Treatment of dental caries – evidence-based information from recent studies
Operative therapy of deep caries involves avoidance of extended excavation and prevention of pulp exposures. How much dentin can be left in the cavity, in relation to the depth of caries? Is it possible to objectively measure inflammation in the pulp? Should we still perform stepwise excavation in relation to the deep caries lesion? This debate has not always been based on sound evidence. Often the depth of the caries lesion is not defined, and there is a lack of randomized clinical trials for the recommendation of one treatment versus another, and consequently a variation in treatment develops between clinicians.
Studies will be reviewed dealing with this dilemma, and the clinical procedures will be presented. The use of stepwise excavation versus one completed excavation on well-defined deep caries (carious dentine radiographically visible in the pulp close to the inner forth of the dentine with a radiodense zone present) on adults is recommended, as the number of pulp exposures is significantly reduced. Neither direct pulp capping nor partial pulpotomy performed on adults can be recommended on well-defined deep caries using calcium hydroxide.
Partial excavation versus stepwise excavation on caries involving half the dentin depth or more (< 18-yrs) shows no significant difference. Pulp-capping procedures using Mineral Trioxide Aggregate (< 18-yrs) on extremely deep caries (carious dentine includes radiographically the entire thickness of the dentine) carries a good prognosis, yet the procedure has not been supported by randomized clinical trial among adults.
