Vital Pulp Therapy in Primary Dentition: Pulpotomy—A 100-Year Challenge

Pulpotomy has long been the most indicated vital pulp procedure in primary molars with extensive caries. The success of a pulpotomy is highly technique sensitive and it depends upon many factors, such as diagnosis accuracy, caries excavation method, pulp dressing material, quality of the final restoration and operator experience. This paper provides an overview of the pulpotomy procedure in primary teeth over a century, with reference to advances in technique, medication and restoration possibilities and challenges and controversies surrounding the subject as well as future directions.

Visual Examination, Fluorescence-Aided Caries Excavation (FACE) Technology, Bitewing X-Ray Radiography in the Detection of Occlusal Caries in First Permanent Molars in Children

Objectives: To compare the effectiveness of visual examination, radiographic examination and fluorescence-aided caries excavation (FACE) in detecting occlusal caries in first permanent molars in 150 children aged 6–14 years with intact occlusal surface with caries lesions without cavitation, or with darkened or deep fissures that had no clear diagnosis. Study design: Two dentists independently performed a visual oral examination, FACE and bitewing radiography. The inter-rater reliability of each detection method was determined and their specificity and sensitivity. Results: All caries detection methods showed high inter-rater reliability with absolute agreement between raters above 90%. Most caries lesions were detected by visual (75.8%) and FACE (79.1%), while only 28.8% of lesions were detected by radiography. Detection by visual examination was strongly correlated with detection by FACE (X2=37.9, Phi=0.498, p<0.001). A lower, yet statistically significant, correlation was found between visual examination and X-ray radiography (X2=5.53, Phi=0.190, p<0.001). FACE had higher sensitivity (87%) and specificity (65%) for detecting occlusal caries in comparison with radiography (60% specificity and 55% sensitivity). Conclusion: Although visual examination remains the best method to detect occlusal caries in young permanent molars in children, FACE is an effective and accurate diagnostic tool that may aid in detection and treatment decisions.

Secondary Caries Adjacent to Bulk or Incrementally Filled Composites Placed after Selective Excavation In Vitro

Objectives: selective caries excavation (SE) is recommended for deep carious lesions. Bulk fill composites (BF) may be considered to restore SE-cavities. We compared the susceptibility for secondary caries adjacent to BF versus incrementally filled composites (IF) in SE and non-selectively excavated teeth (NS) in vitro. Methods: in 72 extracted human premolars, artificial caries lesions were induced on pulpo-axial walls of standardized cavities. The lesions were left (SE) or removed (NS), and teeth were restored using two BF, GrandioSO x-tra/Voco (BF-Gra) and SDR/Dentsply (BF-SDR), and an IF, GrandioSO/Voco (IF-Gra) (n = 12/group for SE and NS). After thermo-mechanical cycling (5–55 °C, 8 days), teeth were submitted to a continuous-culture Lactobacillus rhamnosus biofilm model with cyclic loading for 10 days. Mineral loss (ΔZ) of enamel surface lesions (ESL), dentin surface lesions (DSL), and dentin wall lesions (DWL) was analyzed using transversal microradiography. Results: ΔZ was the highest in DSL, followed by ESL, and it was significantly lower in DWL. There were no significant differences in ΔZ between groups in DSL, ESL, and DWL (p > 0.05). Regardless of lesion location, ΔZ did not differ between SE and NS (p > 0.05). Conclusions: BF and IF both showed low risks for DWL (i.e., true secondary caries) after SE in vitro, and surface lesion risk was also not significantly different between materials. SE did not increase secondary caries risk as compared with NS. Clinical Significance: the risk of secondary caries was low after selective excavation in this study, regardless of whether bulk or incrementally filled composites were used

Evaluation Of Efficacy Of Chemo-mechanical Method Of Caries Removal Using BRIX- 3000 Compared To Conventional Excavation With Burs- A Randomized Controlled Trial – Original Research

Introduction and Aim The study was designed as a randomized double-blind trial to evaluate the efficacy of chemo-mechanical method of caries removal using BRIX 3000 as compared to conventional excavation with burs. Methods The double blind randomized control trial was performed using a split mouth design where patients with bilateral deep carious lesion underwent treatment with Brix 3000 on one side and high speed bur excavation with aerotar on the contralateral side. This was performed to compare the efficacy of Brix 3000 with the conventional high speed caries excavation using aerotar. Group 1 (G1 = 67 teeth) chemomechanical removal with Brix 3000 and Group 2 (G2= 67 teeth) high speed bur excavation with aerotar. The criteria assessed were the time (T) required for each protocol to be completed and pain perceived by the patient at the end of caries excavation. Results All statistical analysis were done using (SPSS) version 17.0 statistics software. Independent sample t test and Mann Whitney U test were one to analyze the data. Conclusions Though time taken for caries excavation was more using BRIX than the high speed procedures, there was less or no pain while caries excavation using BRIX 3000 along with more patient comfort and cooperation during procedure. From the current study, it was observed that BRIX 3000 can be considered as an effective alternative/adjuvant for caries removal in deep carious lesions as compared to aerosol inducing high speed rotary techniques. Keywords : Chemo-mechanical caries removal, non aerosol inducing caries removal techniques, COVID, BRIX 3000, randomised controlled trial, novel caries removal, dentin preservation.