Karthik Venkataraghavan. Sanand, Ahmedabad — Email: ni. Copyright J. Abstract The invention and application of engine driven or rotary instruments in operative treatment of carious lesions has resulted in removal of considerable toothe structure.
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Karthik Venkataraghavan. Sanand, Ahmedabad — Email: ni. Copyright J. Abstract The invention and application of engine driven or rotary instruments in operative treatment of carious lesions has resulted in removal of considerable toothe structure. However, with the introduction of adhesive materials for restorations, and the advent of minimal cavity design this principle has been challenged and is now considered to be too destructive to the tooth structure during caries removal.
A number of techniques are available for cutting tooth tissue. The present study was carried to study the effect of an indigenously developed caries removal agent viz. J Int Oral Health ; 5 4 Keywords: Chemo mechanical Caries Removal, Dental Caries, Primary Teeth, Papain gel Introduction The invention and application of engine driven or rotary instruments in operative treatment of carious lesions has resulted in removal of considerable tooth structure 1.
He had initially proposed that the removal of sound tooth structure at sites that would otherwise encourage stagnation of plaque like occlusal fissure, approximal contacts, etc. However, with the introduction of adhesive materials for restorations, and the advent of minimal cavity design this principle has been challenged and is now considered being too destructive to the tooth structure during caries removal 2.
Techniques of tissue Removal A number of techniques are available for cutting tooth tissue. While some claim, to remove demineralized dentin selectively, others are unable to distinguish this and are not able to remove the softened dentin effectively 1. Having said this there are problems that need to be overcome. Air Abrasion: RB Black in started preliminary investigations into an alternative pseudo-mechanical method of caries removal which involved bombarding the tooth surface with high-velocity particles Aluminum oxide , carried in a stream of air 5.
Air Polishing: This is a process of adding tricalcium phosphate to improve the flow to water soluble particles of sodium bicarbonate and applying this mix to the tooth surface using air pressure coupled with a concentric water jet 8 - 9 which is the contrasting difference between this technique and air abrasion.
The interesting fact that the abrasive is water-soluble ensures that it does not escape from the operating field But as this is non selective, its overzealous use could easily remove a considerable amount of tooth structure especially in the cervical margin 11 - A magnetostrictive instrument with a 25KHz oscillating frequency was developed for this purpose which was used in conjunction with a thick aluminium oxide and water slurry.
The kinetic energy of the water molecules was transferred to the tooth surface via the abrasive through high speed oscillations of the tip. However the results were inconclusive due to erratic and unpredictable performance of the instrument Sono-Abrasion: It is the use of high frequency, sonic, air-scalers with modified abrasive tips. Favorable results from laboratory studies using sono-abrasion to remove softened, carious dentine have indicated possible use for this technique in the future 15 - This system was developed as a chemo-mechanical method for caries removal.
Carious dentine, softened further by NMAB GKE , should have been readily removed by lightly abrading its surface with the applicator tip. Many studies have indicated that in permanent teeth, the ability of carious dentine removal using NMAB was no greater than using a control of isotonic solution. In deciduous teeth, however, addition of urea to the solution significantly improved carious dentine excavation compared with the some control solution without urea 19 - A gel based system was then developed and the carisolv gel was introduced to be used with specially designed non-cutting hand instruments to abrade the carious dentine surface.
This gel consists of two carboxymethycellulose based gels: a red gel containing 0. The two are thoroughly mixed in equal parts at room temperature before use and then applied, using hand instrument onto the exposed carious dentine to leave a hard, caries free cavity.
The gel consistency will allow the active molecules access to dentine for a longer period that the equivalent irrigating solution in the caridex system. It is also highly probable that the gel has a mechanical lubricating action for the hand instrument which will also aid in the removal of the softened tissue. Results from various clinical trials have indicated increased patient compliance to this technique over the use of the dental drill to excavate carious dentine More recently proteolytic agents, such as papain and sodium hypochlorite can be used to further degrade the partially demineralized and altered dentin matrix that has been previously exposed to bacterial action infected dentin , thus facilitating its removal and preventing damage to the underlying remineralizable tissue affected dentine 1.
The papain enzyme part-icularly, a plant derived cysteine protease of broad proteolytic activity has been used as a chem. This selective interaction of the enzyme with the affected components of the carious dentin has been suggested to be due to the lack of an antiprotease of 1-anti-trypsin, which inhibits protein digestion in sound collagen — based tissues 22 - This paper introduces a new papain based chemomechanical caries removal agent — Carie Care. Carie Care In Chemo mechanical method partially degraded collagen in carious dentine will be chlorinated by chemomechanical caries removal solutions.
Carious material removal was thus facilitated. The main advantage of this method is that it does not require complete patient cooperation. Carie care - a product that has been locally introduced has as its main active ingredient from papaya extract - an endoprotein, chloramines and dye.
In addition the preparation contains specific percentages of essential oils from plant sources, which has anti-inflammatory and mild anesthetic effect. The preparation also contains explicit gelling agent in accurate percentage to give exact consistency to the gel so that when applied there is no spill over. The main agents in all these existing gels used in chemo mechanical caries removal consists of a mixture of sodium hypochlorite and three amino acids lysine, leucine and glutamic acid in a gel preparation.
It softens the carious dentine which is then hand excavated and claims that it will not affect the underneath healthy affected dentine. The liquids are mixed just before the treatment and then applied on carious cavity. The mixture cannot be stored and reused.
However present gel preparation does not contain sodium hypochlorite or any other strong chlorinating agent instead has most of the ingredients from natural sources. None of earlier preparations including Papacarie contain essential oils which we have incorporated in our preparation for the first time and which act as anti-inflammatory agent. Carie Care not only softens infected dentine but gives additional advantage of anti-inflammatory activity and aroma.
Carie Care is applied directly onto the tooth having caries by means of a disposable applicator tip; soon gel changes the color in the affected area. After 1 minute the gel along with dissolved caries is removed by means of a Sharp Spoon Excavator.
Carie Care is in the form of single preparation, which can be stored at 4oC for more than 6 months.
Chemochemical caries removal: a review of the techniques and latest developments
As possible alternatives to conventional techniques of caries removal, chemomechanical caries removal systems have emerged. This study aims to clinically observe the advantages of chemomechanical method of caries removal over conventional technique. Materials and Methods: Inthis randomized controlled trial a total of 60 children with Class 1 open carious lesions were selected for the study. They were divided into two equal groups according to a method of caries removal 30 chemomechanical and 30 conventional on permanent molars. In Group A, caries was removed using the Carie-Care system and in Group B with the conventional drill and were restored equally with glass ionomer cement.
Ghanashyam Prasad Email: moc. This article has been cited by other articles in PMC. Abstract Objective: To compare the effectiveness of various caries removal techniques in mandibular primary molars using Smart Burs, atraumatic restorative technique ART mechanical caries removal and Carie-care chemomechanical caries removal [CMCR] among primary school children in clinical and community-based settings. Materials and Methods: A total of 80 carious primary mandibular molars were selected for the study from the dental clinic and community. They were equally assigned to four groups according to caries removal technique and also by the operating site.