Study regarding stepwise therapy in deep caries

Rezumat Scopul studiului. Studiul a urmărit evaluarea rezultatelor terapiei stepwise în cadrul unui lot de dinţi cu carii dentare profunde cu evoluţie acut‑progresivă. Material și metodă. Lotul de studiu a inclus 80 de dinţi cu leziuni carioase profunde acut‑progresive la un grup de 48 pacienţi cu vârste cuprinse între 15 şi 40 de ani. Au fost selectaţi dinţi la care îndepărtarea dentinei afectate ar fi condus la deschiderea camerei pulpare în cazul terapiei cariei dentare prin metoda clasică. La prima şedinţă a fost îndepărtată cu ajutorul unui excavator complet dentina periferică şi parţial dentina necrotică şi afectată localizată pe fundul cavităţii carioase. Au fost realizate, prin intermediul inspecţiei vizuale şi palpării cu sonda, evaluări standardizate ale culorii şi consistenţei dentinare. Coafajul indirect a fost realizat cu ajutorul unor materiale antiseptice, remineralizatoare şi cu rol de stimulare a depunerii de dentină terţiară: lot 1 (20 dinţi)‑hidroxid de calciu (Dycal, DeTreyDentsply), lot 2 (10 dinţi)‑ eugenat de zinc (Caryo‑ san, Spofa) şi lot 3 (10 dinţi)‑cement glassionomer (Ketac, ESPE). Rezultate. Pe parcursul terapiei stepwise are loc o modificare progresivă a culorii dentinare în galben‑brun sau brun‑închis şi modificarea consistenţei. Cele mai bune rezultate au fost obţinute prin asocierea hidroxidului de calciu cu eugenat de zinc care a asigurat o rată de succes de peste 90%. În cadrul lotului de dinţi studiat, un număr de 14cazuri (17,5%) au prezentat pierderea vitalităţii dentare şi au determinat aplicarea unei terapii endodontice. Concluzii. Rata crescută de succes după 6 luni de monitorizare demonstrează că terapia stepwise poate fi recomandată în terapia cariilor cu evoluţie acută. Hidroxidul de calciu asociat cu eugenatul de zinc este alegerea de elecţie dar, în unele situaţii clinice cu distrucţii coronare extinse, asocierea hidroxidului de calciu cu cement glassionomer poate fi considerată o alternativă viabilă.Summary Study regarding stepwise therapy in deep caries This study aimed to assess the results of stepwise excavation therapy in deep carious lesions with acute‑progressive evolution. Material and methods. The material comprised 80 teeth with deep carious lesions (acute‑progressive evolution) in a group of 48 patients which the clinicians considered would result in pulp perforation if treated by a single and terminal excavation. At the first visit excavation of the peripheral dentine was completed. The outermost part of the central and necrotic dentine was gently removed with a sharp excavator. Standardized assessments of the dentine colour and consistency were made before application of calcium hydroxide‑containing base material (Dycal, DeTreyDentsply), zinc‑oxide eugenol (Caryosan, Spofa) and glassionomer cement (Ketac, ESPE). The final excavation was completed after a treatment interval ranging from 6 weeks, 12 weeks to 24 weeks. Reassessments of the dentine colour and consistency were made before complete removal of demineralized dentine. Results. The colour of the central dentine changed to yellow‑brown or dark brown and consistency less softened. The best results were obtained with calcium hydroxide and zinc‑oxide eugenol that had a 90% succes rate. For all cases taken in study only 14 cases (17,5%) resulted in pulp perforation during the final excavation. Conclusion. The high success rate of teeth surviving the final treatment without pulp exposure after 6 months of observation shows that stepwise therapy can be recommended for deep caries with acute‑progressive evolution. Calcium hydroxide associated with zinc‑oxide eugenol must be preffered but in some cases with extensive coronal destruction glassionomer cements associated with calcium hydroxide can be a good alternative stepwise therapy

Study Regarding Neodentinogenesis, Dentinal Hypermineralisation and Pulp Calcification in Dental Caries

Introduction. The aim of study was to correlate dental-pulp reactions to dental caries with diverse localization, evolution and depth. Materials and method. The study was realized on a group of 87 patients with age ranging between 15-35 years. 222 posterior teeth with carious lesions were examined both on clinical and radiographs (ortopantomographs). Type of pulp-dentinal defensive reactions visible on radiographs were as follows: neodentinogenesis with advanced deposition of tertiary dentin, dentinal hypermineralisation, difuse pulp calcification. Parameters taken in study were as follows: sex, age group, dental group, radiographic indices (depth, location). Data were recorded in tables and expressed in Microsoft Excel graphs. Results and discussions. Clinical and radiographic data showed correlation between deep chronic caries localized on occlusal surfaces of mandibular molars and dentinal hypermineralisation reactions; deep chronic caries localized on maxillary molars were associated with massive retraction of pulp room through neodentinogenesis. Lack of pulp-dentinal complex reactions was observed especially for patients with age 15-25 and dental caries with acute evolution. Conclusions. Age, localization and evolution of dental caries can be correlated with presence of specific forms of pulp-dentinal reactions