How 'clean' must a cavity be before restoration?

Area of Science:

• Dentistry
• Oral microbiology
• Biomaterials

Background:

• Dental caries results from metabolic activity in dental plaque, a tooth surface biofilm.
• This activity causes mineral loss from teeth and cavity surfaces.
• Current caries management involves restoring tooth integrity for patient cleaning.

Purpose of the Study:

• To question the necessity of complete bacterial removal from cavities before restoration.
• To investigate the fate and impact of surviving bacteria in sealed cavities.

Main Methods:

• Review of existing evidence on infected dentine removal and its impact on caries progression.
• Analysis of the role of operative dentistry in managing dental caries.
• Discussion on the implications of surviving bacteria within restored cavities.

Main Results:

• Little evidence supports the mandatory removal of infected dentine before sealing a tooth.
• Leaving infected dentine does not appear to cause caries progression, pulpitis, or pulp death.
• A portion of bacteria survive in sealed cavities, but their long-term effects require further investigation.

Conclusions:

• The critical cleanliness of a cavity before restoration may be less important than previously thought.
• Focusing on restoring tooth surfaces to enable effective patient cleaning is key.
• Further research is needed to understand the implications of surviving bacteria in caries management.