Latest Updates in The Management of Deep Caries Lesions

   

Alkhansa Abdulnabi Alqaddafi1*

Teaching Assistant at conservative and endodontic departments at Tripoli dental college Tripoli university, Libya

*Corresponding author: Alkhansa Abdulnabi Alqaddafi, Teaching Assistant at conservative and endodontic departments at Tripoli dental college Tripoli university, Libya.

Citation: Alqaddafi AA. Latest Updates in The Management of Deep Caries Lesions. J Oral Med and Dent Res. 5(4):1-3.

Received: September 25, 2024 | Published: October 01, 2024

Copyright© 2024 genesis pub by Alqaddafi AA, et al. CC BY-NC-ND 4.0 DEED. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International License. This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation

DOI: https://doi.org/10.52793/JOMDR.2024.5(4)-77

Abstract

The management of deep caries lesions has evolved significantly, focusing on preserving tooth structure and maintaining pulp vitality. Recent studies and guidelines emphasize selective caries removal techniques over traditional complete excavation methods.

Keywords

Deep Careless; Techniques; Clinical Guidelines; Vital Teeth

Introduction

The management of deep caries lesions has evolved significantly, focusing on preserving tooth structure and maintaining pulp vitality. Recent studies and guidelines emphasize selective caries removal techniques over traditional complete excavation methods. Here's a detailed overview of the latest strategies and findings in this area.

Method

Current Techniques for Caries Management

• Selective Caries Removal

This method involves the removal of carious tissue only until firm dentin is reached, allowing for the retention of more healthy tooth structure. It is particularly recommended for asymptomatic teeth, where the risk of pulp exposure is lower. Recent studies indicate that dentists are increasingly adopting this approach, aligning with the International Caries Consensus Collaboration (ICCC) guidelines, which advocate for preserving healthy dentin and maximizing restoration success.

• ​Stepwise Caries Removal

IF This technique entails a two-visit approach where carious tissue is partially removed initially, followed by a second visit to complete the excavation after a period of observation. Evidence suggests that this method can also effectively maintain pulp vitality, although it may require more patient compliance for follow-up visits. Studies indicate comparable success rates between selective and stepwise removal, with selective methods showing slightly better outcomes in terms of pulp vitality retention.​

• Non-selective (Complete) Caries Removal

Traditionally, this method involved the complete excavation of all carious tissue. However, recent evidence points to a high a higher risk of pulp exposure and postoperative complications associated with this approach. As a result, it is being recommended less frequently in favor of more conservative techniques.​

Evidence-Based Recommendations

• Clinical Guidelines

​The American Dental Association (ADA) has yet to issue specific guidelines on selective caries removal, but the ICCC has published recommendations emphasizing the importance of preserving tooth structure and maintaining pulpal health. These guidelines suggest that in deep carious lesions, selective removal to soft dentin should be the preferred approach.

• Future Directions

Ongoing education and dissernination of best practices are essential to improve adherence to these guidelines. Research continues to explore the long-term outcomes of different caries management techniques, with a focus on minimizing patient discomfort and maximizing restoration longevity.

 

 

Figure 1: Management of Deep Caries Lesions.

 

 

Figure 2: Cross section of a moderately deep carious lesion.

 

Conclusion

Management of deep caries lesions is shifting towards more conservative, evidence-based approaches that prioritize the preservation of tooth structure and pulp vitality. Selective and stepwise removal techniques are gaining traction, supported by recent research and clinical guidelines. Further studies are needed to standardize definitions and methodologies in this evolving field.

References

1. Jurasic MM, Gillespie S, Sorbara P, Clarkson J, Ramsay C, et al. (2022) Deep caries removal strategies: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc. 153(11):1078-88.

2. Figundio N, Lopes P, Tedesco TK, Fernandes JCH, Fernandes GVO, et al. (2023) Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials. Healthcare Basel. 11(16):2338.

3. Ali-Ali M, Camilleri J. (2022) The scientific management of deep carious lesions in vital teeth using contemporary materials—a narrative review. Front Dent Med. 3(1):1-13.

4. Barrett B, Sullivan M. (2020) Management of the deep carious lesion: a literature review. Journal of the Irish Dental Association. 67 (1):36-42.

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7. Duggal M, Gizani S, Albadri S, Krämer N, Stratigaki E, et al. (2022) Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document. Eur Arch Paediatr Dent. 23(5):659-66.