Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal.
The International Caries Consensus Collaboration undertook a consensus process and here presents clinical recommendations for carious tissue removal and managing cavitated carious lesions, including restoration, based on texture of demineralized dentine. Dentists should manage the disease dental caries and control activity of existing cavitated lesions to preserve hard tissues and retain teeth long-term. Entering the restorative cycle should be avoided as far as possible. Controlling the disease in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal or control first. Only when cavitated carious lesions either are noncleansable or can no longer be sealed are restorative interventions indicated. When a restoration is indicated, the priorities are as follows: preserving healthy and remineralizable tissue, achieving a restorative seal, maintaining pulpal health, and maximizing restoration success. Carious tissue is removed purely to create conditions for long-lasting restorations. Bacterially contaminated or demineralized tissues close to the pulp do not need to be removed. In deeper lesions in teeth with sensible (vital) pulps, preserving pulpal health should be prioritized, while in shallow or moderately deep lesions, restoration longevity becomes more important. For teeth with shallow or moderately deep cavitated lesions, carious tissue removal is performed according toselective removal to firm dentine.In deep cavitated lesions in primary or permanent teeth,selective removal to soft dentineshould be performed, although in permanent teeth,stepwise removalis an option. The evidence and, therefore, these recommendations support less invasive carious lesion management, delaying entry to, and slowing down, the restorative cycle by preserving tooth tissue and retaining teeth long-term.
Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany falk.schwendicke@charite.de.
F
F
Schwendicke
Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
J E
JE
Frencken
Department of Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
L
L
Bjørndal
Department of Preventive and Social Dentistry, Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
M
M
Maltz
Melbourne Dental School, University of Melbourne, Melbourne, Australia.
D J
DJ
Manton
Section of Operative Dentistry, Fixed Prosthodontics and Endodontology, Dundee Dental Hospital and School, University of Dundee, Dundee, UK.
D
D
Ricketts
KULeuven BIOMAT, Department of Oral Health Sciences, University of Leuven and Dentistry University Hospitals Leuven, Leuven, Belgium.
K
K
Van Landuyt
Conservative and MI Dentistry, King's College London Dental Institute, London, UK.
A
A
Banerjee
Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Italy; WHO Collaborating Centre for Epidemiology and Community Dentistry, University of Milan, Milan, Italy.
G
G
Campus
CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, Clermont-Ferrand, France; Univ Clermont1, UFR d'Odontologie, Clermont-Ferrand, France; Centre de Recherche en Odontologie Clinique EA 4847, F-63000 Clermont-Ferrand, France.
S
S
Doméjean
Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.
M
M
Fontana
Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil.
S
S
Leal
Faculty of Dentistry, University of Hong Kong, Hong Kong, China.
E
E
Lo
Department of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
V
V
Machiulskiene
Department of Special Care Dentistry, Faculty of Health, University of Witten/Herdecke, Witten, Germany.
A
A
Schulte
Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany.
C
C
Splieth
Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA.
A F
AF
Zandona
Paediatric Dentistry, Dundee Dental Hospital and School, University of Dundee, Dundee, UK.
N P T
NP
Innes
D032921:Consensus; D003731:Dental Caries / Q000628:therapy*; D003782:Dental Pulp; D003804:Dentin; D006801:Humans
caries sealing; dental caries; incomplete excavation; minimally invasive dentistry; selective excavation; stepwise excavation