The treatment of deep dentine caries lesions

This paper discusses the excavation of deep caries lesions, focusing on indirect pulp-capping and the stepwise excavation approach. The concept of a modified and less invasive stepwise excavation is presented, based on considerations of caries pathology. The aim of the first excavation is primarily to make a change within the cariogenic environment, and not to remove carious dentine close to the pulp because this risks an iatrogenic pulp exposure. Microbiological and clinical studies have shown that the number of bacteria decrease during stepwise excavation procedures, and that lesions clinically arrest. The active, soft-yellowish, demineralized dentine turns into a darker, harder and drier demineralized dentine, resembling a slowly progressing lesion, where the carious dentine is easier to remove at the final visit. The final excavation has two aims: (i) to verify that arrestation has taken place, ie a clinical control of the tooth reactions and (ii) to remove the slowly progressing but still slightly infected discoloured demineralized dentine, before carrying out the permanent and final restoration.

Knowledge of guidelines for treatment of deep dentine caries may reduce the risk of pulpal exposure.