Chapter 9.3: Current Concepts of Caries Removal in Daily Practice

Although the discussion about the amount of carious dentin to be removed during cavity preparation is quite old, concepts for caries removal have evolved and changed considerably over the last decades. The antiquate understanding that it was necessary to eliminate the microbial contamination of a cavity before placing the restoration was replaced by the current knowledge that maintaining contaminated dentin beneath restorations is inevitable and is not associated with treatment failure. This chapter brings together the body of evidence behind carious dentin removal to indicate a conservative treatment, aiming to preserve both tooth vitality and structure. Studies that evaluated the effects of sealing contaminated dentin are described, which are focused on different outcomes, such as microbiological counts, clinical characteristics, laboratory analysis, and radiographic findings. Long-term studies and randomized clinical trials also support the current recommendations. After addressing the available literature on this topic, this chapter concludes that (1) the amount of carious dentin to be removed should be defined by lesion depth; (2) sealing and/or selective caries removal to firm dentin is recommended for the management of shallow and moderate lesions; (3) the selective caries removal to soft dentin in a single session is indicated for deep caries lesions aiming to preserve tooth vitality; and (4) the use of a cavity liner after selective caries removal seems to be an unnecessary clinical step.