Stepwise Excavation may Enhance Pulp Preservation in Permanent Teeth Affected by Dental Caries
ABSTRACT ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Ways of enhancing pulp preservation by stepwise excavation-a systematic review. Hayashi M, Fujitani M, Yamaki C, Momoi Y. J Dent 2011;39(2):95-107. Epub 2010 Dec 3. REVIEWER: Lars Bjørndal, DDS, PhD, Dr Odont PURPOSE/QUESTION: To determine the clinical effectiveness of stepwise excavation for pulp preservation SOURCE OF FUNDING: Japanese Society of Conservative Dentistry TYPE OF STUDY/DESIGN: Systematic review LEVEL OF EVIENCE: Level 2: Limited-quality patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Grade B: Limited-quality patient-oriented evidence.
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ABSTRACT: There is a gap between the endodontic outcome that can be achieved and the outcome observed on the basis of worldwide general dental practitioner data. The quality of root canal treatment (RCT) is shaped by the dentist's knowledge, attitude, and skills, but it may also be influenced by the patient's demands and degree of satisfaction. The topic has only been sparsely investigated. Although dental health has increased over the years in Denmark, the number of performed root fillings has also increased, probably because the number of tooth extractions have declined and more molar teeth have been treated. Caries appears to be the main cause for performing RCT and a preventive approach by employing stepwise excavation may reduce RCT, but this strategy does not remove the gap. Factors influencing RCT quality could be the status on adoption of nickel-titanium rotary technology, more focus on infection control (rubber dam use, knowledge of factors important for prognosis), as dentists often think that they are good at doing RCT, but often perform inadequately, an alteration of clinician's awareness of their performance in the context of dental practices, seems warranted. Finally, the development of new preventive modalities for pulp and apical inflammation are crucial.International Journal of Dentistry 03/2012; 2012:526137. DOI:10.1155/2012/526137
Article: Restorative: Bio-treatment of caries[Show abstract] [Hide abstract]
ABSTRACT: Bio-treatment of caries Deep carious lesions are challenging with regard to selecting a restorative treatment method which preserves pulp vitality. In recent years the treatment trend has changed from traditional complete caries removal to stepwise excavation (SE), partial caries removal (PCR) and no caries removal (NCR) modalities. Clinical trials carried out in this field have shown several shortcomings questioning the validity of the study: application of calcium hydroxide as the common liner, restoration of the teeth with different restorative materials in a single trial, and including both permanent and primary teeth in a single study are among some of the confounding variables that may be responsible for the lower validity or bias of some trials. Some of these issues were also pointed out recently by the Cochrane Database Systematic Review. In the last two decades biomaterials have been introduced in dentistry. In spite of the advances in this area, it is surprising that none of the studies on deep carious lesions assessed the application of new biomaterials such as MTA and Biodentine which could have higher antibacterial activity, biocompatibility and sealing ability than calcium hydroxide, which is applied as a common liner in SE or PCR. According to the results of a clinical trial we have carried out, the application of biomaterials or ‘bio-treatment of deep carious lesions’ can be considered as an effective method to restore the involved tooth both biologically and functionally with long-term pulp vitality. We encourage dental researchers and professionals to establish guidelines to conduct high quality clinical trials and introduce a scientific, reliable and valid method to dentists for bio-treatment of deep caries.British dental journal official journal of the British Dental Association: BDJ online 03/2014; 216(6):267. DOI:10.1038/sj.bdj.2014.211 · 1.08 Impact Factor
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ABSTRACT: Glass-ionomer cements (GICs) are essential materials in clinical practice because of their versatility, self-adhesion to enamel and dentine, and good biocompatibility. In addition, being chemically cured, with no shrinkage stress, makes them well suited for minimally invasive restorative techniques. This article looks at some of the clinical situations where the chemical adhesion and high biocompatibility of GIC are important for clinical success: excavation of deep carious lesions, fissure sealing and protection of root surfaces against caries.British dental journal 05/2014; 216(10):561-5. DOI:10.1038/sj.bdj.2014.398 · 1.08 Impact Factor