Skip to main content
Erschienen in: wissen kompakt 1/2015

01.02.2015 | Zahnärztliche Fortbildung

Moderne Konzepte bei der Kariesexkavation

Zwischen Vollständigkeit und Dentinschonung

verfasst von: S. Paris, Dr. F. Schwendicke

Erschienen in: wissen kompakt | Ausgabe 1/2015

Einloggen, um Zugang zu erhalten

Zusammenfassung

Zahnärzten stehen heute verschiedene Methoden zu Beurteilung der Vollständigkeit der Kariesexkavation zur Verfügung. Während einige dieser Verfahren in vitro durchaus Vorteile gegenüber der klassischen Exkavation mit Stahlrosenbohrern versprechen, wurde ihre klinische Überlegenheit klinisch bisher kaum untersucht. Das weit verbreitete Dogma und die Forderung nach einer immer vollständigen Kariesexkavation vor einer Restauration ist heute durch die Ergebnisse verschiedener klinischer Studien nicht aufrechtzuerhalten. Vieles spricht dafür, dass es bei tiefer Karies besser ist, etwas kariöses Dentin zu belassen und unter einer dichten Restauration zu versiegeln, als durch eine vermeintlich vollständige Exkavation eine Exposition der Pulpa und postoperative Symptome zu riskieren. Wie viel kariöses Dentin belassen werden kann oder sollte, ist jedoch bisher nicht klar. Hinsichtlich der Sinnhaftigkeit der Anwendung von Kavitätenlinern gibt es bisher widersprüchliche Daten, sodass hier keine definitiven Aussagen für oder gegen die Anwendung von Linern gegeben werden können.
Literatur
1.
Zurück zum Zitat Loesche WJ (1979) Clinical and microbiological aspects of chemotherapeutic agents used according to the specific plaque hypothesis. J Dent Res 58:2404–2412PubMedCrossRef Loesche WJ (1979) Clinical and microbiological aspects of chemotherapeutic agents used according to the specific plaque hypothesis. J Dent Res 58:2404–2412PubMedCrossRef
2.
Zurück zum Zitat Banerjee A, Kidd EA, Watson TF (2003) In vitro validation of carious dentin removed using different excavation criteria. Am J Dent 16:228–230PubMed Banerjee A, Kidd EA, Watson TF (2003) In vitro validation of carious dentin removed using different excavation criteria. Am J Dent 16:228–230PubMed
3.
Zurück zum Zitat Lennon AM, Attin T, Buchalla W (2007) Quantity of remaining bacteria and cavity size after excavation with FACE, caries detector dye and conventional excavation in vitro. Oper Dent 32:236–241PubMedCrossRef Lennon AM, Attin T, Buchalla W (2007) Quantity of remaining bacteria and cavity size after excavation with FACE, caries detector dye and conventional excavation in vitro. Oper Dent 32:236–241PubMedCrossRef
4.
Zurück zum Zitat Banerjee A, Kidd EA, Watson TF (2000) In vitro evaluation of five alternative methods of carious dentine excavation. Caries Res 34:144–150PubMedCrossRef Banerjee A, Kidd EA, Watson TF (2000) In vitro evaluation of five alternative methods of carious dentine excavation. Caries Res 34:144–150PubMedCrossRef
5.
Zurück zum Zitat Boston DW (2003) New device for selective dentin caries removal. Quintessence Int 34:678–685PubMed Boston DW (2003) New device for selective dentin caries removal. Quintessence Int 34:678–685PubMed
6.
Zurück zum Zitat Schwendicke F, Paris S, Tu Y (2014) Effects of using different criteria and methods for caries removal: a systematic review and network meta-analysis. J Dent 2014 Oct 22 [Epub ahead of print]. doi: 10.1016/j.jdent.2014.10.004 Schwendicke F, Paris S, Tu Y (2014) Effects of using different criteria and methods for caries removal: a systematic review and network meta-analysis. J Dent 2014 Oct 22 [Epub ahead of print]. doi: 10.1016/j.jdent.2014.10.004
7.
Zurück zum Zitat Dammaschke T, Rodenberg TN, Schafer E et al (2006) Efficiency of the polymer bur SmartPrep compared with conventional tungsten carbide bud bur in dentin caries excavation. Oper Dent 31:256–260PubMedCrossRef Dammaschke T, Rodenberg TN, Schafer E et al (2006) Efficiency of the polymer bur SmartPrep compared with conventional tungsten carbide bud bur in dentin caries excavation. Oper Dent 31:256–260PubMedCrossRef
8.
Zurück zum Zitat Kuboki Y, Liu CF, Fusayama T (1983) Mechanism of differential staining in carious dentin. J Dent Res 62:713–714PubMedCrossRef Kuboki Y, Liu CF, Fusayama T (1983) Mechanism of differential staining in carious dentin. J Dent Res 62:713–714PubMedCrossRef
9.
Zurück zum Zitat Neves Ade A, Coutinho E, De Munck J et al (2011) Caries-removal effectiveness and minimal-invasiveness potential of caries-excavation techniques: a micro-CT investigation. J Dent 39:154–162CrossRef Neves Ade A, Coutinho E, De Munck J et al (2011) Caries-removal effectiveness and minimal-invasiveness potential of caries-excavation techniques: a micro-CT investigation. J Dent 39:154–162CrossRef
10.
Zurück zum Zitat Lennon AM (2003) Fluorescence-aided caries excavation (FACE) compared to conventional method. Oper Dent 28:341–345PubMed Lennon AM (2003) Fluorescence-aided caries excavation (FACE) compared to conventional method. Oper Dent 28:341–345PubMed
11.
Zurück zum Zitat Jablonski-Momeni A, Heinzel-Gutenbrunner M, Klein SM (2013) In vivo performance of the VistaProof fluorescence-based camera for detection of occlusal lesions. Clin Oral Investig 18(7):1757–1762PubMedCrossRef Jablonski-Momeni A, Heinzel-Gutenbrunner M, Klein SM (2013) In vivo performance of the VistaProof fluorescence-based camera for detection of occlusal lesions. Clin Oral Investig 18(7):1757–1762PubMedCrossRef
12.
Zurück zum Zitat Ogawa K, Yamashita Y, Ichijo T et al (1983) The ultrastructure and hardness of the transparent layer of human carious dentin. J Dent Res 62:7–10PubMedCrossRef Ogawa K, Yamashita Y, Ichijo T et al (1983) The ultrastructure and hardness of the transparent layer of human carious dentin. J Dent Res 62:7–10PubMedCrossRef
13.
Zurück zum Zitat Schwendicke F, Paris S (2014) Kariesexkavation: Ein systematischer Überblick. Dtsch Zahnarztl Z 69:456–466 Schwendicke F, Paris S (2014) Kariesexkavation: Ein systematischer Überblick. Dtsch Zahnarztl Z 69:456–466
15.
16.
Zurück zum Zitat Lager A, Thornqvist E, Ericson D (2003) Cultivatable bacteria in dentine after caries excavation using rose-bur or carisolv. Caries Res 37:206–211PubMedCrossRef Lager A, Thornqvist E, Ericson D (2003) Cultivatable bacteria in dentine after caries excavation using rose-bur or carisolv. Caries Res 37:206–211PubMedCrossRef
17.
Zurück zum Zitat Griffin SO, Oong E, Kohn W et al (2008) The effectiveness of sealants in managing caries lesions. J Dent Res 87:169–174PubMedCrossRef Griffin SO, Oong E, Kohn W et al (2008) The effectiveness of sealants in managing caries lesions. J Dent Res 87:169–174PubMedCrossRef
18.
Zurück zum Zitat Oong EM, Griffin SO, Kohn WG et al (2008) The effect of dental sealants on bacteria levels in caries lesions. J Am Dent Assoc 139:271–278PubMedCrossRef Oong EM, Griffin SO, Kohn WG et al (2008) The effect of dental sealants on bacteria levels in caries lesions. J Am Dent Assoc 139:271–278PubMedCrossRef
19.
Zurück zum Zitat Bjorndal L, Larsen T, Thylstrup A (1997) A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res 31:411–417PubMedCrossRef Bjorndal L, Larsen T, Thylstrup A (1997) A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res 31:411–417PubMedCrossRef
20.
Zurück zum Zitat Leksell E, Ridell K, Cvek M et al (1996) Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth. Endod Dent Traumatol 12:192–196PubMedCrossRef Leksell E, Ridell K, Cvek M et al (1996) Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth. Endod Dent Traumatol 12:192–196PubMedCrossRef
21.
Zurück zum Zitat Lula EC, Almeida LJ Jr, Alves CM et al (2011) Partial caries removal in primary teeth: association of clinical parameters with microbiological status. Caries Res 45:275–280PubMedCrossRef Lula EC, Almeida LJ Jr, Alves CM et al (2011) Partial caries removal in primary teeth: association of clinical parameters with microbiological status. Caries Res 45:275–280PubMedCrossRef
22.
Zurück zum Zitat Magnusson BO, Sundell SO (1977) Stepwise excavation of deep carious lesions in primary molars. J Int Assoc Dent Child 8:36–40PubMed Magnusson BO, Sundell SO (1977) Stepwise excavation of deep carious lesions in primary molars. J Int Assoc Dent Child 8:36–40PubMed
23.
Zurück zum Zitat Mertz-Fairhurst EJ, Curtis JW, Ergle JW et al (1998) Ultraconservative and cariostatic sealed restorations: Results at year 10. J Am Dent Assoc 129:55–66PubMedCrossRef Mertz-Fairhurst EJ, Curtis JW, Ergle JW et al (1998) Ultraconservative and cariostatic sealed restorations: Results at year 10. J Am Dent Assoc 129:55–66PubMedCrossRef
24.
Zurück zum Zitat Ribeiro CC, Baratieri LN, Perdigão J et al (1999) A clinical, radiographic, and scanning electron microscopic evaluation of adhesive restorations on carious dentin in primary teeth. Quintessence Int 30:591–599PubMed Ribeiro CC, Baratieri LN, Perdigão J et al (1999) A clinical, radiographic, and scanning electron microscopic evaluation of adhesive restorations on carious dentin in primary teeth. Quintessence Int 30:591–599PubMed
25.
Zurück zum Zitat Ricketts D, Lamont T, Innes NP et al (2013) Operative caries management in adults and children. Cochrane Database Syst Rev 28:CD003808 Ricketts D, Lamont T, Innes NP et al (2013) Operative caries management in adults and children. Cochrane Database Syst Rev 28:CD003808
26.
Zurück zum Zitat Schwendicke F, Dörfer CE, Paris S (2013) Incomplete caries removal: a systematic review and meta-analysis. J Dent Res 92:306–314PubMedCrossRef Schwendicke F, Dörfer CE, Paris S (2013) Incomplete caries removal: a systematic review and meta-analysis. J Dent Res 92:306–314PubMedCrossRef
27.
Zurück zum Zitat Schwendicke F, Stolpe M (2014) Direct pulp capping after a carious exposure versus root canal treatment: a cost-effectiveness analysis. J Endod 40(11):1764–1770PubMedCrossRef Schwendicke F, Stolpe M (2014) Direct pulp capping after a carious exposure versus root canal treatment: a cost-effectiveness analysis. J Endod 40(11):1764–1770PubMedCrossRef
28.
Zurück zum Zitat Schwendicke F, Stolpe M, Meyer-Lueckel H et al (2013) Cost-effectiveness of one- and two-step incomplete and complete excavations. J Dent Res 90:880–887CrossRef Schwendicke F, Stolpe M, Meyer-Lueckel H et al (2013) Cost-effectiveness of one- and two-step incomplete and complete excavations. J Dent Res 90:880–887CrossRef
29.
Zurück zum Zitat Bakhshandeh A, Qvist V, Ekstrand K (2012) Sealing occlusal caries lesions in adults referred for restorative treatment: 2–3 years of follow-up. Clin Oral Investig 16:521–529PubMedCrossRef Bakhshandeh A, Qvist V, Ekstrand K (2012) Sealing occlusal caries lesions in adults referred for restorative treatment: 2–3 years of follow-up. Clin Oral Investig 16:521–529PubMedCrossRef
30.
Zurück zum Zitat Schwendicke F, Meyer-Lückel H, Dorfer C et al (2013) Failure of incompletely excavated teeth – a systematic review. J Dent 41:569–580PubMedCrossRef Schwendicke F, Meyer-Lückel H, Dorfer C et al (2013) Failure of incompletely excavated teeth – a systematic review. J Dent 41:569–580PubMedCrossRef
31.
Zurück zum Zitat Hevinga MA, Opdam NJ, Frencken JE et al (2010) Does incomplete caries removal reduce strength of restored teeth? J Dent Res 89:1270–1275PubMedCrossRef Hevinga MA, Opdam NJ, Frencken JE et al (2010) Does incomplete caries removal reduce strength of restored teeth? J Dent Res 89:1270–1275PubMedCrossRef
32.
Zurück zum Zitat Schwendicke F, Kern M, Blunck U et al (2014) Marginal integrity and secondary caries of selectively excavated teeth in vitro. J Dent 42:1261–1268PubMedCrossRef Schwendicke F, Kern M, Blunck U et al (2014) Marginal integrity and secondary caries of selectively excavated teeth in vitro. J Dent 42:1261–1268PubMedCrossRef
33.
Zurück zum Zitat Schwendicke F, Kern M, Meyer-Lueckel H et al (2013) Fracture resistance and cuspal deflection of incompletely excavated teeth. J Dent 42:107–113PubMedCrossRef Schwendicke F, Kern M, Meyer-Lueckel H et al (2013) Fracture resistance and cuspal deflection of incompletely excavated teeth. J Dent 42:107–113PubMedCrossRef
34.
35.
Zurück zum Zitat Corralo DJ, Maltz M (2013) Clinical and ultrastructural effects of different liners/restorative materials on deep carious dentin: a randomized clinical trial. Caries Res 47:243–250PubMedCrossRef Corralo DJ, Maltz M (2013) Clinical and ultrastructural effects of different liners/restorative materials on deep carious dentin: a randomized clinical trial. Caries Res 47:243–250PubMedCrossRef
36.
Zurück zum Zitat Cox CF, Hafez AA, Akimoto N et al (1999) Biological basis for clinical success: pulp protection and the tooth-restoration interface. Pract Periodontics Aesthet Dent 11:819–826 (quiz 827)PubMed Cox CF, Hafez AA, Akimoto N et al (1999) Biological basis for clinical success: pulp protection and the tooth-restoration interface. Pract Periodontics Aesthet Dent 11:819–826 (quiz 827)PubMed
37.
Zurück zum Zitat De Souza Costa CA, Hebling J, Hanks CT (2000) Current status of pulp capping with dentin adhesive systems: a review. Dent Mater16:188–197 De Souza Costa CA, Hebling J, Hanks CT (2000) Current status of pulp capping with dentin adhesive systems: a review. Dent Mater16:188–197
38.
Zurück zum Zitat Hilton TJ (1996) Cavity sealers, liners, and bases: current philosophies and indications for use. Oper Dent 21:134–146PubMed Hilton TJ (1996) Cavity sealers, liners, and bases: current philosophies and indications for use. Oper Dent 21:134–146PubMed
39.
Zurück zum Zitat Mccomb D, Ericson D (1987) Antimicrobial action of new, proprietary lining cements. J Dent Res 66:1025–1028PubMedCrossRef Mccomb D, Ericson D (1987) Antimicrobial action of new, proprietary lining cements. J Dent Res 66:1025–1028PubMedCrossRef
40.
Zurück zum Zitat King JB, Crawford JJ, Lindahl RL (1965) Indirect pulp capping: a bacteriologic study of deep carious dentine in human teeth. Oral Surg Oral Med Oral Pathol 20:663–669PubMedCrossRef King JB, Crawford JJ, Lindahl RL (1965) Indirect pulp capping: a bacteriologic study of deep carious dentine in human teeth. Oral Surg Oral Med Oral Pathol 20:663–669PubMedCrossRef
41.
Zurück zum Zitat Leung RL, Loesche WJ, Charbeneau GT (1980) Effect of Dycal on bacteria in deep carious lesions. J Am Dent Assoc 100:193–197PubMed Leung RL, Loesche WJ, Charbeneau GT (1980) Effect of Dycal on bacteria in deep carious lesions. J Am Dent Assoc 100:193–197PubMed
42.
Zurück zum Zitat Bressani AE, Mariath AA, Haas AN et al (2013) Incomplete caries removal and indirect pulp capping in primary molars: a randomized controlled trial. Am J Dent 26:196–200PubMed Bressani AE, Mariath AA, Haas AN et al (2013) Incomplete caries removal and indirect pulp capping in primary molars: a randomized controlled trial. Am J Dent 26:196–200PubMed
43.
Zurück zum Zitat Duque C, Negrini TC, Nacono NT et al (2009) Clinical and microbiological performance of resin-modified glass-ionomer liners after incomplete dentine caries removal. Clin Oral Investig 13:465–471PubMedCrossRef Duque C, Negrini TC, Nacono NT et al (2009) Clinical and microbiological performance of resin-modified glass-ionomer liners after incomplete dentine caries removal. Clin Oral Investig 13:465–471PubMedCrossRef
44.
Zurück zum Zitat Neelakantan P, Rao CV, Indramohan J (2012) Bacteriology of deep carious lesions underneath amalgam restorations with different pulp-capping materials – an in vivo analysis. J Appl Oral Sci 20:139–145PubMedCentralPubMedCrossRef Neelakantan P, Rao CV, Indramohan J (2012) Bacteriology of deep carious lesions underneath amalgam restorations with different pulp-capping materials – an in vivo analysis. J Appl Oral Sci 20:139–145PubMedCentralPubMedCrossRef
45.
Zurück zum Zitat Kuhn E, Chibinski AC, Reis A et al (2014) The role of glass ionomer cement on the remineralization of infected dentin: an in vivo study. Pediatr Dent 36:118–124 Kuhn E, Chibinski AC, Reis A et al (2014) The role of glass ionomer cement on the remineralization of infected dentin: an in vivo study. Pediatr Dent 36:118–124
46.
Zurück zum Zitat Ngo HC, Mount G, Mc Intyre J et al (2006) Chemical exchange between glass-ionomer restorations and residual carious dentine in permanent molars: an in vivo study. J Dent 34:608–613PubMedCrossRef Ngo HC, Mount G, Mc Intyre J et al (2006) Chemical exchange between glass-ionomer restorations and residual carious dentine in permanent molars: an in vivo study. J Dent 34:608–613PubMedCrossRef
47.
Zurück zum Zitat Alves LS, Fontanella V, Damo AC et al (2010) Qualitative and quantitative radiographic assessment of sealed carious dentin: a 10-year prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:135–141PubMedCrossRef Alves LS, Fontanella V, Damo AC et al (2010) Qualitative and quantitative radiographic assessment of sealed carious dentin: a 10-year prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:135–141PubMedCrossRef
48.
Zurück zum Zitat Yoshiyama M, Tay FR, Doi J et al (2002) Bonding of self-etch and total-etch adhesives to carious dentin. J Dent Res 81:556–560PubMedCrossRef Yoshiyama M, Tay FR, Doi J et al (2002) Bonding of self-etch and total-etch adhesives to carious dentin. J Dent Res 81:556–560PubMedCrossRef
49.
Zurück zum Zitat Ivanovic V, Santini A (1989) Rate of formation of tertiary dentin in dogs‘ teeth in response to lining materials. Oral Surg Oral Med Oral Pathol 67:684–688PubMedCrossRef Ivanovic V, Santini A (1989) Rate of formation of tertiary dentin in dogs‘ teeth in response to lining materials. Oral Surg Oral Med Oral Pathol 67:684–688PubMedCrossRef
50.
Zurück zum Zitat Schroder U (1985) Effects of calcium hydroxide-containing pulp-capping agents on pulp cell migration, proliferation, and differentiation. J Dent Res 64(Spec No):541–548PubMed Schroder U (1985) Effects of calcium hydroxide-containing pulp-capping agents on pulp cell migration, proliferation, and differentiation. J Dent Res 64(Spec No):541–548PubMed
51.
Zurück zum Zitat Murray PE, About I, Franquin JC et al (2001) Restorative pulpal and repair responses. J Am Dent Assoc 132:482–491PubMedCrossRef Murray PE, About I, Franquin JC et al (2001) Restorative pulpal and repair responses. J Am Dent Assoc 132:482–491PubMedCrossRef
52.
Zurück zum Zitat Krifka S, Spagnuolo G, Schmalz G et al (2013) A review of adaptive mechanisms in cell responses towards oxidative stress caused by dental resin monomers. Biomaterials 34:4555–4563PubMedCrossRef Krifka S, Spagnuolo G, Schmalz G et al (2013) A review of adaptive mechanisms in cell responses towards oxidative stress caused by dental resin monomers. Biomaterials 34:4555–4563PubMedCrossRef
53.
Zurück zum Zitat Hincapie S, Fuks A, Mora I et al (2014) Teaching and practical guidelines in pulp therapy in primary teeth in Colombia – South America. Int J Paediatr Dent: 2014 Mar 21 [Epub ahead of print]. doi: 10.1111/ipd.12103 Hincapie S, Fuks A, Mora I et al (2014) Teaching and practical guidelines in pulp therapy in primary teeth in Colombia – South America. Int J Paediatr Dent: 2014 Mar 21 [Epub ahead of print]. doi: 10.1111/ipd.12103
54.
Zurück zum Zitat Schwendicke F, Meyer-Lueckel H, Dorfer C et al (2013) Attitudes and behaviour regarding deep dentin caries removal: a survey among German dentists. Caries Res 47:566–573PubMedCrossRef Schwendicke F, Meyer-Lueckel H, Dorfer C et al (2013) Attitudes and behaviour regarding deep dentin caries removal: a survey among German dentists. Caries Res 47:566–573PubMedCrossRef
55.
Zurück zum Zitat Franzon R, Casagrande L, Pinto AS et al (2007) Clinical and radiographic evaluation of indirect pulp treatment in primary molars: 36 months follow-up. Am J Dent 20:189–192PubMed Franzon R, Casagrande L, Pinto AS et al (2007) Clinical and radiographic evaluation of indirect pulp treatment in primary molars: 36 months follow-up. Am J Dent 20:189–192PubMed
56.
Zurück zum Zitat Wegehaupt F, Betke H, Solloch N et al (2009) Influence of cavity lining and remaining dentin thickness on the occurrence of postoperative hypersensitivity of composite restorations. J Adhes Dent 11:137–141PubMed Wegehaupt F, Betke H, Solloch N et al (2009) Influence of cavity lining and remaining dentin thickness on the occurrence of postoperative hypersensitivity of composite restorations. J Adhes Dent 11:137–141PubMed
57.
Zurück zum Zitat Whitworth JM, Myers PM, Smith J et al (2005) Endodontic complications after plastic restorations in general practice. Int Endod J 38:409–416PubMedCrossRef Whitworth JM, Myers PM, Smith J et al (2005) Endodontic complications after plastic restorations in general practice. Int Endod J 38:409–416PubMedCrossRef
58.
Zurück zum Zitat Miyashita H, Worthington H, Qualtrough A et al (2007) Pulp management for caries in adults: maintaining pulp vitality. Cochrane Database Syst Rev 18(2):CD004484 Miyashita H, Worthington H, Qualtrough A et al (2007) Pulp management for caries in adults: maintaining pulp vitality. Cochrane Database Syst Rev 18(2):CD004484
Metadaten
Titel
Moderne Konzepte bei der Kariesexkavation
Zwischen Vollständigkeit und Dentinschonung
verfasst von
S. Paris
Dr. F. Schwendicke
Publikationsdatum
01.02.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
wissen kompakt / Ausgabe 1/2015
Print ISSN: 1863-2637
Elektronische ISSN: 2190-3816
DOI
https://doi.org/10.1007/s11838-014-0224-0

Weitere Artikel der Ausgabe 1/2015

wissen kompakt 1/2015 Zur Ausgabe

Zahnärztliche Fortbildung

Kleben ohne Phosphorsäureätzung

Zahnärztliche Fortbildung

Bulk-Fill-Komposite

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Zahnmedizin und bleiben Sie gut informiert – ganz bequem per eMail.