In vitro evaluation of five alternative methods of carious dentine excavation

This in-vitro, split-tooth study aimed to evaluate the efficiency (time taken) and effectiveness (quantity of dentine removed) of four techniques of carious dentine excavation (bur, air-abrasion, sono-abrasion and Carisolv gel) compared to conventional hand excavation. Eighty freshly extracted human molars were assigned to four experimental groups (n = 20), sectioned longitudinally through occlusal lesions and pre-excavation colour photomicrographs obtained. Using the natural autofluorescence of carious dentine (detected using confocal laser scanning microscopy) as an objective and reproducible guide, carious dentine removal was assessed in each half of the split tooth sample, comparing hand excavation to the test method. The time taken to reach a cavity floor that was hard to a dental probe was noted and final colour photomicrographs were taken. From the results, it was concluded that bur excavation was quickest but overprepared cavities relative to the autofluorescent signature, whereas Carisolv excavation was slowest but removed adequate quantities of tissue. Sono-abrasion tended to underprepare whereas air-abrasion was more comparable to hand excavation in both the time and amounts of dentine removed. Conventional hand excavation appeared to offer the best combination of efficiency and effectiveness for carious dentine excavation within the parameters used in this study.