Minimally invasive selective caries removal: a clinical guide

Lim, Zi En; Duncan, Henry F.; Moorthy, Advan; McReynolds, David

doi:10.1038/s41415-023-5515-4

Cited by 9 publications

(5 citation statements)

References 45 publications

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“…Whereas hand excavation allows the operator to have tactile sensation while removing carious tissue. Rotary instruments greatly limit tactile feedback during selective excavation and increase the possibility of iatrogenic removal of extra tooth structure at this critical region [24]. Other techniques investigated include air abrasion, chemical agents, polymer burs, and lasers for the eradication of caries.…”

Section: What Is the Recommended Methods For Removing Dental Caries?mentioning

confidence: 99%

Current Concepts on Caries Removal

Bhimjibhai Sodvadia

2024

Dental Caries Perspectives - A Collection of Thoughtful Essays

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This chapter offers a comprehensive introduction of dental caries management, with a central emphasis on selective caries removal as a cornerstone of minimally invasive dentistry. Rooted in evidence-based dentistry and a grasp of carious dentin progression, the shift from conventional dental paradigms is explored. Various challenges and debates surrounding selective caries removal techniques are discussed, encompassing non-selective, selective, and stepwise methods. Histological and clinical identification methods for carious dentin are explored till the date, including color, hardness, and texture variations. It is important to pay attention to the connection between tactile examinations and the International Caries Detection and Assessment System (ICDAS) index. The relationship between clinical staging and histological aspects of carious dentin is established. Diverse techniques like hand excavation, polymer-based burs, chemomechanical agents, air abrasion, lasers, and tungsten carbide burs are evaluated, highlighting benefits, limitations, and comparisons. The chapter underscores selective caries removal’s role in minimally invasive dentistry, focusing on tissue preservation and its impact on pulp vitality, restoration durability, and patient well-being. This comprehensive presentation covers clinical, histological, and technological facets of caries management in a minimally invasive context.

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Section: What Is the Recommended Methods For Removing Dental Caries?mentioning

confidence: 99%

Current Concepts on Caries Removal

Bhimjibhai Sodvadia

2024

Dental Caries Perspectives - A Collection of Thoughtful Essays

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“…When direct fillings are deemed clinically necessary, practitioners should use the most minimally invasive, selective caries excavation techniques, with a view towards preserving pulpal health, as much natural tooth structure as possible, and optimising restoration performance. 18 With this in mind, rubber dam isolation creates ideal moisture control conditions and facilitates aseptic technique, which is beneficial even when the pulp is not directly exposed (Figure 3A). Carious and undermined enamel should be excavated with a diamond fissure-type bur in a high-speed handpiece under copious water coolant (Figure 3B).…”

Section: Figure 1: At Present the Majority Of Dentists Are Using A Ba...mentioning

confidence: 99%

Caries and the older patient

Hayes

McReynolds

2023

Journal of the Irish Dental Association

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Population ageing is global and pervasive and in Ireland, we can expect to see the proportion of the population aged over 65 grow to nearly 30% in the next thirty years. Along with this we have seen a reduction in tooth loss. Therefore we will be managing increasing numbers of partially and fully dentate older adults in dental practice. Older adults in Ireland have high levels of past caries experience and, in particular, root caries is almost exclusively a disease seen in this cohort. Preventing and managing caries in older adults with heavily restored dentitions will bring both treatment planning and operative challenges to the dental profession.

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“…The management of deep dentin carious lesions have been directed towards more conservative and biological directions 1 , as the traditional rotary excavation causes adverse biological reactions to the dentin-pulp complex. This is attributed to the heat and vibration associated with the procedure, as well as the non-selective behavior in removing both healthy and diseased tissues 2 , 3 .…”

Section: Introductionmentioning

confidence: 99%

An in vitro assessment of the residual dentin after using three minimally invasive caries removal techniques

Al-Sagheer,

Addie,

Al-Taee

2024

Sci Rep

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To evaluate the efficiency and effectiveness of three minimally invasive (MI) techniques in removing deep dentin carious lesions. Forty extracted carious molars were treated by conventional rotary excavation (control), chemomechanical caries removal agent (Brix 3000), ultrasonic abrasion (WOODPECKER, GUILIN, China); and Er, Cr: YSGG laser ablation (BIOLASE San Clemente, CA, USA). The assessments include; the excavation time, DIAGNOdent pen, Raman spectroscopy, Vickers microhardness, and scanning electron microscope combined with energy dispersive X-ray spectroscopy (SEM–EDX). The rotary method recorded the shortest excavation time (p < 0.001), Brix 3000 gel was the slowest. DIAGNOdent pen values ranged between 14 and 18 in the remaining dentin and laser-ablated surfaces recorded the lowest reading (p < 0.001). The Ca:P ratios of the remaining dentin were close to sound dentin after all excavation methods; however, it was higher in the ultrasonic technique (p < 0.05). The bur-excavated dentin showed higher phosphate and lower matrix contents with higher tissue hardness that was comparable to sound dentin indicating the non-selectiveness of this technique in removing the potentially repairable dentin tissue. In contrast, the MI techniques exhibited lower phosphate and higher organic contents associated with lower microhardness in the deeper dentin layers. This was associated with smooth residual dentin without smearing and patent dentinal tubules. This study supports the efficiency of using MI methods in caries removal as conservative alternatives to rotary excavation, providing a promising strategy for the clinical dental practice.

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Minimally invasive selective caries removal: a clinical guide

Cited by 9 publications

References 45 publications

Current Concepts on Caries Removal

Current Concepts on Caries Removal

Caries and the older patient

An in vitro assessment of the residual dentin after using three minimally invasive caries removal techniques

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