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New guide offers refresher on caries treatment and pulp capping

A handy new guide provides an overview on caries management and pulp capping that even the most seasoned clinicians will find useful. (Image: HenadziPechan/Shutterstock)

SAN DIMAS, Calif., US: In a fresh overview on a hot topic, researchers with Stevenson Dental Research Institute in California have released a curated guide on the modern techniques and materials used in dental caries management, specifically pulp capping, which as a treatment option has set social media ablaze as patients seek alternatives to root canal therapy. The guide also emphasises the importance of preserving natural tooth structure and minimising iatrogenic damage.

The guide begins with a review of the evolution in caries treatment approaches, shifting from extensive removal to conservative techniques. This change aligns with modern guidelines emphasising the preservation of sound tooth structure while effectively removing carious tissue. Advancements in diagnostic aids and minimally invasive techniques have allowed early detection and targeted interventions for caries.

The guide discusses various strategies for managing non-cavitated lesions, including dietary control, biofilm removal, remineralisation and the use of self-assembling peptides. The last form scaffolds once applied to the initial lesion and then attract and integrate calcium, phosphate and hydroxide to form hydroxyapatite. For cavitated lesions, the authors deem invasive interventions necessary. They advocate for a conservative approach, especially for deep carious lesions near the pulp, emphasising the importance of maintaining a clean amelodentinal junction and a peripheral zone of healthy dentine.

In addition to providing detailed steps on caries removal, the guide covers vital pulp therapy, which aims to preserve the natural function of the tooth pulp. The paper describes various techniques, including direct pulp capping and indirect pulp capping, along with pulpotomy. The guide also provides useful comparison between materials used for pulp capping, such as traditional materials like calcium hydroxide and modern alternatives like mineral trioxide aggregate and Biodentine.

The guide also offers instruction for treatment after pulp capping, advising immediate permanent restoration for better healing outcomes. Follow-up appointments to assess pulp vitality and ensure the absence of periapical radiolucency are key.

Improvements in prevention methodologies and minimally invasive approaches necessitate diversified caries removal techniques. Despite guidelines, the extent of caries removal remains a debated topic, and dentists must balance preserving tooth structure with preventing caries recurrence.

The study, titled “Navigating through caries excavation and pulp capping techniques in permanent teeth”, was published online on 21 January 2024 in Dentistry Review, ahead of inclusion in an issue.

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