Selective removal of carious dentin

Abstract

In adult patients where dental cavities are a cause of pain with ongoing active carious lesions, plaque biofilm stagnation, poor aesthetics and/or structural/functional problems, restorative intervention will need to be considered. In order to preserve tooth structure and pulp sensibility long term, carious tissue removal should be adapted accordingly, employing a minimally invasive (MI) approach, aiming to avoid harm to the tooth and the pulp. The extent of carious tissue removal will depend on lesion-pulp proximity/pulp sensibility, the extent/restorability of remaining supragingival tooth structure, the patient's caries susceptibility and operative factors (e.g. moisture control, access). In deep lesions, selective removal to soft dentin is recommended, avoiding pulp exposure and sealing the remaining (residual) carious dentin beneath an adhesive restoration. Modern removal technologies including air-abrasion, chemomechanical agents and rotary plastic burs can assist selective caries removal. Avoiding pulp exposure, having healthy enamel/dentin margins at the cavity periphery and by using adhesive restorative biomaterials, the operator can, if handling all with care, optimise the histological substrate coupled with the applied chemistry of the material, form a durable peripheral seal and bond to aid retention of the restoration as well as arresting the lesion without pulpal harm. Achieving a smooth tooth-restoration interface clinically to aid the co-operative, motivated patient in plaque biofilm agitation/removal is an essential prerequisite to prevent/manage the disease caries and to avoid carious lesions adjacent to the restoration margins. These procedures coupled with patient-focused supportive caries management consultations enable the tooth-restoration complex to attain its maximal survival rate in the functioning oral environment.