14. Scanning electron microscope (SEM) was used to assess the surface topography of dentin after excavation with gel/bur. Results:The results show that the baseline mineral content and microhardness of dentin were significantly lower in Carisolv™treated samples in comparison with that treated with burs (p ≤ 0.05). However, there were comparable mineral levels in the two groups after 14 days' storage in SBF (p ≥ 0.05), which showed statistically insignificant differences from the sound control (p ≥ 0.05). Microhardness and mineral contents decreased significantly in the sound control after 14 days' storage in DW (p ≤ 0.05). The SEM images showed partially open dentin tubules with less smear layer after Carisolv™ excavation compared with more occluded dentin tubules with an abundance of smear layer after bur excavation. Conclusion:Although gel excavation retains more CAD in comparison with bur, remineralization of this remaining tissue is evident after 2 weeks. Clinical significance:The use of Carisolv™ gel provides an alternative to rotary burs in terms of preserving the tooth structure and not hindering the remineralization potential of valuable tooth structure, a clinical advantage for minimally invasive dentistry.

Chemo-mechanical characterization of carious dentine using Raman microscopy and Knoop microhardness

“…The CID layer has lower KHN value because of greater dissolution of HA compared with the deeper CAD layers [26,27]. Thereby, hardness values have become a global validation to evaluate the effectiveness of mechanical caries removal techniques [5,10,12,23,28]. The data from this study regarding the levels of microhardness agrees with previous studies in that the hardness increases from superficial heart of the lesion towards the inner (deeper) lesion surface of carious dentine.…”

“…Recently, the biochemical tissue changes occurring during the caries process have gained significant research interest, as these insights aid understanding of the pathophysiology of lesion development during the caries process, and this knowledge can assist development of approaches to help remineralize/heal such compromised dental tissues as opposed to surgically excising them and replacing them with biologically inadequate artificial biomaterials [12,13]. Raman spectroscopy has emerged in the dental field as a non-invasive technology for in vitro studies, after sectioning the teeth, to characterize chemically both healthy and carious dentine, through the characteristic molecular vibrational energy signatures [14].…”

Self-Limiting versus Rotary Subjective Carious Tissue Removal: A Randomized Controlled Clinical Trial—2-Year Results

“…However, this caries-affected layer needs to be remineralized, therefore the use of MTA in such cases is recommended. Carious teeth excavated with CarisolvTM gel and capped with MTA in vitro showed an increase in mineral deposition and surface hardening in the caries-affected dentine layer up to the level of sound dentine after a storage period [ 26 ]. In addition, microbiological investigations suggest that different bacteriological prints of the remaining carious dentine between the two excavation protocols may refer to the varied ecological effect of each excavation process on the microbiome of the remaining dentine after the excavation process.…”

Vibrational Imaging Techniques for the Characterization of Hard Dental Tissues: From Bench-Top to Chair-Side

“…It is known that the organic component can act as an inhibitor of hydroxyapatite crystals' growth during the processes of formation and development of caries, causing organic and inorganic biochemical alterations [68,93]. Therefore, a detailed analysis of these biochemical changes is mandatory to assess the best approach to help with remineralization of compromised dental tissue [94,95].…”