Managing Carious Lesions

Advances in dental research - Tập 28 Số 2 - Trang 58-67 - 2016
Falk Schwendicke1, Jo E. Frencken2, Lars Bjørndal3, Marisa Maltz4, David J. Manton5, David Ricketts6, Kirsten Van Landuyt7, Avijit Banerjee8, Guglielmo Campus9,10, Sophie Doméjean11, Margherita Fontana12, Soraya Coelho Leal13, Edward Chin Man Lo14, Vita Mačhiulskienė15, A. Schulte16, Christian H. Splieth17, Andréa Ferreira Zandoná18, Nicola Innes19
1Department of Operative and Preventive Dentistry, Charité−Universitätsmedizin Berlin, Berlin, Germany
2Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
3Department of Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
4Department of Preventive and Social Dentistry, Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
5Melbourne Dental School, University of Melbourne, Melbourne, Australia
6Section of Operative Dentistry, Fixed Prosthodontics and Endodontology, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
7KULeuven BIOMAT, Department of Oral Health Sciences, University of Leuven and Dentistry University Hospitals Leuven, Leuven, Belgium
8Conservative and MI Dentistry, King’s College London Dental Institute, London, UK
9Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Italy; WHO Collaborating Centre for Epidemiology and Community Dentistry, University of Milan, Milan, Italy
10WHO Collaborating Centre for Epidemiology and Community Dentistry, University of Milan, Milan, Italy
11CHU Clermont-Ferrand, Service d’Odontologie, Hôtel-Dieu, Clermont-Ferrand, France; Univ Clermont1, UFR d’Odontologie, Clermont-Ferrand, France; Centre de Recherche en Odontologie Clinique EA 4847, F-63000 Clermont-Ferrand, France
12Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
13Department of Dentistry, Faculty of Health Sciences University of Brasília, Brasília, Brazil
14Faculty of Dentistry, University of Hong Kong, Hong Kong, China
15Department of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
16Department of Special Care Dentistry, Faculty of Health, University of Witten/Herdecke, Witten, Germany
17Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
18Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA
19Paediatric Dentistry, Dundee Dental Hospital and School, University of Dundee, Dundee, UK

Tóm tắt

The International Caries Consensus Collaboration undertook a consensus process and here presents clinical recommendations for carious tissue removal and managing cavitated carious lesions, including restoration, based on texture of demineralized dentine. Dentists should manage the disease dental caries and control activity of existing cavitated lesions to preserve hard tissues and retain teeth long-term. Entering the restorative cycle should be avoided as far as possible. Controlling the disease in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal or control first. Only when cavitated carious lesions either are noncleansable or can no longer be sealed are restorative interventions indicated. When a restoration is indicated, the priorities are as follows: preserving healthy and remineralizable tissue, achieving a restorative seal, maintaining pulpal health, and maximizing restoration success. Carious tissue is removed purely to create conditions for long-lasting restorations. Bacterially contaminated or demineralized tissues close to the pulp do not need to be removed. In deeper lesions in teeth with sensible (vital) pulps, preserving pulpal health should be prioritized, while in shallow or moderately deep lesions, restoration longevity becomes more important. For teeth with shallow or moderately deep cavitated lesions, carious tissue removal is performed according to selective removal to firm dentine. In deep cavitated lesions in primary or permanent teeth, selective removal to soft dentine should be performed, although in permanent teeth, stepwise removal is an option. The evidence and, therefore, these recommendations support less invasive carious lesion management, delaying entry to, and slowing down, the restorative cycle by preserving tooth tissue and retaining teeth long-term.

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Advances in dental research

Tập 28 Số 2

58-67

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