Efficacy of Caries Removal by Carie-Care and Erbium-doped Yttrium Aluminum Garnet Laser in Primary Molars: A Scanning Electron Microscope Study

Abstract

Aim: To compare and evaluate morphological changes and bacterial deposits in primary carious molars after caries excavation with Carie-Care, erbium-doped yttrium aluminum garnet (Er:YAG) laser, and round tungsten carbide bur.

Materials and methods: Thirty human carious primary molars extracted for therapeutic reasons were sectioned mesiodistally. These sectioned samples were allocated into three groups (20 samples each): group I: Carie Care, group II: Er:YAG laser, and group III: round tungsten carbide bur. After caries excavation, all samples were processed and examined under conventional light microscope to examine for bacterial deposits. Representative samples from each group were processed and analyzed to examine the morphology of caries-excavated tissue by scanning electron microscope (SEM). Statistical analysis was done using Fisher's exact test, Kruskal-Wallis test, and Mann-Whitney U test.

Results: The Er:YAG laser showed best results with no smear layer followed by chemomechanically excavated surfaces with Carie-Care. Amount of bacterial deposits was observed to be more in group I while least in group II (p-value < 0.001). Mann-Whitney U test and Fisher's exact test revealed that there was statistically significant difference among all the three groups.

Conclusion: Among the three different methods of caries excavation, Er:YAG laser was found to be more effective compared with Carie-Care and round tungsten carbide bur.

Clinical significance: Laser-induced caries excavation by Er:YAG laser and chemomechanical method of caries removal by Carie-Care can be considered as future of noninvasive pediatric and preventive dentistry.How to cite this article: Prabhakar A, Lokeshwari M, Naik SV, Yavagal C. Efficacy of Caries Removal by Carie-Care and Erbium-doped Yttrium Aluminum Garnet Laser in Primary Molars: A Scanning Electron Microscope Study. Int J Clin Pediatr Dent 2018;11(4):323-329.

Keywords: Carie-Care; Caries excavation; Carious primary molars; Erbium-doped yttrium aluminum garnet laser; Light microscopy; Round tungsten carbide bur; Scanning electron microscope..

Fig. 1:

Representative histological section (40×) after treatment with Carie-Care showing slight amount of dentinal tubule destruction and less bacterial remnants in the cavity floor

Fig. 2:

Representative histological section (40×) after treatment with Er:YAG laser showing irregular cavity floor and infected layer almost completely removed with no destruction of dentinal tubules

Fig. 3:

Representative histological section (40×) after treatment with round tungsten carbide bur showing smooth cavity floor, without irregularities and with marked dentinal tubule destruction

Figs 4A and B:

(A) Micrograph representative of specimen from group I (2,000×) showing irregularities on the cavity surface with minimally formed smear layer and few open dentinal tubules. (B) Micrograph representative of specimen from group I (5,000×) showing irregularities on the cavity surface with minimally formed smear layer and few open dentinal tubules

Figs 5A and B:

(A) Micrograph representative of specimen from group II (2,000×) showing irregular rugged appearance and no smear layer formation and opening of dentinal tubule orifices. (B) Micrograph representative of specimen from group II (5,000×) showing irregular rugged appearance and no smear layer formation and opening of dentinal tubule orifices

Figs 6A and B:

(A) Micrograph representative of specimen from group III (2,000×) showing rougher cavity floor with well-defined smear layer and occluded dentinal tubules. (B) Micrograph representative of specimen from group III (5,000×) showing rougher cavity floor with well-defined smear layer and occluded dentinal tubules

Graph 1:

Intergroup comparison of number of bacterial counts after caries excavation in all the three groups

Graph 2:

Distribution of scoring given to caries excavated dentin in all the three groups