Abstract
Deep carious lesions frequently lead to pulpal exposure and require subsequent root canal treatment in order to save the tooth. Unfortunately, this treatment is often unsuccessful in the long term with periapical disease as the result. New insights into the biological processes associated with pulpal healing and innovations in biocompatible capping agents have led to new treatment strategies, which can keep teeth vital and functional for longer. Dentine is a bioactive substance that releases growth factors when demineralised by carious processes, which has a positive effect on the regeneration of the pulp. Controlling caries in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal and control. Only when cavitated carious dentine lesions are either non-cleansable, or can no longer be sealed, are restorative interventions indicated. Carious tissue is removed purely to create conditions suitable for long-lasting restoration. Bacterially contaminated or demineralised tissue close to the pulp does not need to be removed. To ascertain the state of the pulp, the symptoms observed are critical in determining the most appropriate treatment modality and often with only partial removal of inflamed pulp tissue, the remainder of the pulp can heal. The evidence and, therefore, these recommendations support minimally invasive carious lesion management in conjunction with less invasive endodontic treatment to preserve tooth tissue and maintain pulp viability and function in the long term.
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References
Abella F, Patel S, Duran-Sindreu F, Mercadé M, Bueno R, Roig M (2012) Evaluating the periapical status of teeth with irreversible pulpitis by using cone-beam computed tomography scanning and periapical radiographs. J Endod 38(12):1588–1591. https://doi.org/10.1016/j.joen.2012.09.003
Accorinte Mde L, Holland R, Reis A, Bortoluzzi MC, Murata SS, Dezan E Jr, Souza V, Alessandro LD (2008) Evaluation of mineral trioxide aggregate and calcium hydroxide cement as pulp-capping agents in human teeth. J Endod 34(1):1–6
Aguilar P, Linsuwanont P (2011) Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review. J Endod 37(5):581–587. https://doi.org/10.1016/j.joen.2010.12.004
Al-Nuaimi N, Patel S, Davies A, Bakhsh A, Foschi F, Mannocci F (2018) Pooled analysis of 1-year recall data from three root canal treatment outcome studies undertaken using cone beam computed tomography. Int Endod J 51:e216. https://doi.org/10.1111/iej.12844
Alqaderi H, Lee CT, Borzangy S, Pagonis TC (2016) Coronal pulpotomy for cariously exposed permanent posterior teeth with closed apices: a systematic review and meta-analysis. J Dent 44:1–7. https://doi.org/10.1016/j.jdent.2015.12.005
Asgary S, Eghbal MJ, Parirokh M, Ghanavati F, Rahimi H (2008) A comparative study of histologic response to different pulp capping materials and a novel endodontic cement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106(4):609–614. https://doi.org/10.1016/j.tripleo.2008.06.006
Asgary S, Eghbal MJ, Ghoddusi J, Yazdani S (2013) One-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter, randomized, non-inferiority clinical trial. Clin Oral Investig 17(2):431–439. https://doi.org/10.1007/s00784-012-0712-6
Asgary S, Fazlyab M, Sabbagh S, Eghbal MJ (2014) Outcomes of different vital pulp therapy techniques on symptomatic permanent teeth: a case series. Iran Endod J 9(4):295–300
Asgary S, Eghbal MJ, Fazlyab M, Baghban AA, Ghoddusi J (2015) Five-year results of vital pulp therapy in permanent molars with irreversible pulpitis: a non-inferiority multicenter randomized clinical trial. Clin Oral Investig 19(2):335–341. https://doi.org/10.1007/s00784-014-1244-z
Baume LJ, Holz J (1981) Long term clinical assessment of direct pulp capping. Int Dent J 31(4):251–260
Bender IB (2000) Reversible and irreversible painful pulpitides: diagnosis and treatment. Aust Endod J 26(1):10–14
Bjørndal L (2008) The caries process and its effect on the pulp: the science is changing and so is our understanding. Pediatr Dent 30(3):192–196
Bjørndal L (2011) In deep cavities stepwise excavation of caries can preserve the pulp. Evid Based Dent 12(3):68. https://doi.org/10.1038/sj.ebd.6400803
Bjørndal L, Larsen T (2000) Changes in the cultivable flora in deep carious lesions following a stepwise excavation procedure. Caries Res 34(6):502–508
Bjørndal L, Reit C, Bruun G, Markvart M, Kjaeldgaard M, Näsman P, Thordrup M, Dige I, Nyvad B, Fransson H, Lager A, Ericson D, Petersson K, Olsson J, Santimano EM, Wennström A, Winkel P, Gluud C (2010) Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci 118(3):290–297. https://doi.org/10.1111/j.1600-0722.2010.00731.x
Bjørndal L, Demant S, Dabelsteen S (2014) Depth and activity of carious lesions as indicators for the regenerative potential of dental pulp after intervention. J Endod 40(4 Suppl):S76–S81. https://doi.org/10.1016/j.joen.2014.01.016
Bogen G, Kuttler S (2009) Mineral trioxide aggregate obturation: a review and case series. J Endod 35(6):777–790. https://doi.org/10.1016/j.joen.2009.03.006
Brynolf I (1967) Histological and roentgenological study of periapical region of human upper incisors. Odontol Revy 18(Suppl 11)
Cao Y, Song M, Kim E, Shon W, Chugal N, Bogen G, Lin L, Kim RH, Park NH, Kang MK (2015) Pulp-dentine regeneration: current state and future prospects. J Dent Res 94(11):1544–1551. https://doi.org/10.1177/0022034515601658
Cassidy N, Fahey M, Prime SS, Smith AJ (1997) Comparative analysis of transforming growth factor-beta isoforms 1-3 in human and rabbit dentine matrices. Arch Oral Biol 42(3):219–223
Chavez de Paz LE (2007) Redefining the persistent infection in root canals: possible role of biofilm communities. J Endod 33(6):652–662
Cooper PR, Takahashi Y, Graham LW, Simon S, Imazato S, Smith AJ (2010) Inflammation-regeneration interplay in the dentine-pulp complex. J Dent 38(9):687–697. https://doi.org/10.1016/j.jdent.2010.05.016
Cooper PR, McLachlan JL, Simon S, Graham LW, Smith AJ (2011) Mediators of inflammation and regeneration. Adv Dent Res 23(3):290–295. https://doi.org/10.1177/0022034511405389
van der Sluis L, Kidd E, Gruythuysen R, Peters L (2013) Preventive endodontics - an argument for avoiding root canal treatment. ENDO 4:259–274
Dominguez MS, Witherspoon DE, Gutmann JL, Opperman LA (2003) Histological and scanning electron microscopy assessment of various vital pulp-therapy materials. J Endod 29(5):324–333
Drake DR, Wiemann AH, Rivera EM, Walton RE (1994) Bacterial retention in canal walls in vitro: effect of smear layer. J Endod 20(2):78–82
Eren B, Onay EO, Ungor M (2018) Assessment of alternative emergency treatments for symptomatic irreversible pulpitis: a randomized clinical trial. Int Endod J 51:e227. https://doi.org/10.1111/iej.12851
European Society of Endodontology (2006) Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J 39(12):921–930
Farges JC, Alliot-Licht B, Baudouin C, Msika P, Bleicher F, Carrouel F (2013) Odontoblast control of dental pulp inflammation triggered by cariogenic bacteria. Front Physiol 4:326. https://doi.org/10.3389/fphys.2013.00326
Fejerskov O, Nyvad B, Kidd EA (2015) Pathology of dental caries. In: Fejerskov O, Nyvad B, Kidd EAM (eds) Dental caries: the disease and its clinical management, 3rd edn. Wiley Blackwell, Oxford, pp 7–9
Finkelman RD, Mohan S, Jennings JC, Taylor AK, Jepsen S, Baylink DJ (1990) Quantitation of growth factors IGF-I, SGF/IGF-II, and TGF-beta in human dentine. J Bone Miner Res 5(7):717–723
Flemming HC, Wingender J (2010) The biofilm matrix. Nat Rev Microbiol 8(9):623–633. https://doi.org/10.1038/nrmicro2415
Gruythuysen RJ, van Strijp AJ, Wu MK (2010) Long-term survival of indirect pulp treatment performed in primary and permanent teeth with clinically diagnosed deep carious lesions. J Endod 36(9):1490–1493. https://doi.org/10.1016/j.joen.2010.06.006
Haapasalo M, Shen Y, Ricucci D (2011) Reasons for persistent and emerging post-treatment endodontic disease. Endod Topics 18:31–50. https://doi.org/10.1111/j.1601-1546.2011.00256.x
Hashem D, Mannocci F, Patel S, Manoharan A, Brown JE, Watson TF, Banerjee A (2015) Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial. J Dent Res 94(4):562–568. https://doi.org/10.1177/0022034515571415
Hoefler V, Nagaoka H, Miller CS (2016) Long-term survival and vitality outcomes of permanent teeth following deep caries treatment with step-wise and partial-caries-removal: a systematic review. J Dent 54:25–32. https://doi.org/10.1016/j.jdent.2016.09.009
Innes NPT, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, Van Landuyt K, Banerjee A, Campus G, Doméjean S et al (2016) Managing carious lesions: consensus recommendations on terminology. Adv Dent Res 28(2):49–57. https://doi.org/10.1177/0022034516639276
Kundzina R, Stangvaltaite L, Eriksen HM, Kerosuo E (2017) Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide. Int Endod J 50(10):924–932. https://doi.org/10.1111/iej.12719
Leksell E, Ridell K, Cvek M, Mejà re I (1996) Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth. Endod Dent Traumatol 12(4):192–196
Li Z, Cao L, Fan M, Xu Q (2015) Direct pulp capping with calcium hydroxide or mineral trioxide aggregate: a meta-analysis. J Endod 41(9):1412–1417. https://doi.org/10.1016/j.joen.2015.04.012
Liu R, Kaiwar A, Shemesh H, Wesselink PR, Hou B, Wu MK (2013) Incidence of apical root cracks and apical dentineal detachments after canal preparation with hand and rotary files at different instrumentation lengths. J Endod 39(1):129–132. https://doi.org/10.1016/j.joen.2012.09.019
Maltz M, Garcia R, Jardim JJ, de Paula LM, Yamaguti PM, Moura MS, Garcia F, Nascimento C, Oliveira A, Mestrinho HD (2012a) Randomized trial of partial vs. stepwise caries removal: 3-year follow-up. J Dent Res 91(11):1026–1031. https://doi.org/10.1177/0022034512460403
Maltz M, Henz SL, de Oliveira EF, Jardim JJ (2012b) Conventional caries removal and sealed caries in permanent teeth: a microbiological evaluation. J Dent 40(9):776–782. https://doi.org/10.1016/j.jdent.2012.05.011
Maltz M, Jardim JJ, Mestrinho HD, Yamaguti PM, Podestá K, Moura MS, de Paula LM (2013) Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results. Caries Res 47(2):103–109. https://doi.org/10.1159/000344013
Maltz M, Koppe B, Jardim JJ, Alves LS, de Paula LM, Yamaguti PM, Almeida JCF, Moura MS, Mestrinho HD (2018) Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial. Clin Oral Investig 22:1337. https://doi.org/10.1007/s00784-017-2221-0
Marquis VL, Dao T, Farzaneh M, Abitbol S, Friedman S (2006) Treatment outcome in endodontics: the Toronto Study. Phase III: initial treatment. J Endod 32(4):299–306
Matsuo T, Nakanishi T, Shimizu H, Ebisu S (1996) A clinical study of direct pulp capping applied to carious-exposed pulps. J Endod 22(10):551–556
Molander A, Reit C, Dahlén G, Kvist T (1998) Microbiological status of root-filled teeth with apical periodontitis. Int Endod J 31(1):1–7
Murray PE, Garcia-Godoy F, Hargreaves KM (2007) Regenerative endodontics: a review of current status and a call for action. J Endod 33(4):377–390
Nair PN, Duncan HF, Pitt Ford TR, Luder HU (2008) Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial. Int Endod J 41(2):128–150
Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K (2008) Outcome of primary root canal treatment: systematic review of the literature -- Part 2. Influence of clinical factors. Int Endod J 41(1):6–31
Ørstavik D, Qvist V, Stoltze K (2004) A multivariate analysis of the outcome of endodontic treatment. Eur J Oral Sci 112(3):224–230
Paddick JS, Brailsford SR, Kidd EA, Beighton D (2005) Phenotypic and genotypic selection of microbiota surviving under dental restorations. Appl Environ Microbiol 71(5):2467–2472
Pashley DH (1996) Dynamics of the pulpo-dentine complex. Crit Rev Oral Biol Med 7(2):104–133
Pashley DH, Tao L, Boyd L, King GE, Horner JA (1988) Scanning electron microscopy of the substructure of smear layers in human dentine. Arch Oral Biol 33(4):265–270
Peterson BW, He Y, Ren Y, Zerdoum A, Libera MR, Sharma PK, van Winkelhoff A-J, Neut D, Stoodley P, van der Mei HC, Busscher HJ (2015) Viscoelasticity of biofilms and their recalcitrance to mechanical and chemical challenges. FEMS Microbiol Rev 39(2):234–245. https://doi.org/10.1093/femsre/fuu008
Qudeimat MA, Alyahya A, Hasan AA (2017) Mineral trioxide aggregate pulpotomy for permanent molars with clinical signs indicative of irreversible pulpitis: a preliminary study. Int Endod J 50(2):126–134. https://doi.org/10.1111/iej.12614
Reeves R, Stanley HR (1966) The relationship of bacterial penetration and pulpal pathosis in carious teeth. Oral Surg Oral Med Oral Pathol 22(1):59–65
Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE (2013) Operative caries management in adults and children. Cochrane Database Syst Rev 3:CD003808. https://doi.org/10.1002/14651858.CD003808.pub3
Ricucci D, Loghin S, Siqueira JF Jr (2014) Correlation between clinical and histologic pulp diagnoses. J Endod 40(12):1932–1939. https://doi.org/10.1016/j.joen.2014.08.010
Saoud TM, Martin G, Chen YH, Chen KL, Chen CA, Songtrakul K, Malek M, Sigurdsson A, Lin LM (2016) Treatment of mature permanent teeth with necrotic pulps and apical periodontitis using regenerative endodontic procedures: a case series. J Endod 42(1):57–65. https://doi.org/10.1016/j.joen.2015.09.015
Schwendicke F, Dörfer CE, Paris S (2013) Incomplete caries removal: a systematic review and meta-analysis. J Dent Res 92(4):306–314. https://doi.org/10.1177/0022034513477425
Shemesh H, Wesselink PR, Wu MK (2010) Incidence of dentineal defects after root canal filling procedures. Int Endod J 43(11):995–1000. https://doi.org/10.1111/j.1365-2591.2010.01740.x
Simon SR, Berdal A, Cooper PR, Lumley PJ, Tomson PL, Smith AJ (2011) Dentine-pulp complex regeneration: from lab to clinic. Adv Dent Res 23(3):340–345. https://doi.org/10.1177/0022034511405327
Simon S, Perard M, Zanini M, Smith AJ, Charpentier E, Djole SX, Lumley PJ (2013) Should pulp chamber pulpotomy be seen as a permanent treatment? Some preliminary thoughts. Int Endod J 46(1):79–87. https://doi.org/10.1111/j.1365-2591.2012.02113.x
Siqueira JF Jr (2011) Treatment of endodontic infections. Quintessence Publishing, London
Sjogren U, Hagglund B, Sundqvist G, Wing K (1990) Factors affecting the long-term results of endodontic treatment. J Endod 16(10):498–504
Smith AJ, Scheven BA, Takahashi Y, Ferracane JL, Shelton RM, Cooper PR (2012) Dentine as a bioactive extracellular matrix. Arch Oral Biol 57(2):109–121. https://doi.org/10.1016/j.archoralbio.2011.07.008
Smith AJ, Duncan HF, Diogenes A, Simon S, Cooper PR (2016) Exploiting the bioactive properties of the dentine-pulp complex in regenerative endodontics. J Endod 42(1):47–56. https://doi.org/10.1016/j.joen.2015.10.019
Stewart PS, Franklin MJ (2008) Physiological heterogeneity in biofilms. Nat Rev Microbiol 6(3):199–210. https://doi.org/10.1038/nrmicro1838
Taha NA, Ahmad MB, Ghanim A (2017) Assessment of mineral trioxide aggregate pulpotomy in mature permanent teeth with carious exposures. Int Endod J 50(2):117–125. https://doi.org/10.1111/iej.12605
Tomson PL, Lumley PJ, Smith AJ, Cooper PR (2017) Growth factor release from dentine matrix by pulp-capping agents promotes pulp tissue repair-associated events. Int Endod J 50(3):281–292. https://doi.org/10.1111/iej.12624
Torabinejad M, Parirokh M (2010) Mineral trioxide aggregate: a comprehensive literature review--part II: leakage and biocompatibility investigations. J Endod 36(2):190–202. https://doi.org/10.1016/j.joen.2009.09.010
Violich DR, Chandler NP (2010) The smear layer in endodontics - a review. Int Endod J 43(1):2–15. https://doi.org/10.1111/j.1365-2591.2009.01627.x
Wang Z, Pan J, Wright JT, Bencharit S, Zhang S, Everett ET, Teixeira FB, Preisser JS (2010) Putative stem cells in human dental pulp with irreversible pulpitis: an exploratory study. J Endod 36(5):820–825. https://doi.org/10.1016/j.joen.2010.02.003
Wang Z, Shen Y, Ma J, Haapasalo M (2012) The effect of detergents on the antibacterial activity of disinfecting solutions in dentine. J Endod 38(7):948–953. https://doi.org/10.1016/j.joen.2012.03.007
Wang J, Chen W, Jiang Y, Liang J (2013) Imaging of extraradicular biofilm using combined scanning electron microscopy and stereomicroscopy. Microsc Res Tech 76(9):979–983. https://doi.org/10.1002/jemt.22257
Wolters WJ, Duncan HF, Tomson PL, Karim IE, McKenna G, Dorri M, Stangvaltaite L, van der Sluis LWM (2017) Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs. Int Endod J 50(9):825–829. https://doi.org/10.1111/iej.12793
Wu MK, Wesselink PR, Walton RE (2000) Apical terminus location of root canal treatment procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89(1):99–103
Wu MK, Dummer PM, Wesselink PR (2006) Consequences of and strategies to deal with residual post-treatment root canal infection. Int Endod J 39(5):343–356
Wu MK, Shemesh H, Wesselink PR (2009) Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment. Int Endod J 42(8):656–666. https://doi.org/10.1111/j.1365-2591.2009.01600.x
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Wolters, W.J., van der Sluis, L.W.M. (2019). Current and Emerging Innovations in Minimally Invasive Caries and Endodontic Treatments. In: Duncan, H., Cooper, P. (eds) Clinical Approaches in Endodontic Regeneration. Springer, Cham. https://doi.org/10.1007/978-3-319-96848-3_1
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