Early band instrument.5 In Air-Abrasion, abrasive particles are

Early in the 20th century,
dental caries treatment was based on the principle of “extension for
prevention.” The complete infected dentin and part of the sound tooth structure
were removed to ensure elimination of disease and prevent the development of
new lesions (Black & Black, 1924). In addition, to improve retention of
the restorative materials, the cavities needed to present specific forms
which cause weakening of the remaining crown. The practice of “extension for prevention” gave way
to “minimally invasive dentistry.”1
Minimally Invasive dentistry (MID) advocates the maximum preservation
of Intact and repairable dental hard tissues through minimizing the
unnecessary alteration of healthy tooth structure.2
Dental caries can be divided into
several different layers. The superficial or outer layer is contaminated with
bacteria, which dissolves the mineralized tissue of dentin and damages the
collagen matrix so that remineralization becomes impossible. This layer must
be completely removed during caries excavation. The inner layer is less frequently
or, at best, not contaminated with bacteria. However, bacteria also dissolves
mineralized tissue in this layer, but the cross-banded ultrastructure of the collagen
matrix will remain. If these bacteria and their metabolic products the main
cause for caries are removed, the inner layer of dentin caries can remineralize
(Ogushi & Fusayama, 1975).3
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The Traditional approach using
mechanical rotary instruments is not fundamentally conservative because it
often results in cavity preparations extending beyond the infected outer
carious dentin layer into the non-infected or lightly infected inner carious
dentin or into normal dentin. Carbide dental burs are designed to efficiently
remove non-decalcified enamel and dentin but do not facilitate the
differentiation between carious and normal dentin during cavity preparation.
When this relatively aggressive procedure is combined with the dentist’s goal
to obtain an excavated surface that feels normal, inadvertent sacrifice of
sound dentin is likely to occur.4
caries removal
is the use of a solution to chemically alter carious tooth tissue to further
soften it, thus facilitating its easier removal. The softened dentine is then
mechanically removed using a band instrument.5
In Air-Abrasion, abrasive particles are emitted from a nozzle in an
air stream and aimed at the tooth surface. These particles impact the hard
tooth surface at high velocity. This technology uses the kinetic energy of
abrasive particles to promote the cut of the tooth structure. When compared
to the high-speed bur, the air-abrasion technique provides more conservative
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bur (polymer
bur) single-use, bur-like instrument, which is a unique flute design and is constructed from a medical?grade
polyether?ketone?ketone, with a particular hardness and wear resistance.7 It is designed for the selective
removal of carious dentin through the loss of its cutting efficiency upon
reaching the caries-affected dentin.4  The bur quickly dulls and vibrates when it encounters the
more highly calcified caries?affected dentin.7
The common features of these
techniques is the selective removal of caries-infected tissue, whilst leaving
intact the ‘caries-affected’ tissue. The ‘caries-affected’ dentine is
characterized by demineralization of 
the intertubular dentine, deposition of crystals in tubules, minimal
destruction of the collagen matrix and no bacterial penetration.5
The efficacy of caries removal was
evaluated  using visual and tactile
criteria. The visual criterion was the absence of any dentin discoloration
and the tactile criterion was the smooth passage of an explorer over the
surface of the affected area of the dentin without a catch or a ‘tug back’
sensation. The efficacy of caries  removal was verified using Caries Detector
(Kuraray Medical Inc, Tokyo, Japan) caries detector dye for ten seconds
followed by rinsing with water for ten seconds. Efficacy was graded as
complete, partial, and incomplete and numerically scored as 0, 1, 2, 3, 4, 5
using the criteria proposed by Munshi AK, et al.4
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The time taken for the caries
removal was noted from the start of the procedure until the complete caries
removal was achieved by stopwatch. Efficacy, pain threshold, and anxiety were
evaluated during the caries removal by Ericson D et al. scale, visual analog
scale (VAS)6
Fear and anxiety are known
barriers to the receptivity of dental treatment and in detriment to oral
health. The conventional drilling techniques are associated with discomfort,
especially among children. Moreover, the use of drill equally removes
infected and affected dentin, resulting in excessive loss of healthy tooth

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