YasserAliAlMortadaAlWasifiBDS,MSc,PhD,DDS.AssistantProfessorofEstheticRestorativeDentistryTaibahUniversity(KSA)Ain ShamsUniversity(EGYPT)

a) Visual-Tactile Examinationb) Conventional radiography

a) DigitalRadiographyb) EnhancedVisualTechniquesc) FluorescentTechniqued) Electric-BasedDetectionSystemse) UltrasoundTechniquesf) ChemicalDyes

1. Stepwise Excavation2. Air Abrasion3. Laser4. Ozone5. Chemo-Mechanical Caries Removal6. Photo-Activated Disinfection7. Polymer Bur8. Micro-Preparation Bur

LIKE ! " DISLIKE

False positive = Questionable lesionFalse negative = Lesion redetected

Sensitivity=TruePositives

TruePositives+FalseNegatives

False positive = Questionable lesionFalse negative = Lesion redetected

Specificity=TrueNegatives

TrueNegatives+FalsePostives

Score SurfaceStatus Score SurfaceStatus0 Notsealedorrestored 5 StainlessSteel Crowns1 Sealant,partial 6 PorcelainorgoldorPFMcrownorveneer2 Sealant,Full 7 Lostorbrokenrestoration3 ToothColoredRestoration 8 Temporaryrestoration4 AmalgamRestoration

9 Usedformissedteethduetooneofthefollowingconditions:

979899

ToothextractedbecauseofcariesToothextractedforreasonsotherthancariesUnerupted

Score SurfaceStatus Score SurfaceStatusE Excludedrootsurfaces(nogingival

recession)3 Cavitated (greaterthan0.5mmindepth)

cariousrootsurface softorleathery0 Sound(nocariesorrestoration) 4 Cavitated (greaterthan0.5mmindepth)

cariousrootsurfacehardandglossy1 Non-cavitated cariousrootsurface soft

orleathery6 Extensivecavity:anextensivecavity

involvesatleasthalfofatoothsurfaceandpossiblyreachingthepulp.

2 Non-cavitated cariousrootsurface hardandglossy

7 Filledrootwithnocaries

A) DIGITAL RADIOGRAPHYB) ENHANCED VISUAL TECHNIQUESC) FLUORESCENT TECHNIQUED) ELECTRIC-BASED DETECTION SYSTEMSE) ULTRASOUND TECHNIQUESF) CHEMICAL DYES

A) DIGITAL RADIOGRAPHYB) ENHANCED VISUAL TECHNIQUESC) FLUORESCENT TECHNIQUED) ELECTRIC-BASED DETECTION SYSTEMSE) ULTRASOUND TECHNIQUESF) CHEMICAL DYES

A) DIGITAL RADIOGRAPHYB) ENHANCED VISUAL TECHNIQUESC) FLUORESCENT TECHNIQUED) ELECTRIC-BASED DETECTION SYSTEMSE) ULTRASOUND TECHNIQUESF) CHEMICAL DYES

A) DIGITAL RADIOGRAPHYB) ENHANCED VISUAL TECHNIQUESC) FLUORESCENT TECHNIQUED) ELECTRIC-BASED DETECTION SYSTEMSE) ULTRASOUND TECHNIQUESF) CHEMICAL DYES

A) DIGITAL RADIOGRAPHYB) ENHANCED VISUAL TECHNIQUESC) FLUORESCENT TECHNIQUED) ELECTRIC-BASED DETECTION SYSTEMSE) ULTRASOUND TECHNIQUESF) CHEMICAL DYES

A) DIGITAL RADIOGRAPHYB) ENHANCED VISUAL TECHNIQUESC) FLUORESCENT TECHNIQUED) ELECTRIC-BASED DETECTION SYSTEMSE) ULTRASOUND TECHNIQUESF) CHEMICAL DYES

22 2 New Developments in Caries Removal and Restoration

Fig. 2.4 Air abrasionsystems allow minimalcavity preparation andthe removal of surfacestain

Fig. 2.5 The air abra-sion handpiece is lightand the flow of powderhas a controlled vari-able outflow

but they have the disadvantage that they can easily cause iatrogenic dam-age by removing exposed cementum and root dentin in teeth affected bygingival recession and periodontal disease. Atkinson et al. (1984) found thattheir air-powder abrasive system removed a mean depth of 637m of rootstructure in 30s of exposure time. Further research aimed at identifying lessabrasive powders is ongoing (Petersilka et al. 2003), because softer particlesmight be more effective in removing carious dentin more selectively. Lau-rell et al. (1995) showed in dogs that higher pressures and smaller particlesyielded significantly fewer pulpal effects than treatment with high-speed ro-tary burs.

22 2 New Developments in Caries Removal and Restoration

Fig. 2.4 Air abrasionsystems allow minimalcavity preparation andthe removal of surfacestain

Fig. 2.5 The air abra-sion handpiece is lightand the flow of powderhas a controlled vari-able outflow

but they have the disadvantage that they can easily cause iatrogenic dam-age by removing exposed cementum and root dentin in teeth affected bygingival recession and periodontal disease. Atkinson et al. (1984) found thattheir air-powder abrasive system removed a mean depth of 637m of rootstructure in 30s of exposure time. Further research aimed at identifying lessabrasive powders is ongoing (Petersilka et al. 2003), because softer particlesmight be more effective in removing carious dentin more selectively. Lau-rell et al. (1995) showed in dogs that higher pressures and smaller particlesyielded significantly fewer pulpal effects than treatment with high-speed ro-tary burs.

18 2 New Developments in Caries Removal and Restoration

2.1.1Lasers

Early use of infrared lasers, such as carbon dioxide (10.6m wavelength) andruby lasers, to remove carious dentin resulted in slow removal of tissue andexcessive heat transfer to the dental pulp. Lasers have achieved success withremoval of hyperplastic soft tissue, but sufficient research has now establishedthe use of other laser technologies in restorative dentistry.

Traditional removal of carious dentin with a bur does involve some dis-comfort. One of the main advantages of lasers is the absence of vibration,which alleviates much of the discomfort experienced by patients. Despite theprecision of lasers, the absence of tactile contact with the tooth during cavitypreparation can make detection of softened dentin difficult for the dentist.The erbium yttrium aluminum garnet (erbium:YAG, 2.94m wavelength)laser has received much research interest, and in 1997, the Food and DrugAdministration approved the erbium:YAG laser for caries removal in the USA.The Fidelis erbium:YAG laser (Fotona, Ljubljana, Slovenia) is one example ofthe commercially available lasers for dental use, but it is a rather large device(Fig. 2.1), with settings for varying the cutting speed (Fig. 2.2).

Erbium:YAG laser treatment of teeth produces no smear layer, so the adap-tation of filling materials to the enamel and dentin surfaces should be optimal.

Fig. 2.1 The erbium-YAG laser is commer-cially available, but many perceive it ascostly and offering few advantages overconventional methods of cavity prepara-tion. The machine is large and occupiesconsiderable space in the dental office

Carisolv gel multimix

25% faster compared with previous gelThe removal of caries with the new gel takes an average of 5.2 min-utes, less than 30 per cent of the total treatment time. This develop-ment of Carisolv makes it possible to remove caries as fast as withthe drill but with all the advantages a minimally-invasive methodcan offer. The time aspect is no longer clinically significant.

Minimally-invasive, precise and reliable caries removal

www.mediteam.com

50009 GB-0 02.08

Carisolv minimally-invasive method forcaries removalMinimally-invasive dentistry comprises biologically-oriented procedures. The teeth are treated with preci-sion and caution in order to last as long as possible,avoid post-operative complications and fulfil the de-mands of present-day patients.Using the gel-based caries removal method Carisolvbrings you as close to minimally-invasive proceduresas possible. The method involves the use of a gel thatselectively reacts with denatured collagen, thereby mak-ing the carious dentine softer. Specially-designedinstruments hand and power-operated are used toremove the softened material. Drill, air abrasion orsimilar techniques are used if access to the cavity isrequired.

Carisolv Well documented Minimally-invasive, selective and precise Minimises the need for the drill and anaesthetics

and enhances patient comfort Makes it possible to avoid drilling close to the

pulp Carisolv instruments with sharp yet blunt cutting

angles help to protect healthy tissue

Carisolv the clinical procedure1. The gel does not affect healthy dentine or soft

tissue. Nor does it affect enamel. ConsequentlyCarisolv should be used in combination with thedrill or alternative techniques.

2. Drilling could preferably be used whenever thecavity needs to be opened up, for adjustment ofcavity periphery or whenever there are largeamounts of caries and when the risk to affecthealthy tissue is minimal.

3. Cover the cavity with gel and wait for 30 secondsuntil the carious dentine has been softened.

4. Softened caries can then be scraped away usingthe PowerDrive and/or the Carisolv handinstruments.

5. Repeat steps three and four without waiting 30seconds, until the cavity is free from caries.

6. Inspect and fill as usual.

Specifications of Carisolv gel multimixWith the multimix package, the gel components areextruded when the plunger is depressed. The gel ismixed automatically in the correct proportions in thetip (static mixer) of the syringe. If a static mixer is notbeing used, the gel should be mixed manually. A twin

MediTeam Dental AB, Gteborgsvgen 74, SE-433 63 Svedalen, SwedenTel. +46 31 336 91 00. Fax +46 31 336 82 10

www.mediteam.com

Carisolv is protected by patents and patent applications.

syringe should be sufficient for approximately 10 treat-ments. Only the amount of gel that is needed for eachindividual treatment is extruded.An opened package can be kept at room temperatureduring working hours. At all other times, it should bekept in a refrigerator. An opened package can be keptup to one month, for subsequent use.The gel comprises uncoloured fluid of high viscosity,which contains three different amino acids, and a trans-parent fluid consisting of a low concentration of so-dium hypochlorite. When the fluids are mixed, theircaries-softening ability is released.The chemical compositions of the amino acids and thesodium hypochlorite components respectively, havebeen further optimised compared with the previous gel,resulting in a significantly more effective Carisolv gel.

50009 GB-0 02.08

Carisolv minimally-invasive method forcaries removalMinimally-invasive dentistry comprises biologically-oriented procedures. The teeth are treated with preci-sion and caution in order to last as long as possible,avoid post-operative complications and fulfil the de-mands of present-day patients.Using the gel-based caries removal method Carisolvbrings you as close to minimally-invasive proceduresas possible. The method involves the use of a gel thatselectively reacts with denatured collagen, thereby mak-ing the carious dentine softer. Specially-designedinstruments hand and power-operated are used toremove the softened material. Drill, air abrasion orsimilar techniques are used if access to the cavity isrequired.

Carisolv Well documented Minimally-invasive, selective and precise Minimises the need for the drill and anaesthetics

and enhances patient comfort Makes it possible to avoid drilling close to the

pulp Carisolv instruments with sharp yet blunt cutting

angles help to protect healthy tissue

Carisolv the clinical procedure1. The gel does not affect healthy dentine or soft

tissue. Nor does it affect enamel. ConsequentlyCarisolv should be used in combination with thedrill or alternative techniques.

2. Drilling could preferably be used whenever thecavity needs to be opened up, for adjustment ofcavity periphery or whenever there are largeamounts of caries and when the risk to affecthealthy tissue is minimal.

3. Cover the cavity with gel and wait for 30 secondsuntil the carious dentine has been softened.

4. Softened caries can then be scraped away usingthe PowerDrive and/or the Carisolv handinstruments.

5. Repeat steps three and four without waiting 30seconds, until the cavity is free from caries.

6. Inspect and fill as usual.

Specifications of Carisolv gel multimixWith the multimix package, the gel components areextruded when the plunger is depressed. The gel ismixed automatically in the correct proportions in thetip (static mixer) of the syringe. If a static mixer is notbeing used, the gel should be mixed manually. A twin

MediTeam Dental AB, Gteborgsvgen 74, SE-433 63 Svedalen, SwedenTel. +46 31 336 91 00. Fax +46 31 336 82 10

www.mediteam.com

Carisolv is protected by patents and patent applications.

syringe should be sufficient for approximately 10 treat-ments. Only the amount of gel that is needed for eachindividual treatment is extruded.An opened package can be kept at room temperatureduring working hours. At all other times, it should bekept in a refrigerator. An opened package can be keptup to one month, for subsequent use.The gel comprises uncoloured fluid of high viscosity,which contains three different amino acids, and a trans-parent fluid consisting of a low concentration of so-dium hypochlorite. When the fluids are mixed, theircaries-softening ability is released.The chemical compositions of the amino acids and thesodium hypochlorite components respectively, havebeen further optimised compared with the previous gel,resulting in a significantly more effective Carisolv gel.