INTRODUCTION
In the treatment of carious dentin, a number of techniques have been used to date. Recent outcomes obtained from experimental studies about tooth caries pathology, natural protection mechanism of teeth and advances in dental restorative materials have resulted in the necessity of the removal of only infected carious dentin.1 The hardness and, to a lesser extent, the color of dentin are presently the main parameters used by dental practitioners to differentiate between infected and non-infected dentin during caries excavation.1 Histologically, it is possible to distinguish between an outer unremineralizable and an inner remineralizable layer of carious tissue.2
Researchers have stated that in the determination of the complete removal of the carious dentin, color (visual criteria) and hardness (tactile criteria) have been used as criteria for the clinical assessment.3 Estimation of hardness of the remaining dentin by tactile procedures, however, may not be a reliable guide for the clinical removal of caries.3 Discoloration is considered reliable only in chronic caries where it is usually marked, and that the extent of bacterial invasion follows closely the discoloration front. In acute caries, the zones of discoloration are less evident, and bacterial invasion is usually diffuse and extends beyond the discoloration front.3 Thus, discoloration is not a reliable guide for the removal of infected dentin.
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Caries detecting dyes have been used to facilitate clinical discrimination of carious dentin from sound dentin during caries removal.4 The use of these dyes, however, does not provide a completely objective method for assessment of caries removal. Excessive removal of dentin has been reported when these dyes were used to remove caries.5
The laser fluorescence device, DIAGNOdent (KaVo Co., Biberach, Germany), has been developed for objective caries diagnosis.6 Also, DIAGNOdent was shown to be applicable for caries diagnosis during caries removal.7 With this device, the tooth surface is illuminated with pulses of red laser light, and the fluorescence emitted from the surface is analyzed and quantified. Caries process alters the amount of fluorescence, which can be seen as an elevated reading. The fluorescence emitted from a test surface is displayed as numerical values ranging from 0 to 99, with deeper carious lesions producing higher values.7,8 DIAGNOdent exhibited greater sensitivity than caries detecting dye in caries detection.9 Thus, apart from the use of caries detecting dyes, the DIAGNOdent may be used to evaluate the extent of demineralization of dentin during caries removal.10 However, further detailed studies are needed before DIAGNOdent values can be used to differentiate the layers of carious dentin.
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Studies carried out so far show that the layer of the carious dentine, which is rich in bacteria, unremineralizable and has necrotic tissue remaining on its surface, should be removed by any technique.1,3,5 However, secondary or reparative dentine developed as a positive response under the infected region should not be removed.5 Currently, there is a growing interest to develop minimal invasive techniques such as chemomechanical caries removal in the treatment of the carious lesion. The chemomechanical method does not produce an uncomfortable machine sound as do rotary cutting instruments, and tooth substance can be removed without pain.11 Both clinical reliability and accepting of patient as well as activity of the carious removal have a great interest in pediatric dentistry.11 Therefore, in recent years, the use of the chemomechanical method for treating dental caries has become widespread. However, Splieth et al12 reported that more than 50 μm of carious dentin were left following Carisolv treatment when compared to the conventional mechanical tooth preparation. Yazici et al13 showed that the residual bacteria mainly at the dentinoenamel junction following caries removal with Carisolv. The firm feeling of sound dentin is not always differentiated, and color and sound do not give a true indication of sound dentin.13 Hossain et al14 reported that Carisolv is capable of removing complete carious dentin if proper clinical guide is applied.
The laser fluorescence score depends on the amount of metabolic by-products of caries-causing bacteria and fluorescent protoporphyrin present,15 and the color of carious dentin.7 Moreover, differences in the structure of dentine surface being evaluated influence the results using the DIAGNOdent. Thus, in order to use the DIAGNOdent for removal of caries, it is necessary to clarify the influence that the evaluated dentin’s structure (for example, the existence of caries or the course of dentinal tubules or the presence of a smear layer) has on the DIAGNOdent readings.
The aim of this in vitro study was to compare the performance of a visual-tactile examination and a laser fluorescence device (DIAGNOdent) for detection of residual dentinal caries after carious dentin removal with the bur excavation, hand excavation and Carisolv system. Also, we also assessed the surface morphologies using scanning electron microscope (SEM). The hypothesis tested was that not to be of influence of the structures of the prepared dentin surfaces after different caries removal methods on the results of diagnosis using the DIAGNOdent.
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