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Current status of conservative treatment of deep carious lesions Juliana Mattos Giulia Marins Soares Apoena de Aguiar Ribeiro Dental Update 2024 41:5, 707-709.
Authors
JulianaMattos
Student at School of Dentistry, Fluminense Federal University
Traditionally, deep carious lesions are treated by removal of all carious tissue, which may lead to pulp exposure. To minimize this risk, conservative carious tissue removal techniques have been proposed, including partial removal and stepwise excavation. However, there is no consensus in the literature about which is the better technique. Thus, the aim of this article is to describe and discuss the main techniques for carious tissue removal, according to scientific evidence. It was observed that both stepwise excavation and partial carious tissue removal presented lower pulp exposure rates and higher success rates.
Clinical Relevance: Clinicians must be aware that conservative carious tissue removal techniques, such as stepwise excavation and partial carious tissue removal, present lower pulp exposure rates and higher success rates than traditional methods.
Article
Dental caries lesions are a localized pathology resulting from biofilm accumulation and its metabolism on tooth surfaces.1 Lesions affect a large proportion of the population, leading to severe problems in the stomatognathic system. In the case of deep caries lesions, complete removal of the carious tissue close to the pulp frequently leads to pulp exposure.2,3 In these cases, many dentists resort to more invasive procedures, such as direct pulp capping, pulpotomy or pulpectomy. However, it is known that vital pulp tissue maintains a capacity of defence against the advance of carious lesions. It is the best barrier that acts against bacterial invasion,4 and this emphasizes the importance of preserving a layer of dentine to protect the pulp.5
In order to prevent or minimize the potential complications of complete excavation of carious dentine close to the pulp, many authors have studied and proposed alternative approaches to the treatment of deep carious lesions. Among these alternatives, partial carious tissue removal3,4,6,7,8 and stepwise excavation2,5,9,10,11,12 are the most common. However, today there is still no scientific evidence about which approach should be preferred in dental practice; that is to say, it has still not been proved whether it is necessary or not to re-open and re-excavate teeth submitted to partial carious tissue removal.6 Thus, the aim of this article is to present the treatment techniques for deep carious lesions and discuss them in the light of evidence-based studies.
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