Evaluation of the brush technique used in indirect pulp treatment.

Voogt, L.A. (2015) Evaluation of the brush technique used in indirect pulp treatment. thesis, Dentistry.

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Abstract

Clinical problem Literature suggests that elimination of biofilm in active sites of a lesion could be sufficient to stimulate reparative mechanisms of a vital dentin-pulp complex. This supports a new minimal invasive approach of caries treatment. However, sufficient understanding of the biological mechanisms is needed to judge the status of the pulp. Indirect pulp treatment (IPT) is a minimal invasive approach of caries treatment where a thin dentin layer over a nearly exposed pulp is left. This should allow the pulp to recover and the tooth maintains its normal vitality and function. The periphery of the cavity should be clean at the DEJ to obtain a predictable site for bonding of restoration material. The active part of the deep carious lesion should be cleaned from biofilm, but dentin should be preserved as much as possible. IPT was introduced as a caries treatment in pediatric dentistry. It is now believed to be effective in adult patients as well. This translational study examines brush techniques used in IPT and analyses in vitro the macro-visual clinical features of dentin in extracted teeth with carious lesions. Clinical relevance The protocol for indirect pulp treatment in deep carious lesions is released at the Center for Oral Hygiene and Dentistry, Groningen in November 2013. It is written by Peters, Van der Sluis and Blanksma under authorization of Prof. Dr. F. Abbasa. Revision is demanded to specify the instructions of the brush technique. (Appendix I) The degree of bacterial infection in demineralized dentin with overlying biofim in proximity of the pulp is not evident3, whereas the conventional excavation procedures in deep carious lesions often lead to pulp exposure and significant tissue loss.63 Treatment complications and insufficient arrest of the caries progress may lead to additional pulp damage and eventually necrosis.4 Used criteria during excavation of dentin are tissue hardness and tissue stain. Criteria for biofilm removal with a brush in deep carious lesions should be reconsidered to update clinical decision making during treatment.3 Aim of this study Evaluation of the visual and clinical effects of the brush technique used in IPT, as written in the protocol for “deep caries treatment” at Center for Oral Hygiene and Dentistry, Groningen, The Netherlands. Research question What is the determined visual (biofilm fluorescence) and clinical effect (remaining dentin) on dentin after brush technique is used to remove biofilm during IPT in deep carious lesions? Sub questions 1 What is the determined effect of brush technique on biofilm and dentin in deep carious lesions by means of QLF imaging? 2 What is the determined effect on RDT before and after brush technique in deep carious lesions? 3 Are changes in autofluorescence of biofilm and dentin related to changes in RDT? Null Hypotheses 1 Brush technique is not related to changes in red/green fluorescence ratios of dentin and/or pathological biofilm considering time and speed of the brush technique. 2 Brush technique is not related to RDT considering time and speed of the brush technique. 3 Changes in autofluorescence are not related to changes in RDT. Method The treatment cycle uses the brush technique for 10 seconds, cycles of 5 times for 2 seconds. Consequently white and violet light images are captured of samples in freshly extracted permanent human teeth with deep carious lesions. Two groups (n=25) with different speed of the brushes (1000rpm and 2000rpm) are investigated. Sample size was 49. The evaluation of the ratio in autofluorescence changes is measured with auto fluorescent images of the QLF-D camera. The evaluation of the remaining dentin thickness (RDT) is measured in millimeters of dentin covering the pulp in images of split samples. Analysis was done with rANOVA. Results Results suggest that there is no effect of (interaction of) rotation speed and/or time on R/G values in autofluorescence of biomass and dentin during the brush technique, although a negative trend was observed within samples for time of brushing (p = 0.077). Time of brushing is associated within the samples with decrease in RDT within the limitations of this study (p = 0.000). This effect was seen most in the first 4 seconds, with an average reduction of 0.02 (mm/s). Association was not found between R/G values and RDT. Conclusion The brush technique has no effect on biofilm and dentin according to QLF imaging considering time, interaction of rotation speed and time and rotation speed self. Autofluorescence and RDT were not related. Within the limitations of this study, a statistically significant difference was found for the time the brush technique was used and decrease in RDT within samples. Use the brushtechnique for 4 seconds at low rotation speed (1000 or 2000 rpm).

Item Type:	Thesis (Thesis)
Supervisor name:	Sluis, L.W.M. Van der and Kishen, A. and Dijkstra, R.J.B.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:50
Last Modified:	25 Jun 2020 10:50
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1155

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