Lecture Outline

⦁ Introduction
⦁ Paradigm shift and different
⦁ New Evidence
⦁ Diagnosis of deep carious
⦁ Material used Deep Caries Management

Management of deep caries
⦁ Paradigm shift
⦁ In past
⦁ We manage our case by extension for prevention tech by G.V black
⦁ Recently
⦁ We understand the caries process and use conservation tech
importance of conservation
⦁ that we want preserve tooth as can as possible
⦁ Different caries removal technique
⦁ Complete caries removal
⦁ It is not recommended in deep cavities to avoid pulpal exposure especially with patient with any symptoms
⦁ Incomplete caries removal techniques
⦁ Partial caries removal
⦁ Step wise excavation
⦁ ART
⦁ Partial caries removal or Step wise excavation

Partial caries removal Stepwise excavation
⦁ 1 entry with final restoration
⦁ Less cost and time
⦁ Less incidence of pulpal exposure ⦁ 2 entry (after 6 months to 1 year)
⦁ More time
⦁ Increase risk of pulpal exposure at the second visit
We prefer Partial caries removal Due to
⦁ Less Less cost and time
⦁ Less incidence of pulpal exposure
⦁ Less of failure rate

⦁ ART technique
⦁ Use only hand instrument to remove caries
⦁ Usually use glass ionomer restoration
⦁ And we prefer capsulated restoration that have best powder to liquid ratio that affect on strength
⦁ All pit and fissured should be sealed
⦁ Rational
We find that not all carries dentin have bacteria
There are affected dentin by just acids and and etch but not affected
⦁ Clinical step
At least 2mm of sound tooth structure all around
⦁ to remove caries near pulp:
Use hand excavator or low speed large round bur
⦁ Finishing of enamel and removal of cavity wall is a must

Pulp capping Vital pulp therapy
⦁ in case of pulpal exposure in deep cavity
⦁ It used with in case of healthy pulp.
⦁ Pulp capping requirement in 2019
⦁ Cavity must be isolated by rubber dam
⦁ Remove all carious tissue
⦁ Controlled pulpal bleeding is essential
⦁ Use of disinfectant (example: chlorhexidine)
⦁ Use hydraulic calcium silicate cement not calcium hydroxide

New evidence
⦁ International Caries Consensus Collaboration (ICCC )
make guide line for terminology
⦁ Partial caries removal become Selective caries removal
Hardness Description
Soft dentin Can easily spooned up
Leathery dentin Need some pressure while spooning
Firm dentin Physically retention to sound dentin
Need more pressure with resistant
Hard dentin Need shape hand propping force to engage
And hear dentin sound

Diagnosis of deep carious lesion
⦁ history of pain have
⦁ No sudden pain within long time
⦁ Pain resolve without analgesic
⦁ Pain with cold not hot stimulus
⦁ Due to it will indicate of irreversible pulpitis
⦁ Cavity lesion without pain indicated necrotic pulp
Preoperative x-ray
⦁ Estimated depth
⦁ Periapical lesion
⦁ Presence of radiopaque dentine layer separate the lesion and pulp
⦁ Sensitivity to cold Sensitivity or test Electric
Pulp tester

⦁ Glass ionomer:
Material used

⦁ Good initial seal
⦁ Fluoride release (antibacterial and remineralization)
⦁ Composite we make prefect seal

This done by
Dr .Tadros selim salah