International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 13 , ISSUE 6 ( November-December, 2020 ) > List of Articles

Original Article

Comparing the Efficacy of Three Minimally Invasive Techniques on Demineralized Dentin in Primary Teeth and Evaluating Its Residual Dentin and Microhardness Levels: An In Vitro Study

R Abinaya, Priya Nagar, Pallavi Urs, J Janani, S Smitha

Keywords : Bromelain, Chemomechanical caries removal, Minimally invasive techniques, Original research, Smart burs, Vickers microhardness

Citation Information : Abinaya R, Nagar P, Urs P, Janani J, Smitha S. Comparing the Efficacy of Three Minimally Invasive Techniques on Demineralized Dentin in Primary Teeth and Evaluating Its Residual Dentin and Microhardness Levels: An In Vitro Study. Int J Clin Pediatr Dent 2020; 13 (6):585-589.

DOI: 10.5005/jp-journals-10005-1815

License: CC BY-NC 4.0

Published Online: 31-03-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: This study aims to compare the caries removal efficacy of three minimally invasive techniques and to analyze qualitatively under stereomicroscopy and quantitatively using Vickers hardness test. Materials and methods: Thirty non-carious anterior primary teeth were selected and subjected to demineralization and the same was confirmed using RadioVisioGraphy (RVG). Samples were divided into three groups: Bromelain gel, smart bur, and atraumatic restorative technique (ART). Caries removal was carried out for a time period of 2 minutes. The remaining demineralized dentin was measured using stereomicroscopy. Random dentin blocks were prepared and a microhardness test was conducted. Statistical analysis: Data were subjected to statistical analysis by one-way analysis of variance (ANOVA) test. Results: Stereomicroscopic analysis revealed bromelain gel and smart burs to be superior to ART. Bromelain gel was found to have comparable microhardness levels as healthy dentin. Statistically significant (p < 0.001) results were obtained. Conclusion: In terms of caries removal and microhardness, bromelain gel was highly efficient when compared to other groups. Clinical significance: Fear and anxiety of children and parents about conventional drills led to the emerging trends of minimally invasive restorative dentistry. This research indicated the use of bromelain gel and smart bur in the process of caries removal and that bromelain was more efficient when compared to other groups.


  1. Anwar AS, Kumar RK, Prasad Rao VA, et al. Evaluation of microhardness of residual dentin in primary molars following caries removal with conventional and chemomechanical techniques: an in vitro study. J Pharm Bioall Sci 2017;9(5):S166–S172. DOI: 10.4103/jpbs.JPBS_148_17.
  2. Garcia-Contreras R, Scougall-Vilchis RJ, Contreras-Bulnes R, et al. A comparative in vitro efficacy of conventional rotatory and chemomechanical caries removal: influence on cariogenic flora, microhardness, and residual composition. J Conserv Dent 2014;17(6):536–540. DOI: 10.4103/0972-0707.144588.
  3. Jain P, Kaul R, Saha S, et al. Smart materials making pediatric dentistry bio-smart. Int J Pedod Rehabil 2017;2(2):55–59. DOI: 10.4103/ijpr.ijpr_8_17.
  4. Khijmatgar S, Balagopal S. Minimally invasive dentistry: polymer burs. J Dent Oral Biol 2016;1(2):1009.
  5. Kumar KS, Prasad MG, Sandeep RV, et al. Chemomechanical caries removal method versus mechanical caries removal methods in clinical and community-based setting: a comparative in vivo study. Eur J Dent 2016;10(03):386–391. DOI: 10.4103/1305-7456.184151.
  6. Heiniche RM, Gortner. WA. Stem bromelain – a new protease preparation from pineapple plants. Econ Bot 1957;11(3):225–234. DOI: 10.1007/BF02860437.
  7. Kelly GS, Bromelain ND. A literature review and discussion of its therapeutic applications. Alt Med Rev 1996;1(4):243–257.
  8. Dayem RN, Tameesh MA. A new concept in hybridization: bromelain enzyme for deproteinizing dentin before application of adhesive system. Contemp Clin Dent 2013;4(4):421–426. DOI: 10.4103/0976-237X.123015.
  9. Mohamed Rehab SK. Clinical evaluation of papacarie in primary teeth. J Clin Pediatr Dent 2009;34(2):117–124. DOI: 10.17796/jcpd.34.2.f312p36g18463716.
  10. Kumar RG. Minimally invasive dentistry - a review. Int J Clin Prev Dent 2013;9(2):109–120.
  11. Bertassoni LE, Marshall GW. Papain-gel degrades intact nonmineralized type I collagen fibrils. NIH public access. Scanning 2009;31(6):253–258. DOI: 10.1002/sca.20171.
  12. Murachi T, Neuratii H. Fractionation and specificity studies on stem bromelain. J Bio Chem 1960;235(1):99–107.
  13. Houck JC, Chang CM, Klein G. Isolation of an effective debridement agent from the stems of pineapple plants. Int J Tissue Reacts 1983;5:125–134.
  14. Tausigg SJ, Yokoyama MM, Chinen N, et al. Bromelain – a proteolytic enzyme and its clinical application. Hir J Med Sci 1975;24:185–193.
  15. Chauhan K, Basavanna RS, Shivanna V. Effect of bromelain enzyme for dentin deproteinization on bond strength of adhesive system. J Conserv Dent 2015;18(5):360–363. DOI: 10.4103/0972-0707.164029.
  16. Kocchar R, Dewan R, et al. Comparative evaluation of shear bond strength of resin bonded dentin with and without dentin deproteinization. IOSR J Dent Med Sci 2018;17(3):74–77.
  17. Tomer AK, Miglani A. Residual dentine thickness. Int J Appl Dent Sci 2016;2(4):96–99.
  18. Fernanda NP. Evaluation of residual dentin after conventional and chemomechanical caries removal using SEM. J Clin Pediatr Dent 2007;32(2):115–120. DOI: 10.17796/jcpd.32.2.44n2787118133880.
  19. Quasim AS, Sullaiman AA. Evaluation of chemomechanical caries removal (Carisolv™) using the Vickers hardness test - “An in vitro study”. J Minim Interv Dent 2008;1(2):113–125.
  20. Hossain M, Nakamura Y, Tamaki Y, et al. Dentinal composition and Koop hardness measurements of cavity floor following carious dentin removal with Carisolv. Oper Dent 2003;28:346–351.
  21. Corrêa FN, Rocha Rde O, Rodrigues Filho LE, et al. Chemical versus conventional caries removal techniques in primary teeth: a microhardness study. J Clin Pediatr Dent 2007;31(3):187–192. DOI: 10.17796/jcpd.31.3.l440852707v3g1u0.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.