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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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ORIGINAL ARTICLE
Year : 2007  |  Volume : 25  |  Issue : 2  |  Page : 93-96
 

Various methods of caries removal in children: A comparative clinical study


Department of Pedodontics, Preventive and Community Dentistry, D. A. V. Dental College, Yamuna Nagar, India

Correspondence Address:
L Verma
D.A.V. Centenary Dental College, Model Town, Yamuna Nagar 135001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.33456

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   Abstract 

An in vivo study comparing the different methods of caries removal was done in children of age group 6-9 years. Among these patients a total number of 150 carious deciduous teeth were selected. Caries removal was done by hand instruments, airotor and carisolv. The efficacy, time taken and pain experienced by the patient during caries removal was evaluated. The results showed that airotor was the most efficient method (mean value 0.38), while carisolv was the least painful (mean value 0.080) and the most time consuming method (534.8 seconds).


Keywords: Caries removal, efficacy, pain


How to cite this article:
Pandit I K, Srivastava N, Gugnani N, Gupta M, Verma L. Various methods of caries removal in children: A comparative clinical study. J Indian Soc Pedod Prev Dent 2007;25:93-6

How to cite this URL:
Pandit I K, Srivastava N, Gugnani N, Gupta M, Verma L. Various methods of caries removal in children: A comparative clinical study. J Indian Soc Pedod Prev Dent [serial online] 2007 [cited 2019 Nov 21];25:93-6. Available from: http://www.jisppd.com/text.asp?2007/25/2/93/33456



   Introduction Top


The word "caries" is derived from the Latin word meaning "rot," and in Greek (ker), it means "death." According to WHO, caries is defined as a "localized post-eruptive, pathological process of external origin involving softening of hard tooth tissue and proceeding to the formation of a cavity." [1]

There are a number of techniques available for removal of caries. The most primitive approach to the treatment of caries was by the hand instruments, which was a painful, ineffective and tedious method for caries removal. [2] This led to the evolution of rotary instruments - from low speed to ultrahigh speed. The thermal and pressure effects on the pulp which produced pain were the major drawbacks with this technique. [3] Due to the shortcomings of the drill, alternative techniques like air abrasion, ultrasonic instrumentation, lasers and chemomechanical approach to caries removal were developed. Out of these, air abrasion, sonoabrasion, ultrasonic instrumentation, lasers are costly and tooth-sensitive methods and therefore less frequently used. [4] Therefore, chemomechanical approach is the most documented alternative to traditional drilling.


   Aims and Objectives Top


To compare the efficacy of caries removal by different methods, to evaluate the time taken by different methods and to evaluate the pain threshold experienced by the patient during caries removal by different methods.


   Materials and Methods Top


Seventy-five patients were selected from the Outpatient Department of Pedodontics, Preventive and Community Dentistry, D.A.V. (C) Dental College and Hospital, Yamuna Nagar, who on intraoral examination were found to have single or multiple carious primary teeth.

The patients selected had single or multiple primary carious teeth; and from among these patients, 150 teeth were selected for the study group. The carious teeth were called "samples" and were randomly divided into three groups as follows:ş

Group I: Caries removal by hand instruments [Figure - 1]

This group comprised of 50 carious teeth in which caries was removed using sharp spoon excavator.

Group II: Caries removal by airotor [Figure - 2]

This group comprised of 50 carious teeth in which the caries was removed using number 245 round bur along with adequate coolant.

Group III: Caries removal by chemomechanical method [Figure - 3]

Fifty carious teeth were taken in this group and the caries was removed using carisolv gel.

After the caries was removed by using different methods, the caries-detecting dye (propylene glycol) was applied on carious lesion for 1 minute. Washing was done with water and the efficacy, time taken and pain threshold were evaluated during the caries removal by Ericson D et al.; scale, time scale, visual analogue scale and verbal scale respectively. Data was collected and statistically analyzed.


   Results Top


[Table - 1] shows the comparison of mean values of efficacy of caries removal by different methods. The mean value of efficacy of caries removal by hand instrument was observed to be 1.26 ▒ 1.046. Efficacy of caries removal by airotor showed a mean value of 0.38 ▒ 0.753, while the mean value of efficacy of caries removal by carisolv method was 0.42 ▒ 0.758. The efficacy of caries removal has been observed to be the highest with airotor, followed by almost comparable effectiveness by carisolv method and least by the hand instrument technique [Graph I].

[Table - 2] shows the comparison of mean values of the time taken for caries removal by different methods. The mean value of time taken for caries removal by carisolv method was observed to be maximum of 534.8 seconds with a standard deviation of 227.293, followed by hand instrument method (424.6 ▒ 224.783 respectively) and airotor method (257.4 ▒ 100.566 respectively). Thus, it is observed that out of the three methods, airotor removed caries in the minimum time [Graph 2].

[Table - 3] shows the mean visual analogue scale (VAS) score using different methods of caries removal. The mean value of VAS score using hand instrument was observed to be 3.78 ▒ 1.433. VAS score during airotor procedure showed a mean value of 4.24 ▒ 1.255, while the mean value of VAS score during carisolv method was 2.18 ▒ 1.119. Thus, pain experienced has been observed to be the maximum with airotor, followed by hand instrument method and least by carisolv method [Graph 3].

[Table - 4] shows the mean values of pain using verbal scale. The mean value of verbal scale pain score reported by the subjects in whom carisolv method for caries removal was used, was observed to be 0.080 with a standard deviation of 0.274 as compared to mean scores of 1.280 and 1.440 in case of hand instrument and airotor techniques respectively. Thus, it is derived that out of the three methods adopted in the present investigation, carisolv method seems to be the least painful with respect to caries removal [Graph 4].


   Discussion Top


Efficacy

The mean value of efficacy of caries removal in Group I (hand instruments) was found to be 1.26 ▒ 1.046, while that in Group II (airotor) was 0.38 ▒ 0.753 and in Group III (carisolv) was 0.42 ▒ 0.758. These results indicated that the efficacy of caries removal was highest with airotor, followed by almost comparable effectiveness by carisolv method and the least by the hand instruments. The studies done by Ericson et al . [5] and Watson et al. [3] had also concluded that the carisolv method was as effective as bur in removing infected dentin. However, studies done by Banerjee et al. [6] showed that effectiveness of caries removal was the highest with airotor, followed by hand excavation and the least by carisolv. Another study done by Maragakis et al. [4] also reported that the efficacy of caries removal by carisolv was only 62.5%, showing that it did not remove caries efficiently.

Time

Carisolv method needed more time for caries removal than hand instruments and airotor. This was in accordance with the study conducted by Banerjee et al. [6] who evaluated five alternative methods of carious dentin excavation and found that airotor was the quickest method and carisolv excavation was the slowest out of the five methods. According to the study done by Kakaboura et al. , [7] the reason for increased time taken by carisolv might be because of the multiple applications of carisolv gel for complete caries removal. They also stated that when the carisolv gel was applied on the carious lesion, it was clear; but it became opaque/cloudy with debris from the lesion. When the gel was heavily contaminated with debris, it was removed with a cotton pellet and fresh gel was again applied. [8] The procedure was repeated until the gel was no longer contaminated with debris.

Pain

The pain experienced was found to be maximum with airotor, followed by hand excavation and the least by carisolv method. Rafique et al., [9] concluded that air abrasion/carisolv treatment was a well accepted and viable alternative to local anesthesia and drills. The wide difference in pain scores between carisolv and airotor/hand instruments could be, because in carisolv sound dentin is not removed. [10] Anusavice and Kinchloe [11] demonstrated that cutting or removing carious dentin generally elicits little or no sensation, while cutting sound dentin often results in some level of pain. This has been the basis of the clinical evaluation of the chemomechanical method of caries removal.


   Conclusion Top


  1. All the three methods removed caries effectively; however, the efficacy of caries removal determined using Ericson et al. scale was the highest with airotor, followed by almost comparable effectiveness by carisolv method and the least by hand instruments.
  2. The time taken to remove caries by carisolv method was observed to be maximum, followed by hand instrument method and the minimum time was taken by airotor method.
  3. The pain experienced by the patients during caries removal was found to be maximum with airotor method, followed by hand excavation and the least by carisolv method.


 
   References Top

1.McDonald RE, Avery DR. Dentistry for the child and adolescent. 7 th ed. Mosby Publication: 2005.  Back to cited text no. 1    
2.Ring ME. Dentistry an illustrated history. 2 nd ed. Harry N. Abrams Inc. Publishers: 1992.  Back to cited text no. 2    
3.Banerjee A, Waston TF, Kidd EA. Dentine caries excavation: A review of current clinical technique. Br Dent J 2000;188:ş476-82.  Back to cited text no. 3    
4.Maragakis GM, Hahn P, Hellwig E. Clinical evaluation of chemomechanical caries removal in primary molars and its acceptance by patients. Caries Res 2001;35:205-10.  Back to cited text no. 4    
5.Ericson D, Zimmerman M, Raber H, Gotrick B, Bornstein R, Thorell J. Clinical evaluation of efficacy and safety of a new method of chemo mechanical removal of caries. A multi centre study. Caries Res 1999;33:171-7.  Back to cited text no. 5    
6.Banerjee A, Kidd EA, Watson TF. Invitro evaluation of five alternative methods of carious dentin excavation. Caries Res 2000;34:144-50.  Back to cited text no. 6    
7.Kakaboura A, Masouras C, Staikou O, Vougiouklakis G. A comparative clinical study on the caries removal method. Quintessence Int 2003;34:269-71.  Back to cited text no. 7    
8.Munshi AK, Hegde AM, Shetty PK. Clinical evaluation of Carisolv in the chemico-mechanical removal of carious dentin. J Clin Pediatr Dent 2001;26:49-54.  Back to cited text no. 8    
9.Rafique S, Fiske J, Banerjee A. Clinical trial of an air-abrasion/chemomechanical operative procedure for the restorative treatment of dental patients. Caries Res 2003;37:360-4.  Back to cited text no. 9    
10.Mediteam. New Carisolv gel for faster treatment. [Cited on 1999 Dec 4]. Available from: http://www.mediteam.com/gelinst /pdf. [Last accessed on 2003 Aug 14].  Back to cited text no. 10    
11.Anusavice KJ, Kincheloe JE. Comparison of pain associated with mechanical and chemomechanical removal of caries. J Dent Res 1987;66:1680-3.  Back to cited text no. 11    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]


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    Abstract
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    Aims and Objectives
    Materials and Me...
    Results
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