Scribd Logo
Importer

Bienvenue sur Scribd !

  • Qi - 2012 - 03 - S0197a Systematic Approach To Deep Caries Removal End Points - The Peripheral Seal Con PDF

    Transféré par

    Patri Meisaros
    288 vues12 pages
    This document outlines a systematic approach for determining ideal caries removal end points for deep lesions in vital teeth. It combines knowledge of dental anatomy, histology, microbiology, and adhesive dentistry with caries-detecting dye and laser fluorescence technology. The goal is to create a peripheral seal zone of healthy enamel, dentin, and dentin-enamel junction that can support long-term restorations, while avoiding pulp exposure. By leaving slightly infected but highly bondable inner carious dentin inside this seal zone, pulp vitality can be maintained and restorations supported, generating excellent long-term prognosis.

    Description originale:

    Titre original

    qi_2012_03_s0197A systematic approach to deep caries removal end points- The peripheral seal con.pdf

    Copyright

    © © All Rights Reserved

    Formats disponibles

    PDF, TXT ou lisez en ligne sur Scribd

    Avez-vous trouvé ce document utile ?

    Ce contenu est-il inapproprié ?

    Signaler ce document
    This document outlines a systematic approach for determining ideal caries removal end points for deep lesions in vital teeth. It combines knowledge of dental anatomy, histology, microbiology, and adhesive dentistry with caries-detecting dye and laser fluorescence technology. The goal is to create a peripheral seal zone of healthy enamel, dentin, and dentin-enamel junction that can support long-term restorations, while avoiding pulp exposure. By leaving slightly infected but highly bondable inner carious dentin inside this seal zone, pulp vitality can be maintained and restorations supported, generating excellent long-term prognosis.

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    288 vues12 pages

    Qi - 2012 - 03 - S0197a Systematic Approach To Deep Caries Removal End Points - The Peripheral Seal Con PDF

    Transféré par

    Patri Meisaros
    This document outlines a systematic approach for determining ideal caries removal end points for deep lesions in vital teeth. It combines knowledge of dental anatomy, histology, microbiology, and adhesive dentistry with caries-detecting dye and laser fluorescence technology. The goal is to create a peripheral seal zone of healthy enamel, dentin, and dentin-enamel junction that can support long-term restorations, while avoiding pulp exposure. By leaving slightly infected but highly bondable inner carious dentin inside this seal zone, pulp vitality can be maintained and restorations supported, generating excellent long-term prognosis.

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 12

    Q U I N T E S S E N C E I N T E R N AT I O N A L

    fo r

    in adhesive dentistry
    David S. Alleman, DDS1/Pascal Magne, DMD, PhD2

    The objective of this article is to present evidence-based protocols for the diagnosis and
    treatment of deep caries lesions in vital teeth. These protocols combine caries-detecting
    EZFXJUIBOBUPNJDBMBOEIJTUPMPHJDLOPXMFEHFUPBSSJWFBUJEFBMDBSJFTSFNPWBMFOEQPJOUT
    GPSBEIFTJWFSFTUPSBUJPOT%*"(/0EFOUMBTFSGMVPSFTDFODFUFDIOPMPHZDBOBMTPCFVTFEUP
    confirm these end points. These ideal caries removal end points generate a peripheral seal
    [POFUIBUDBOTVQQPSUMPOHUFSNCJPNJNFUJDSFTUPSBUJPOT"SFWJFXPGUIFQVCMJTIFEMJUFSBUVSF
    since 1980 on caries, caries diagnosis, and caries treatments and their relationships to
    BEIFTJWFCPOEJOHUFDIOJRVFTXBTDBSSJFEPVU$PNCJOJOHBOBUPNJDBMNFBTVSFNFOUTBOE
    QBUIPMPHJDBOEIJTUPMPHJDLOPXMFEHFXJUIDBSJFTEFUFDUJOHEZFBOE%*"(/0EFOUMBTFS
    fluorescence technologies can produce ideal caries removal end points for adhesive
    EFOUJTUSZXJUIPVUFYQPTJOHWJUBMQVMQT(Quintessence Int 2012;43:197208)

    Key words: adhesive dentistry, biomimetic restorations, caries removal,


    indirect pulp capping

    The most common pathology clinicians treat

    junction (DEJ), complete removal of caries

    is caries and its resulting decay.1 The treat-

    by the traditional visual and tactile tech-

    ment of this disease involves the diagnosis

    nique has been successful. The minimally

    and management of the patients biofilm

    invasive dental treatments for these smaller

    and then the remineralization or restoration

    lesions using air abrasion, sonic diamond

    of the damaged tooth structure.25 Treating

    tips, glass-ionomer cement, and bonded

    EFDBZ XJUIPVU USFBUJOH UIF DBVTF PG EFDBZ

    composite resin have reduced the need for

    JT B QSPCMFN UIBU UIF $".#3" $BSJFT

    traditional preparations that eliminate impor-

    .BOBHFNFOU#Z3JTL"TTFTTNFOU
    QSPHSBN

    tant anatomical structures.1115 )PXFWFS  GPS

    6,7

    is seeking to resolve.

    Small lesions can

    lesions of medium and large depths, more

    often be treated nonsurgically, according

    sophisticated techniques are required for

    UPUIFSFWJTFE*OUFSOBUJPOBM$BSJFT%FUFDUJPO

    determining ideal caries removal end points

    BOE "TTFTTNFOU 4ZTUFN *$%"4 **


    8 After

    (Fig 1).

    the systemic disease is treated and incipi-

    Using traditional visual and tactile tech-

    ent lesions are remineralized9 or infiltrat-

    niques for these larger lesions is often

    ed,10 DMJOJDJBOT BSF MFGU UP EFUFSNJOF IPX

    inconsistent for determining optimal caries

    much of the caries should be removed

    removal end points that consistently preserve

    CFGPSF SFTUPSBUJPO 'PS TNBMM  TIBMMPX

    UPPUI TUSVDUVSF BOE SFNPWF JOGFDUJPO XJUIPVU

    lesions limited to the enamel and super-

    exposing the pulp. Such ideal caries removal

    ficial dentin closest to the dentinoenamel

    FOEQPJOUTXPVMEQSFTFSWFQVMQWJUBMJUZXJUIout limiting the strength and durability of the


    BEIFTJWF SFDPOTUSVDUJPO 3FTFBSDIFST BOE

    Codirector, Alleman-Deliperi Center for Biomimetic Dentistry,

    DMJOJDJBOT IBWF TUSVHHMFE XJUI UIF QSPCMFN

    South Jordan, Utah, USA.

    PGUPPNVDIWTOPUFOPVHIXIFOJUDPNFTUP

    Associate Professor, Don and Sybil Harrington Foundation

    the removal of decayed tissue.1618

    Chair of Esthetic Dentistry, Division of Primary Oral Health Care,

    This paper outlines a system for deter-

    The Herman Ostrow School of Dentistry of the University of

    mining more predictable caries removal

    Southern California, Los Angeles, California, USA.

    end points for deeper lesions in vital teeth.


    Correspondence: Dr David S. Alleman, Alleman-Deliperi Center
    for Biomimetic Dentistry, 10319 S. Beckstead Ln, South Jordan,
    UT 84095. Email: allemancenter@gmail.com

    VOLUME 43 t /6.#&33 t ."3$) 2012

    5IJT BQQSPBDI JT CBTFE PO EFUBJMFE LOPXMedge of three-dimensional dental anatomy,

    197

    ot

    Q ui

    by N
    ht

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    tio
    A systematic approach to deep caries removal
    n
    te
    e
    s
    s
    c
    en
    end points: The peripheral seal concept

    Q U I N T E S S E N C E I N T E R N AT I O N A L
    Alleman/Magne

    fo r

    Fig 1 Intermediate and deep


    caries lesions have many visual
    and tactile complexities that can
    be systematically approached
    with caries removal end point and
    peripheral seal zone protocols.

    histology,

    Fig 2 The concept of a peripheral seal zone is that the enamel,


    DEJ, and superficial dentin constitute the caries-free area of a highly bonded adhesive restoration.

    microbiology,

    and

    Fig 3 Caries removal end points for the peripheral seal


    zone can be determined with a combination of cariesdetecting dye and DIAGNOdent technologies.

    seal zone, a bondability of approximately 30

    adhesive

    EFOUBM TDJFODF 5IJT LOPXMFEHF JT UIFO

    .1BXJMMCFPCUBJOFEJOUIFEFFQFSBSFBTPG

    JOUFHSBUFE XJUI WJTVBM EZF TUBJOJOH -BTFS

    the preparation.25 5IJT XJMM CF DPOGJSNFE CZ

    fluorescence technologies can also be

    light pink staining from caries-detecting dye.

    added to guide the clinician in deep caries

    %*"(/0EFOU DBO BMTP IFMQ EFUFSNJOF UIF

    diagnosis and removal. This combination

    DBSJFT SFNPWBM FOE QPJOU XJUI SFBEJOHT PG

    of multiple overlapping techniques can

    approximately 2024 for intermediate dentin

    remedy the shortcomings of using only the

    and approximately 36 for deep dentin (Fig

    tactile and visual method.19

    3).26,27 On average, intermediate dentin is 3

    The general objectives of this systematic

    to 4 mm from the occlusal surface and deep

    approach to caries removal end point deter-

    dentin is 4 to 5 mm from the occlusal sur-

    mination are the maintenance of pulp vitality

    GBDF $MJOJDJBOT DBO QSFWFOU QVMQ FYQPTVSF

    after restoration by adhesive methods; the

    by leaving the infected outer caries inside

    elimination of dentinal infections by remov-

    UIF QFSJQIFSBM TFBM [POF XIFO SFNPWBM

    ing, deactivating, or sealing in bacteria; and

    XPVME SJTL QVMQ FYQPTVSF 5IJT XPVME CF

    the conservation of intact tooth structure

    in small circumpulpal areas deeper than

    for long-term biomimetic function. The spe-

    5 mm from the occlusal surface. These

    cific objectives of caries removal end point

    TNBMMJOGFDUFEBSFBTXJMMTUBJOSFEGSPNDBS-

    determination are the creation of a peripher-

    JFTEFUFDUJOH EZF BOE IBWF %*"(/0EFOU

    al seal zone and the absolute avoidance of

    readings higher than 36. Achieving these

    QVMQBM FYQPTVSF XIJMF HFOFSBUJOH B IJHIMZ

    objectives should result in highly bondable

    CPOEFESFTUPSBUJPOXJUIFYDFMMFOUMPOHUFSN

    QSFQBSBUJPOT UIBU XJMM TVQQPSU BEIFTJWF MBZ-

    prognosis. First, by creating a peripheral

    ers and remain bonded for the long term, an

    TFBM [POF  UP NN XJEF DPOTJTUJOH PG

    essential requirement for large biomimetic

    normal superficial dentin, DEJ, and enamel

    dental reconstructions (Fig 3).2833

    (Fig 2), a bond strength of approximately


    4555 MPa can be generated.20,21
    5IJT QFSJQIFSBM TFBM [POF XJMM CF

    HISTOLOGY
    OF CARIES LESIONS

    confirmed by the total absence of caries-detecting dye staining.2224 This cariesfree zone can also be confirmed by a
    %*"(/0EFOU ,B7P
     SFBEJOH PG BQQSPYJ-

    In 1980, Takao Fusayama published the

    NBUFMZ  $PNNFSDJBM QSPEVDUT TVDI BT

    research carried out by his team at Tokyo

    $BSJFT %FUFDUPS ,VSBSBZ


     $BSJFT 'JOEFS

    Medical and Dental University on the analy-

    (Danville), and Seek (Ultradent) are exam-

    sis of caries lesions.34 Using histologic, bio-

    ples of caries-detecting dye. Second, by

    chemical, biomechanical, microscopic, and

    leaving the slightly infected and partially

    microbiologic techniques, the researchers

    demineralized but highly bondable affected

    XFSFBCMFUPEJTUJOHVJTIUXPMBZFSTJODBSJFT

    inner carious dentin inside the peripheral

    MFTJPOT UIBU XFSF WFSZ EJGGFSFOU JO OBUVSF

    198

    VOLUME 43 t /6.#&33 t ."3$) 2012

    ot

    Q ui

    by N
    ht

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    tio
    n
    te
    ss e n c e

    Q U I N T E S S E N C E I N T E R N AT I O N A L
    Alleman/Magne

    MBZFS XFSF EFOBUVSFE  IBWJOH MPTU NPTU

    tin stained dark red, and the inner carious

    of their intermolecular cross-linkages. This

    dentin stained lighter (pink for the red dye

    MBZFSXBTOPUTFOTJUJWFUPDPOUBDUBOEDPVME

    GPSNVMB
    5IFJOUFSQIBTFCFUXFFOUIFPVUFS

    CF SFNPWFE XJUIPVU BOFTUIFTJB CFDBVTF JU

    BOEJOOFSDBSJPVTEFOUJOXBTSFGFSSFEUPBT

    had lost the hydrodynamic system of intact

    the turbid layer. This interphase is a mixture

    fo r

    dentinal tubules. This layer also failed to

    PGQBSBMMFMHSPVQTPGUVCVMFT TPNFPGXIJDI

    SFNJOFSBMJ[F JO B OBUVSBM XBZ CFDBVTF UIF

    BSFPVUFSDBSJPVTEFOUJOBOETPNFPGXIJDI

    DPMMBHFO GSBNFXPSL DPVME OPU SFUVSO UP

    are inner carious dentin (depending on

    OPSNBM FWFO JG UIF BDJE FOWJSPONFOU XBT

    IPX MPOH UIF UVCVMFT IBWF CFFO JOGFDUFE

    OFVUSBMJ[FE 5IF TFDPOE MBZFS XBT UFSNFE

    and under the influence of bacterial acids).

    iJOOFS DBSJPVT EFOUJOw 5IJT MBZFS XBT QBS-

    Under the turbid layer, the inner carious

    tially demineralized and slightly infected,

    dentin becomes the transparent zone. The

    but the collagen fibrils retained their natural

    transparent zone is translucent in histologic

    structure around intact dentinal tubules.

    FYBNJOBUJPO XJUI B MJHIU NJDSPTDPQF 5IF

    #FDBVTF PG UIJT SFNBJOJOH TUSVDUVSBM JOUFH-

    pink staining (often referred to as a pink

    SJUZ  UIF JOOFS DBSJPVT EFOUJO XBT TFOTJUJWF

    haze) in the turbid layer becomes lighter as

    UP SFNPWBM XJUIPVU BOFTUIFTJB 5IF MVNFOT

    it moves into the transparent zone. In this

    of the dentinal tubules in this layer had no

    zone, the large lumens of the dentin tubules

    QFSJUVCVMBS SJOHT PG IZESPYZBQBUJUF <$B10

    BSF GJMMFE UP TPNF EFHSFF XJUI 8IJUMPDLJUF

    (PO4)6 0)
    2]. Instead, the enlarged lumens

    5IFTF MBSHF DSZTUBMT TMPX CBDUFSJBM JOWB-

    XFSF OPX QBSUJBMMZ PS DPNQMFUFMZ GJMMFE XJUI

    sion and reduce dentin permeability. This

    large crystals of tribeta calcium phosphate

    reduced permeability decreases the out-

    <$B3 (PO4)2] called Whitlockite.35 Whitlockite

    XBSEGMPXPGQVMQBMGMVJE XIJDIJTSFGFSSFEUP

    is crystallized into the dentinal tubules as

    BTiUSBOTVEBUJPOw*UBMTPSFEVDFTUIFNPWF-

    hydroxyapatite is dissolved from intertu-

    ment of pulpal fluid caused by temperature

    bular dentin by bacterial acids. This inner

    changes. Underneath the transparent zone

    MBZFS PG UIF DBSJFT MFTJPO XBT BCMF UP CF

    is an interphase of the transparent zone, as

    SFTUPSFE UP B OPSNBM NJOFSBMJ[BUJPO XJUI B

    XFMM BT OPSNBM TFOTJUJWF EFOUJO DBMMFE UIF

    hydroxyapatite matrix surrounding the col-

    iTVCUSBOTQBSFOU[POFw 'JH
    

    lagen fibrils (intertubular dentin) and around


    UIFUVCVMFT QFSJUVCVMBSEFOUJO
    XIFOUIFQ)
    XBTOFVUSBMJ[FE36
    Since the late 1960s, the goal of removing only outer caries and saving the inner

    The subtransparent zone stains even


    more lightly than the transparent zone.
    3FNPWBMPGUIFUSBOTQBSFOUBOETVCUSBOTQBSent zones in an attempt to reach hard dentin
    is the cause of most pulp exposure (Fig 5).

    caries for remineralization has been recog-

    The pink-haze staining (as differentiated

    nized.375IFQSPCMFNXBTUIBUFBDIPQFSB-

    from the red staining) of the inner carious

    tor had a different sense of hard and soft.

    EFOUJO XBT OFWFS EJTDVTTFE CZ 'VTBZBNB

    $MJOJDBMMZ GJOEJOH UIF JOUFSQIBTF CFUXFFO

    JO FJUIFS PG IJT UXP CPPLT PS BOZ PG IJT

    the outer and inner carious dentin layers

    NBOZ QVCMJTIFE BSUJDMFT )F POMZ SFGFSSFE

    XBT JODPOTJTUFOU "EEJOH UP UIF EJGGJDVMUZ

    to stained or unstained caries. As a result,

    XBT UIF BOBUPNJDBM TPGUFOJOH PG EFOUJO BT

    many users of caries-detecting dye solu-

    it nears the pulp (reparative dentin, laid

    UJPOT CFDBNF DPOGVTFE BCPVU FYBDUMZ IPX

    EPXOEVSJOHUIFDBSJFTQSPHSFTTJPO JTFWFO

    to use it. If all of the lightly stained dentin

    softer than deep dentin) and the fact that

    XBT SFNPWFE  VOEFS UIF BTTVNQUJPO UIBU JU

    different instruments (hand, rotary, or ultra-

    contained a significant number of bacteria,

    sonic) removed more or less of the lesion

    then an increased number of pulp expo-

    during excavation. All of this subjectivity

    sures occurred.3941 Other researchers in

    and variability made for inconsistent car-

    +BQBOXIPIFMQFEXJUI'VTBZBNBTPSJHJOBM

    ies removal end points. Fusayama made

    research came to the conclusion that the

    QSPHSFTT UPXBSE B TPMVUJPO UP UIJT QSPC-

    MJHIUMZTUBJOFEBSFBTXFSFNPTUMZVOJOGFDUFE

    MFNCZGJOEJOHUXPQSPQZMFOFHMZDPMoCBTFE

    XJUI JOUBDU DPMMBHFO GJCSJMT TVSSPVOEFE CZ

    VOLUME 43 t /6.#&33 t ."3$) 2012

    199

    ot

    38

    EFOUJOw *U XBT IJHIMZ JOGFDUFE  BDJEJD  BOE

    Q ui

    5IF GJSTU MBZFS XBT OBNFE iPVUFS DBSJPVT

    by N
    ht

    demineralized. The collagen fibrils in this

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    colored solutions (one purple, one red)
    tio
    that stained the outer and inner carious den- t
    ess c e n
    en
    tin layers differently. The outer carious den-

    Q U I N T E S S E N C E I N T E R N AT I O N A L
    Alleman/Magne

    fo r

    Fig 4 The deep caries lesion has two parts: outer and inner carious dentin. The inner carious dentin has three parts: the turbid
    layer, transparent zone, subtransparent zone, and normal dentin.

    Fig 5 By using only visual and tactile methods


    for deep caries removal, the pulp is often exposed
    because the tansparent zone, the subtransparent
    zone, normal deep dentin, and reparative dentin are
    all softer than superficial and intermediate dentin.

    high levels of hydroxyapatite and Whitlockite

    5IFTFGJOEJOHTXFSFSFQSPEVDFEJOBTFDPOE

    and should therefore be preserved for

    TUVEZBUUIF6OJWFSTJUZPG#FSO26,51 The differ-

    remineralization.

    4245

    ent readings in deeper lesions correspond

    Further research in

    "NFSJDB DMBSJGJFE UIF SFMBUJPOTIJQ CFUXFFO

    approximately to the proportional differences

    TUBJOJOHBOECBDUFSJBMMFWFMT)JTUPMPHJDBOE

    in pulpal fluid/mm2 at the DEJ vs circumpulpal

    NJDSPCJPMPHJDBOBMZTJTTIPXFEUIBUUIFDPS-

    areas. This is because dentinal tubules are

    relation is high in the darkly stained outer

    three times more concentrated near the pulp

    DBSJFT CVUOPUXJUIJOUIFJOOFSDBSJFT XIJDI

    than they are near the DEJ.15,52 Depending

    stained lightly.46There appeared to be a

    POUIFQFSNFBCJMJUZPGUIFJOOFSDBSJFT XIJDI

    need for a clinical technology that could

    is related to the amount of Whitlockite in the

    assess the amount of bacteria in the lightly

    EFOUJOBM UVCVMFT
     UIFSF XJMM CF B HSFBUFS PS

    stained inner caries.

    lesser diffusion of the porphyrins (hence, the


    IJHIWBSJBODFJOUIF%*"(/0EFOUSFBEJOHTJO

    *O UIF MBUF T  B OFX MBTFSGMVPSFTDFODFUFDIOPMPHZ %*"(/0EFOU


    XBTJOUSP-

    intermediate and deep inner carious dentin).

    EVDFE BT B XBZ UP EJBHOPTF JOJUJBM DBSJFT

    An increase of demineralized dentin in inner

    lesions (Fig 6). Teams of investigators in

    DBSJPVT EFOUJO BOE EFOBUVSFE DPMMBHFO XJUI

    (FSNBOZBOE4XJU[FSMBOEGPVOEUIBUCBDUF-

    high demineralization in the outer carious den-

    rial metabolic products called porphyrins

    UJO XJMM JODSFBTF UIF WPMVNF PG QVMQBM GMVJE JO

    XPVME GMVPSFTDF XIFO JSSBEJBUFE XJUI B

    the outer and inner carious dentin. In turn, this

    655-nm red laser. This fluorescence could

    XJMM BMMPX UIF QPSQIZSJO EJGGVTJPO UP JODSFBTF 

    be read and given a numeric value that cor-

    XIJDI XJMM DBVTF IJHIFS %*"(/0EFOU SFBE-

    responded approximately to the amount of

    ings in the outer carious dentin and deep

    bacteria present.47,48

    JOOFS DBSJPVT EFOUJO #PTUPO BOE 4BVCMF22

    %*"(/0EFOU QSPWFE JUT FGGJDJFODZ GPS

    DPOGJSNFE UIF (FSNBO BOE 4XJTT FYQFSJ-

    the nondestructive diagnosis of pit and fis-

    NFOUTBOEDPSSFMBUFEUIFNXJUIUIF+BQBOFTF

    sure caries.49,50 In vivo investigations using

    SFTFBSDI VTJOH DBSJFTEFUFDUJOH EZF #PTUPO

    %*"(/0EFOU TIPXFE UIBU JU NJHIU BMTP CF

    and Liao also investigated the light pink stain-

    used to establish a caries removal end point

    ing of circumpulpal dentin and concluded

    UIBU DPSSFMBUFE XJUI USBEJUJPOBM FYDBWBUJPO

    UIBU JU XBT EVF UP UIF IJHIFS QFSDFOUBHF PG

    UFDIOJRVFT %*"(/0EFOU SFBEJOHT GPS UIF

    collagen not completely surrounded by the

    TVQFSGJDJBMEFOUJOFOEQPJOUXFSF

    hydroxyapatite matrix and not from denatured

    = (< 12). The end points for intermediate to

    collagen (as in outer carious dentin) or from

    EFFQ EFOUJO XFSF      


    

    acidic demineralization (as in inner carious

    200

    VOLUME 43 t /6.#&33 t ."3$) 2012

    ot

    Q ui

    by N
    ht

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    tio
    n
    te
    ss e n c e

    Q U I N T E S S E N C E I N T E R N AT I O N A L
    Alleman/Magne

    fo r

    dentin).18,53,54 Staining and remineralization

    achieved predictably inside the peripheral

    also makes for higher variability and less pre-

    seal zone by further excavation of the red

    dictability of any technology. For superficial

    PVUFSDBSJPVTEFOUJO)PXFWFS XIFOFYDB-

    EFOUJO UIF%*"(/0EFOUSFBEJOHTPGPS

    vation is near the pulp (> 5 mm from the

    corresponded to a nonstaining and bacteria-

    occlusal surface or > 3 mm from the DEJ)

    free caries-removal end point.12 A group at

    and the caries-detecting dye still stains red,

    4IPXB6OJWFSTJUZJO5PLZPEFWFMPQFEBQPMZ-

    FYDBWBUJPO TIPVME TUPQ 5IJT QSPUPDPM XJMM

    QSPQZMFOF HMZDPMoCBTFE $BSJFT$IFDL EZF

    eliminate most pulp exposures (Figs 7 to 9).


    Avoiding direct pulp caps has been

    dentin and not the inner carious dentin. This

    TIPXO UP SFEVDF UIF OFFE GPS TVCTFRVFOU

    type of caries-detecting dye gave the same

    endodontic treatment.5860$POTFSWJOHNPSF

    SFTVMUT JO TVQFSGJDJBM EFOUJO %*"(/0EFOU 

    dentin in tooth preparations has also been

     XJUI OP TUBJOJOH


     BT 'VTBZBNBT QSPQZM-

    TIPXO UP SFEVDF UIF JODJEFODF PG JSSFWFST-

    ene glycolbased caries-detecting dye.55#VU

    ible pulpitis.61#ZFMJNJOBUJOHPSSFEVDJOHUIF

    CFDBVTFUIJTIJHIFSNPMFDVMBSXFJHIUDBSJFT

    surface area and thickness of the nonelastic

    detecting dye formula does not lightly stain

    and deformable outer carious dentin, the

    the turbid layer, transparent zone, and sub-

    performance of a bonded composite under

    transparent zone, it is not as useful to find the

    GVODUJPOBMMPBETXJMMBMTPJNQSPWF62

    caries removal end point that is ideal for the

    The final goal of ideal caries removal

    highest dentin bond strength in the peripheral

    end points and peripheral seal zones is

    seal zone.56 This is because clinicians are not

    UP DSFBUF BO BEIFTJWF CPOE UIBU XJMM CF

    able to detect inner carious dentin that should

    preserved for as long as possible. Such a

    be removed for the highest bond strength in

    bond to dentin should mimic the strength

    UIFQFSJQIFSBMTFBM[POF)PXFWFS "NFSJDBO

    of a natural tooth. The tensile strength of

    and Japanese researchers did not test the

    the DEJ has been measured at 51.5 MPa.63

    deeper lesions like the Europeans did.

    Only bonding to sound dentin can achieve

    $PNCJOJOH DBSJFTEFUFDUJOH EZF BOE

    and even exceed this tensile bond strength.

    %*"(/0EFOU DBO HJWF DMJOJDJBOT BOPUI-

    6TJOHUIFiHPMETUBOEBSETwUISFFTUFQUPUBM

    FS XBZ UP EFUFSNJOF XIFO UIF FYDBWBUFE

    FUDI PS UXPTUFQ NJMEMZ BDJEJD TFMGFUDIJOH

    MFTJPO JT FTTFOUJBMMZ CBDUFSJBGSFF XIJMF BU

    dentinal bonding systems are the most

    the same time not removing affected inner

    consistent bonding strategies to obtain

    carious dentin inside the peripheral seal

    these high bond strengths.20,64 Adhesive

    zone.

    57

    The anatomical depth of the lesion

    bonding to normal and carious dentin has

    needs to be monitored to make the cor-

    been studied for the past 15 years at the

    SFDU EFUFSNJOBUJPO PO XIFUIFS UP QSPDFFE

    .FEJDBM$PMMFHFPG(FPSHJBVOEFSUIFEJSFD-

    XJUI UIF SFNPWBM PG PVUFS DBSJPVT EFOUJO

    tion of David Pashley.25,65 These studies

    inside the peripheral seal zone. Measuring

    have been continued at many Japanese

    GSPN JOUBDU UPPUI TUSVDUVSF XJUI POF PS UXP

    universities. This research has established

    periodontal probes (see Fig 4) is a useful

    the bond strengths of normal and carious

    UFDIOJRVF UP EFUFSNJOF XIFO UIF FYDBWB-

    dentin. Inner carious dentin loses 25% to

    tion is into circumpulpal areas (5 to 6 mm

    33% of its bondability.25,65 Outer carious

    from the occlusal surface). If the excavation

    dentin has a reduction of bondability of over

    is into intermediate dentin (3 to 4 mm from

    66%.21,66 This reduction in bondability cor-

    the occlusal surface), the caries removal

    responds to the amount of demineralization

    FOE QPJOUT XJUI MJHIU QJOL TUBJOJOH DBO CF

    in the outer and inner carious dentin.67 The

    VOLUME 43 t /6.#&33 t ."3$) 2012

    201

    ot

    Q ui

    Fig 6 DIAGNOdent reads bacterial products called


    porphyrins and is used to assess the relative amount
    of bacteria present in a caries lesion.

    /JTIJLB
     UIBU TUBJOFE POMZ UIF PVUFS DBSJPVT

    by N
    ht

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    tio
    n
    te
    ss e n c e

    Q U I N T E S S E N C E I N T E R N AT I O N A L
    Alleman/Magne

    fo r

    Fig 8 Caries removal end points for a deep lesion.


    The peripheral seal zone has been created without
    exposing the pulp. A small amount of outer carious
    dentin is left on top of the inner carious dentin inside
    the peripheral seal zone.

    Fig 7 Deep caries lesion showing the outer carious


    dentin staining red and extending to the circumpulpal dentin ( > 5 mm from the occlusal surface).

    Fig 9 Clinical case illustrating Fig 8. The ideal caries


    removal end points for highly bonded restorations
    without pulpal exposure.

    $BSJTPMW DIFNPNFDIBOJDBM UFDIOJRVF PG

     UP  SFEVDUJPO JO CPOE TUSFOHUI XJMM

    caries removal leaves a thin layer of residu-

    be observed after (approximately in the first

    al outer carious dentin that may reduce the

    12 months) restoration placement. A 0.2% to

    NJDSPUFOTJMFCPOETUSFOHUI N5#4
    68,69 This

     DIMPSIFYJEJOF TPMVUJPO XJMM EFBDUJWBUF

    technique can be clinically successful in

    the matrix metalloproteinases and preserve

    TIBMMPXSFTUPSBUJPOTCVUJTOPUJEFBMJOMBSHFS

    the maximum bond strength.7577 Mild self-

    16,70

    load-bearing situations.

    etching dentinal bonding systems produce an

    4JNQMJGJFE UXPTUFQ UPUBMFUDI EFOUJOBM

    acid/base resistant zone of a 1 to 1.5 micron

    CPOEJOHTZTUFNTMPTFUPPGN5#4

    UIJDLOFTT SFGFSSFE UP BT iTVQFS EFOUJOw

    XIFO CPOEFE UP JOOFS DBSJPVT EFOUJO71 The

    CFDBVTF PG JUT BCJMJUZ UP XJUITUBOE IJHI BOE

    TBNFEFDSFBTFJOCPOETUSFOHUIXJMMPDDVSJG

    MPX Q) BUUBDLT 4& 1SPUFDU ,VSBSBZ


     XJUI

    acid etching is performed on dentin that is to

    the unique proprietary methacryloyloxydo-

    CFCPOEFEXJUIBNJMEUXPTUFQTFMGFUDIJOH

    decylpyridinium bromide monomer contain-

    dentinal bonding system.72,73 Dual-cure den-

    ing pyridinium bromide produces this super

    tinal bonding systems can have the same

    dentin and also deactivates matrix metal-

    negative effect.74 The acid from caries lesions

    loproteinases. Other mild self-etching dential

    also

    collagenase

    bonding systems also produce the acid/base

    enzymes called matrix metalloproteinases. In

    resisitant zones but need additional matrix

    the presence of matrix metalloproteinases, a

    metalloproteinase-deactivating

    202

    activates

    endogenous

    chemicals

    VOLUME 43 t /6.#&33 t ."3$) 2012

    ot

    Q ui

    by N
    ht

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    tio
    n
    te
    ss e n c e

    Q U I N T E S S E N C E I N T E R N AT I O N A L
    Alleman/Magne

    fo r

    The anatomical location of the peripher-

    reduced, the bond strength is decreased by

    al seal zone dentin must also be considered

    30% to 50% during the first 24 hours and

    UPQSFEJDUQPUFOUJBMCPOETUSFOHUI$FSWJDBM

    by another 10% during functional loading

    root dentin loses approximately 20% of its

    in the first years of service.94$BSFGVMPQFSB-

    CPOEBCJMJUZ DPNQBSFE XJUI DPSPOBM TVQFS-

    UPST XIP UBLF BMM PG UIFTF DPOTJEFSBUJPOT

    ficial dentin. If the cervical root dentin has

    into account during caries excavation and

    inner carious dentin present, the bond

    bonding procedures can decrease the array

    strength is only 50% of sound coronal den-

    of differences in regional bond strengths in

    tin.81 Deep dentin vs superficial dentin bond

    their restorations.95

    strengths are also dependant on the type of


    dentinal bonding system used. Three-step
    UPUBMFUDI BOE UXPTUFQ NJME TFMGFUDIJOH
    UPEFFQEFOUJO CVUTJNQMJGJFEUXPTUFQUPUBM

    TREATMENT GOALS
    FOR DEEP CARIES LESIONS

    etch and one-step highly acidic self-etching


    systems can lose up to 50% of their bond
    strength in deep dentin.73,82
    During

    placement

    of

    1. $SFBUFBQFSJQIFSBMTFBM[POFPGFOBNFM 
    DEJ, and normal superficial dentin near

    the

    restorative

    material, the ratio of bonded to unbonded

    the DEJ (this should bond at 55 MPa)


    (Figs 10 and 11).

    surface areas of each layer or increment of

    2. Leave the inner carious dentin inside

    composite (the configuration factor or c-fac-

    of the peripheral seal zone (this should

    tor)83 XJMM BGGFDU UIF TUSFTT PG QPMZNFSJ[BUJPO

    bond at 30 MPa) (compare Figs 2 and 3

    shrinkage that is applied to the maturing


    CPOE UP EFOUJO )JHIFS DGBDUPST BMXBZT

    XJUI'JHTBOE
    
    3. 3FNPWF IJHIMZ JOGFDUFE PVUFS DBSJPVT

    JODSFBTFTUSFTTPOUIFCPOEUPEFOUJO XIJDI

    dentin inside of the peripheral seal zone

    EFDSFBTFTJUTN5#484 VOMFTTJUJTBGMPXBCMF

    XJUIPVU FYQPTJOH UIF QVMQ 4NBMM BSFBT

    DPNQPTJUF XJUI B MPX NPEVMVT PG FMBTUJD-

    of circumpulpal outer carious dentin are

    ity compared to dentin85). Therefore, high

    left to prevent exposure (see Figs 7 to 9).

    DGBDUPSMBZFSJOHXJUIIJHINPEVMVTDPNQPT-

    4. Seal in and deactivate any remaining

    ites (thicker than 0.5 mm) should be avoided

    bacteria left inside the peripheral seal

    XIJMF UIF CPOE UP EFOUJO JT NBUVSJOH 5IJT


    can best be accomplished by using an indi-

    zone.
    5. Use adhesive restorative techniques

    rect or semidirect restorative technique.86 If

    UIBU XJMM NBYJNJ[F UIF CPOE TUSFOHUI

    direct restoration is necessary for socioeco-

    of the peripheral seal zone and the

    nomic reasons, compensatory measures

    inner carious affected dentin inside the

    are required to prevent excessive stresses

    peripheral seal zone.

    to the bond and remaining hard tissue. This


    can best be accomplished by multiple thin
    IPSJ[POUBM MBZFST XIJDI UBLF NPSF UJNF UP
    BQQMZ
     PO B UIJO MBZFS PG GMPXBCMF DPNQPTite.20,87 " UIJO NJDSPO
     NJDSPGJMMFE GMPX-

    STEP-BY-STEP
    TECHNIQUE

    able composite or a thick dentinal bonding


    system adhesive layer (50 to 80 microns)

    1. 5FTU GPS QVMQBM WJUBMJUZ XJUI JDF PS BFSP-

    can secure the dentin bond and create a

    TPM SFGSJHFSBOU &OEP*DF $PMUOF

    GBJMTBGFMBZFS4VDIBSFTJODPBUJOHXJMMTUBZ

    Whaledent).

    CPOEFE FWFO XIFO PWFSMBZJOH MBZFST GBJM

    QSPDFFE XJUI DBSJFT EJBHOPTJT BOE

    under high stress.88,89*OTIBMMPXQSFQBSBUJPOT

    treatment. If the test is ambiguous or

    in superficial dentin, the detrimental effect of

    negative, inform the patient of the pos-

    resin shrinkage is not as great because the


    c-factor is reduced.90,91

    Polyethylene fiber

    nets used to line high c-factor prepara-

    VOLUME 43 t /6.#&33 t ."3$) 2012

    If

    the

    test

    is

    positive,

    sible need for endodontic treatment.


    2. Anesthetize the tooth. Isolate it using rubber dam or other isolation techniques.

    203

    ot

    92,93

    EFOUJOBMCPOEJOHTZTUFNTCPOEFRVBMMZXFMM

    by N
    ht

    %BOWJMMFPS&UDI #JTDP
    7880

    Q ui

    TVDIBTDIMPSIFYJEJOF $POTFQTJT 6MUSBEFOU


    
    PS CFO[BMLPOJVN DIMPSJEF .JDSP1SJNF # 

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    UJPOT IBWF BMTP CFFO TIPXO UP SFEVDF UIF
    tio
    effects of polymerization stress and cervical t
    ess c e n
    en
    microleakage.
    If c-factor stresses are not

    Q U I N T E S S E N C E I N T E R N AT I O N A L
    Alleman/Magne

    fo r

    Fig 10 Ideal caries removal end points and peripheral seal zone developed in an intermediate-depth lesion using combined technologies.

    Fig 11 The peripheral seal zone is free of outer and


    inner carious dentin. Inside the peripheral seal zone,
    the lightly stained inner carious dentin is retained
    and will remineralize in vital teeth.

    3. Access the lesion after removal of any

    intermediate (middle third), or deep

    failed

    restorations.

    Stain

    the

    (pulpal third) dentin (see Fig 4).

    caries

    MFTJPO XJUI SFE DBSJFTEFUFDUJOH EZF

    7. After removing the red and leaving the


    QJOL CFUXFFO UIF QVMQ IPSOT  UIF QJOL

    Wait 10 seconds and rinse (see Fig 12).


    4. Starting near the DEJ, use a 1-mm round

    inner carious dentin areas in these

    diamond bur of fine to medium grit (30

    intermediate dentin areas can be evalu-

    to 100 microns) to create a peripheral

    BUFE XJUI %*"(/0EFOU 5IF OVNCFST

    seal zone area free of red-stained outer

    should read approximately 24 (accept-

    caries and pink-stained inner caries.

    able range, 12 to 36). Those readings

    5IJT TVQFSGJDJBM OPSNBM EFOUJO XJMM CF

    indicate a virtually bacteria-free area in

    UPNNXJEFEFQFOEJOHPOXIFUIFS

    the intermediate to deep dentin inside

    it is on the buccal or the occlusal areas

    the peripheral seal zone (see Figs 10


    and 11).

    of a molar (1.5 to 2 mm) or on the mesial

    8. Move to the deep pulp horn areas last.

    or distal root dentin (1 mm). Premolars


    are smaller, and the superficial dentin is

    $BSFGVMMZSFNPWFSFETUBJOFEPVUFSDBSJ-

    OBSSPXFSJOBMMBSFBT 'JHTBOE
    

    ous dentin until deep dentin is reached

    5. Staining and removing outer and inner

    (5 mm from occlusal surface). If the

    carious dentin is repeated until the

    tissue continues to stain red and mea-

    caries removal end point in the periph-

    TVSFNFOUT XJUI UIF QFSJPEPOUBM QSPCF

    eral seal zone is stain free. This can be

    indicate that you are deeper than 5 mm

    DPOGJSNFECZ%*"(/0EFOUSFBEJOHTPG

    from the occlusal surface (> 3 mm from

    approximately 12 (see Fig 3) and the

    the DEJ), stop excavation to avoid pulp


    exposure (compare Figs 4 to 9).

    total absence of caries-detecting dye.

    9. Optional step: Treat the peripheral seal

    (This indicates virtually bacteria-free

    zone, inner carious dentin, and outer

    superficial dentin.)
    6. 3FNPWF UIF SFETUBJOFE PVUFS DBSJPVT

    DBSJPVT EFOUJO XJUI  UP  DIMPS

    dentin from the area inside the periph-

    hexidine for 30 seconds to inactivate both

    eral seal zone (being careful to avoid

    the matrix matalloproteinases and any

    the pulp horn areas). Measure from

    remaining bacteria; 0.1% to 1.5% benzal-

    the occlusal surface to determine if the

    konium chloride solution in the acid-etch

    excavation is in superficial (outer third),

    or

    204

    methacryloyloxydodecylpyridinium

    VOLUME 43 t /6.#&33 t ."3$) 2012

    ot

    Q ui

    by N
    ht

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    tio
    n
    te
    ss e n c e

    Q U I N T E S S E N C E I N T E R N AT I O N A L
    Alleman/Magne

    fo r

    Fig 12 Application of caries-detecting dyes guides


    the creation of the peripheral seal zone using
    DIAGNOdent and 3D measurements to make end
    point decisions in the intermediate and deep dentin
    areas.

    Fig 13 Magnification of 6.5 to 8.0 is ideal for


    implementing minimally invasive caries removal.

    bromide monomer in the dentinal bond-

    The intermediate and deeper areas of light

    JOHTZTUFNXJMMBMTPBDIJFWFUIFTFHPBMT80

    QJOLoTUBJOFE JOOFS DBSJPVT EFOUJO XJMM MJLFMZ

    If using a three-step total-etch dentinal

    generate a dentin bond of 30 MPa. If any

    bonding system, this step is performed

    outer caries is left in deep circumpulpal

    after acid etching and rinsing. If using

    areas to prevent pulp from being exposed,

    B UXPTUFQ TFMGFUDIJOH EFOUJOBM CPOEJOH

    UIF N5#4 JO UIPTF TNBMM BSFBT XJMM CF

    system, after applying chlorhexidine or

    approximately 15 MPa. To maximize all of

    benzalkonium chloride, dry the prepara-

    these bond strengths, the dentinal bonding

    tion for 10 seconds before applying the

    TZTUFNDBOCFBMMPXFEUPNBUVSFGPSBDFS-

    self-etching primer.96

    tain length of time (3 minutes to 24 hours)

    10. 0QUJPOBM TUFQ JG VTJOH B NJME UXPTUFQ

    before being bonded to another layer of

    self-etching dentinal bonding system:

    polymerizing resin cement or composite

    Use air abrasion on the preparation to

    resin.98,99 5IJT JT XIZ JU JT JNQPSUBOU UP VTF

    NBYJNJ[FUIFN5#497

    the immediate dentin sealing technique

    11. 4UBSU EFOUJO CPOEJOH XJUI B UISFFTUFQ

    XIFOFWFSQPTTJCMF86,89,100,101

    UPUBMFUDI PS B NJME UXPTUFQ TFMGFUDIing dentinal bonding system.


    These techniques for caries removal

    CONCLUSION

    end point determination and peripheral seal


    zone development are the foundation of

    #Z DPNCJOJOH EFUBJMFE BOBUPNJDBM BOE

    conservative dentistry. Such minimally inva-

    QBUIPIJTUPMPHJD LOPXMFEHF XJUI UIF UFDI-

    sive procedures are best performed under

    nologies of caries-detecting dyes and laser

    magnification. This type of microdentistry is

    fluorescence, an ideal caries removal end

    greatly aided by using high-magnification

    QPJOU DBO CF BDIJFWFE GPS WJUBM UFFUI XJUI

    prismatic loupes of 6.5 to 8.0PSXJUIBO

    deep caries lesions. These ideal end points

    PQFSBUPSZ NJDSPTDPQF XJUI TJNJMBS NBHOJGJ-

    XJMM QSFTFSWF NPSF WJUBM QVMQT  DPOTFSWF

    cation (Fig 13).

    more dental hard tissue, and create a highly

    The peripheral seal zone in superficial

    CPOEBCMFQFSJQIFSBMTFBMUIBUXJMMNJNJDUIF

    EFOUJOXJMMBMMPXCJPNJNFUJDCPOETUSFOHUIT

    OBUVSBM UPPUI XIFO SFTUPSFE XJUI MPX TUSFTT

    of approximately 4555 MPa to be created.

    adhesive techniques.

    VOLUME 43 t /6.#&33 t ."3$) 2012

    205

    ot

    Q ui

    by N
    ht

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    tio
    n
    te
    ss e n c e

    Q U I N T E S S E N C E I N T E R N AT I O N A L

    by N
    ht

    19.

    Q ui

    REFERENCES

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    Yazici AR, Baseren M, Gokalp S. The in vitro perfortio
    n
    mance of laser fluorescence and caries-detector dye
    te
    for detecting residual carious dentin during tooth ss e c e
    n
    n

    T.

    Simple

    Pain-Free

    Adhesive

    Restorative System by Minimal Reduction and Total


    Etching. Tokyo: Ishiyaku EuroAmerica, 1993;12.
    2. Axelsson P. An Introduction to Risk Prediction and
    Preventive Dentistry. Chicago: Quintessence, 1999.
    3. Axelsson P. Diagnosis and Risk Prediction of Dental
    Caries. Chicago: Quintessence, 2000.
    4. Axelsson P. Preventive Materials, Methods and
    Programs. Chicago: Quintessence, 2004.

    fo r

    1. Fusayama

    preparation. Quintessence Int 2005;36:417422.


    20. Shirai K, De Munck J, Yoshida Y, et al. Effect of
    cavity configuration and aging on the bonding
    effectiveness of six adhesives to dentin. Dent Mater
    2005;21:110124.
    21. Yoshiyama M, Urayama A, Kimochi T, Matsuo T,
    Pashley D. Comparison of conventional vs selfetching adhesive bonds to caries-affected dentin.
    Oper Dent 2000;25:163169.

    5. Fejerskov O, Kidd E (eds). Dental Caries: The Disease


    and its Clinical Management. Oxford, Blackwell
    Munksgaard, 2003:275292.

    22. Boston DW, Sauble JE. Evaluation of laser fluorescence for differentiating caries dye-stainable versus
    caries dye-unstainable dentin in carious lesions. Am

    6. Featherstone JD. The caries balance: The basis for

    J Dent 2005;18:351354.

    caries management by risk assessment. Oral Health


    Prev Dent 2004;2(suppl):259264.

    23. Krause F, Braun A, Eberhard J, Jepsen S. Laser


    fluorescence measurements compared to electrical

    7. Young DA, Featherstone JD, Roth JR. Curing the


    silent epidemic: Caries management in the 21st cen-

    resistance of residual dentin in excavated carvities


    in vivo. Caries Res 2007;41:135140.

    tury and beyond. J Calif Dent Assoc 2007;35:681685.


    24. Iwami Y, Shimizu A, Narimatsu M, Hayashi M,
    8. Ekstrand KR, Martignon S, Ricketts DJ, Qvist V.
    Detection and activity assessment of primary coronal caries lesions: A methodologic study. Oper Dent

    Takeshige F, Ebisu S. Relationship between bacterial


    infection and evaluation using a laser fluorescence
    device, DIAGNOdent. Eur J Oral Sci 2004;112:419423.

    2007;32:225235.
    25. Nakajima M, Ogata M, Okuda M, Tagami J, Snao H,
    9. Jenson L, Budenz AW, Featherstone JD, RamosGomez FJ, Spolsky VW, Young DA. Clinical protocols

    Pashley DH. Bonding to caries-affected dentin using


    self-etching primers. Am J Dent 1999;12:309314.

    for caries management by risk assessment. J Calif


    Dent Assoc 2007;35:714723.

    26. Lucci A, Francescut P, Achermann F, Reich E, Hotz P,


    Megert B. The use of the DIAGNOdent during cavity

    10. Paris S, Meyer-Lueckel H, Kielbassa AM. Resin infil-

    preparation. Caries Res 2000;34:327328.

    tration of natural caries lesions. J Dent Res 2007;86:


    662666.

    27. Yonemoto K, Eguro T, Maeda T, Tanaka H. Application


    of DIAGNOdent as a guide for removing carious

    11. Milicich G, Rainey JT. Stress distribution in teeth

    dentin with Er:YAG laser. J Dent 2006;34:269276

    and the significance in operative dentistry. Pract


    Periodontics Aesthet Dent 2000;12:695700.

    28. Magne P, Belser U. Bonded Porcelain Restorations


    in the Anterior DentitionA Biomimetic Approach.

    12. Magne P, Oganesyan T. CT scanbased finite ele-

    Chicago: Quintessence, 2002:2355.

    mental analysis of premolar cuspal deflection following operative procedures. Int J Periodontics
    Restorative Dent 2009;29:361369.

    29. Magne P. Composite resins and bonded porcelain:


    The postamalgam era? J Calif Dent Assoc 2006;34:
    135147.

    13. Splieth CH, Ekstrand KR, Alkilzy M, et al. Sealants


    in dentistry: Outcomes of the ORCA Saturday
    Afternoon Symposium 2007. Caries Res 2010;44:313.

    30. Magne P. Esthetic and Biomimetic Restorative


    Dentistry: Manual for Posterior Esthetic Restorations.
    Los Angeles: USC School of Dentistry, 2006.

    14. Neuhas KW, Ciucchi P, Donnet M, Lussi A. Removal


    of enamel caries with an air abrasion powder. Oper
    Dent 2010;35:538546.

    31. Deliperi S, Bardwell D. An alternative method to


    reduce polymerization shrinkage stress in direct posterior composite restorations. J Am Dent Assoc 2002;

    15. Schroeder H. Oral Structural Biology. New York:

    133:13861398.

    Thieme Medical Publishers, 1991:6072.


    32. Deliperi S, Alleman D. Stress-reducing protocol for
    16. Neves AA, Coutinho E, Cardoso V, Lambrechts P,
    Van Meerbeek B. Current concepts and techniques
    for caries excavation and adhesion to residual den-

    direct composite restorations in minimally invasive cavity preparations. Pract Proced Aesthet Dent
    2009;21:e1e6.

    tin. J Adhes Dent 2011;13:722.


    33. Opdam
    17. Neves AA, Coutinho E, Cardoso M, de Munck J,
    VanMeerbeek B. Microtensile bond strength and
    interfacial characterization of an adhesive bonded
    to dentin prepared by contemporary caries-excavation techniques. Dent Mater 2011;552562.
    18. Neves AA, Coutinho E,de Munck J, Lambrechts
    P, VanMeerbeek B. Does DIAGNOdent provide a
    reliable caries removal end point? J Dent 2011;39:
    351360.

    206

    NJM,

    Bronkhorst

    EM,

    Loomans

    BAC,

    Huysmans MCDNJM. 12-year survival of composite vs


    amalgam restorations. J Dent Res 2010;89:10631067.
    34. Fusayama T. New Concepts in Operative Dentistry:
    Differentiating Two Layers of Carious Dentin and Using
    an Adhesive Resin. Chicago: Quintessence, 1980:1359.
    35. Ogawa K, Yamashita Y, Ichijo T, Fusayama T. The
    ultrastructure and hardness of the transparent layer
    of human carious dentin. J Dent Res 1983;62:710.

    VOLUME 43 t /6.#&33 t ."3$) 2012

    ot

    Alleman/Magne

    Q U I N T E S S E N C E I N T E R N AT I O N A L
    Alleman/Magne

    carious lesions. Br Dent J 1967;123:547548.


    38. Fusayama T. Clinical guide for removing caries
    using a caries-detecting solution. Quintessence Int
    1988;19:397401.

    fo r

    2001;32:561570.
    37. Massler M. Changing concepts in the treatment of

    formance. Caries Res 2003;37:816.


    55. Itoh K, Kusunoki M, Oikawa M, Tani C, Hisamitsu H.
    In vitro comparison of three caries dyes. Am J Dent
    2009;22:195199.
    56. Boston DW, Jefferies SR, Gaughan JP. The relative
    location of the dye staining endpoint indicated

    39. Anderson MH, Charbeneau GT. A comparison of

    with polypropylene glycol-based caries dye versus

    digital and optical criteria for detecting carious

    conventional propylene glycol-based caries dye.

    dentin. J Prosthet Dent 1985;53:643646.


    40. McComb D. Caries-detector dyesHow accurate and
    useful are they? J Can Dent Assoc 2000;66:195198.
    41. Banerjee A, Kidd EAM, Watson TF. In vitro validation
    of carious dentin removed using different excavation criteria. Am J Dent 2003;16:228230.
    42. Fukushima M. Adhesive resin penetration into carious dentin [in Japanese]. Kokubyo Gakkai Zasshi
    1981;48:362385.

    Eur J Dent 2008;2:2936.


    57. Lennon AM, Attin T, Buchalla W. Quantitiy of
    remaining bacteria and cavity size after excavation
    with fluoresence aided caries excavation (FACE),
    caries detector dye and conventional excavation in
    vitro. Oper Dent 2007;32:236241.
    58. Thompson V, Craig R, Curro FA, Green WS, Ship
    JA. Treatment of deep carious lesions by complete
    excavation or partial removal: A critical review. J Am
    Dent Assoc 2008;139:705712.

    43. Sano H. Relationship between caries detector staining and structural characteristics of carious dentin [in
    Japanese]. Kukubyo Gakkai Zasshi 1987;54:241270.

    59. Gruythuysen R, van Strijp G, Wu M. Long-term survival of indirect pulp treatment performed in primary and permanent teeth with clinically diagnosed

    44. Iwami Y, Shimizu, Narimatsu M, Kinomoto Y, Ebisu

    deep carious lesions. J Endod 2010;36:14901493.

    S. The relationship between the color of carious


    dentin stained with a caries detector dye and bacterial infection. Oper Dent 2005;30:8389.

    60. Casagrande L, Bento LW, Dalpian DM, Garcia-Godoy


    F, de Araujo FB. Indirect pulp treatment in primary
    teeth: 4-year results. Am J Dent 2010;23:3438.

    45. Wei S, Sadr A, Shimada Y, Tagami J. Effect of cariesaffected dentin hardness on the shear bond strength
    of current adhesives. J Adhes Dent 2008;10:431440.

    61. Zollner A, Gaengler P. Pulp reactions to different


    preparation techniques on teeth exhibiting periodontal disease. J Oral Rehabil 2000;27:93102.

    46. Boston DW, Graver HT. Histobacteriological analysis


    of acid red dye-stainable dentin found beneath
    intact amalgam restorations. Oper Dent 1994;19:
    6569.

    62. Hevinga MA, Opdam NJ, Frencken JE, Truin GJ,


    Huysmans MC. Does incomplete caries removal
    reduce strength of restored teeth? J Dent Res 2010;
    89:12701275.

    47. Lussi A, Hibst R, Paulus R. DIAGNOdent: An optical method for caries detection. J Dent Res 2004;
    83(spec no c):c80c83.

    63. Urabe I, Nakajima M, Sano H, Tagami J. Physical


    properties of the dentin-enamel junction region.
    Am J Dent 2000;13:129135.

    48. Buchalla W, Attin T, Niedmann Y, Niedman PD,


    Lennon AM. Porphyrins are the cause of red fluorescence of carious dentine: Verified by gradient
    reversed-phase HPLC. Caries Res 2008;42:223.
    49. Lussi A, Imwinkelried S, Pitts NB, Longbottom C,
    Reich E. Performance and reproducibility of a laser
    fluorescence system for detection of occlusal caries
    in vitro. Caries Res 1999;33:261266.
    50. Lussi A, Megert B, Longbottom C, Reich E,

    64. De Munck J. An In Vitro and In Vivo Study of


    the Durability of Biomaterial-Tooth Bonds [thesis].
    Belgium: Catholic Universtiy of Leuven, 2004;7476.
    65. Yoshiyama M, Tay F, Torri Y, et al. Resin adhesion to
    carious dentin. Am J Dent 2003;16:4752.
    66. Yoshiyama M, Tay FR, Doi J, et al. Bonding of selfetch and total-etch adhesives to carious dentin.
    J Dent Res 2002;81:556560.

    Francescut P. Clinical performance of a laser fluores-

    67. Pugach MK, Strother J, Darling CL, et al. Dentin car-

    cence device for detection of occlusal caries lesions.

    ies zones: Mineral, structure, and properties. J Dent

    Eur J Oral Sci 2001;109:1419.

    Res 2009;88:7176.

    51. Reich E, Berakdar M, Netuschil L, Pitts N, Lussi A.

    68. Albrektsson TO, Bratthall D, Glantz PJ, Lindhe JT

    Clinical caries diagnosis compared to DIAGNOdent

    (eds). Tissue Preservation in Caries Treatment.

    evaluations. Caries Res 1999;33:299.


    52. Brannstrom M. Dentin and Pulp in Restorative
    Dentistry. London: Wolfe Medical, 1982:93.
    53. Boston DW, Liao J. Staining of non-carious human
    coronal dentin by caries dyes. Oper Dent 2004;29:

    London: Quintessence, 2001:263274.


    69. Yazici A, Atilla P, Ozgunaltay G, Muftuoglu S. In vitro
    comparison of the efficacy of Carisolv and conventional rotary instruments in caries removal. J Oral
    Rehab 2003;30:11771182.

    280286.

    VOLUME 43 t /6.#&33 t ."3$) 2012

    207

    ot

    measurements, EDS, and SEM. Quintessence Int

    by N
    ht

    interface: In vivo evaluation with nanoindentation

    54.

    A, Cox C. Remineralization across the resin-dentin

    Q ui

    36. Akimoto N, Yokoyama G, Ohmori K, Suzuki S, Kohno

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    Cortes D, Ellwood R, Ekstrand K. An in vitro comtio
    parison of a combined FOTI/visual examination of
    n
    t
    e
    occlusal caries with other caries diagnostic methss e n c e
    ods and the effect of stain on their diagnostic per-

    Q U I N T E S S E N C E I N T E R N AT I O N A L

    fo r

    bond strength of two-step etch-and-rinse adhesive

    88. Jayasooriya PR, Pereira PNR, Nikaido T, Tagami J.

    systems on sound and artificial caries-affected den-

    Efficacy of a resin coating on bond strengths of resin

    tin. Am J Dent 2010; 23:152156.

    cement to dentin. J Esthet Restor Dent 2003;15:

    72. Yazici AR, Akca T, Ozgunaltay G, Dayangac B. Bonding


    strength of a self-etching adhesive system to cariesaffected dentin. Oper Dent 2004;29:176181.
    73. Proenca JP, Polido M, Osorio E, et al. Dentin bond
    strength of self-etch and total-etch adhesive systems. Dent Mater 2007;23:15421548.

    105113.
    89. Magne P, So W, Cascione D. Immediate dentin
    sealing supports delayed restoration placement.
    J Prosthet Dent 2007;98:166174.
    90. He Z, Shimada Y, Sadr A, Ikeda M, Tagami J. The
    effects of cavity size and filling method on the bond-

    74. Say EC, Nakajima M, Senawongse P, Soyman M,

    ing to Class I cavities. J Adhes Dent 2008;10:447453.

    Ozer F, Tagami J. Bonding to sound vs caries-affect-

    91. Schmidlin PR, Huber T, Gohring TN, Attin T, Bindl A.

    ed dentin using photo-and dual-cure adhesives.

    Effects of total and selective bonding on marginal

    Oper Dent 2005;30:9098.

    adaptation and microleakage of Class I resin compos-

    75. Pashley DH, Tay FR, Yiu C, et al. Collagen degradation by host-derived enzymes during aging. J Dent
    Res 2004;83:216221.
    76. Hebling J, Pashley DH, Tjaderhane L, Tay FR.
    Chlorhexidine arrests subclinical degradation of
    dentin hybrid layers in vivo. J Dent Res 2005;84:
    741746 [erratum 2006;85:34].
    77. Breschi L, Mazzoni A, Nato F, et al. Chlohexidine
    stabilizes the adhesive interface: A 2-year in vitro
    study. Dent Mater 2010;26:320325.

    ite restorations in vivo. Oper Dent 2008;33:629635.


    92. Belli S, Donmez N, Eskitascioglu G. The effect of
    c-factor and flowable resin or fiber use at the
    interface on microtensile bond strength to dentin.
    J Adhes Dent 2006;8:247253.
    93. El-Mowafy O, El-Badrawy W, Eltanty A, Abbasi K,
    Habib N. Gingival microleakage of Class II resin
    composite restoration with fiber inserts. Oper Dent
    2007;32:298305.
    94. Nikaido T, Kunzelmann K-H, Chen H, et al. Evaluation

    78. Nikaido T, Weerasinghe D, Waidyasekera K, Inoue G,

    of thermal cycling and mechanical loading on bond

    Foxton R, Tagami J. Assessment of the nanostruc-

    strength of a self-etching primer system to dentin.

    ture of acid-base resistant zone by the application


    of all-in-one adhesive systems: Super dentin formation. Bio-Med Mater Eng 2009;19:163171.
    79. Donmez N, Belli S, Pashley DH, Tay FR. Ultrastructural
    correlates of in vivo/in vitro bond degradation in
    self-etch adhesives. J Dent Res 2005;84:355359.

    Dent Mater 2002;18:269275.


    95. Shono Y, Ogawa T, Terashita M, Carvalho RM,
    Pashley EL, Pashley DH. Regional measurement of
    resin-dentin bonding as an array. J Dent Res 1999;
    78:699705.
    96. Toledano M, Osorio R, Moreira MAG, et al. Effect of

    80. Tezvergil-Mutluay A, Murat Mutluay M, Gu L, et al.

    the hydration status of the smear layer on the wet-

    The anti-MMP activity of benzalkonium chloride.

    tability and bond strength of a self-etching primer

    J Dent 2011;38:5764.

    to dentin. Am J Dent 2004;17:310314.

    81. Doi J, Itota T, Yoshiyama M, Tay FR, Pashley DH.

    97. Van Meerbeek B, De Munck J, Mattar D, Van Landuyt

    Bonding to root caries by a self-etching adhesive

    K, Lambrechts P. Microtensile bond strengths of an

    system containing MDPB. Am J Dent 2004;17:8993.

    etch and rinse and self-etch adhesive to enamel

    82. Nakajima M, Sano H, Zheng L, Tagami J, Pashley DH.


    Effect of moist vs dry bonding to normal vs cariesaffected dentin with Scotchbond Multi-Purpose
    Plus. J Dent Res 1999;78:12981303.
    83. Feilzer AJ, De Gee AJ, Davidson CL. Setting stress in
    composite resin in relation to configuration of the
    restoration. J Dent Res 1987;66:16361639.
    84. Yoshikawa T, Sano H, Burrow MF, Tagami J, Pashley
    DH. Effects of dentin depth and cavity configuration
    on bond strength. J Dent Res 1999;78:898905.

    and dentin as a function of surface treatment. Oper


    Dent 2003;28:647660.
    98. Dietschi D, Monasevic M, Krejci I, Davidson C.
    Marginal and internal adaptation of Class II restorations after immediate or delayed composite placement. J Dent 2002;30:259269.
    99. Asaka Y, Miyazaki M, Takamizawa T, Tsubota K,
    Moore BK. Influence of delayed placement of
    composites over cured adhesives on dentin bond
    strength of single-application self-etch systems.
    Oper Dent 2006;31:1824.

    85. Kleverlaan CJ, Feilzer AJ. Polymerization shrinkage


    and contraction stress of dental resin composites.
    Dent Mater 2005;21:11501157.

    100. Magne P, Kim TH, Cascione D, Donovan TE. Immediate


    dentin sealing improves bond strength of indirect
    restorations. J Prosthet Dent 2005;94:511519.

    86. Iida K, Inokoshi S, Kurosaki N. Interfacial gaps following ceramic inlay cementation vs direct composites.
    Oper Dent 2003;28:445452.

    101. Dietschi D. Evaluation of Marginal and Internal


    Adaptation of Adhesive Class II Restorations: In
    Vitro Fatigue Tests [thesis]. Amsterdam: Academic
    Center for Dentistry of the University of Amsterdam
    and the Vrije University, 2003:3554, 7594.

    208

    by N
    ht

    3185]. IADR 2009.


    71. Zanchi CH, Lund RG, Perrone LR, et al. Microtensile

    87.

    of caries dentin by CarisolvTM system [abstract

    Q ui

    70. Oikawa M, Kusunoki M, Itoh K, Hisamitsu H. Removal

    pyrig
    No Co
    t fo
    rP
    ub
    lica
    Nikolaenko SA, Lohybauer U, Roggendorf M, Petschlt
    tio
    A, Dasch W, Frankenberger R. Influence of c-facn
    t
    e
    tor and layering technique on micro tensile bond ss
    e
    c
    en
    strength to dentin. Dent Mater 2004;20:579585.

    VOLUME 43 t /6.#&33 t ."3$) 2012

    ot

    Alleman/Magne

    Vous aimerez peut-être aussi