The selective carious tissue removal approach

Deep carious tissue can be removed following 3 different approaches: non-selective removal of hard dentine, selective removal of carious tissue in one step or in two steps. Science no longer recommends the non-selective approach, although there is still controversy.

A minimally invasive approach to managing deep carious lesions

A minimally invasive approach to managing deep carious lesions – removing only the infected dentin – is scientifically proven to help prevent issues when exposing the pulp. Dr. Stefano Daniele (University of Milan, Italy), expert in cariology, explains the concept of selective carious tissue removal.

Clinical indications of selective carious tissue removal

Selective removal of carious tissue is recommended for treating severe caries on permanent teeth (according to the International caries detection and assessment system), very deep caries in primary teeth and in children/teenagers’ permanent teeth with open apex. Dr. Stefano Daniele explains the advantages of this conservative approach.

The instrumentation

66% of dentists use hand excavators to remove deep caries. The tactile feedback of a manual instrument helps the practitioner identify the consistency of the dentin. Soft dentin will deform when an instrument is pressed onto it, unlike leathery dentin. In a minimally-invasive approach, the dentist can thus determine the excavation level needed.
Dr. Daniele describes the instruments he uses during a selective removal of carious tissue process.

-Innes, N.; Schwendicke, F.; Frencken, J. An Agreed Terminology for Carious Tissue Removal. Oral Biofilms 2018, 27, 155–161, doi:10.1159/000487842.
– Robles A., Lawson N., Treatment of Deep Caries, Decisions in Dentistry. February 2019;5(2):10—12,14.
– Marending, M., Attin, T., & Zehnder, M. (2016). Treatment options for permanent teeth with deep caries. Swiss dental journal, 126(11), 1007–1027.

– FDI, International caries detection and evaluation system “ICDAS“ codes 5 and 6
– Koopaeei MM, Inglehart MR, McDonald – N, Fontana M. General dentists’, pediatric dentists’, and endodontists’ diagnostic assessment and treatment strategies for deep carious lesions: A comparative analysis. J Am Dent Assoc. 2017;148(2):64-74. doi:10.1016/j.adaj.2016.11.001