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Operative Dentistry - Best Practices

Caries Management: Deep caries removal

(last modified September 1, 2016)

Deep (Advanced/Extensive) caries lesion management options include:

(1) Selective removal to soft dentin

Selective removal to soft dentine is recommended in deep cavitated lesions (i.e., extending into the pulpal third or quarter of the dentine). Soft carious tissue is left over the pulp to avoid exposure and “stress” to the pulp, thereby promoting pulpal health, while peripheral enamel and dentine are prepared to hard dentine, to allow a tight seal and placement of a durable restoration. Selective removal to soft dentine reduces the risk of pulpal exposure significantly as compared with nonselective removal to hard or selective removal to firm dentine (Schwendicke et al ADR 2016;28:58-67). A sharp hand excavator can be used to check the hardness/softness of the remaining dentine; remember that soft dentine will deform when an instrument is pressed onto it and little force would be required to lift it (Innes et al ADR 28:49-57).

(2) Stepwise removal (see next subheading)