Technique tips – a ‘get out of jail’ material

The treatment of deep caries lesions may be fraught with difficulty, and total removal of deep caries in an asymptomatic tooth may result in a pulp exposure. The sealing of caries into the tooth has been suggested following the work of Metz-Fairhurst et al,1 but the recent introduction of a material (Biodentine, Septodont, UK), which has demonstrable dentine repair properties,2,3 may be of value. This material is composed of a purified tricalcium silicate powder which is mixed with water in a capsule, with the reaction releasing calcium hydroxide.

Deep caries was noted on a bitewing radiograph (Figure 1) in a number of otherwise symptom-free teeth in a 22-year-old female patient with high caries activity. The maxillary 1st and 2nd molar teeth tested vital. After removal of wet and infected dentine, it was decided that a pulpal exposure was likely if excavation was to be continued (Figure 2). Accordingly, excavation was stopped and Biodentine placed in the cavities and, after 15 minutes’ setting time, basic carving could be carried out (Figure 3). After 9 months, the restorations were intact (Figure 4) and the tooth symptom free. A decision will be made in due course regarding the need for replacement of the restorations and whether removal of the remaining caries will be carried out, or simply that the restorations be resurfaced with resin composite.