Stepwise Excavation in a Permanent Molar: 17-year Follow-up

Abstract

Due to the risk of pulp exposure in deep carious lesions, stepwise excavation can be a conservative and successful option for selected cases, when signs and symptoms of a normal pulp are present. FF Lima • RC Pascotto • AR BenettiStepwise Excavation in a Permanent Molar:17-year Follow-up SUMMARYThe current study presents a 17-year clinical report of stepwise excavation and indirect pulp capping in a lower right first molar, with great dentin destruction and a lack of dentin support of the cusps. At the first appointment, indirect pulp capping with calcium hydroxide and a temporary filling with zinc oxide cement were performed to minimize the risk of pulp exposure during excavation. After 45 days, the remaining carious tissue was removed and a restoration with glass-ionomer lining (Vitrebond) and resin composite (P-50) was performed. Satisfactory morphology and function of the restoration and pulp vitality were preserved for 17 years, thus indicating that stepwise excavation can be a good treatment alternative in selected cases.

To Fill or do a Root Canal??? That’s the Question

“…Stepwise (incomplete caries removal in two steps) and complete caries excavation [5]. Statistics from literature [6,7] has shown that in comparison to complete caries removal, there is atleast 73% to 95% [6,7] success rate with different techniques of indirect pulp capping like step-wise removal (SWR) [8][9][10] of caries and partial caries removal (PCR) at a single visit [3] which has shown 82% better results as compared to SWR (62%) [6].…”

“…A 17 year old follow up case study [9] has favored stepwise excavation -which is partial removal of the carious lesion which is then lined with Calcium hydroxide and bulk filled with Zinc oxide eugenol [10]. After 45 days the lesion is revisited and given a Glass Ionomer restoration.…”

“…After 45 days the lesion is revisited and given a Glass Ionomer restoration. The tooth can finally be restored preferably with composite [9,17]. But the downside of the stepwise technique is increased risk of pulp exposure at re-entry [18]; cost [19] and microleakage [2], as zinc oxide is softer than glass ionomer cement causing failure of the IPC [2,20].…”

Deri̇n Denti̇n Çürükleri̇ni̇n Tedavi̇si̇nde Alternati̇f Yeni̇ Yöntemler

“…10 yıllık süreçte tatmin edici marjinal uyum gözlenmiĢ, ağrı, hassasiyet ve periapikal radyolusensi gözlenmemiĢtir. 129 17 yıllık takip sonucunda pulpanın vitalitesinin korunduğu bildirilmiĢtir. Bir baĢka çalıĢma-da aĢamalı çürük tedavisi yapılan diĢlerde baĢarılı tedavi oranı %74.1, çürüğün tamamen uzaklaĢtırıldığı diĢlerde de %62.4 olarak tespit edilmiĢtir.…”

Remineralization, Regeneration, and Repair of Natural Tooth Structure: Influences on the Future of Restorative Dentistry Practice

“…A routine practice is to limit caries excavation to the outer infected dentin and maintain the remineralizable affected dentin. 19 Recent endeavors in biomineralization, repair, and regeneration of hard dental tissues have accomplished enormous goals and created novel technologies. 20 The first section of this Review reports on some relevant compositional and developmental features of mineralized tooth structures to provide the basic knowledge for understanding current strategies of remineralizing, regenerating, and repairing natural tooth structural defects that are subsequently elaborated in successive sections.…”