Keywords
deep decay lesion, pulp protection, calcium hydroxide
How to Cite
Manejo clínico de la caries profunda. (2009). Odontoestomatología, 11(13), 59-67. https://www.odon.edu.uy/ojs/index.php/ode/article/view/256
Abstract
The deep decay lesion represent a serious disturbs of teeth’s calcify tissues, and the possible appears of pulp affectation. Practices and strict protocols are necessary to apply restoratives and conservatives tactics. A correct knowledge of the etiopathology lesion, a certain pulp diagnosis, a management of pulp protects proprieties, to obtain and support a correct seal border at coronal obturation, together with the know that a time waiting helps to recuperate capacity of the pulp tissue.
Anyway, the final object will be to keep the health of the pulp, and will obtain a tooth apt to receive a final restoration. This paper collects the results of a commission work in the matter. In there, was systematized clinics protocols for Indirect Pulp Protection (IPP) and Indirect Pulp Treatment (IPT), with deferring decay elimination. This protocols are been applied in the Integral Clinical of Adults III, at Odontology Faculty, University of the Republic (Uruguay). Even emerges new techniques, materials or new methods in practice , the Calcium Hydroxide(Ca(OH)2) maintain validity in the treatment of this pathology, ever we had a healthy pulp and the need of defensive reaction with calcify tissue deposit.References
1.Thylstrup A., Fejerskov O. Textbook of clinical cariology. 2ª ed. Copenhagen: Munskgaard; 1994. Cap 11, pág. 170- 193.
2.Fejerskov O., Kidd E.- Dental Caries- The disease and its clinical management- Blackwell Munksgaard, 2003.
3.Anderson M., Bales D.J., Money K.A. Manejo moderno de la caries dental. JADA. Vol. 124, Junio 1993: 37-44.
4.Reeves R., Stanley H.R. The relationship of bacterial penetration and pulp pathosis in carious teeth. Oral Surg. Oral Med Oral Pathol. 1966 Jul; 22(1): 59-65.
5.Ricketts D. Management of the deep carious lesion and the vital pulp dentine complex. Br. Dent. J. 2001; 191 (11): 606-610.
6.Fusayama T, .Differentiation of two layers of carious dentin by staining. J.Dent Res. 1972;51 (3): 866 .
7.Fusayama T. Clinical guide for removing caries using a caries detecting solution. Oper. Dent. 1988; 19(6): 397-408.
8.Boston D.W., Graver H.T. Histological study of an acid red caries disclosing dye. Oper. Dent. 1989; 14(4):186-192.
9.Ansari G., Beely J.A., Reid J.S., Foye R.H. Caries detector dyes- an in vitro assessment of some new compounds. J. Oral Rehab. 1999; 26(6):453-458.
10.De Botero M., Martínez C., Rivas P. Restrepo B.E. Necesidad o no del uso de colorantes durante la remoción de la dentina cariada: soporte microbiológico. Rev. Fac. Odont Univ. Ant. 1988; 19(2): 73-80.
11.Schwartz R.S., Summitt J.B., Robbins J.W. Fundamentos en Odontología Operatoria. Un logro contemporáneo. Edit. Actualidades Médico Odontológicas Latinoamericanas, C.A. Venezuela. 1999. Cap. 3, Págs. 51-66.
12.Alvarez Cantoni H. y Cols. Fundamentos, Técnicas y Clínica en Rehabilitación Bucal. 1999. Edit. Hacheace. Cap. 3, Pág.:75-84.
13.Banerjee T.F., Watson, E.A., Kidd M. Dentine Caries: Take it or leave it? Dental Update- July/August 2000, 27: 272- 276.
14.Henostroza Haro G., Caries Dental. Principios y procedimientos para el diagnóstico. Universidad Peruana Cayetano Heredia, 2007. Ripano Edit. Médica. Primera edición.
15.Turell J.C. Rehabilitaciones Dentarias. Edit. Mundi 1976.
16.Yip H. y Cols.- The specificity of caries detector dyes in cavity preparation- Br. Dent J. 1994; 176: 417- 421.
17.Kidd E.A., Joyston-Bechal S, Beighton D. The use of a caries detector dye during cavity preparation: a microbiological assessment. Br Dent J. 1993 Apr 10; 174 (7): 245-248.
18.Kidd E y cols. Criteria for caries removal at the enamel-dentin junction: a clinical and microbiological study- Br. Dent J 1996; 180: 287- 291.
19.List G., Lommel T.J, Tilk M.A., Murdoch H.G. Use o a dye in caries identification. Quintessence International. Vol. 18. Number5/1987.
20.Trejo-Alvarado A., Hernández-Pérez M. & Diez-De-Bonilla J. (1995). In vivo diagnostic assessment of dentinal caries utilising acid red and povidone-iodine dyes. Operative Dentistry, 20, 119.
21.Barrancos Mooney J. Operatoria Dental. Editorial Médica Panamericana, 1999.Cap.8, Pág.: 239 – 277; cap 23, págs.:691-717.
22.Uribe Echevarría J. Operatoria Dental: ciencia y práctica. Ediciones Avances Médico-Dentales, 1990. Cap. 6. Págs.:147-194.
23.Langeland K. Tissue response to dental caries. Endod Dent Traumatol. 1987 Aug; 3 (4): 149-71.
24.Mount G.J., Hume W.R. Conservacion y restauración de la estructura dental. Harcourt brace, 1999.
25.Camejo M.V. y Cols. Protección dentinopulpar. Acta Odontol. Venez. 1999; 37 (3): 98-105.
26.Hasse P.N.; Conrado C.A., De Olivera M.R.- Proteção Pulpar Indirecta- Uma revisão bibliográfica, analítica e apresentação de casos clínicos. Rev. Od. Cien. 2001; 16 (34): 288- 297.
27.Perrone J.R. Temas de endodoncia: cofiado y pulpotomía. Universidad de la República. Facultad de Odontología, 1982.
28.Tziafas D, Simth A.J, Lesot H. Desingning new strategies in vital pulp therapy. J. Dent. 2000; 28: 77-92.
29.Ten Cate, A.R. Oral histology: development, structure and function. 5th ed. Mosby, 1998
30.Camp J.H. Terapéutica pulpar de los dientes permanentes jóvenes. Clin. Odontol. Nort. Am. 1984; (4): 639-656.
31.Cevallos Gutiérrez F.A. Diseño de nuevas estrategias de tratamiento en la terapia pulpar de dientes vitales: parte 1. Univ. Odontol. 2002(a); 22 (47): 37-47.
32.Tay F.., Pshley D. H., Loushine R.J., Weller R.N., Monticelli F., Osorio R. Self-Etching Adhesives Increase Collagenolytic Activity in Radicular Dentin. JOE. Vol 32,Nº9. Set. 2006.
33.Hebling J., Pashley D.H., Tjäderhane L., Tay F.R. Clorhexidine arrests subclinical degradation of dentin hybrid layers in vivo. J Dent Res 2005; 84: 741-6.
34.Costa C.A. y Cols. Pulp-capping studies with zinc oxide-eugenol, varying the age of materials, correlated with fluidity. Rev. Odont. UNESP 1993; 22(2): 223-230.
35.Cox C.F. Biocompatibility of dental materials in the absence of bacterial infection. Oper Dent. 1987; 12(4): 146-52.
36.Cox C.F., Suzuki S. Re-evaluating pulp protection: calcium hydroxide liners vs cohesive hybridization. 1994; 125 (7): 823-31.
37.Cox C.F. y Cols. Biocompatibility of various dental materials: pulp healing with a surface seal. Int. J. Periodontics Restorative Dent .1996; 16 (3): 240-251.
38.Burrow M.F., Satoh M., Tagami J. Dentin bond durability after three years using a dentin bonding agent with and without priming. Dent. Mater. 1996 Sep; 12(5): 302-307.
39.Estrela C. Ciencia endodóntica. Cap 1: pag1-21 Editorial Artes Médicas. 2005.
40.Fernández Monjes J., Maresca B.M. Consideraciones sobre el uso del hidróxido de calcio y el ión de calcio en endodoncia. Presentación de un caso clínico. RAAO. Vol. XLVII/Nº2. Jun.-Set. 2008.
41.Conrado C.A. Remineralization of Carious Dentin. II: In Vivo Microradiographic and Chemical Studies in Human Permanent Teeth Capped with Calcium Hydroxide. Braz Dent J 2004, 15(3): 186-189.
42.Estrela C., de Almeida Decurcio d.:; Gonçalvez de Alencar A. H.,Blitzkow Sydney G., Almeida Silva J. Efficacy of calcium hydroxide dressing in endodontic infection treatment: a systematic review. Rev. Odonto ciênc. 2008; 23(1):82-86.
43.Farhad A., Mohammadi Z. Calcium Hydroxide: a review. Int. Dental J. Int Dent J. 2005 Oct; 55(5): 293-301.
44. Foreman PC, Barnes J.E. Review of calcium hydroxide. Int Endod J. 1990 Nov; 23(6): 283-97. Review.
45.Holland R. y Cols. The influence of the sealing material in the healing process of inflamed pulps capped with calcium hydroxide on zinc oxide eugenol cement. Acta Odontol. Pediatr. 1981; 2(1): 5-9.
46.Hume W. The pharmacologic and toxicological properties of zinc oxide-eugenol. J AmDent Assoc. 1986 Nov; 113(5): 789-91.
47.Ingle J., Bakland L.- Endodoncia- Cap. 17, págs. 875-878. Mc Graw Hill Interamericana. México, 2004. 5° edición.
48.Mjôr, Ivar A. - Pulp Dentin Biology in Restorative Dentistry- Quintessence- Chicago, 2002.
49.Murray P.E., Lumley P.J., Smith A.J., Ross H.F. The influence of sample dimensions on hydroxyl ion from calcium hydroxide products. Endo. Dent Traumatol. 2000 Dec; 16(6):251-7.
50.Perdigão J., Ramos J.C., Lambrechts P. In vitro interfacial relationship between human dentin and one-bottle dental adhesives. Dent. Mater. 1997 jul; 13(4): 218-27.
51.Safavi K.E., Nichols F. C. Alteration of biological properties of bacterial lipopolysaccharide by calcium hydroxide treatment. J Endod. 1994 Mar; 20(3): 127-9.
52.Salazar C. Hidróxido de calcio: efectos biológicos y mecanismos de acción. Rev. Fac. Odont. Antioquía 1994; 5(2).
53.Sarmiento M., y Col. Efecto del hidróxido de calcio a nivel intracelular. Rev. Fed. Odontol. Colomb; 1994 Oct; 49(182): 89-99.
54.Segura J.J. y Cols. Calcium hydroxide inhibits substrate adherence capacity of macrophages. J Endod. 1997 Jul; 23(7): 444-7.
55.Siqueira J.F. Jr., Lopes H. P. Mechanisms of antimicrobial activity of calcium hydroxide: a critical review. Int Endod. J. 1999; 32: 361-369.
56.Staehle H.J., Pioch T., Hoppe W. The alcalizing properties of calcium hydroxide compounds. Endod Dent Traumatol 1989; 5: 147- 152.
57.Stanley H.R., Pameijer C.H. Dentistry’s friend, calcium hydroxide. Oper. Dent. 1997 Jan- Feb; 22(1):1-3.
58.Fisher F.J., Shortall A.C. Setting Calcium Hydroxide Base Materials. Studies on their Antibacterial Effects in vitro. Br Den J. 1984; 1157: 133
59.Ten Cate A.R. Histología oral: desarrollo, estructura y función. 2da ed. Panamericana, 1986
60.Weine F.S. Tratamiento endodóntico. 5ta Ed. Harcourte Brace, 1997.
61.Sano H. y Cols. Nanoleakage: leakage within the hybrid layer. Oper. Dent. 1995 Jan-Feb.; 20(1): 18-25.
62.Bjorndal L. Indirect Pulp Therapy and Stepwise Excavation. JOE. Vol. 34, Nº78. July 2008.
63.Torabinejad M., Walton R. E. Endodontics Principles and Practice. Edit Saunders 4ta ed. 2009. Cap 3, págs: 38-48.
64.Endodoncia Clínica. Manual de Apoyo a la Enseñanza Clínica en Terapias Endodónticas. Cátedra de Endodoncia. Facultad de Odontología. UDELAR.
65.Witherspoon D.E., y cols. Mineral trioxide agrégate pulpotimies: a cese series outcomes assessment. J Am. Dent Assoc. 2006 May; 137(5): 610-18.
66.Kurosaki N., Kubota M., Yamamoto Y., Fusayama T. El efecto del grabado sobre el suelo de la cavidad. Quintessence (ed. Esp.), Vol. 4, Nº 1, 1991.
67.Trondstad L. y Cols. Influence of coronal restorations on the periapical health of endodontically treated teeth, Endod. Dent Traumatol, Copenhagen, Vol. 16: 218-21, 2000.
68.Bottino M.A. Nuevas Técnicas de Endodoncia. Edit. Artes Médicas. Brasil, 2008. Cap. 2, págs. 29- 32.
2.Fejerskov O., Kidd E.- Dental Caries- The disease and its clinical management- Blackwell Munksgaard, 2003.
3.Anderson M., Bales D.J., Money K.A. Manejo moderno de la caries dental. JADA. Vol. 124, Junio 1993: 37-44.
4.Reeves R., Stanley H.R. The relationship of bacterial penetration and pulp pathosis in carious teeth. Oral Surg. Oral Med Oral Pathol. 1966 Jul; 22(1): 59-65.
5.Ricketts D. Management of the deep carious lesion and the vital pulp dentine complex. Br. Dent. J. 2001; 191 (11): 606-610.
6.Fusayama T, .Differentiation of two layers of carious dentin by staining. J.Dent Res. 1972;51 (3): 866 .
7.Fusayama T. Clinical guide for removing caries using a caries detecting solution. Oper. Dent. 1988; 19(6): 397-408.
8.Boston D.W., Graver H.T. Histological study of an acid red caries disclosing dye. Oper. Dent. 1989; 14(4):186-192.
9.Ansari G., Beely J.A., Reid J.S., Foye R.H. Caries detector dyes- an in vitro assessment of some new compounds. J. Oral Rehab. 1999; 26(6):453-458.
10.De Botero M., Martínez C., Rivas P. Restrepo B.E. Necesidad o no del uso de colorantes durante la remoción de la dentina cariada: soporte microbiológico. Rev. Fac. Odont Univ. Ant. 1988; 19(2): 73-80.
11.Schwartz R.S., Summitt J.B., Robbins J.W. Fundamentos en Odontología Operatoria. Un logro contemporáneo. Edit. Actualidades Médico Odontológicas Latinoamericanas, C.A. Venezuela. 1999. Cap. 3, Págs. 51-66.
12.Alvarez Cantoni H. y Cols. Fundamentos, Técnicas y Clínica en Rehabilitación Bucal. 1999. Edit. Hacheace. Cap. 3, Pág.:75-84.
13.Banerjee T.F., Watson, E.A., Kidd M. Dentine Caries: Take it or leave it? Dental Update- July/August 2000, 27: 272- 276.
14.Henostroza Haro G., Caries Dental. Principios y procedimientos para el diagnóstico. Universidad Peruana Cayetano Heredia, 2007. Ripano Edit. Médica. Primera edición.
15.Turell J.C. Rehabilitaciones Dentarias. Edit. Mundi 1976.
16.Yip H. y Cols.- The specificity of caries detector dyes in cavity preparation- Br. Dent J. 1994; 176: 417- 421.
17.Kidd E.A., Joyston-Bechal S, Beighton D. The use of a caries detector dye during cavity preparation: a microbiological assessment. Br Dent J. 1993 Apr 10; 174 (7): 245-248.
18.Kidd E y cols. Criteria for caries removal at the enamel-dentin junction: a clinical and microbiological study- Br. Dent J 1996; 180: 287- 291.
19.List G., Lommel T.J, Tilk M.A., Murdoch H.G. Use o a dye in caries identification. Quintessence International. Vol. 18. Number5/1987.
20.Trejo-Alvarado A., Hernández-Pérez M. & Diez-De-Bonilla J. (1995). In vivo diagnostic assessment of dentinal caries utilising acid red and povidone-iodine dyes. Operative Dentistry, 20, 119.
21.Barrancos Mooney J. Operatoria Dental. Editorial Médica Panamericana, 1999.Cap.8, Pág.: 239 – 277; cap 23, págs.:691-717.
22.Uribe Echevarría J. Operatoria Dental: ciencia y práctica. Ediciones Avances Médico-Dentales, 1990. Cap. 6. Págs.:147-194.
23.Langeland K. Tissue response to dental caries. Endod Dent Traumatol. 1987 Aug; 3 (4): 149-71.
24.Mount G.J., Hume W.R. Conservacion y restauración de la estructura dental. Harcourt brace, 1999.
25.Camejo M.V. y Cols. Protección dentinopulpar. Acta Odontol. Venez. 1999; 37 (3): 98-105.
26.Hasse P.N.; Conrado C.A., De Olivera M.R.- Proteção Pulpar Indirecta- Uma revisão bibliográfica, analítica e apresentação de casos clínicos. Rev. Od. Cien. 2001; 16 (34): 288- 297.
27.Perrone J.R. Temas de endodoncia: cofiado y pulpotomía. Universidad de la República. Facultad de Odontología, 1982.
28.Tziafas D, Simth A.J, Lesot H. Desingning new strategies in vital pulp therapy. J. Dent. 2000; 28: 77-92.
29.Ten Cate, A.R. Oral histology: development, structure and function. 5th ed. Mosby, 1998
30.Camp J.H. Terapéutica pulpar de los dientes permanentes jóvenes. Clin. Odontol. Nort. Am. 1984; (4): 639-656.
31.Cevallos Gutiérrez F.A. Diseño de nuevas estrategias de tratamiento en la terapia pulpar de dientes vitales: parte 1. Univ. Odontol. 2002(a); 22 (47): 37-47.
32.Tay F.., Pshley D. H., Loushine R.J., Weller R.N., Monticelli F., Osorio R. Self-Etching Adhesives Increase Collagenolytic Activity in Radicular Dentin. JOE. Vol 32,Nº9. Set. 2006.
33.Hebling J., Pashley D.H., Tjäderhane L., Tay F.R. Clorhexidine arrests subclinical degradation of dentin hybrid layers in vivo. J Dent Res 2005; 84: 741-6.
34.Costa C.A. y Cols. Pulp-capping studies with zinc oxide-eugenol, varying the age of materials, correlated with fluidity. Rev. Odont. UNESP 1993; 22(2): 223-230.
35.Cox C.F. Biocompatibility of dental materials in the absence of bacterial infection. Oper Dent. 1987; 12(4): 146-52.
36.Cox C.F., Suzuki S. Re-evaluating pulp protection: calcium hydroxide liners vs cohesive hybridization. 1994; 125 (7): 823-31.
37.Cox C.F. y Cols. Biocompatibility of various dental materials: pulp healing with a surface seal. Int. J. Periodontics Restorative Dent .1996; 16 (3): 240-251.
38.Burrow M.F., Satoh M., Tagami J. Dentin bond durability after three years using a dentin bonding agent with and without priming. Dent. Mater. 1996 Sep; 12(5): 302-307.
39.Estrela C. Ciencia endodóntica. Cap 1: pag1-21 Editorial Artes Médicas. 2005.
40.Fernández Monjes J., Maresca B.M. Consideraciones sobre el uso del hidróxido de calcio y el ión de calcio en endodoncia. Presentación de un caso clínico. RAAO. Vol. XLVII/Nº2. Jun.-Set. 2008.
41.Conrado C.A. Remineralization of Carious Dentin. II: In Vivo Microradiographic and Chemical Studies in Human Permanent Teeth Capped with Calcium Hydroxide. Braz Dent J 2004, 15(3): 186-189.
42.Estrela C., de Almeida Decurcio d.:; Gonçalvez de Alencar A. H.,Blitzkow Sydney G., Almeida Silva J. Efficacy of calcium hydroxide dressing in endodontic infection treatment: a systematic review. Rev. Odonto ciênc. 2008; 23(1):82-86.
43.Farhad A., Mohammadi Z. Calcium Hydroxide: a review. Int. Dental J. Int Dent J. 2005 Oct; 55(5): 293-301.
44. Foreman PC, Barnes J.E. Review of calcium hydroxide. Int Endod J. 1990 Nov; 23(6): 283-97. Review.
45.Holland R. y Cols. The influence of the sealing material in the healing process of inflamed pulps capped with calcium hydroxide on zinc oxide eugenol cement. Acta Odontol. Pediatr. 1981; 2(1): 5-9.
46.Hume W. The pharmacologic and toxicological properties of zinc oxide-eugenol. J AmDent Assoc. 1986 Nov; 113(5): 789-91.
47.Ingle J., Bakland L.- Endodoncia- Cap. 17, págs. 875-878. Mc Graw Hill Interamericana. México, 2004. 5° edición.
48.Mjôr, Ivar A. - Pulp Dentin Biology in Restorative Dentistry- Quintessence- Chicago, 2002.
49.Murray P.E., Lumley P.J., Smith A.J., Ross H.F. The influence of sample dimensions on hydroxyl ion from calcium hydroxide products. Endo. Dent Traumatol. 2000 Dec; 16(6):251-7.
50.Perdigão J., Ramos J.C., Lambrechts P. In vitro interfacial relationship between human dentin and one-bottle dental adhesives. Dent. Mater. 1997 jul; 13(4): 218-27.
51.Safavi K.E., Nichols F. C. Alteration of biological properties of bacterial lipopolysaccharide by calcium hydroxide treatment. J Endod. 1994 Mar; 20(3): 127-9.
52.Salazar C. Hidróxido de calcio: efectos biológicos y mecanismos de acción. Rev. Fac. Odont. Antioquía 1994; 5(2).
53.Sarmiento M., y Col. Efecto del hidróxido de calcio a nivel intracelular. Rev. Fed. Odontol. Colomb; 1994 Oct; 49(182): 89-99.
54.Segura J.J. y Cols. Calcium hydroxide inhibits substrate adherence capacity of macrophages. J Endod. 1997 Jul; 23(7): 444-7.
55.Siqueira J.F. Jr., Lopes H. P. Mechanisms of antimicrobial activity of calcium hydroxide: a critical review. Int Endod. J. 1999; 32: 361-369.
56.Staehle H.J., Pioch T., Hoppe W. The alcalizing properties of calcium hydroxide compounds. Endod Dent Traumatol 1989; 5: 147- 152.
57.Stanley H.R., Pameijer C.H. Dentistry’s friend, calcium hydroxide. Oper. Dent. 1997 Jan- Feb; 22(1):1-3.
58.Fisher F.J., Shortall A.C. Setting Calcium Hydroxide Base Materials. Studies on their Antibacterial Effects in vitro. Br Den J. 1984; 1157: 133
59.Ten Cate A.R. Histología oral: desarrollo, estructura y función. 2da ed. Panamericana, 1986
60.Weine F.S. Tratamiento endodóntico. 5ta Ed. Harcourte Brace, 1997.
61.Sano H. y Cols. Nanoleakage: leakage within the hybrid layer. Oper. Dent. 1995 Jan-Feb.; 20(1): 18-25.
62.Bjorndal L. Indirect Pulp Therapy and Stepwise Excavation. JOE. Vol. 34, Nº78. July 2008.
63.Torabinejad M., Walton R. E. Endodontics Principles and Practice. Edit Saunders 4ta ed. 2009. Cap 3, págs: 38-48.
64.Endodoncia Clínica. Manual de Apoyo a la Enseñanza Clínica en Terapias Endodónticas. Cátedra de Endodoncia. Facultad de Odontología. UDELAR.
65.Witherspoon D.E., y cols. Mineral trioxide agrégate pulpotimies: a cese series outcomes assessment. J Am. Dent Assoc. 2006 May; 137(5): 610-18.
66.Kurosaki N., Kubota M., Yamamoto Y., Fusayama T. El efecto del grabado sobre el suelo de la cavidad. Quintessence (ed. Esp.), Vol. 4, Nº 1, 1991.
67.Trondstad L. y Cols. Influence of coronal restorations on the periapical health of endodontically treated teeth, Endod. Dent Traumatol, Copenhagen, Vol. 16: 218-21, 2000.
68.Bottino M.A. Nuevas Técnicas de Endodoncia. Edit. Artes Médicas. Brasil, 2008. Cap. 2, págs. 29- 32.