Comparative Evaluation of Selective Caries Removal Techniques Followed by SDF Application In Primary Molars - An In Vivo Study

Preoperative clinical and radiographic examinations will be done to ensure proper case selection. The involved tooth will be isolated with cotton rolls and a saliva ejector. The working time will be calculated from the beginning of caries excavation in all three groups, using a stopwatch. GROUP I (Caries removal using Hand Instruments followed by SDF application): The affected tooth will be visually inspected or probed, to determine the extent of decay. Then, the caries will be excavated using a sharp spoon excavator in gentle scraping motions to scoop out the soft, decayed dentin. Caries excavation will be considered complete when no caries can be detected with tactile method. GROUP II (Caries removal using chemo-mechanical caries removing agent followed by SDF application): The chemo-mechanical caries removing gel (Dengen Dental Carie Fix Caries

Removing Gel) will be applied to the lesion. After 30 seconds (as per the manufacturer’s instructions), the gel will be removed using a moistened cotton pellet, and softened carious dentin will be removed using a spoon excavator. If necessary, a second application can be performed in areas where the caries are hard, to soften the caries for easier removal. Once again, the gel will be removed using a moistened cotton pellet and the remaining caries will be excavated using a spoon excavator. Caries excavation will be considered complete when no caries can be detected with tactile method. GROUP III (Caries removal using polymer bur followed by SDF application): Caries will be excavated using polymer bur (SS White Smart Burs II). The polymer bur will be mounted on a low-speed contra-angled handpiece. Caries will be removed in a circular motion starting from the centre of the lesion towards the periphery. Caries removal will continue until polymer bur becomes dull after repeated contact with healthy dentin and becomes visibly abraded and blunt. Cutting will be done till no more softened dentin is present. Additional polymer burs can be used until caries are completely removed. Caries excavation will be evaluated using Ericson D et al. scale (1999). Caries excavation will be followed by the application of 38% Silver Diamine Fluoride solution (FAgamin). It will allow the removal of gross debris, allowing SDF to be in maximum contact with the affected dentin surface. Before the application of SDF, a protective coating of petroleum jelly will be applied to surrounding soft tissues to avoid their discoloration. One drop of SDF will be placed in a plastic dappen dish and will be applied to the excavated area with an applicator tip for 1 minute, using a gentle flow of compressed air until the liquid is dry. The remaining tooth structure will be restored with GC Gold Label Universal Restorative Cement. Time taken in caries excavation followed by SDF application during each procedure will be compared. Patient acceptance will be assessed using the Wong-Baker Faces Pain Scale which can easily be understood by

children as it consists of a series of faces depicting different levels of pain, ranging from a smiling face representing “no hurt” with a score of 0 and to a crying face indicating “hurts worst” with a score of 10. After the completion of the treatment, patients will be recalled after 1, 3, 6, and 9 months. Clinical and radiographic outcomes of the procedure will be recorded during each visit.