In Dr. Philip Hudson’s June JADA article, "Conservative Treatment of the Class I Lesion: A New Paradigm for Dentistry," he speaks at great length about the paradigm shift in how dentists should now manage the Class I caries lesion. Dr. Hudson appears to have overlooked an important evidence-based reference that would have given his article even more momentum toward embracing the concept of minimally invasive dentistry.
In particular is the highly referenced fissure clinical trial by Mertz-Fairhurt and colleagues,1 in which carious dentin was sealed and evaluated radiographically and clinically over a 10-year period. The results of this well-controlled study revealed that the carious process had been arrested. These summary findings were that, when properly sealed, carious lesions did not progress over the 10 years of the study. These long-term clinical data appear to suggest that the most conservative treatment alternative would not require exploration of the suspicious fissure.
Additionally, a more recent article by Kidd2 examines the concept that the caries process is driven by activity in the biofilm, and that there is little evidence that infected dentin must be removed prior to sealing the tooth. Kidd presents a rationale for moving the bacterial biofilm out of the fissure system as a functional method to stop caries progression. This, too, could be accomplished without exploration of the fissure system.
These are two valuable resources that must not be overlooked as we move beyond "codes for what we do" to what is really best for the longevity of our patients’ dentition.
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