The goal of this narrative review was to summarize and compare treatment options for permanent teeth carious lesions that are radiographically close to the pulp chamber.
Thanks to adhesive restorative materials, minimally invasive approaches are possible.
In this context, the old question arises as to whether caries must be excavated completely, i.e., down to hard dentin, or whether it could be advantageous to leave some soft dentin, or even merely seal the whole lesion.
To answer this question, the microbiological aspects of the lesion must be considered, along with the immunological response in the dental pulp, with the concurrent possible negative outcomes for the patient. Both aspects are considered in this review, and clinical studies comparing different treatment modalities are discussed.
Situations in which calcium silicate cements could be advantageous over the gold standard calcium hydroxide preparations for covering the dentin/pulp wound are also discussed.
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This has renewed interest in minimally invasive concepts also in teeth with deep caries, i.e. those with a lesion that reaches close to the pulp space on the radiograph. These procedures, aiming to preserve tooth vitality, shall be discussed in the current discourse.
The underlying ideas of minimally invasive caries excavation are not necessarily new. Different excavation methods to avoid pulp exposure were suggested a long time ago.
However, incomplete excavation concepts have neither become established in teaching institutions, nor in dental practices.
°SWISS DENTAL JOURNAL SSO
°Monika Marending / Thomas Attin / Matthias Zehnder