Influence of chitosan on dentin biomodification after selective removal of caries lesion using Er: YAG laser. Clinical longitudinal, photographic analysis, marginal adaptation of the replica of the restoration and microbiological

Author(s)

Raí Matheus Carvalho Santos

• Document type: Master's Dissertation
• Press: Ribeirão Preto.
• Institution: Universidade de São Paulo (USP). Faculdade de Odontologia de Ribeirão Preto (PCARP/BC)
• Defense date: 2018-12-04

Examining board members

Silmara Aparecida Milori Corona; Danielle Cristine Furtado Messias; Renata Siqueira Scatolin; Fabiana Almeida Curylofo Zotti

• Advisor: Silmara Aparecida Milori Corona

Abstract

The objective of this clinical study was to evaluate the effect of Er: YAG laser for the removal of caries lesions in primary teeth, followed by the biomodification of dentin affected with 2.5% chitosan gel, reducing the amount of Streptococcus mutans and Lactobacillus ssp, and the clinical behavior of the performed restorations. The sample consisted of 52 children who presented lesions of active caries reaching dentin, located on the occlusal surface in a deciduous molar. For the microbiological analysis (n = 10), the teeth were randomly distributed in 4 groups according to the selective removal of caries lesions: Er: YAG laser (250mJ / 4Hz) or contra-angle (conventional method) and treatment of the dentin surface: without biomodification and with biomodification (chitosan gel). Dentin tissue was collected in three periods: before selective removal of the caries lesion, after selective removal of the caries lesion and after the dentin biomodification with chitosan gel. The colony forming units (CFU/mg) were counted and the data were analyzed by means of the Shapiro-Wilk test and Mann-Whitney test for the Er: YAG laser after application of chitosan. After the selective removal of the caries lesion with Er:YAG laser there was a significant reduction in the amount of S. mutans (p = 0.0068). For Lactobacillus ssp, no significant difference was observed between the removal methods (p = 0.089). After biomodification with 2.5% chitosan gel, there was a significant reduction in the amount of S. mutans, for both removal methods (p=0.0524). The application of chitosan promoted reduction of the amount of Lactobacillus ssp after selective removal by the conventional method, but not with Er: YAG laser (p = 0.000487). For the clinical analysis, the teeth were restored with adhesive (Single Bond Universal / 3M) and composite resin (Z350 Filtek / 3M) and evaluated in 7-day periods (baseline), 6 months and 1 year using modified USPHS criteria. Photographic images were taken to aid in the clinical analysis of the restorations. For analysis of the marginal adaptation of the replica of the restoration in electron microscopy, the teeth were molded with addition silicone. The data obtained in the clinical analysis were submitted to nonparametric Kruskal Wallis tests and Dun\'s complement (p<0.05). In the clinical analysis, a significant difference was observed for the selective removal of the caries lesion using the Er: YAG laser in relation to the descoloration and marginal adaptation criteria (p<0.05). It was concluded that the Er: YAG laser reduced the amount of S. mutans and Lactobacillus ssp and the biomodification with chitosan was effective to potentiate the antimicrobial effect, and that the clinical behavior of the restorations was not influenced by the method of removing the lesion from caries and biomodification of the affected dentin (AU)

• FAPESP's process: 16/14864-5 - Influence of the dentin rewetting with chitosan after selective removal of carious lesion by Er: YAG: longitudinal clinical analysis, photographic evaluation, marginal adaptation of the replica of the restoration and microbiological analysis
• Grantee: Raí Matheus Carvalho Santos
• Support Opportunities: Scholarships in Brazil - Master