Stepwise Excavation.

Abstract

The most recent inspiration for stepwise carious tissue removal in 2 stages originates from the knowhow on intralesion changes in deep carious lesions. The environmental change that takes place during the first stage of carious tissue removal is aiming for the arrest of the deep lesion, by placing a temporary restoration on top of the soft carious dentine. The cavity is optimised during the second stage for a final restoration, as potential shrinkage of the retained dentine may occur during the period of carious dentine arrestment. However, basic clinical limitations on the objective evaluation of pulp inflammation creates dilemmas in treating the deep lesions. Also, a global consensus is lacking for the definition of a so-called deep lesion. Finally, an optimal evidence goal for choosing the best approach for deep lesion treatment in adults has still not been fully defined. Taken together, it may not be a surprise that treatment variation is reported amongst general dental practitioners on deep caries treatment. Here, facts are presented supporting the treatment, including some drawbacks, as well as updated guidelines for the procedure. Recent clinical high evidence data from randomised clinical trials significantly favour the stepwise approach as a predictable and reliable treatment for well-defined deep carious lesions located in the pulpal quarter of the dentine in terms of avoiding pulp exposure, keeping the tooth vital and without the development of apical pathosis.