Dentin Topographic Features following Chemomechanical Caries Removal in Primary Teeth

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.

Chemomechanical caries removal, dentin caries, primary teeth, Papacarie.

1. Beeley JA, Yip HK and Stevenson AG. Chemochemical caries removal: a review of the techniques and latest developments. Br Dent J 188: 427-30, 2000.

2. Maragakis GM, Hahn P and Hellwig E. Clinical evaluation of chemomechanical caries removal in primary molars and its acceptance by patients. Caries Res 35: 205-10, 2001.

3. Hamama H, Yiu C and Burrow M. Current update of chemomechanical caries removal methods. Aust Dent J 59: 446-56, 2014.

4. Osata JA, Santiago LA, Remo GM, Cuadra MS and Mori A. Antimicrobial and antioxidant activities of unripe papaya. Life Sci 53: 1383-9, 1993.

5. Kimmel JR and Smith EL. The properties of papain. Adv Enzymol Relat Subj Biochem 19: 267-334, 1957.

6. Bussadori SK, Castro LC and Galvão AC. Papain gel: a new chemo-mechanical caries removal agent. J Clin Pediatr Dent 30: 115-9, 2006.

7. Kotb RM, Abdella AA, El Kateb MA and Ahmed AM. Clinical evaluation of Papacarie in primary teeth. J Clin Pediatr Dent 34: 117-23, 2009.

8. Motta LJ, Bussadori SK, Campanelli AP, da Silva AL, Alfaya TA, de Godoy CH and Navarro MF. Pain during removal of carious lesions in children: a randomized controlled clinical trial. Int J Dent 2013; 2013:896381. doi: 10.1155/2013/896381.

9. Corrêa FN, Rodrigues Filho LE and Rodrigues CR. Evaluation of residual dentin after conventional and chemomechanical caries removal using SEM. J Clin Pediatr Dent 32: 115-20, 2007.

10. Nakabayashi N. The hybrid layer: a resin-dentin composite. Proc Finn Dent Soc 88: 321-9, 1992.

11. Goldman M, Siu L, White RR and Kronman JA. The dentinal surface of composite restorations after chemo-mechanical caries removal. J Pedod 12: 157-66, 1988.

12. Sakoolnamarka R, Burrow MF, Kubo S and Tyas MJ. Morphological study of demineralized dentine after caries removal using two different methods. Aust Dent J 47: 116-22, 2002.

13. Yazici AR, Ozgunaltay G and Dayanagac B. A scanning electron microscopic study of different caries removal techniques on human dentin. Oper Dent 27: 360-6, 2002.

14. Tonami K, Araki K, Mataki S and Kurosaki N. Effects of chloramines and sodium hypochlorite on carious dentin. J Med Dent Sci 50: 139-46, 2003.

15. Lager A, Thornqvist E and Ericson D. Cultivable bacteria in dentin after caries excavation using rose-bur or carisolv. Caries Res 37: 206-11, 2003.

16. Corrêa FN, Rocha Rde O, Rodrigues Filho LE, Muench A and Rodrigues CR. Chemical versus conventional caries removal techniques in primary teeth: a microhardness study. J Clin Pediatr Dent 31: 187-92, 2007.

17. Torii Y, Itou K, Nishitani Y, Ishikawa K and Suzuki K. Effect of phosphoric acid etching prior to self-etching primer application on adhesion of resin composite to enamel and dentin. Am J Dent 15: 305-8, 2002.

18. Perdigao J. An ultra-morphological study of human dentine exposed to adhesive systems. PhD thesis, Leuven: Catholic University of Leuven, 1995.

19. Arora R, Goswami M, Chaudhary S, Chaitra TR, Kishor A and Rallan M. Comparative evaluation of effects of chemo-mechanical and conventional caries removal on dentinal morphology and its bonding characteristics - an SEM study. Eur Arch Paediatr Dent 13: 179-84, 2012.

20. Ericson D, Zimmerman M, Raber H, Götrick B, Bornstein R and Thorell J. Clinical evaluation of efficacy and safety of a new method for chemo-mechanical removal of caries: A multi-centre study. Caries Res 33: 171-7, 1999.

21. Casamassimo PS, Fields HW, McTigue DJ and Nowak AJ. Pediatric Dentistry; Infancy through Adolescence. 5th ed. St. Louis, Missouri: Elsevier Saunders; 309-18, 2013.

22. Yip HK, Stevenson AG and Beeley JA. Chemomechanical removal of dental caries in deciduous teeth: further studies in vitro. Br Dent J 186: 179-82, 1999.

23. Banarjee A, Kidd EA and Watson TF. In vitro evaluation of five alternative methods of carious dentine excavation. Caries Res 34: 144-50, 2000.

24. Magalhães CS, Moreira AN, Campos WR, Rossi FM, Catilho GAA and Ferreira RC. Effectiveness and efficiency of chemo-mechanical carious dentin removal. Braz Dent J 17: 63-7, 2006.

25. Maragakis GM, Hahn P and Hellwig E. Chemomechanical caries removal: a comprehensive review of the literature. Int Dent J 51: 291-9, 2001.

26. Eick JD, Gwinnett AJ, Pashley DH and Robinson SJ. Current concepts on adhesion to dentin. Crit Rev Oral Biol Med 8: 306-35, 1997.

27. Banerjee A, Kidd EA and Watson TF. Scanning electron microscopic observations of human dentine after mechanical caries excavation. J Dent 28: 179-86, 2000.

28. Elkashlan HI. A Clinical and laboratory evaluation of a chemo-mechanical method of caries removal in primary teeth. PhD thesis, Faculty of Dentistry, Alexandria University, 2003.

29. Cardoso PEC, Moura SK, Miranda JR and Santos JFF. Caries removal: SEM analysis. J Dent Res 80: Abstr 317, 2001.

30. Hahn P, Vongerichten M and Hellwig E. Comparison of the efficacy of caries removal with carisolv versus round burs. Dtsch Zahnarztl Z 56: 184-8, 2001.

31. Cederlund A, Lindskog S and Blomfől J. Efficacy of Carisolv-assisted caries excavation. Int J Periodontics Restorative Dent 19: 465-9, 1999.

32. Fusayama T. New Concepts in the Pathology and Treatment of Dental Caries: A Simple Pain-Free Adhesive Restorative System by Minimal Reduction and Total Etching. Tokyo: Ishiyaku Euro America Inc; 1-21, 1993.

33. Sathyakumar T. Effect of Carisolv on microhardness, surface topography and inorganic composition. Cariology Research, 2004. Available at: https://iadr.confex.com/iadr/sea04/techprogram/abstract_51752.htm

34. Hamama HH, Yiu CK, Burrow MF and King NM. Chemical, morphological and microhardness changes of dentine after chemomechanical caries removal. Aust Dent J 58: 283-92, 2013.

35. Kuboki Y, Ohgushi K and Fusayama T. Collagen biochemistry of the two layers of carious dentin. J Dent Res 56: 1233-7, 1977.

36. Ohgushi K and Fusayama T. Electron microscopic structure of the two layers of carious dentin. J Dent Res 54: 1019-26, 1975.

37. Nakornchai S, Atsawasuwan P, Kitamura E, Surarit R and Yamauchi M. Partial biochemical characterisation of collagen in carious dentin of human primary teeth. Arch Oral Biol 49: 267-73, 2004.

38. Emeruwa AC. Antibacterial substance from Carica papaya fruit extract. J Nat Prod 45: 123-7, 1982.

39. Dawkins G, Hewitt H, Wint Y, Obiefuna PC and Wint B. Antibacterial effects of Carica papaya fruit on common wound organisms. West Indian Med J 52: 290-2, 2003.

40. Motta LJ, Bussadori SK, Guedes CC, Reda SH and Santos EM. In vitro evaluation of the antimicrobial activity of two materials used for chemical and mechanical removal of carious dentin: Carisolv and Papacarie. Arquivos Em Odontologia 41: 273-368, 2005.

41. Fuursted K, Hjort A and Knudsen L. Evaluation of bactericidal activity and lag of regrowth (postantibiotic effect) of five antiseptics on nine bacterial pathogens. J Antimicrob Chemother 40: 221-6, 1997.

42. El-Tekeya M, El-Habashy L, Mokhles N and El-Kimary E. Effectiveness of 2 chemomechanical caries removal methods on residual bacteria in dentin of primary teeth. Pediatr Dent 34: 325-30, 2012.

43. Motta LJ, Bussadori SK, Campanelli AP, Silva AL, Alfaya TA, Godoy CH and Navarro MF. Efficacy of Papacarie in reduction of residual bacteria in deciduous teeth: a randomized, controlled clinical trial. Clinics 69: 319-22, 2014.

44. Goyal PA, Kumari R, Kannan VP and Madhu S. Efficacy and tolerance of papain gel with conventional drilling method: a clinico-microbiological study. J Clin Pediatr Dent 39: 109-12, 2015.

45. Watts A and Paterson C. Detection of bacteria in histological sections of the dental pulp. Int Endod J 23: 1-12, 1990.

46. Dalli M, Çolak H and Mustafa Hamidi M. Minimal intervention concept: a new paradigm for operative dentistry. J Investig Clin Dent 3: 167-75, 2012.

47. Tassery H, Levallois B, Terrer E, Manton DJ, Otsuki M, Koubi S, Gugnani N, Panayotov I, Jacquot B, Cuisinier F and Rechmann P. Use of new minimum intervention dentistry technologies in caries management. Aust Dent J 58: 40-59, 2013.