An in vitro evaluation of selective demineralised enamel removal using bio-active glass air abrasion

Unnecessary over-preparation of carious enamel often occurs clinically during operative caries management. The working hypothesis to be investigated in this study is the potential for bio-active glass air abrasion to remove selectively only demineralised enamel in artificial enamel lesions when compared to equivalent alumina air abrasion, so potentially minimising cavity over-preparation. Bisected artificial, paired smooth surface enamel lesions on ethics-approved, extracted sound human molars were created and subsequently air abraded with 27 microm alumina (n = 19) and bio-active glass (n = 19). The difference between pre-operative lesion boundary and post-operative cavity margin was calculated following optical confocal fluorescent assessment of the lesion boundary. Data indicated mean% over-preparation (sound enamel removal) of 176% with alumina and 15.2% for bio-active glass (p = 0.005). Bio-active glass abrasion removed completely the demineralised enamel from artificial lesions with clinically insignificant over-preparation of sound tissue, indicating technique selectivity towards grossly demineralised enamel. Alumina air abrasion resulted in substantial enamel removal in both sound and demineralised tissues indicating the operator selectivity required to use the techniques effectively in clinical practice.