Lesion orientated caries treatment--a classification of carious dentin treatment procedures

To review experimental and marketed techniques for the treatment of infected dentin as a potential substitute for conventional rotary excavation.

A hand and systematic search of Medline (via DIMDI) was performed. Additionally, manufacturers' data about relevant clinical studies were checked. After classification of the identified techniques described, relevant studies are cited to allow an overview of the different treatment options.

Excavation, disinfection and sealing techniques for the treatment of infected dentin can be differentiated. Besides several mechanical approaches, chemo-mechanical excavation, enzymatic digestion and photo ablation are discussed. Disinfection techniques can be undertaken with even less invasive approaches like gasiform ozone application, photodynamic therapy or local application of antibacterial materials. Additionally, or alternatively, the sealing of carious dentin is discussed using fluoride-releasing cements, dentin adhesives or antibacterial resin materials.

Although some of the techniques are still experimental and much clinical research has to be done, many different approaches are so promising, or already established, that hopefully the days of radical excavation with rotary instruments are numbered.