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The restorative procedure in posterior teeth involves clinical steps related to professional skill, especially when using the incremental technique, which may fail in the long term. A recent alternative is bulk-fill resins, which can reduce polymerization shrinkage, decreasing clinical problems such as marginal leakage, secondary caries, and fracture. This scientific study aims to report a clinical case using bulk-fill resin with an occlusal matrix. As determined in the treatment plan, an acrylic resin matrix was produced to establish an improved oral and aesthetic rehabilitation of the right mandibular first molar, which presented a carious lesion with dentin involvement. The occlusal matrix is a simple technique that maintains the original dental anatomy, showing satisfactory results regarding function and aesthetic rehabilitation.

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• Color stability of bulk‐fill compared to conventional resin‐based composites: A scoping review
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  Journal of Esthetic and Restorative Dentistry.2023; 35(4): 657.     CrossRef
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The restoration of endodontic tooth is always a challenge for the clinician, not only due to excessive loss of tooth structure but also invasion of the biological width due to large decayed lesions. In this paper, the 7 most common clinical scenarios in molars with class II lesions ever deeper were examined. This includes both the type of restoration (direct or indirect) and the management of the cavity margin, such as the need for deep margin elevation (DME) or crown lengthening. It is necessary to have the DME when the healthy tooth remnant is in the sulcus or at the epithelium level. For caries that reaches the connective tissue or the bone crest, crown lengthening is required. Endocrowns are a good treatment option in the endodontically treated tooth when the loss of structure is advanced.

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Early detection of carious lesions increases the possibility of treatment without the need for surgical intervention. Optical coherence tomography (OCT) is an emerging three-dimensional imaging technique that has been successfully used in other medical fields, such as ophthalmology for optical biopsy, and is a prospective candidate for early caries detection. The technique is based on low coherence interferometry and is advantageous in that it is non-invasive, does not use ionizing radiation, and can render three-dimensional images. A brief history of the development of this technique and its principles are discussed in this paper. There have been numerous studies on caries detection, which were mostly in vitro or ex vivo experiments. Through these studies, the feasibility of OCT for caries detection was confirmed. However, further research should be performed, including in vivo studies of OCT applications, in order to prove the clinical usefulness of this technique. In addition, some technological problems must be resolved in the near future to allow for the use of OCT in everyday practice.

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  Young-Hye Sung, Hae-Young Kim, Ho-Hyun Son, Juhea Chang
  Restorative Dentistry & Endodontics.2014; 39(3): 164.     CrossRef
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  Han-Na Kim, Myung-Su Jeong, Se-Yeon Kim, Jin-Bom Kim, Seung-Hwa Jeong
  Journal of Korean Academy of Oral Health.2014; 38(3): 131.     CrossRef

Caries remains prevalent throughout modern society and is the main disease in the field of dentistry. Although studies of this disease have used diverse methodology, recently, X-ray microtomography has gained popularity as a non-destructive, 3-dimensional (3D) analytical technique, and has several advantages over the conventional methods. According to X-ray source, it is classified as monochromatic or polychromatic with the latter being more widely used due to the high cost of the monochromatic source despite some advantages. The determination of mineral density profiles based on changes in X-ray attenuation is the principle of this method and calibration and image processing procedures are needed for the better image and reproducible measurements. Using this tool, 3D reconstruction is also possible and it enables to visualize the internal structures of dental caries. With the advances in the computer technology, more diverse applications are being studied, such automated caries assessment algorithms.

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There are considerable in vitro and in vivo evidences for remineralization and demineralization occurring simultaneously in incipient enamel caries. In order to "heal"the incipient dental caries, many experiments have been carried out to determine the optimal conditions for remineralization. It was shown that remineralization is affected by different pH, lactic acid concentrations, chemical composition of the enamel, fluoride concentrations, etc.

Eighty specimens from sound permanent teeth without demineralization or cracks, 0.15 mm in thickness, were immersed in lactic acid buffered demineralization solutions for 3 days. Dental caries with a surface zone and subsurface lesion were artificially produced. Groups of 10 specimens were immersed for 10 or 12 days in lactic acid buffered remineralization solutions consisting of pH 4.3 or pH 6.0, and 100, 50, 25, or 10 mM lactic acid. After demineralization and remineralization, images were taken by polarizing microscopy (x100) and micro-computed tomography. The results were obtained by observing images of the specimens and the density of the caries lesions was determined.

As the lactic acid concentration of the remineralization solutions with pH 4.3 was higher, the surface zone of the carious enamel increased and an isotropic zone of the subsurface lesion was found. However, the total decalcification depth increased at the same time.

In the lactic acid buffer solutions with the lower pH and higher lactic acid concentration, there were dynamic changes at the deep area of the dental carious lesion.

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• Effect of fluoride concentration in pH 4.3 and pH 7.0 supersaturated solutions on the crystal growth of hydroxyapatite
  Haneol Shin, Sung-Ho Park, Jeong-Won Park, Chan-Young Lee
  Restorative Dentistry & Endodontics.2012; 37(1): 16.     CrossRef

The purpose of this study is to compare and to evaluate the effect of pH and lactic acid concentration on the progression of artificial root caries lesion using polarizing microscope, and to evaluate the morphological changes of hydroxyapatite crystals of the demineralized area and to investigate the process of demineralization using scanning electron microscope.

Artificial root caries lesion was created by dividing specimens into 3 pH groups (pH 4.3, 5.0, 5.5), and each pH group was divided into 3 lactic acid concentration groups (25 mM, 50 mM, 100 mM). Each group was immersed in acid buffer solution for 5 days and examined. The results were as follows:

1. Under polarized microscope, the depth of lesion was more effected by the lactic acid concentration rather than the pH.

2. Under scanning electron microscope, dissolution of hydroxyapatite crystals were increased as the lactic acid concentration increased and the pH decreased.

3. Demineralized hydroxyapatite crystals showed peripheral dissolution and decreased size and number within cluster of hydroxyapatite crystals and widening of intercluster and intercrystal spaces as the pH decreased and the lactic acid concentration increased.

4. Under scanning electron microscope evaluation of the surface zone, clusters of hydroxyapatite crystals were dissolved, and dissolution and reattachment of crystals on the surface of collagen fibrils were observed as the lactic acid concentration increased.

5. Under scanning electron microscope, demineralization of dentin occurred not only independently but also with remineralization simultaneously.

In conclusion, the study showed that pH and lactic acid concentration influenced the rate of progression of the lesion in artificial root caries. Demineralization process was progressed from the surface of the cluster of hydroxyapatite crystals and the morphology of hydroxyapatite crystals changed from round or elliptical shape into irregular shape as time elapsed.

Mechanical removals in decayed teeth have been performed using drill and sharp hand instruments. These methods have some disadvantages such as pain, local anesthesia and overextended cavities. Therefore chemo-mechanical excavation of dentin carious lesions has been introduced. The purpose of this study was to evaluate the efficacy of traditional mechanical methods using burs and chemo-mechanical methods (Carisolv) of caries dentin.

Mechanical caries removal was carried with low speed round bur. Chemo-mechanical caries excavation was performed with Carisolv (Medi-team), using the Carisolv hand instruments. The mean time to remove caries with two different methods was evaluated and the data analyzed with SPSS software (ver 11.5) by t-test (p < 0.05). For histomorphometry of caries removal were also carried with mechanical or chemo-mechanical (Carisolv) methods from 20 extracted caries permanent molars. Complete caries removal was verified with a #23 sharp explorers, Caries Detector (Kuraray Co. Japan), and standard apical radiography.

1. Chemo-mechanical method was taken more times than mechanical method (1.5 fold) (p < 0.05).

2. Excavation for caries took more time for molar lesion than premolar lesion, and the least time was taken to remove the caries in incisor lesion (p < 0.05).

3. There were no significant differences to remove the caries between the maxilla and mandible (p > 0.05).

4. The remaining carious dentin was detected after the chemo-mechanical removal of the carious dentin, and no smear layer were seen after the mechanical and chemo-mechanical removal of the carious dentin.

The purpose of this study was to evaluate the effect of multiple application of all-in-one dentin adhesive system on microtensile bond strength to caries-affected dentin.

Twenty one extracted human molars with occlusal caries extending into mid-dentin were prepared by grinding the occlusal surface flat. The carious lesions were excavated with the aid of caries detector dye. The following adhesives were applied to caries-affected dentin according to manufacturer's directions; Scotchbond™ Multi-Purpose in SM group, Adper Prompt L-Pop™ 1 coat in LP1 group, 2 coats in LP2 group, 3 coats in LP3 group, Xeno® III 1 coat in XN1 group, 2 coats in XN2 group, and 3 coats in XN3 group. After application of the adhesives, a cylinder of resin-based composite was built up on the occlusal surface. Each tooth was sectioned vertically to obtain the 1 × 1 mm² sticks. The microtensile bond strength was determined. Each specimen was observed under SEM to examine the failure mode. Data were analyzed with one-way ANOVA.

The results of this study were as follows;

1. The microtensile bond strength values were; SM (14.38 ± 2.01 MPa), LP1 (9.15 ± 1.81 MPa), LP2 (14.08 ± 1.75 MPa), LP3 (14.06 ± 1.45 MPa), XN1 (13.65 ± 1.95 MPa), XN2 (13.98 ± 1.60 MPa), XN3 (13.88 ± 1.66 MPa). LP1 was significantly lower than the other groups in bond strength (p < 0.05). All groups except LP1 were not significantly different in bond strength (p > 0.05).

2. In LP1, there were a higher number of specimens showing adhesive failure. Most specimens of all groups except LP1 showed mixed failure.

Dental caries is a chronic disease that causes the destruction of tooth structure by the interaction of plaque bacteria, food debris, and saliva.

There has been attempts to induce remineralization by supersaturating the intra-oral environment around the surface enamel, where there is incipient caries.

In this study, supersaturated remineralized solution "R" was applied to specimens with incipient enamel caries, and the quantitative ananlysis of remineralization was evaluated using microradiography. Thirty subjects volunteered to participate in this study. Removable appliances were constructed for the subjects, and the enamel specimen with incipient caries were embedded in the appliances. The subjects wore the intra-oral appliance for 15 days except while eating and sleeping.

The removable appliance were soaked in supersaturated solution "R", saline, or Senstime® to expose the specimen to those solutions three times a day, 5 minutes each time. After 15 days, microradiography was retaken to compare and evaluate remineralization.

The results were as the following:

1. The ratio of remineralized area to demineralized area was significantly higher in the supersaturated solution "R" and Senstime® than in the saline. (p<0.05)

2. Remineralization in the supersaturated buffer solution "R" occurred in the significantly deeper parts of the tooth, compared to the Senstime® group containing high concentration of fluoride.(p<0.05)

As in the above results, the remineralization effect of remineralized buffer solution "R" on incipient enamel caries has been proven. For clinical utilization, further studies on soft tissue reaction and the effect on dentin and cementum are necessary.

In conclusion compared to commercially available fluoride solution, remineralization solution "R" showed better remineralization effect on early enamel caries lesion, so it is considered as effecient solution for clinical application.

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