Clinical Recommendations on Carious Tissue Removal in Cavitated Lesions

Falk Schwendicke, Jo Frencken, Nicola Innes

Research output: Chapter in Book/Report/Conference proceedingChapter (peer-reviewed)

Abstract

Non-cleansable carious lesions where sealing is no longer an option should be restored in the vast majority of cases. Prior to restoring the cavity, carious tissue removal is performed, mainly to increase the longevity of the restoration. Such removal, however, should not be conducted in a way that the vital pulp is harmed. This means that in teeth with shallow or moderately deep lesions, selective removal to firm dentine is recommended, while in deep lesions (radiographically extending into the pulpal third or quarter of the dentine) selective removal to soft dentine should be performed. In permanent teeth, stepwise removal is a possible alternative, while in primary teeth the Hall Technique can be considered too. To assess carious tissue removal, the hardness of the dentine should be the primary criterion. Moisture, colour, and additional parameters (like fluorescence of bacterial porphyrins, etc.) might be used, but should be critically evaluated towards their validity and patients' benefit. There is insufficient evidence to recommend a specific single carious tissue removal method. However, hand or chemomechanical excavation seem useful, as they reduce pain and discomfort during treatment. Current evidence also does not support any specific restoration material or (bonding) strategy for restoring cavities resulting from different carious tissue removal strategies. Prior to restoring the cavity, cavity disinfection is not recommended any longer.

Original languageEnglish
Title of host publicationCaries Excavation
Subtitle of host publicationEvolution of Treating Cavitated Carious Lesions
EditorsF Schwendicke, J Frencken, N Innes
PublisherKarger
Pages162-166
Number of pages5
Volume27
ISBN (Electronic)978-3-318-06369-1
ISBN (Print)978-3-318-06368-4
DOIs
Publication statusPublished - Jun 2018

Publication series

NameMonographs in oral science
ISSN (Print)0077-0892

Fingerprint

Dentin
Tooth
Deciduous Tooth
Disinfection
Porphyrins
Hardness
Hand
Color
Fluorescence
Pain
Therapeutics

Cite this

Schwendicke, F., Frencken, J., & Innes, N. (2018). Clinical Recommendations on Carious Tissue Removal in Cavitated Lesions. In F. Schwendicke, J. Frencken, & N. Innes (Eds.), Caries Excavation: Evolution of Treating Cavitated Carious Lesions (Vol. 27, pp. 162-166). (Monographs in oral science). Karger. https://doi.org/10.1159/000487843
Schwendicke, Falk ; Frencken, Jo ; Innes, Nicola. / Clinical Recommendations on Carious Tissue Removal in Cavitated Lesions. Caries Excavation: Evolution of Treating Cavitated Carious Lesions. editor / F Schwendicke ; J Frencken ; N Innes. Vol. 27 Karger, 2018. pp. 162-166 (Monographs in oral science).
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Schwendicke, F, Frencken, J & Innes, N 2018, Clinical Recommendations on Carious Tissue Removal in Cavitated Lesions. in F Schwendicke, J Frencken & N Innes (eds), Caries Excavation: Evolution of Treating Cavitated Carious Lesions. vol. 27, Monographs in oral science, Karger, pp. 162-166. https://doi.org/10.1159/000487843

Clinical Recommendations on Carious Tissue Removal in Cavitated Lesions. / Schwendicke, Falk; Frencken, Jo; Innes, Nicola.

Caries Excavation: Evolution of Treating Cavitated Carious Lesions. ed. / F Schwendicke; J Frencken; N Innes. Vol. 27 Karger, 2018. p. 162-166 (Monographs in oral science).

Research output: Chapter in Book/Report/Conference proceedingChapter (peer-reviewed)

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AB - Non-cleansable carious lesions where sealing is no longer an option should be restored in the vast majority of cases. Prior to restoring the cavity, carious tissue removal is performed, mainly to increase the longevity of the restoration. Such removal, however, should not be conducted in a way that the vital pulp is harmed. This means that in teeth with shallow or moderately deep lesions, selective removal to firm dentine is recommended, while in deep lesions (radiographically extending into the pulpal third or quarter of the dentine) selective removal to soft dentine should be performed. In permanent teeth, stepwise removal is a possible alternative, while in primary teeth the Hall Technique can be considered too. To assess carious tissue removal, the hardness of the dentine should be the primary criterion. Moisture, colour, and additional parameters (like fluorescence of bacterial porphyrins, etc.) might be used, but should be critically evaluated towards their validity and patients' benefit. There is insufficient evidence to recommend a specific single carious tissue removal method. However, hand or chemomechanical excavation seem useful, as they reduce pain and discomfort during treatment. Current evidence also does not support any specific restoration material or (bonding) strategy for restoring cavities resulting from different carious tissue removal strategies. Prior to restoring the cavity, cavity disinfection is not recommended any longer.

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ER -

Schwendicke F, Frencken J, Innes N. Clinical Recommendations on Carious Tissue Removal in Cavitated Lesions. In Schwendicke F, Frencken J, Innes N, editors, Caries Excavation: Evolution of Treating Cavitated Carious Lesions. Vol. 27. Karger. 2018. p. 162-166. (Monographs in oral science). https://doi.org/10.1159/000487843