Treatment of the deep carious lesion
Date: 2015-10-07; view: 599.
Children and young adults who have not received early and adequate dental care and optimal systemic fluoride and do not have adequate oral hygiene often develop deep carious lesions in the primary and permanent teeth. Many of the lesions appear radiographically to be dangerously close to the pulp or to actually involve the dental pulp. Approximately 75% of the teeth with deep caries have been found from clinical observations to have pulpal exposures. But over 90% of the asymptomatic teeth with deep carious lesions could be successfully treated without pulp exposure using indirect pulp therapy techniques.
The procedure in which only the gross caries is removed from the lesion and the cavity is sealed for a time with a biocompatible material is referred to as indirect pulp treatment. Indirect pulp treatment is not a new procedure but has attracted renewed interest. Laboratory studies and favorable clinical evidence justify its' routine use. Teeth with deep caries that are free of symptoms of painful pulpitis are candidates for this procedure. The clinical procedure involves removing the gross caries but allowing sufficient caries to remain over the pulp horn to avoid exposure of the pulp. The walls of the cavity are extended to sound tooth structure because the presence of carious enamel and dentin at the margins of the cavity will prevent the establishment of an adequate seal (extremely important) during the period of repair. The remaining thin layer of caries in the base of the cavity is covered with a radiopaque biocompatible base material (calcium hydroxide liner) and sealed with a durable interim restoration. Some interim restorative materials may also serve as the base material. It is often helpful to adapt and cement a preformed stainless steel band to the tooth to support the interim restoration during the observation period. Other operative procedures can be performed at subsequent visits. However, the treated teeth should not be re-entered to complete the removal of caries for at least 6 to 8 weeks. During this time the caries process in the deeper layer is arrested. At the conclusion of the minimum 6- to 8-week waiting period, the tooth is re-entered. Careful removal of the remaining carious material, now somewhat sclerotic, may reveal a sound base of dentin without an exposure of the pulp. If a sound layer of dentin covers the pulp, the tooth is restored in the conventional manner.
Treatment can be a stressful experience for the child, the parent, and the dentist. It is important that there is a positive health gain from any treatment that is provided.