40 Questions
What is the difficulty in removing dentin?
The gradual changes between different dentin qualities
What is correlated with the residual bacterial numbers in dentin?
Hardness of dentin
What is the recommendation regarding moisture assessment in dentin removal?
Moisture should not be the focus
What is the characteristic of 'soft dentin'?
It can be easily scooped up with little force
What is the purpose of the 'FACE' criterion in assessing dentin removal?
To evaluate the fluorescence of dentin
What is the characteristic of 'leathery dentin'?
It can be scooped up easily but with a little more force required
What is the recommended indicator for caries activity?
Color of dentin
What is the characteristic of 'hard dentin'?
A sharp cutting edge or bur is required to lift it
What is a crucial factor for the success of direct pulp capping?
The tooth is isolated with a rubber dam and adequate hemostasis is achieved.
What is the primary goal of indirect pulp capping?
To avoid pulp exposure.
What is a contraindication for direct pulp capping?
The tooth has a history of spontaneous pain.
What is the purpose of using a spoon excavator or a large round bur in indirect pulp capping?
To excavate the caries-softened dentin slowly and carefully.
What should be removed during indirect pulp capping?
Demineralized dentin not near the pulp.
What is the primary advantage of proper pulp medication?
Maintaining pulp vitality.
What is a crucial step in the management of deep carious lesions?
Sealing the final restoration properly.
What is the purpose of periodic follow-up radiographs and vitality tests?
To assess the condition of the pulp tissues.
What is the definition of deep caries?
Radiographic evidence of caries reaching the inner ⅓: ¼ of dentine with a risk of pulp exposure
What was the concept of dental caries pathology revolved around 300 years ago?
The idea that caries is a bacterially associated disease
What is the main goal of caries removal?
To remove all carious bacteria
What is the priority in carious tissue removal in deep lesions with vital pulp?
Maintain pulpal health and prevent its exposure
What is the biggest problem during caries removal?
Assessing the balance between carious tissue removal and pulpal health
What is the limitation of the clinical appearance of carious tissues?
It does not always correlate with histological features
What is the characteristic of carious layers?
They merge into each other, often gradually
What is the conclusion of studies on carious dentin removal?
It is not relevant to remove or leave carious dentin of a specific quality or specific layer
What is the primary factor that determines the color of a carious lesion?
The incorporation of external stains
Why is removing stained dentin not necessary?
Because it is not a good indicator of activity
What is the principle behind Caries Detector Dies?
Selective dye uptake into degraded dentin
What is the main limitation of using Caries Detector Dies?
They can lead to pulp complications
What is the primary function of Fluorescence Aided Caries Excavation (FACE)?
To detect bacterial invasion of the dentin
What is the characteristic of infected dentin under FACE?
It displays red autofluorescence
What is the advantage of using FACE in caries excavation?
It reduces the need for repeated probing of the dentin
What is the most important consideration when treating deep carious lesions near the pulp?
Maintaining pulp integrity
What is the primary concern when excavating caries near the pulp?
Avoiding pulpal exposure
What type of dentin should be allowed to remain when excavating caries near the pulp?
Dry, fibrous, demineralized dentin
What is the primary rationale behind using dentin bonding agents for direct pulp capping?
To provide an effective, permanent seal against bacterial invasion
What is the primary advantage of the stepwise excavation approach compared to conventional complete excavation?
Reduced pulpal exposure
What is the primary mechanism of action of the Carisolv system in removing carious dentin?
Application of a mixture of sodium hypochlorite and amino acids
What is the primary purpose of covering the remaining soft, infected dentine with calcium hydroxide or zinc oxide and eugenol in the stepwise excavation approach?
To seal the infected dentine from the mouth
What is the expected outcome of the stepwise excavation approach on the pulp-dentine complex?
Reparative dentine and tubular sclerosis
What is the primary benefit of using a hand excavator in removing soft, infected dentine?
Increased precision and control
Study Notes
Deep Carious Lesion Removal
• Deep caries is defined as radiographic evidence of caries reaching the inner ⅓: ¼ of dentine with a risk of pulp exposure. • The aim of caries removal is to remove all carious bacteria, aiming to have a proper floor for the final restorations and improve pulp outcomes.
Principles and Priorities
• Preserve non-demineralized and generalizable tissue. • Achieve an adequate restoration seal. • Avoid discomfort and dental anxiety. • Maintain pulpal health and prevent its exposure. • Maximize longevity of the restoration.
Assessing Carious Tissue Removal
• Clinical appearance of carious tissues does not always correlate with histological features. • Carious layers have no clear-cut boundaries, but merge into each other, often gradually. • No study has found it relevant to remove or leave carious dentin of a specific quality or specific layer. • Instead, the principles above should be adhered to, as these are based on clinical evidences.
Criteria for Assessing Removed and Retained Dentin
• Hardness of dentin: assessed using probes or via tactile feedback during excavation. • Moisture of dentin: associated with bacterial numbers, but no studies have evaluated the clinical impact of leaving or removing all moist dentin. • Color of dentin: not a good indicator of activity, as inactive lesions can be highly stained, and removing hard dentin is not required. • Dye stainability: not recommended for treating deep lesions due to the risk of pulp complications and exposure. • Fluorescence Aided Caries Excavation (FACE): a method to determine the degree of bacterial contamination of the dentin.
Techniques for Management of Deep Carious Lesion
• Direct pulp capping: only reasonable chance to permit formation of dentin bridge and maintain pulp vitality under ideal conditions. • Indirect pulp capping: excavate caries-softened dentin, leaving hard, sound dentin, and avoiding pulpal exposure.
Calcium Hydroxide versus Dentin Bonding Agents
• Calcium hydroxide may be used for direct pulp capping, providing a permanent seal against bacterial invasion. • Dentin bonding agents may be used, but the issue is controversial regarding the quality of the formed dentin bridge, pulp irritation, and pulp toxicity.
How Should Soft, Infected Dentin Be Removed?
• Slowly rotating bur • A hand excavator • Chemo-mechanical caries removal system (CarisolvTM)
Stepwise Excavation
• Only remove the necrotic layer of dentine at the first visit, and cover the remaining soft, infected dentine with calcium hydroxide or zinc oxide and eugenol before placing a temporary restoration. • After a period of weeks, cavities are reopened and further excavation is carried out prior to a definitive restoration.
This quiz assesses the principles and criteria for evaluating the removal and retention of dentin, including factors such as hardness, moisture, and color.
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