Elsevier

Dental Abstracts

Volume 61, Issue 2, March–April 2016, Pages 108-109
Dental Abstracts

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Clinically relevant excavation

https://doi.org/10.1016/j.denabs.2015.03.054Get rights and content

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Background

The conventional approach to caries excavation has sought to remove whatever was not hard, dry dentin. Because this is a subjective criterion, more reproducible criteria such as caries-detection dyes have been suggested. Recent evidence indicates that complete excavation such as this may not be the best course of action, especially near the pulp. Leaving bacteria under a restoration may be unavoidable but acceptable if the seal imposed keeps any nutritional material from the microorganisms that

Methods

The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for clinical trials that evaluated the excavation of cavitated lesions. The search identified 28 studies with 1782 patients (2555 lesions) that met the criteria. Most of the teeth undergoing excavation were primary teeth. The criteria used for excavation were divided into six groups for analysis. The excavation was done until pulpoproximal dentin on the cavity floor was (1) hard on probing, (2)

Results

Complications were reported in 11 studies. Fewer complications were noted when the clinician did not attempt to remove all softened dentin compared with excavation until only hard dentin remained. Leaving softened dentin significantly reduced the risk of complications. The risk of complications with CMCR gel use and excavation until only hard or nonstainable dentin remained did not differ significantly. The lowest risk of complications was found when no attempt was made to remove all softened

Discussion

The risk of complications is not reduced by the removal of all softened biomass until only hard or nonstainable dentin remains. This form of “complete” excavation offered no clear advantages over removing only soft or chemomechanically degradable dentin. Time was not saved and patients experienced pain when this complete method was pursued. CMCR methods had an efficacy similar to that of conventional excavation with a significantly lessened risk of pain. It required more time than other

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Schwendicke F, Paris S, Tu Y-K: Effects of using different criteria for caries removal: A systematic review and network meta-analysis. J Dent 43:1-15, 2015

Reprints available from F Schwendicke, Charité Ctr for Dental Medicine, Dept for Operative and Preventive Dentistry, Aßmannshauser Str 4-6,14197 Berlin, Germany; fax: +49 30 450 7562 556; e-mail: [email protected]

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