Enzymatic caries removal and the impact on the tooth substrate

We evaluated a new enzymatic technique in comparison to the clinically established chemo-mechanical excavation or the new polymer burs. In theory one therapeutic endpoint could be to remove the tooth substance which is demineralised and exhibits also denatured collagen fibres assuming that there is no chance for remineralization in this case. A direct evaluation of this criterion is hard to find. Therefore a multitude of techniques was applied like micro-computer-tomography, CLSM, epifluorescence like with QLF, WDX-element-analysis, FE-SEM, TEM or micro- and nano-hardness measurements.

Our results suggest that it is possible with the use of enzymes to come close to this ideal therapeutic endpoint. However, using the new self-limiting caries excavation methods the tactile feedback with an explorer suggests that the surface is still soft. We have to be sure that we really can rely on the excavation quality of the new approaches. Therefore, in addition to the morphological appearance the bonding quality and also the contamination with micro-organisms have to be evaluated carefully before the self-limiting caries excavation techniques can be recommended for routine use.