Caries Excavation: Evolution of Treating Cavitated Carious Lesions

Caries Excavation: Evolution of Treating Cavitated Carious Lesions
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Описание книги

Currently there is no reason, in most cases of cavitated caries lesions, to remove affected tissue. This book presents evidence-based research on the topic and provides assessments of diagnostic devices. It offers new insights into how a dentine carious cavity can be managed by either tissue removal or restoration. Methods for preserving dental tissue are presented and ample evidence highlights the need to seal with a quality restorative material. An update on how to conduct a randomized clinical trial is followed by a chapter on agreed upon terminology for supporting improved communication among oral health professionals around the world. This is a must-read for general practitioners, restorative specialists, dental students, and oral hygienists/therapists.

Оглавление

Группа авторов. Caries Excavation: Evolution of Treating Cavitated Carious Lesions

Monographs in Oral Science

Caries Excavation: Evolution of Treating Cavitated Carious Lesions

Contents

List of Contributors

Foreword

Preface

Pathophysiology of Dental Caries

Abstract

Microbiology of Tooth Decay

Histology of a Carious Tissue – The Microbiological Perspective

Pulp Response to Dental Caries

Dentine Histology at the Dentine Enamel Junction Is Different from that of Deep Dentine

Dentine Matrix Contains Sequestered Signalling Molecules

The Dental Pulp Defence Strategies

Dental Pulp Local Regulation

References

Caries Epidemiology and Its Challenges

Abstract

Detection and Assessment Devices

Visual/Tactile Devices Currently in Use

Reporting Data from Caries Epidemiological Surveys

Global Epidemiology of Dental Caries

Global Burden of Untreated Cavitated Dentine Carious Lesions

Prevalence and Extent of Carious Lesions in Infants and Young Children

Prevalence and Extent of Carious Lesions in Children

Which Are the Most Carious Lesion-Susceptible Permanent Teeth and Surfaces in Child Populations?

Prevalence and Extent of Carious Lesions in Adults and the Elderly

Challenges

References

Carious Lesion Diagnosis: Methods, Problems, Thresholds

Abstract

Detection versus Diagnosis of Caries

Caries Detection Methods. Visual-Tactile Inspection

Radiography

Fluorescence-Based Technologies

Transillumination

Lesion Activity Assessment

References

Removing or Controlling? How Caries Management Impacts on the Lifetime of Teeth

Abstract

Traditional Management (Removal) of Caries

Carious Lesions and Factors Impacting on Lesion Management

Intervention Thresholds: Lesion Changes over Time

Differences between Lesions: Impact of Surface Cavitation

The Problem with Invasive Therapies

The Repeat Restoration Cycle

Principles to Avoid or Slow Down the Repeat Restoration Cycle

Conclusions

References

Restoring the Carious Lesion

Abstract

Restorative Risks for the Pulp. Pulpal Trauma due to Preparation

Tooth Hypersensitivity

Use of Liners

Challenges for Bonding Resin-Based Materials to Different Dentine Surfaces

Adhesion of Glass-Ionomer-Based Materials to Tooth Tissue

Factors Limiting Durability of Resin Bonding to Dentine

Alterations of Dentine

Different Bonding Systems and Their Suitability for Different Lesions. Bonding Systems

Restorative Materials

Resin Composite Restorative Materials

Glass-Ionomer Cement

The Problem of Carious Dentine – The Mechanics of Teeth with Deep Lesions

Conclusion

References

Removing Carious Tissue: Why and How?

Abstract

The Aims of Carious Tissue Removal

The Principles of Carious Tissue Removal

The Problems of Assessing Carious Tissue Removal

Overview of Removal Strategies

Non-Selective Removal to Hard Dentine

Selective Removal to Firm Dentine

Selective Removal to Soft Dentine

Stepwise Removal

No Removal at All. Sealing in Strategies

Non-Restorative Cavity Control

Conclusion

References

Stepwise Excavation

Abstract

The Clinical Manipulation of Lesion Activity: The Key to Deep Lesion Management

The Dilemma: Issues for the Deep Carious Lesion

No Global Consensus

The Deeper Stages of Lesion Progression: Definition and Subjacent Pathology

Deep Carious Lesion and Radiographical Definition

Potential Reasons for Failures following Pulp Capping in Deep Lesions

Extremely Deep Carious Lesions and Subjacent Pulp Responses

Microbial Data

Why Does the Colour of Demineralised Dentine Change?

An Improved Evidence Platform Should Be the Solution to the Historical Dilemma

The Evidence behind Avoiding Pulp Exposure

Clinical Trials and Stepwise Excavation

Stepwise Excavation and Some Critical Points

Future Expectation of Clinical Evidence between Less Invasive Carious Removal Procedures

Is Shrinkage of Retained Carious Dentine a Problem in Selective Carious Tissue Removal?

The Stepwise Carious Tissue Removal Principles and Protocol

References

Selective Removal of Carious Tissue

Abstract

Evolution of Caries Tissue Removal

Risk of Pulpal Exposure and Outcome of Non-Selective Carious Tissue Removal

Selective Removal to Firm Dentine

Selective Removal to Soft Dentine

How to Perform Selective Carious Tissue Removal

Diagnostic Issues with Selective Carious Tissue Removal to Soft Dentine

Health of Pulp

Monitoring Carious Lesion Progression

Conclusion

References

Atraumatic Restorative Treatment: Restorative Component

Abstract

Indications and Contra-Indications of ART Restorations

Setting

Patient Age and Profile

Cavities

Caries Tissue Removal in the ART Method

Restorative Material in the ART Approach: GICs

Cavity Depth

The Use of Hand Instruments

Survival of ART Restorations. Criteria to Evaluate ART Restorations

Survival of Single- and Multiple-Surface ART/HVGIC Restorations in Primary and Permanent Posterior Teeth by Year of Survival

ART/HVGIC and Conventionally Produced Restorations

Final Remarks

References

Sealing Carious Tissue Using Resin and Glass-Ionomer Cements

Abstract

No Excavation of Any Carious Tooth Tissue/Lesion: Effects of Sealing on Bacteria in Lesions

Current State of the Evidence

Non-Cavitated Occlusal Lesions Managed Using Sealants

Non-Cavitated Proximal Lesions Sealed Using Sealants and Resin Infiltration

Cavitated Lesions Managed Using Adhesive Restorations

Effects of Sealing

Advantages and Disadvantages, Pulpal and Restorative Issues, Limitations of the Material to Seal

Diagnostic Challenges

When and When Not to Seal Carious Tissue

Summary of Clinical Recommendations

References

Sealing Carious Tissue in Primary Teeth Using Crowns: The Hall Technique

Abstract

Overview

History of the Hall Technique

Summary

Technique Acceptance

Summary

Cost-Effectiveness

Summary

The Hall Technique Step by Step

Step 1: Case Selection

Step 2: Child and Parent Preparation and the Materials Needed

Step 3: Assessment of Crown Morphology, Contact Areas and Occlusion

Step 4: Size of the Hall Crown

Step 5: Fill the Crown

Step 6: Fit and Seat the Crown

Step 7: Further Seating

Step 8: Final Cement Clearance and Occlusion Check

Conclusion

References

No Removal and Inactivation of Carious Tissue: Non-Restorative Cavity Control

Abstract

Is Restorative Treatment Necessary?

Non-Restorative Cavity Control: Primary Dentition

Indication of NRCC

Treatment Protocol of NRCC

Scientific Evidence for Success of NRCC in Primary Dentition

Non-Restorative Cavity Control: Permanent Dentition

Scientific Evidence for Success of NRCC in Permanent Dentition

The Role of Fluoride in Arresting Dentine Caries

Adverse Effects of SDF

Conclusion

References

Evidence-Based Deep Carious Lesion Management: From Concept to Application in Everyday Clinical Practice

Abstract

What Do Dental Practitioners Do in Practice?

Facilitators and Barriers to Implementing Science into Practice

Conclusion and Perspectives

References

The Problem: Relevance, Quality, and Homogeneity of Trial Designs, Outcomes, and Reporting

Abstract

Pathway of Evidence to Practice

Barriers to Evidence Synthesis

Ask the Correct Questions

Outcomes as a Barrier to Synthesis

Limitations to the External Validity of RCTs

Improving the Pathway to Practice

Marginal Gains Add Up

Ask the Correct Questions

Align Research Questions to Clinical Questions

Improve Reporting

References

An Agreed Terminology for Carious Tissue Removal

Abstract

Background to Standardisation in Terminology

Updating the Existing Terminology

Dental Caries Management and Carious Lesion Management

Terminology for Descriptions of States of Carious Dentine

Carious Tissue Removal Terminology

Atraumatic Restorative Treatment

No Removal (No Dentinal Carious Tissue Removal)

Selective Removal

Stepwise Removal (Stepwise Carious Lesion Removal)

Non-Selective Removal

Conclusion

References

Clinical Recommendations on Carious Tissue Removal in Cavitated Lesions

Abstract

Appendix

References

Caries Excavation: Evidence Gaps

Abstract

Evidence-Based Practice

How Much Caries Should We Excavate and How Should We Do It?

What Do Dentists Do Now?

When Do Clinicians Decide to Intervene?

Other Contentious Areas

What Can We Do When Evidence Is Lacking to Inform Clinical Decision Making and Practice?

Conclusion

References

Author Index

Subject Index

Отрывок из книги

Vol. 27

Series Editors

.....

E-Mail t.lamont@dundee.ac.uk

Soraya Leal

.....

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