ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Dental Air Abrasion Versus High Speed Rotary Instrumentation In Caries Preparation
Clinical Question In a patient with carious lesions, is the use of air abrasives more effective than rotary instruments in the removal of tooth decay?
Clinical Bottom Line No evidence was found which directly compared air abrasion and rotary instruments. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18949309Livia/2008 15 teeth (5 deciduous teeth, group D; 5 permanent teeth, group P; and 5 bovine teeth, group B) were selected using a light microscope In vitro lab study
Key resultsHigh speed instruments yielded U-shaped cavities with well defined cavosurface margins and inner angles with the presence of an amorphous smear layer. Air abrasion yielded more irregular w- or v-shaped cavities with cavosurface and internal contours forming a margin around the cavity preparation, with the presence of a smear layer impregnated with aluminum oxide particles.
Evidence Search Search "Air Abrasion, Dental"[Mesh] Limits: Randomized Controlled Trial Search "Air Abrasion, Dental"[Mesh] Limits: Systematic Reviews, Search "Air Abrasion, Dental"[Mesh] Limits: Meta-Analysis, Search "Air Abrasion, Dental"[Me]
Comments on
The Evidence
The teeth used in this study were similar to begin with and individually evaluated before the study, all were subjected to the same microscopic evaluation. It was not a double blind study, and it is uncertain if there is any competing interest in the outcome of the study.
Applicability The evidence found in this article is applicable to the general practitioner and their patients as air abrasion is feasible in the properly equipped dental office and may offer an alternative to rotary instrumentation.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Air abrasion, caries preparation, rotary instruments
ID# 850
Date of submission: 04/14/2011spacer
E-mail barnesjl@livemail.uthscsa.edu
Author Joseph Barnes
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Mark Littlestar, DDS
Faculty mentor/Co-author e-mail littlestarm@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
post a comment
by James Dix, Ju Ri Hur (San Antonio, TX) on 10/03/2014
A PubMed and Trip database search was conducted in September 2014. Two more recent systematic reviews from 2011 (PubMed ID: 2140392) and 2014 (PubMed ID: 25177659) were examined. While these reviews don’t directly compare the efficiency of rotary instrumentation with air abrasion, they indicate differences in effect on dentin removal. Air abrasion provides the practitioner with decreased tactile sensation. Air abrasion is also less selective in dentin removal and this literature actually indicates a more effective removal of sound dentin than carious dentin because soft, carious dentin absorbs the impact and energy of the abrasive particles unlike hard, sound dentin. The decreased tactile sensation combined with decreased selectivity of dentin removal leads to unintentional removal of sound dentin. These articles suggest that air abrasion would best be used to only remove carious dentin at the end of cavity preparation. Lastly, these articles indicate that the removal of caries with rotary instrumentation and air abrasion both lead to a smear layer that, with proper bonding techniques, can be removed and lead to successful bonding.
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