Behandling af dyb caries – indikation, forbedret klinisk evidens og ny nomenklatur af ekskavering
Engelsk titel: Treatment of deep caries - indication, improved clinical evidence and new nomenclature of excavation
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Författare:
Björndal, Lars
Email: labj@sund.ku.dk
Språk: Dan
Antal referenser: 26
Dokumenttyp:
Artikel
UI-nummer: 18030067
Sammanfattning
The procedure for the treatment of deep caries using stepwise excavation is presented in which deep caries in adults is defined as carious demineralized dentin extending to 1/4 of the dentin or more on the radiograph, and with a well-defined radiopaque dentin towards pulp. Selective (previously described as partial) carious removal to soft dentin should be avoided in extremely deep carious lesions (extending throughout the thickness of the dentin), as the pulp is infected with bacteria. A new 5-year follow-up study confirms that stepwise excavation in deep caries on adults can be successfully performed in two visits and has a better longevity than non-selective removal in one visit (previously described as complete excavation). The performance of pulp capping in deep caries has a poor prognosis. The same follow-up study shows that only 9% of the teeth treated with direct capping or partial pulpotomy had maintained pulp vitality without pain and without apical radiolucency after 5 years. This emphasizes the importance of avoiding exposure to pulp. Whether one visit with selective carious removal in well-defined deep caries in adult teeth will be sufficient instead of two visits, is still not supported by sufficiently high evidence.