Technique tips: patient information leaflet information for patients for whom deep caries has been sealed into a vital asymptomatic tooth

The concept of sealing deep caries into a vital asymptomatic tooth, rather than removing all caries and risking a pulpal exposure with all the inevitable sequelae (ranging from pulp-capping to root canal-filling), has gained increasing acceptance from the time when Mertz-Fairhurst and colleagues published their ten-year randomized controlled trial in 1998.¹ In this work, in a split mouth research design study, all patients received an amalgam restoration (50% of which were sealed after restoration placement) and a resin composite restoration, with all the caries being removed from the amalgam cavities, but only the ‘soft strands of decay’ being removed from the composite cavities. Results of subsequent work by Kidd et al indicated that, when caries was sealed into a cavity and the cavity re-opened after five months, the residual caries had become harder, darker and dryer, and that the number of bacteria associated with the lesion had substantially decreased.² In clinical research on primary teeth from Brazil,³ there were two treatment groups, with incomplete caries removal in 4 to 7-year-old children, cavities treated with Ca(OH)₂ or gutta-percha (gutta-percha to indicate an inert base), the cavities sealed with resin composite for 4 to 7 months, and then re-opened and examined.The soft caries changed to hard or leathery and the number of bacteria reduced in both treatment groups. The authors concluded that ‘the resin-based composite sealing of caries lesion, with or without a calcium hydroxide liner over the infected remaining tissue, may help preserve dental tissue as well as pulp vitality’. A related study⁴ concluded that ‘resin-based composite may arrest the progress of underlying caries’. Review articles and Cochrane reviews have also supported the concept of sealing caries into vital asymptomatic teeth,^5,6,7,8 providing statements such as: