1. Surgical Removal of Caries Flashcards by J L

Dentinal Caries
Progress more \_\_\_\_ than enamel
Tubules are natural \_\_\_\_ for bacteriologic migration 
\_\_\_\_ is first defense
coagulation of \_\_\_\_ at orifice
absorption of \_\_\_\_ 
Softened dentin may be \_\_\_\_
Denatured collagenous matrix= impossible to \_\_\_\_

rapid
channels
intratubular fluid
fluid
minerals
remineralized
remineralize

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Infected Dentin- ____ dentin with ____ bacterial infection

Affected Dentin- ____ dentin with ____ infection

softened
significant
slightly softened
minimal

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Criteria for Deep Lesion Therapy

____ carious teeth without a history of ____ pain, pain on percussion and only to ____ stimuli (cold or heat)
Teeth with no ____
No ____on radiograph
Teeth that could be ____ by a rubber dam

deep
spontaneous
provoked
percussion sensitivity
periapical pathology
isolated

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How do we decide what is decay in the cavity preparation?
____- compressive force Spoon excavator
____ rotating ____ bur
Dyes

How much \_\_\_\_?
How sticky is sticky?
How \_\_\_\_ do we 􏰄scoop􏰅?
What is the ideal \_\_\_\_ of dentin?
of enamel?

explorer
slowly
round

force
hard
color

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Round Bur
\_\_\_\_ speed handpiece 
\_\_\_\_ rotating
\_\_\_\_ pressure
Select the \_\_\_\_ bur that will fit in the preparation, slowly rotating

slow
slowly
light
largest

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Caries Removal
Open cavity to allow ____
Remove all decay from ____
Excavate decay pulpally, but do not ____
Determine how ____ remaining dentin is
If dentin is extremely soft continue ____
If dentin is leathery or firm, decide whether or not
dentin should remain based on pulp ____, ____ and likelihood of pulp ____

access
periphery
expose
soft
removal
health
demineralization
exposure

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Occlusal Caries
Carious process accompanied by enamel decalcification on lateral walls of ____
Visible with ____ air drying of the tooth
Dessicated demineralized enamel is ____

fissures
5 sec
opaque

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Early or Occlusal

Carious process not apparent with: ____ inspection
May or may not be visible with ____ drying
Lesion may be arrested
These difficult to discern on ____

visual
extensive
radiograph

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Carious Pulp Exposure
Is it ____?
What are the ____?
What are the important ____?

necessary
alternatives
decisions

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How do we remove caries
____ invasive lesion access
Must be adequate for appropriate ____ caries instrumentation and creation of a peripheral ____
Avoid ____ to adjacent teeth and pulp dentin complex
Potential for caries ____ excavation techniques

minimally
peripheral
seal
iatrogenic
limiting

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How much caries do we remove
Peripheral caries (DEJ &amp; peripheral dentin) 
Caries removal to clinically sound \_\_\_\_ to achieve a peripheral seal is essential.

hard enamel/dentin

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How much caries do we remove
Peripheral caries (DEJ &amp; peripheral dentin) Caries removal to clinically sound hard enamel/dentine to achieve a peripheral seal is essential.

Pulpal caries
Remove carious tissue to optimize ____ (minimal thickness needed for material

restoration performance

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How much caries do we remove
Leaving infected, demineralized, stained dentin is proven and ____ scientifically
____ dentin should be removed
____should be avoided
Every tooth should be assessed for pulp ____ …no ____
…no sensitivity to ____

accepted
soft "mushy"
pulp exposure
health
periapical pathology
percussion

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Deep Caries Lesion Management

Indirect Pulp Cap
____ Caries Removal
To ____ or not re-enter
What is the ideal ____ for both?

Direct Pulp Cap (for caries)
What is the ideal ____?

stepwise
re-enter
medication
medication

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Deep Caries Lesion Management
Pulp Cap

Indirect Pulp Cap
Indication- \_\_\_\_ caries lesion Caries near \_\_\_\_
No Sensitivity to \_\_\_\_ 
No \_\_\_\_ 
“\_\_\_\_” dentin
NO \_\_\_\_

deep
pulp
percussion
periapical pathology
leathery
caries exposure

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Deep Caries Lesion Management

Pulp Cap

Indirect Pulp Cap
Technique- Excavate periphery to ____
Excavate ____ wall to 0.5mm
Place ____ and/or base

clean
axial
liner

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Deep Caries Lesion Management

Pulp Cap
Indirect Pulp Cap
Medication- \_\_\_\_
\_\_\_\_
\_\_\_\_

CaOH
glass ionomer
composite

Deep Caries Lesion Management
Pulp Cap

Indirect Pulp Cap
Technique- Excavate ____ to clean
Excavate axial wall to____mm
Place ____ and/or base

Close with ____ then re-enter and restore with
____!…. Or just restore with ____

periphery
0.5
liner
temporary
amalgam
amalgam

Deep Caries Lesion Management

Pulp Cap
Indirect Pulp Cap
Technique- Excavate periphery to clean Excavate axial wall to 0.5mm
Place liner and/or base What was the hitch… “leaving ____”

decay

Deep Caries Lesion Management
Direct Pulp Cap
Indications: ____ exposure…ONLY
Exposure of

mechanical

0.5

Deep Caries Lesion Management

Direct Pulp Cap Medication
- ____
____
____

CaOH
glass ionomer
composite

Deep Caries Lesion Management
Direct Pulp Cap Medication- CaOH
Glass Ionomer Composite

The final restoration was “____”

amalgam

Deep Caries Lesion Management
Where has the science led us?
‘it is better that a layer of ____ should be allowed to remain for the protection of the pulp rather than run the risk of sacrificing the tooth’

discolored dentin

Deep Caries Lesion Management
Where has the science led us?
‘it is better that a layer of discoloured dentine should be allowed to remain for the protection of the pulp rather than run the risk of sacrificing the tooth’ (John Tomes-1859),
‘… it will often be a question of whether or not the pulp will be exposed when all decayed dentine overlaying it is removed … it is better to expose the ____ of a tooth than to leave it covered only with ____’ (G.V. Black-1908)

pulp

softened dentine

Deep Caries Lesion Management Where has the science led us? 10-year follow-up of occlusal restorations placed over moist, soft, infected dentine left both at the enamel- dentine junction and over the pulp. Lesion progression was ____ and there were no more ____ failures in this group than in control groups with conventional caries removal

arrested | clinical

``` Deep Caries Lesion Management Where has the science led us? Indirect Pulp Cap/ Incomplete Dentin Caries Removal/Stepwise Excavation Medication- ____ ____ ____ ____ ```

CaOH glass ionomer composite MTA - mineral trioxide aggregate

Deep Caries Lesion Management Where has the science led us? Indirect Pulp Cap/ Incomplete Dentin Caries Removal/Stepwise Excavation ____% success rates- no need to ____(M. Maltz, E.F. Oliveira, V. Fontanella, G. Carminatti Deep Caries Lesions after Incomplete Dentine Caries Removal: 40-Month Follow-Up Study. Caries Res 2007;41:493–496) (Ricketts D, Kidd E, Innes NPT, Clarkson JE. Complete or ultraconservative removal of decayed tissue in unfilled teeth. Cochrane Database of Systematic Reviews 2006, Issue 3)

88-95 | re-enter

Deep Caries Lesion Management Where has the science led us? Direct Pulp Cap (____ OR Mechanical) Advantage: avoidance of more ____ treatment, such as root canal ____ or extraction Decreased ____

carious extensive treatment cost

``` Deep Caries Lesion Management Where has the science led us? Direct Pulp Cap (Carious OR Mechanical) Medication- CaOH Glass Ionomer Composite ____ ```

MTA- mineral trioxide aggregate

``` CaOH- Calcium Hydroxide Advantages Provides ____ ____ Environment- stimulates remin ____ Easy to apply-sets ____, convenient package ``` ``` Disadvantage ____ Can not be used ____ Does not bond to ____ Low ____ strength ```

calcium basic cheap fast soluble wet tooth compressive

Glass Ionomer Advantages ____ Environment Cheap Seals well- bonds to ____, does not mind moisture(?) Leaches ____- helps ____ High ____ strength Easy to apply-sets ____, convenient package Disadvantage Not ____ ____ must be stopped

``` acidic tooth fluoride remineralization compressive fast soluble bleeding ```

Glass Ionomer | ____ plus Polymaleic Acid

silicate glass

Composite Advantages Seals well- bonds to tooth, does not mind ____ (?) Very high ____ strength Not ____ ____ Easy to apply-sets ____, convenient package Disadvantage ____ must be stopped

``` moisture compressive soluble cheap fast bleeding ```

MTA- Mineral Trioxide Aggregate ____ in the form of ____, dicalcium silicate, tricalcium aluminate, and ____ oxide for ____ Developed for ____ (Mahmoud Torabinejad 1993) Similar to ____ (Joseph Aspdin 1824)

``` calcium oxide tricalcium silicate bismuth radiopacity dentistry portland cement ```

MTA- Mineral Trioxide Aggregate ``` Advantages ____ Environment Seals well- bonds to tooth, does not mind ____ ____ ____ compressive strength ____ must be stopped Not ____ ``` Disadvantage Difficult to apply-sets ____ Expensive ____ must be stopped

``` acidic moisture hydrophilic high bleeding soluble ``` slow bleeding

Deep Caries Lesion Management Where has the science led us? Direct Pulp Cap (Carious OR Mechanical) Medication- CaOH Glass Ionomer Composite MTA- Mineral Trioxide Aggregate Multiple studies have indicated ____% success rates with mixed data MTA v CaOH (Cochrane review- No Difference, Ferrecane- MTA superior)

70-97

``` When Direct Pulp Caps Fail- ____% require extraction, ____% treated with endodontics (T.J. Hilton, J.L. Ferracane, and L. Mancl, Comparison of CaOH with MTA for Direct Pulp Capping: A PBRN Randomized Clinical Trial JDR July 2013) ```

2 | 98

Deep Caries Lesion Management Technique Pre-treatment 1. Deep carious teeth without a history of ____ pain, pain on percussion and only to ____ stimuli (cold or heat) 2. Teeth with no ____ sensitivity 3. No ____ on radiograph 4. Teeth that can be ____ by a rubber dam

``` spontaneous provoked percussion periapical pathology isolated ```

Deep Caries Lesion Management Technique Pre-treatment 1. Excavate to clean, firm, well supported enamel at periphery of lesion 2. Excavate axially without ____ 3. Pulp cap with “appropriate” ____ 4. Restore ____ 5. Discuss with patient that they need to see Dentist ____ if sensitivity to hot/cold/percussion/spontaneous pain develops

exposing material tooth immediately

Deep Caries Lesion Management Technique ``` Pre-treatment 1. Excavate to clean, firm, well ____ enamel at periphery of lesion Avoid ____ and discomfort Preserve non-demineralized and ____ tissue Achieve good ____ of restoration Maintain pulp ____ Maximize restoration ____ ```

``` supported pain remineralizable seal health longevity ```