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Operative Dentistry - Best Practices

Caries Management: Deep caries lesion removal

(last modified August 8, 2014)

 

Partial Caries Lesion Removal
Indirect Pulp Capping

Partial Caries Lesion Removal
Stepwise Excavation

Complete Caries Lesion Removal

Objective

  • Maintain pulp vitality
  • Avoid pulp exposure
  • Placement of final restoration
  • Maintain pulp vitality
  • Promote remineralization & tubule sclerosis(biological treatment approach)
  • Placement of transitional restoration
  • Re-evaluation after 6 months before final restoration placement
  • see Caries Lesion Removal best Practice
  • Place RMGI liner when within 1 mm of pulp
  • Placement of final restoration

Indications

  • Chronic/ Arrested /Inactive/slowly progressing lesion
  • Recurrent caries lesion under deep restoration with thin remaining dentinal thickness
  • Reversible pulpitis
  • No periradicular pathosis
  • No history of pain/may have no lingering cold sensitivity
  • Older patients
  • RCT denied by patient and indications above
  • Active/Soft/Rapid lesion progression
  • Primary caries lesion or recurrent caries lesion under shallow restorations
  • Reversible pulpitis
  • No periradicular pathosis
  • No history of pain/ may have no lingering cold sensitivity
  • Younger patients
  • Patient willing to wait for re-evaluation (6 mo.)
  • To clarify diagnosis and treatment plan when restorability is compromised
  • "Key teeth" eg. Indirect restorative procedures, abutments for FPP or RPP.
  • Tooth structure integrity is compromised and intra-radicular retention may be necessary
  • Irreversible pulpitis or uncertain pulp prognosis
  • Patient informed decision

Advantages

  • One Visit
  • Cost
  • Preserve tooth structure / minimally invasive procedure
  • Promotes formation of secondary/ sclerotic dentin
  • Allows/maintains thicker remaining dentin
  • Clarifies pulpal diagnosis and prognosis
  • One visit

Disadvantages

  • More tooth structure removed
  • Sclerosis of dentinal tubules and dentin formation not promoted
  • Greater risk of pulpal exposure

 

  • Two or more visits
  • Time
  •  Requires patient compliance
  • Cost
  • "Key teeth"

 

 

  • High risk  of  pulp exposure
  • Invasive treatment for deep caries lesion TX
  • Extensive removal of tooth structure
  • Follows mechanical approach instead of biological approach
  • Cost (increases probability of RCT)