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The current study presents a 17-year clinical report of stepwise excavation and indirect pulp capping in a lower right first molar, with great dentin destruction and a lack of dentin support of the cusps. At the first appointment, indirect pulp capping with calcium hydroxide and a temporary filling with zinc oxide cement were performed to minimize the risk of pulp exposure during excavation. After 45 days, the remaining carious tissue was removed and a restoration with glass-ionomer lining (Vitrebond) and resin composite (P-50) was performed. Satisfactory morphology and function of the restoration and pulp vitality were preserved for 17 years, thus indicating that stepwise excavation can be a good treatment alternative in selected cases.

Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (-22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.

The current study presents a 17-year clinical report of stepwise excavation and indirect pulp capping in a lower right first molar, with great dentin destruction and a lack of dentin support of the cusps. At the first appointment, indirect pulp capping with calcium hydroxide and a temporary filling with zinc oxide cement were performed to minimize the risk of pulp exposure during excavation. After 45 days, the remaining carious tissue was removed and a restoration with glass-ionomer lining (Vitrebond) and resin composite (P-50) was performed. Satisfactory morphology and function of the restoration and pulp vitality were preserved for 17 years, thus indicating that stepwise excavation can be a good treatment alternative in selected cases.

Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (-22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.

[Comparative study on dogs between CO2 laser and conventional technique in direct pulp capping]. Three dogs have been used in this experiment. Class V cavities were made in sixty teeth. A pulpal communication was provoked intentionally in these cavities. Teeth were randomly split in 2 groups (30 teeth for each). On first group, the pulp bleeding was stopped until appearance of coagulum on exposed pulp surfaces by means of CO2 laser irradiation (Output Power: 3 W, Pulse duration: 0.1 sec, frequency: 1 Hz, spot size diameter: 0.3 mm, Energy density: 425 J/cm2). Calcium Dihydroxide was deposited followed by a temporary filling (IRM, Dentsply, De Trey, Germany). In the second group, the calcium Dihydroxide was deposited directly on exposed bleed pulp (conventional technique) followed by the same temporary filling. Ten weeks later, all teeth were extracted and prepared for histological study. RESULTS: 93% of treated teeth preserved their pulp vitality in the group treated with CO2 laser for direct pulp capping versus 82% in the group treated by conventional technique. The average of the thickness of the dentinal bridge newly formed was 391.5 +/- 33 microm for teeth irradiated with laser and 294.1 +/- 28 microm for teeth treated by conventional technique. The thickness of the dentinal bridge newly formed in teeth treated by means of CO2 laser was 33% more important than in those treated by the conventional technique. Statistical analysis showed a significant difference between the averages of values in all groups (p < 0.05). To conclude, CO2 Laser use in the direct pulp capping increases significantly the percentage of pulp vitality preservation and the thickness of the dentinal bridge newly formed after pulp exposition.

On non-vital deciduous molars, inter-radicular bone resorption is often an indication of extraction. The endodontic treatment of these teeth by means of zinc oxide-eugenol (ZOE) paste also showed its limits. To mitigate the deficiencies of this material, we suggested a preliminary treatment by means of calcium hydroxide (Ca(OH)2) for its anti-inflammatory and antiseptic properties as well as its ability to stimulate calcified tissues apposition or remineralisation. This study concerns 21 non-vital deciduous molars. X-rays excluded any lesion of the underlying permanent bony crypt (bone tissue) as well as any inflammation of the dental follicle. After preparation, root canals were filled by means of Pulpdent. An initial X-ray check was made 15 days and then every 3 months. After disappearance of the inflammatory resorption, root canal fillings were performed with ZOE paste. The remineralisation of the inter-radicular alveolar bone was observed for 14 deciduous molars, which were then filled using ZOE. The remineralisation period varies from 3 to 18 months depending on the scale of the lesion. Of the 7 failed treatments, 3 failed following downfall of the crown filling material, and 2 due to failure to keep appointments and late replacement of resorbed Ca(OH)2. On 2 teeth, the treatment did not stop the lesion forming. Calcium hydroxide (Ca(OH)2) give encouraging results in the treatment of inter-radicular alveolar bone resorption of non-vital deciduous tooth. Its fast resorption requires rigorous controls, frequent refills, and thus strong motivation on the part of the child and parents. It cannot, on any account, be considered as permanent filling material.