الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Atraumatic restorative treatment (ART) is a minimally invasive operative approach to manage cavitated dentin carious lesions. The ART involves excavation of the soft carious dentin using hand instruments only and sealing the cavity and adjacent pits and fissures with glass ionomer cement (GIC).
Since ART removes only the infected dentin layer using hand instruments and preserves the affected layer, it may be difficult to totally eliminate the bacteria under the restoration. Residual bacteria may progress overtime causing secondary caries and restoration failure. The survival of atraumatic restorative treatment (ART) restorations would probably increase if near total elimination of cariogenic microorganisms could be done in the process of cavity cleaning before going ahead with the restoration. Research proved silver diamine fluoride (SDF) to have a significant antibacterial effect against cariogenic biofilm and it has the ability of hampering caries progression therefore it can increase the resistance of the GIC restoration to secondary caries.
This Study was performed to evaluate the effectiveness of SDF compared to CHX as a cavity disinfectant on residual cariogenic bacteria in ART restorations. Sixty Healthy 4-6 years old children having primary molars with occlusal carious lesions involving the dentin, were recruited for this study. Atraumatic restorative treatment procedures were performed to the whole sample. A baseline visual tactile examination and bacterial sampling from the center of the cavity were performed. Bacteriological samples were cultivated for total viable count (TVC), mutans streptococci (MS) and lactobacilli (LB). Silver diamine fluoride was applied to the cavity floor in group I (n=20), chlorhexidine was applied to the cavity floor in group II (N=20), and conventional Atraumatic Restorative Treatment without disinfectant was performed in group III (n=20). After 14 days the restorations were removed. A second visual
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tactile examination and dentin sampling were performed from the same position for bacteriologic assessment of the outcome.
The results revealed the mean percent reduction for group I (SDF group) was 14%, 88% and 32 % for the TVC, MS and LB respectively. While the mean percent reduction for the group II (CHX group) was 7%, 22 % and 8 % for the TVC, MS and LB respectively. The mean percent reduction for group III (GIC group) was 6%, 13% and 7 % for the TVC, MS and LB respectively. When comparing the three groups group I (SDF group) exhibited significantly higher mean percent reduction of TVC, MS and LB than the other two groups. While group II (CHX group) exhibited higher mean percent reduction of TVC, MS and LB than group III (GIC group) yet the difference did not reach statistical significance.
Regarding the dentin consistency 6 teeth from group I (SDF group), 2 teeth from group II (CHX group) and 3 teeth from group III (GIC group) exhibited increase in hardness but without revealing any statistical significance when compared to the baseline. While in regard to the dentin colour, all group I (SDF group) exhibited a black discolouration, while two samples from group II (CHX group) and 1 sample from group III (GIC group) exhibited lighter colour. The obtained results indicate that SDF improves the antimicrobial action of the ART restoration against residual bacterial and outperforms the CHX disinfectant. Therefore ART performed with SDF disinfection could pose as an alternative to traditional ART performed with GIC alone.