The degree of success in the elimination of bacteria during cavity preparation and prior to the insertion of a restoration may increase the longevity of the restoration and therefore the success of the restorative procedure. The complete eradication of bacteria in a caries-affected tooth, during cavity preparation, is considered a difficult clinical task. In addition to weakening the tooth structure, attempts to excavate extensive carious tissue completely, by only mechanical procedures, may affect the vitality of the pulp. Therefore, disinfection of the cavity preparation after caries excavation can aid in the elimination of bacterial remnants that can be responsible for recurrent caries, postoperative sensitivity, and failure of the restoration. However, the effects of disinfectants on the restorative treatment have been a major concern for dental clinicians and researchers. This review aims to explore existing literature and provide information about different materials and techniques that have been used for disinfecting cavity preparations and their effects and effectiveness in operative dentistry and, therefore, helps dental practitioners with clinical decision to use cavity disinfectants during restorative procedures. Antimicrobial effectiveness and effects on the pulp and dental restorations, in addition to possible side effects, were all reviewed in this paper. How to cite this article: Bin-Shuwaish MS. Effects and Effectiveness of Cavity Disinfectants in Operative Dentistry: A Literature Review. J Contemp Dent Pract 2016;17(10):867-879

Background: This in-vitro study aimed to investigate the effect of two different antibacterial disinfectants on the microleakage performance of newly developed bulk-fill composite, bonded to different tooth structures. Methods: Class V cavities were prepared in 30 sound premolar teeth, with enamel occlusal margins (OM) and dentin cervical margins (CM). Two disinfectants, 2% chlorhexidine gluconate (CHX) and Listerine Miswak (ListM), were used. Teeth were divided into three groups (n = 10): G1, Control; G2, CHX; and G3, ListM. Disinfectants were applied to the cavity preparation walls after they were etched with 35% phosphoric acid. The Single Bond Universal adhesive system was then used, and teeth were restored with Filtek One Bulk Fill composite. Samples were examined, after thermocycling aging, by stereomicroscopy for the evaluation of marginal dye penetration. Results: The highest mean microleakage score was reported in the CM of G1 (2.60 ± 1.174), which was significant compared with that of G2 only (p = 0.02). OM in G1 showed no microleakage, with no significant differences found among groups (χ² = 1.39, p = 0.50). No significant differences were reported between G2 and G3 (p = 0.45 OM; p = 0.17 CM). Conclusions: Cavity pretreatment with CHX is not significantly different to pretreatment with CHX. In contrast, CHX improved the cervical marginal seal as compare to the control group (G1).

Dental laboratories (LABs) are integral to the performance of a dentist in providing successful oral rehabilitation. The aim of this study was to compare the adaptation, contour, contacts, and shade matching of different government and commercial dental LABs in the fabrication of porcelain fused to metal (PFM) crowns. Thirty-two dental LABs were selected to fabricate PFM crowns (one PFM crown each). Marginal adaptation, contour, proximal contacts, and shade matching were evaluated. Evaluation of the crowns’ quality was performed following modified USPHS/FDI criteria. Visual and colorimeter assessments were employed to evaluate shade matching. Differences between groups were examined by Pearson’s Chi-square and Fisher’s exact test. The quality of marginal adaptation of crowns was good in 81.25%, however the quality of contours, contacts, and shade matching was compromised in 43.75%, 59.38%, and 39% of all LABs, respectively. Visual and colorimeter shade matching was acceptable in 62.5% and 80% of LABs in the cervical third and middle third regions of crowns, respectively, however in the incisal third the shade matching was unacceptable in nearly 60% of LABs. Commercial laboratories showed significantly better contours and shade matching, but not marginal adaptation. However, no significant differences were found in comparison of proximal contacts between the groups.

This study compared microleakage of different resin based composite (RBC) materials bonded to dentin, after chlorhexidine (CHX) application, by different adhesion protocols of a universal adhesive system. Class V cavities were prepared on the buccal and lingual surfaces of 40 premolar teeth. The “etch-and-rinse” technique of a universal bond adhesive system (Single Bond Universal Adhesive) was used on buccal preparations, while the “self-etch” protocol was used on the lingual surfaces. Two RBCs, one bulk fill (Filtek Bulk Fill [FBF]) and one conventional (Filtek Z350 XT [Z350XT]), were used. Teeth were divided into two groups of 20 teeth each, 10 per each RBC (n = 10): (1) control; and (2) pretreatment with 2% CHX. For FBF groups, teeth were restored with a single increment; however, for Z350XT, a layering technique was used. Teeth were aged by thermo-cycling and prepared for microleakage testing. Dye penetration was evaluated and scored from 0 to 4. Data were analyzed at a significance level of P < 0.05. The highest microleakage mean scores were found in the control group of the etched margins for both RBCs (2.80 ± 1.033 FBF and 2.10 ± 1.370 Z350XT). The CHX-pretreated group showed significantly lower microleakage than the control for FBF only (P = 0.008). No significant difference was found between groups for the “self-etch” protocol (χ² = 0.884, P = 0.08). No significant differences were found between FBF and Z350XT in all study groups (P > 0.2). When the “self-etch” protocol of the universal adhesive system was used, dentin microleakage was not affected by CHX-pretreatment when teeth were restored with bulk fill or conventional RBCs. In the “etch-and-rinse” protocol, CHX application improved the marginal seal before restoration with bulk fill material. However, in the absence of CHX, the “etch-and-rinse” protocol negatively affected marginal integrity.