How Much Tooth Decay Needs to be Removed: The Peripheral Seal Concept
- Nathan McDonald
- Dec 3, 2015
- 2 min read
Photo Courtesy of Quintessence International. http://www.ncbi.nlm.nih.gov/pubmed/22299120
Dr. David S. Alleman, DDS, and Dr. Pascal Magne, DMD, PhD, come together in the development and progression of biomemetics. As dentistry has developed from trade to a profession, the treatment and diagnosis of patients has progressed from chasing to preventing disease. In the article, “A systemic approach to deep caries removal end points: The peripheral seal concept in adhesive dentistry”, Alleman and Magne seek to persuade the use of technology to aide in the prevention of pulpal exposure through caries-detecting dye and DIAGNOdent laser fluorescence technologies. Since the 1960s dentist have strived to find the correct way to eliminate the highest amount of bacteria from the outer caries and inner caries while preserving the inner caries portion that can still be remineralized. Takao Fusayama in the 1980s developed a caries-detecting dye solution that can be used to differentiate between clean and decayed tooth structure. However, the problem was still how much should be removed? The removal of too much caused pulpal exposures and long term negative effects for the patient, whereas too little left high levels of active bacteria to continue in the decay process. With the development of DIAGNOdent, one can measure the amount of bacteria according the depth (superficial, intermediate, and deep dentin). These two products together can help General Dentists know when to keep going based on the color (red signifies outer caries, which should all be removed and light pink is the inner caries, comprised of less bacteria) and as one reaches inner caries how much to remove based on the amount of dentin.
Dentists of course, still need to know their anatomy, histology, and microbiology. As one approaches pulpal depth from the occlusal table of >5mm the pulp is getting closer and one should stop the procedure and fill the preparation, leaving tooth structure to allow the healing process rather than perforating into the pulpal chamber. Also, the inner caries has shown an ability to remineralize and repair the damaged collagen fibrils unlike outer caries. By eliminating the high levels of the bacteria in the outer caries and leaving the inner caries with low levels the tooth can have a chance to heal as the acidic environment is neutralized. This is done by an immediate dentin seal to prevent the pathway of nutrients to and the accumulation of bacteria. By removing the decay from the outer dentin a peripheral seal of 1.0 -1.5 mm is created which will allow the resin to bond to natural tooth structure and inhibit bacterial growth. Alleman and Magne have found that by utilizing these two tools, excess sensitivity and incidents of too much tooth structure removal can be minimized.
Please read the article in its entirety as it is very informative.
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