بسم الله الرحمن الرحيم. Management of Deep Caries. Definition :. Dental caries is an infectious micro-biologic disease of the teeth that results in localized dissolution & destruction of the calcified tissues. requiring restorative intervention & even extraction. Etiology. bacteria. food.
بسم الله الرحمن الرحيم
Management of Deep Caries
Dental caries is an infectious micro-biologic disease of the teeth that results in localized dissolution & destruction of the calcified tissues. requiring restorative intervention & even extraction..
Affected & Infected Dentin:
In operative procedures, it is convenient to term dentin as either..
In the earliest stages of exposure to microorganisms, there is an effort to seal the tubules. This is accomplished by increased calcification. The result is a visible change known as transparent dentin or dentinal sclerosis .
In addition, pulpal odontoblasts, stimulated by the advancing carious lesion, will rapidly deposit dentin. The dentinal tubules in this new dentin are irregular, making them less permeable this type of dentin is known as : irregular dentin , reparative dentin , secondary dentin or tertiary dentin . Dentinal sclerosis and reparative dentin may be successful deterrents if the carious lesion progresses slowly.
Management of deep caries
The objective is to focus on the:
The results of diagnosis :
Indirect pulp capping
Conventional cavity preparation and restoration
Non-vital (carious) exposure
Direct pulp capping
When caries is thought to extend close to, or into the pulp, excavation of the pulpal caries can be stopped at soft affected but not infected dentine (affected dentine could be remineralised if the acid production was halted). Medication is then applied over the pulpal dentine prior to placement of the definitive restoration.
Medication is left for 6 – 8 weeks .
During this waiting period :
However the difficulty with this tecnique is knowing:
Materials used for indirect pulp capping :
Although CaOH is the most commonly used it has been argued that its effect occurs only in case of its direct contact with pulp tissues . Therefore a material with better sealing ability should be used .
Technique for treating a pulp exposure with a material that seals over the exposure site & promotes reparative dentin formation..
Requirements of direct pulp capping:
Calcium Hydroxide Technique
Total etch technique
Direct Pulp Capping Techniques
Resin modifieed glass ionomer
Resin modifieed glass ionomer
Calcium Hydroxide Technique:
This control may be achieved by :
If bleeding fails to stop after two or three attempts, then endodontic therapy should be considered.
An alternative is to place a zinc oxide-eugenol restoration over the calcium hydroxide cap. Zinc oxide-eugenol provides an excellent seal and, with its anti-microbial properties, makes for a very good temporary restoration.
After three months, assuming pulp vitality and no symptoms, the zinc oxide-eugenol can be removed and a more permanent sealed restoration placed.
Total Etch Technique :
Carisolv™ is a chemo-mechanical method for minimally invasive caries removal .
The system comprises :
instruments used for
removal of the
Carisolv gel consists of two carboxymethylcellulose based gels:
amino acids (glutamic acid, leucine and lysine),
Erythrosine (added in order to make the gel visible during use ).
A soft caries lesion
Gel application. Let gel slide onto the lesion. Wait 30 seconds.
Re-applied gel stays clear. Cavity is hard with a probe.
The lesion is gently scraped with a star instrument
The gel is removed with a dry pellet
Complete caries removal is checked with an explorer
The cavity is cleaned with wet pellets
Action of excavator. Healthy dentine is also removed.
Selective removal of softened dentine caries with the Carisolv™ instrument. Healthy dentine is not affected.
The restorative treatment doesn't cure the caries process, so identifying & eliminating the causative factors for caries must be the primary focus, in addition to the restorative repair of damage caused by caries.