Evaluation of chemomechanical caries removal (Carisolv ...the "Carisolv™ gel" and sodium...

JournalOfMinimum Intervention In Dentistry

J Minim Interv Dent 2008; 1 (2)

113

Abstract

The Vickers hardness of dentin atthe cavity floor after in vitroremoval of caries with Carisolv™gel and the microhardness ofsound dentin was evaluated. Thecarious dentin of 18 extractedhuman permanent molars wasremoved using Carisolv™ for oneminute. Caries removal wasverified according to the colourand hardness of the lesion. TheVickers hardness number (VHN)of the cavity floor wasdetermined and the adjacentsound dentin for each tooth wasused as a control reference. Theresults show that Carisolv™ geldoes not cause a significantchange in the microhardness ofsound dentin. First published in IntDent S Afric 2007; 9: 34-45.

1 Department of Operative Dentistry, Collegeof Dentistry, University of Mosul, Mosul, Iraq.Currently as a Visiting Professor at RestorativeDentistry Department, Faculty of Dentistry,Ajman University of Scinece and TechnologyNetwork.

Address of first author:

Department of Operative Dentistry, College ofDentistry, University of Mosul, Mosul, Iraq.

Introduction

There has been considerable interestin developing alternative methods forcavity preparation and cariesremoval due to the disadvantages ofusing traditional rotatinginstruments, which can result inheat, pressure, dentin desiccation,vibration and pain¹. In addition, forpatients with dental anxiety, cariesremoval by means of conventionalinstruments is often associated withdiscomfort2. Furthermore, tissueshould be preserved whereverpossible; invasive treatment shouldbe kept to a minimum and naturaltissue should be replaced withartificial substitutes only when it isabsolutely unavoidable3.

Our traditional insistence thata cavity floor must be unstained andhard after cavity preparation, thismay be unnecessarily destructive oftooth material and lead to cariousexposures of the pulp. The questionimmediately arises, how 'clean' musta cavity be before restoration? Andwhat is the fate of slightly soft dentinif left behind, and whether it is asource of secondary caries4. Kidd etal.5 took samples of carious dentinduring cavity preparation, andcultured the samples so as to countthe number of bacteria. The numberof bacteria recovered diminishedsignificantly as the caries becamedryer and harder and the cavitybecame deeper. There was nosignificant difference between thenumbers of organisms cultured frommedium as opposed to hard dentin.The color of the sample was notassociated with the number ofbacteria recovered. This suggests

Evaluation of chemomechanical caries removal(Carisolv™) using the Vickers hardness test

"An in vitro study"

Qasim A S¹, Suliman A A¹



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that after the removal of wet softdentin, further removal of mediumhard stained dentin may notcontribute to further reduction ofinfected material.

The technique used in cariousdentin removal has been developedsince GV Black in 1893, who initiallyproposed the principle of extensionfor prevention in the operativetreatment of carious lesion. He alsoproposed that the removal of soundtooth structure and anatomical format sites that might otherwiseencourage plaque stagnation (e.g.occlusal fissure, approximal contactpoint) would help to minimize cariesonset and progression. Theseprinciples of cavity preparation werebased on the clinical presentation ofcaries and constrained by theknowledge of the disease processand the restorative materials, whichare available at that time. However,in more recent years with the adventof adhesive restorative material andthe subsequent development inminimal cavity designs 6,7, the widelyacceptable principle is nowconsidered too destructive methodfor caries removal2. Latest theoriesregarding the rational of cariousdentin removal are also beginning toquestion the amount of tissue thatneed to be excavated in order to besuccessfully treated caries lesion,when removing demineraliseddentin. It is not always easy to knowat what point to stop excavationbecause there is an apparent lack ofobjective clinical markers8. However,hardness of dentin might be a usefulmarker in this respect. Hardness ofcarious dentin is significantly lowerthan the noncarious dentin9-11. Theremoval of infected dentin andsparing the dentin capable ofremineralization has been a goal ofconservative dentistry. Minimallyinvasive dentistry is relying on thistechnique to minimize loss of toothstructure12. A reliable method oflimiting caries removal to infecteddentin will advance the minimallyinvasive dentistry13.

The best way to ensure themaximum lifespan of the naturaltooth is to respect the sound tissuesand protect them from damage.Several alternatives have beenintroduced for conventional cavitypreparation with rotary instrumentsand hand excavation. These methodsinclude air-abrasion, air-polishing,ultrasonic instrumentation,sonoabrasion, different kinds of lasertechniques and chemomechanicalpreparation of carious dentin. Incommon with all these techniques istheir attempt to gain higherselectivity of removing only carioustissue and to avoid the painful andexcessive preparation of sounddentin14,15.

Chemomechanical eliminationof carious dentin has so far been themost promising method as analternative treatment procedure,particularly in paediatric dentistry,and for anxious or medicallycompromised patients16. This newmethod of treatment involves theselective removal of soft cariousdentin without the painful removal ofsound dentin17. It can also be appliedto patients where the administrationof local analgesics is contraindicated,since local analgesia is not necessaryfor 82-92% of the patients with thistechnique18. Miller et al.19 found thatnegative experiences regardingsmell, taste and noise were limited inthe chemomechanical caries removaltechnique.

Chemomechanical cariesremoval is a method for minimally-invasive gentle dentin caries removalbased on biological principles. Thesystem uses a gel and specialinstruments that preserve healthytissue and patient comfort issignificantly enhanced.Chemomechanical caries removalsystem involves the application of agel, which is applied, to the cariesaffected area of the dentin, softeningthe diseased portion of the tooth,while healthy tissue is preserved.The softened carious dentin is



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removed with special instrumentsand the treatment is quiet andeffective20. The dentinal surfacesformed after chemomechanical cariesremoval are very irregular with manyoverhangs and undercuts with visiblepatent and occluded dentinaltubules. The remaining dentin issound, properly mineralized and wellsuited for restoration and bonding tomodern restorative materials16.

The indications for usingchemomechanical caries removal areexposed buccal lesions; cervical orroot caries; very deep carious lesions(potential pulp exposure may bereduced) as well as the treatment ofthe uncooperative paediatric patientor the older, frightened child.Contraindications include sessionsthat necessitate short treatmenttime, and pit and fissure caries thatare not deep where rotarypreparation will suffice to removecaries with little discomfort21.

In comparison with drilling, thechemomechanical method is oftenmore time-consuming22. To optimisethe efficiency and effectiveness ofCarisolv™ gel with respect tochemical caries dissolution andminimal effect on healthy dentin, anew, modified gel has beendeveloped. The original Carisolv™red gel contains three differentlycharged amino acids which aremixed with sodium hypochlorite priorto treatment. The new gel has nocolour agent. It contains half theconcentration of amino acids and ahigher concentration of sodiumhypochlorite 0.475%, almost twicethe 0.250% in the original Carisolv™gel23.

The procedure avoids thepainful removal of sound dentin butit is ineffective in the removal of hardeburnated part of the lesion, removalof eburnated caries, however, it maynot be necessary5. The purpose ofthis in vitro study is to find out if thecomplete removal of carious dentin ispossible with the Carisolv™ system

alone and to compare the effect ofthe "Carisolv™ gel" and sodiumhypochlorite solution 0.25% (whichis the same concentration used inCarisolv™ gel after mixing itscomponents) on the microhardnessof sound dentin. This study was alsomade to evaluate the effect ofaminoacids present in the Carisolv™gel in the control of sodiumhypochlorite during caries removalusing Carisolv™ gel.

Materials and methods

Preparation of the Carious Samples

Eighteen permanent molars withdentin caries on the proximal surfaceand ten caries free premolarsextracted for orthodontic purposewith patient age range between 20to 45 years old were used in thestudy. Teeth were stored in 0.1%thymol solution (BDH Chemicals Ltd.England) at room temperature toavoid dehydration and furthermicrobial growth and used within 2weeks after extraction. Each cariouslesion of the eighteen teeth wasanalyzed according to the color andhardness of the lesion. Cariouslesions with a brown to black colorand medium consistency (resistant toprobing but readily penetrated whentested with a sharp explorer) wereselected for this study.

All lesions had no enamelcoverage and the dentin was easilyaccessible through the cavityopenings. In addition, each toothwas evaluated by a radiograph sothat the carious lesion extends abouthalf distance through the dentinsurface. If caries extends more thanhalf distance of dentin duringtreatment of the sample withCarisolv™ gel, the sample wasneglected. The Carisolv™(MediTeam, GoteborgAB, Sweden)system was applied according to themanufacturer's instructions usingCarisolv™ hand instruments. Foreach tooth a fresh portion of



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Carisolv™ at room temperature wasprepared. Prior to mechanicaltreatment, the solution was appliedfor one minute to the carious tissue.The caries was then gently excavatedusing specially designed instruments.The procedure continued for as longas carious tissue could be removed.The cavity was then rinsedthoroughly with water and gentlydried. The caries removal wasverified according to the color andhardness of the lesion by checkingthe hardness of the dentin with adental explorer until a leather-hardtexture was reached or a sharpscratching sound was heard assuggested by previous studies14,24.

All cavities were cross-sectioned perpendicularly to thetooth axis at the occlusal third of thecrown using a diamond wheel cutterwith water-cooling to avoid injury tothe dentin. The tooth was placed in ajig to avoid movement of the sampleduring cutting (Figure 1). Cavitysections were flattened andsmoothed with sandpaper of 400,500 and 600 grit in a universalpolishing machine. The sections werethen embedded in a chemically-curedacrylic resin so that the occlusalsurface was exposed to externalsurface. The blocks were socked in acontainer filled with distilled waterwith few crystal of thymol,immediately at the dough stage ofpolymerization of the resin. At thedoughy stage the temperature riseas a result of the auto curing is verylow25,26 and it will not affect the toothtissues. After polymerization of theresin, each block was smoothed withsandpaper of 400, 500 and 600 grit.The blocks were kept in distilledwater containing thymol 0.1% atroom temperature until hardnessmeasurement is completed within 24hours.

Figure 1. Tooth fixed on holder to facilitatesectioning.

Measurements of the Hardness of theCavity Floor

Microhardness was measured with aVickers hardness tester (Wolpert,Germany). Testing was performedwith diamond pyramid indenters,which have a square-based diamondindenter with a 136º angle.Measurement was taken using amicroscope of 200x magnificationsince identification was too small tobe seen and measured with thenaked eye. The test was determinedusing a load of 1 Newton (100 gm)applied to the specimens for 15seconds as recommended in the pilotstudy (a pilot study was conducted tochose the most appropriatepreparation of the samples, Thehardness test was first determinedby using load of 0.5 Newton (50 gm)applied for 15 second at four pointsalong the cavity. The indentation wastoo small and its boundaries werenot clear and not sharp under themicroscope so the load wasincreased to 1 Newton (100 gm)which gave a clear indentation). Thisload and time were constant for allsamples throughout the study.

The Vickers hardness number(VHN) was measured at four pointsin each treated cavity where theminimum distance between twoconsecutive indentations was more

never close to any edge of the



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specimen or another indentation. Thecriteria for accepting an indentationwere sharpness of diagonal edges,uniformity of diagonal shape(geometry) and free of irregularitiesin the testing area.

To determine the degree ofresidual softened dentin, thehardness change of the adjacentsound dentin (reference control) onthe same specimens was evaluated.Since obtaining a Vickers hardnessmeasurement of the cavity surfacewas impossible, recordings wereobtained next to the cavity floor. Thehardness of the subsurface at a point

used as that of the cavity floor andregarded as the Carisolv™ treateddentin27, adjacent sound dentin

cavity floor) of the same sampleswas used as a control reference(Figure 2). The mean of themeasurements was used as the VHNof the dentin and a statisticallysignificant difference between theVHN of the Carisolv™ cavity floor andadjacent sound dentin wasdetermined by T test; a value ofp

Figure 2. The picture shows points ofmicrohardness measurements on the sample.

a) Carisolv™ treated dentin, area

cavity floor.b) Control points, area located

floor.

TT

Preparation of the caries freesamples

Ten sound permanent premolarsextracted for orthodontic purposeswere used for this study. Sampleswere sectioned from the occlusalthird of the crown using a water-cooled diamond wheel cutter andplaced in moulds in the same way asthe carious samples and smoothedand polished. The blocks were placedin a container filled with distilledwater, containing thymol crystals0.1% at room temperature untilmeasured.

Microhardness measurement ofcaries-free teeth

After preparation the sample wasfixed in acrylic device and a shallowgroove was made (bucco-lingually)at the midline of with a smalldiamond bur in a high-speed handpiece fixed on surveyor. This wasdone to obtain a parallel lineseparating the test and controlsurfaces into two equal halves andcreating a groove that could be seenin the microscope of the Vickershardness machine. This groove isconsidered the boundary betweenthe test and control surface ofdentin. Adhesive tape was thenplaced on the cut surface of dentin ina parallel direction next to thegroove previously made to separatecontrol area from tested area intotwo equal halves. The five randomlyselected teeth were then treated withCarisolv™ gel, which was applied tothe cross-sectioned dentin for threeminutes and then washed away withwater. The other five teeth weretreated with 0.25% sodiumhypochlorite solution (NaOCl 0.25%),which was applied to the cut dentinsurface for 3 minutes and rinsed offwith water. The tape was removedfor both Carisolv™ and NaOCltreated samples and thus the samesample was used as a control.

The points where the Vickerstest indenter was applied were at the



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mid distance of the dentin, movingparallel and near to the boundarygroove between the test and thecontrol area (Figure 3).Measurements were taken at50micrometer intervals and theVickers hardness test was applied forboth the Carisolv™ and NaOCltreated samples in addition to thenon-treated areas. The data weretabulated and statistically analyzed.

Figure (3): Picture shows carious free sample.a: Points of measurements of

the VHN at non treated control area.b: Points of measurements of

the VHN for Carisolv™ treated area.

Data Analysis

For the carious samples data wereanalyzed using T-test, a value ofpwhile for the caries free samples, T-test were used for the VHN of bothCarisolv™ and NaOCl treated dentinfollowed by the analysis of variance(ANOVA) to indicate if there is anystatistical difference betweenCarisolv™, NaOCl treated sounddentin and control (pmultiple range tests were then usedto compare among the significantlydifferent groups.

Results

The results of this study can beanalyzed by addressing the twotypes of samples used in the studyseparately, namely, carious samplesand caries-free samples.

Carious Samples

The results revealed that the Vickershardness number of the cavity floorprepared by Carisolv™ ranged from60 to 63.5 kg/mm² (mean ±SD:61.85 ±1.23) which does not differnot statistically significantly from theVickers hardness number of theadjacent sound dentin that rangedfrom 61 to 64.6 kg/mm² (mean±SD: 62.58 ±1.03). The resultsindicated no change in themicrohardness of the dentin in thecavity floor after treatment withCarisolv™ gel compared with theadjacent control (p= 0.064).

The microhardness of thedentin in the treated cavity floor withCarisolv™ gel showed no statisticaldifference in the mean valuescompared with the adjacent sounduntreated dentin.

Caries-Free Samples

The mean values of Vickers hardnessnumber for the Carisolv™ treateddentin was (61.77 ±0.599) and forthe adjacent untreated dentin(control) was (62.57 ±0.576). Themicrohardness of dentin for thesamples in which sound dentin istreated with Carisolv™ gel showedno significant difference comparedwith the adjacent untreated dentin.

The mean value of the Vickershardness number for the NaOCl0.25% treated dentin was (56.72±1.07) and for the adjacentuntreated dentin (control) (62.55±0.779). The microhardness for thesamples in which sound dentin aretreated with sodium hypochlorite0.25% showed a significantdifference compared with theadjacent untreated dentin.

A one way analysis ofvariance (ANOVA) was performed tomake a comparison between theCarisolv™ and sodium hypochloritetreated sound dentin with theircontrol, which showed significant



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difference (p(ANOVA) are shown in Table (1). TheDuncan multiple range test for theVHN revealed that the Carisolv™treated sound dentin and control hadno significant difference and thatboth of them are significantlydifferent from NaOCl treated sounddentin (Table 2).

Discussion

Chemomechanical caries removalinvolves the chemical softening ofcarious dentin followed by thecleaning of the softened materialwith instruments similar toexcavators. The typical chemicalsused for such procedures arechloramines, prepared by mixingsodium hypochlorite with aminoacids. The adverse effects of sodiumhypochlorite on sound dentin andsoft tissue are minimized usingchloramines, but the effect oncarious dentin is retained28.

Variations in dentin hardnesswithin a tooth may be due to severalfactors, the first of which is thecalcification level of dentin(transparent dentin was found to beharder than the adjacent dentin).The second is the difference in

dentinal tubule density at differentlocations (increased tubule densitynear the pulp was shown tocorrespond with reduced hardness).The third reason is the reducedhardness of the inter-tubular dentinwhen approaching the pulp.

The fourth is the distance from theDEJ (dentin hardness increased withdistance from the DEJ) (Kinney etal., 1996). The locations for theindentation in this study were thuscarefully selected. The dentin wasinspected to avoid any irregularareas, and the equal distances fromthe DEJ to the pulp were keptconstant for all indentations.

Collys et al.30 suggested aload of 50 g and more for studies ofhardness in teeth because theyfound out that lower loads influencethe indentation size. They indicatedtwo aspects for this load influence:1) the sample surface is alteredduring the polishing process,producing a coating larger than thelargest depth reached for theindenter; and 2) with lower loads,the difficulty to read the indentationmarks increased. However in this

Source DF SS MS F Value P value

Factor 2 118.702 59.351 103.17 0.000

Error 17 9.780 0.575

Total 19 128.482

Table 1. ANOVA Results for the VHN (kg/mm²) of Sound Dentin Treated with Carisolv™, NaOCland Non Treated Control Groups.

DF = Degree of Freedom, SS = Sum of Squares, MS = Mean square,F value = F calculated, P value = Probability value.



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work the use of a load of 100g gavea clear indentation to be observedunder microscope. In this

study, the hardness change ofhuman dentin following cariousdentin removal by Carisolv™ wasassessed by in vitro Vickers hardnessmeasurement of the cavity floor. TheCarisolv™ gel was used according tothe manufacturer's instructions oncarious dentin for one minutefollowed by excavation with specialinstruments until the cavity wasclean. In addition, the hardness ofsound dentin when exposed toCarisolv™ gel and sodiumhypochlorite 0.25% [theconcentration is related to theamount of active chlorine, which is0.25% after mixing the sodiumhypochlorite with the aminoacidliquid23 was studied to find out if theCarisolv™ gel affects the hardness ofsound dentin and if the amino acidspresent in the Carisolv™ gel haveany role in minimizing the effect ofsodium hypochlorite on sounddentin. A time of three minutes waschosen for this study from a clinicalaspect for the use of Carisolv™ gel,

i.e. the material should be in contactwith the adjacent sound dentinfor at least three minutes duringclinical

work before the cavity is completelyclean 31.

Since this material is newlydeveloped there are limited studiesconcerning the hardness of thetreated cavity floor. However,previous studies have indicated thecomplete removal of carious dentin isdifficult with Carisolv™ treatmentand that the possibility of remainingcaries following the Carisolv™treatment is a major concern. Cariesremoval with Carisolv™ leaves up to

dentin than round burs14. Clinicalguidelines are therefore necessary toidentify residual carious dentin.Splieth et al.14 and Cederland et al.24

verified caries removal according tothe colour and hardness of the lesionwith a sharp explorer. The hardnessof dentin was checked with a dentalexplorer until a leather-like hardtexture was reached or a sharpscratching sound was heard.

Source* Mean** N*** DuncanGroup****

Control 62.56 10 A

Carisolv™ 61.77 5 A

NaOCl 56.72 5 B

Table 2. Duncan Multiple Range Test for the VHN (Kg/mm²) of the Carisolv™, NaOCl Treated and NonTreated Control Sound Dentin.

*: Source of significance. ***: Number of samples.**: Mean of VHN (Kg/mm²). ****: Means with the same letters are not significant.



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The degree of softened dentinremoval was determined by Vickershardness number measurement ofthe cavity floor and the adjacentsound dentin as suggested by Aoki etal.32. The results of the Vickershardness measurements of theCarisolv™ cavity floor confirmed thatthe possibility of the remainingresidual softened dentin was minimalin this study as no statisticalsignificant difference was noted inthe microhardness of the Carisolv™cavity floor dentin and the adjacentsound dentin (reference control). Theresults further indicate that theefficiency of complete carious dentinremoval by the Carisolv™ chemo-mechanical system is no longerdifficult when a proper clinical guideis used. The Carisolv™ gel appears tohave no effect on sound dentincompared with sodium hypochloritesolution which has a softening effecton sound dentin when used in thesame concentration present in themixed Carisolv™ gel. This meansthat aminoacids do have a controleffect on the sodium hypochlorite bylimiting its effect to denatured anddemineralized dentin withoutaffecting the sound dentin.

Sodium hypochlorite has twomain properties depending on the pHof the solution. The first is asterilizing effect at around pH 7 andthe second is a solvent effect onorganic material at a higher pH.Chloramines are generally producedby a combination of sodiumhypochlorite and amino nitrogen,which makes the effect of sodiumhypochlorite less aggressive andprolonged. While chloramines arecommonly used as a disinfectant, thesolvent effect is expected in theapplication of chemo-mechanicalcaries removal.

The results are also inagreement with Hanning33 whocompared Carisolv™ with sodiumhypochlorite and reported thatCarisolv™ selectively dissolved anartificially demineralized and

denatured dentin, but did notdissolve a demineralized dentin of nodenaturation. Sodium hypochloritedissolved unselectively bothdemineralized and denatured dentin.The difference between the action ofCarisolv™ containing sodiumhypochlorite and the pure sodiumhypochlorite solution could beexplained by the amino acids addedto Carisolv™. The amino acids mightreact with the sodium hypochlorite,thus reducing the organic tissuesolving properties of the sodiumhypochlorite in Carisolv™ gel.

Tonami et al.31 reported thatCarisolv™ softened only the outerlayer of carious dentin and thehardness of the inner layer of cariousdentin and the sound dentin was notchanged, and that Carisolv™selectively dissolved the degeneratedcollagen in carious dentin. Theresults are in agreement with theresults in this study.

Ericson et al.34 explained thebehavior of amino acids in Carisolv™gel from two aspects: one is thereduction of aggressive effect of thesodium hypochlorite on sound tissueand the other is that the chlorinatedthree amino acids of different electriccharge reacted to different moietiesof carious dentin.

Hossain et al.35 evaluated thedentinal composition and KnoopHardness measurements of thecavity floor following the removal ofcarious dentin by the Carisolv™chemo-mechanical caries removalsystem in vitro and found that therewere no significant differencesbetween the quantities of calciumcontent (Ca weight %), phosphoruscontent (P weight %) and the Ca/Pweight ratio of Carisolv™ cavitieswith that of the adjacent sounddentin (P<0.01). The KnoopHardness number of the Carisolv™cavity floor was almost similar tothat of the adjacent sound dentin.The scanning electron microscopeanalysis revealed an extremely rough



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or irregular surface and thereremained minimal debris like smearlayer; most of the dentinal tubuleswere opened. The results indicatethat Carisolv™ does not produce anyadverse side effect on dentinalcompositions of the treated cavities.The possibility of remaining residualsoftened dentin was also minimal inthis study.

The results in this study werecompared with the results of theprevious study made by Hossain etal.35 that worked with Knoopmicrohardness based on the study byRyge et al.36 who demonstrated thatwhen working with loads between 50and 100 g, Knoop and Vickersmicrohardness is equivalent. Theresults were in agreement with eachother.

In this study the Vickershardness test was used instead ofthe Knoop hardness test as it wassuggested by Maria and Jorge37 thatthe Vickers indenter has to be usedalways in the tooth hardness studiesand, according to Guetierrez-Salazarand Reyes-Gasga38, the Vickersindentor is more useful in toothhardness studies than the Knoop'sbecause a square shape has to bealways conserved, and that close tothe outer surface and the DEJ, asmall elongation of the diagonals ofthe indentations that produce errorsin hardness measurements, is easilydetected. Therefore it was proposedthat the Vickers indenter shouldalways be used in tooth hardnessstudies.

The results in this studydisagree with Splieth et al.14 becauseit was found that complete cariesremoval is not difficult withCarisolv™ alone. The results in thisstudy are in agreement with theresults of several researchers whoinvestigated the hardness of cariousdentin after chemo-mechanical cariesremoval with Carisolv™ andconcluded that when a propertechnique is used, this treatment will

result in complete caries removalwithout affecting the sounddentin31,33,35.

The results of themicrohardness in this study indicatedthat Carisolv™ solution does notproduce any adverse side effects ondentinal microhardness.Furthermore, complete cariousdentin removal by Carisolv™ is nolonger difficult when proper clinicalprocedure is followed. Therefore,cavity preparation with Carisolv™provides a clean dentin surfacewithout affecting the adjacent sounddentin, which may be favourable inclinical dentistry.

Conclusion

Carisolv™ gel does not cause asignificant change in themicrohardness of sound dentin andthe treated carious dentin. Inaddition, the aminoacids present inCarisolv™ gel play a role in thecontrol of the sodium hypochloriteand minimize its aggressive effect onsound dentin. This is because whenNaOCl is used alone in aconcentration of 0.25% (which is thesame concentration used in themixed Carisolv™ gel), it will cause asoftening effect on the sound dentin.However, when mixed with aminoacids such as those found inCarisolv™ gel, this effect isminimized. Furthermore, it wasfound that the complete removal ofcarious dentin is possible with theCarisolv™ system alone when aproper clinical procedure is used.

Carisolv™

18Carisolv™

VHN



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Carisolv™Int Dent

S Afric 2007; 9: 34-45

Resumen

Se evaluaron la dureza Vickersde la dentina a nivel del piso dela cavidad, luego de quitar lacaries in vitro con gel Carisolv™,y la microdureza de dentinasana. Se quitó la dentina cariadade 18 molares permanentesextraídos de seres humanos,utilizando Carisolv™ por espaciode un minuto. La remoción delas caries se verificó de acuerdoal color y dureza de la lesión. Sedeterminó el número de durezaVickers (VHN) del piso de lacavidad y se usó la dentina sanacontigua a cada diente comoelemento referencial de control.Los resultados mostraron que elgel Carisolv™ no causa uncambio significativo en lamicrodureza de la dentina sana.Publicado primero en Int Dent S Afric2007; 9: 34-45.

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