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J Am Dent Assoc, Vol 139, No 6, 705-712.
© 2008 American Dental Association
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CLINICAL PRACTICE

JADA Continuing Education

Treatment of deep carious lesions by complete excavation or partial removal

A critical review



Van Thompson, DDS, PhD, Ronald G. Craig, DMD, PhD, Fredrick A. Curro, DMD, PhD, William S. Green, AB and Jonathan A. Ship, DMD

Background. The classical approach to treatment of deep carious lesions approaching the pulp mandates removing all infected and affected dentin. Several studies call this approach into question.

Types of Studies Reviewed. A search of five electronic databases using selected key words to identify studies relating to partial versus complete removal of carious lesions yielded 1,059 reports, of which the authors judged 23 to be relevant. Three articles reported the results of randomized controlled trials.

Results. The results of three randomized controlled trials, one of which followed up patients for 10 years, provide strong evidence for the advisability of leaving behind infected dentin, the removal of which would put the pulp at risk of exposure. Several additional studies have demonstrated that cariogenic bacteria, once isolated from their source of nutrition by a restoration of sufficient integrity, either die or remain dormant and thus pose no risk to the health of the dentition.

Clinical Implications. There is substantial evidence that removing all vestiges of infected dentin from lesions approaching the pulp is not required for caries management.

Key Words: Deep caries; deep carious lesions; partial caries removal; indirect pulp capping; pulpal exposure; stepwise excavation; alternative restorative treatment

Abbreviations: ART: Alternative restorative treatment. • CFU: Colony-forming unit. • DEJ: Dentinoenamel junction. • GIC: Glass ionomer cement. • PEARL: Practitioners Engaged in Applied Research and Learning.






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