TREATMENT OF DEEP CARIES LESION AND STEPWISE EXCAVATION TECHNIQUE

Abstract

Introduction, aim: Treatment of caries lesion has been for a long time one of the basic procedures in dentistry, but even today there is not completely uniform approach to this treatment in case of deep caries lesion near the dental pulp. There are three different techniques that have both advantages and disadvantages; nevertheless their common goal is to maintain the vitality of the tooth. The first approach to treatment is the total excavation of all carious tissues and a definitive filling application. The other method of treatment is the selective excavation with leaving a small area of softened dentin pulpally and application of a permanent filling. The third technique is stepwise excavation, which means two-visit treatment with gradual excavation of all carious tissues. This review article is focused on the third type of the treatment and the possibility of using various remineralization materials. Methods: For this article, studies in English were searched using key words (deep caries, stepwise excavation, indirect pulp capping, calcium hydroxide, glassionomer cement, calcium silicate cement, calcium phosphate cement) and their variations in order to summarize current knowledge about stepwise excavation method and materials used in this indication. The search was performed using PubMed, Web of Science and Cochrane Library databases and supplied by sources of Czech literature. Studies were selected mainly from journals with impact factor and published between 2010 and 2020. For the deeper understanding of the historical development of the issue, the literature was supplemented by several publications from the second half of the last century. Conclusion: The treatment of deep caries lesion with the preservation of vitality is a much discussed topic today and there is still not uniform approach, how to perform this procedure. In case of stepwise excavation, calcium hydroxide-based materials, glass ionomer cements and calcium silicate cements are usually used for indirect pulp capping. Due to their properties, calcium phosphate cements have a high potential for use in this indication and may increase the success rate of treatment, however more detailed in vitro research and clinical studies are still needed.

Keywords

• deep caries; stepwise excavation; indirect pulp capping
• calcium hydroxide
• glassionomer cement
• calcium silicate cement
• calcium phosphate cement