This document discusses different methods for treating dental caries lesions based on their severity. Shallow lesions can be treated through improved oral hygiene, while deep lesions require more invasive procedures. Treatment options for moderate lesions include removing carious dentin and applying protective medicaments before restoring. For deep lesions, options are emergency treatment, indirect pulp capping by sealing questionable dentin, direct pulp capping for exposed pulps, or endodontic treatment. Both direct and indirect pulp capping aim to preserve the pulp but have varying prognosis depending on the exposure and pulp health.

1. Methods and Principles of
Caries Treatment
Zohaa Al-Shekhly
Nazima Ansari
Daria Gholamifard
Danial Hashemimoghaddam

2. Introduction
The treatment of a carious lesion will differ
according to it’s Manifestation ( clinical picture ),
• Shallow Lesions will require a modification in
the oral hygiene of the patient which will permit
them to be re-mineralized without any invasive
procedures
•Deep Lesions will be treated through invasive
procedures.
•Caries Lesions with pulp exposure, are treated
with more complicated and extensive tooth lose.

3. Biological & Mechanical
Principles of Cavity
Preparation:-
1. Location of the Lesion.
2. Amount of the lost tooth substance.
3. The extension and amount of the lesion.
4. The restorative material to be used.
5. The presence of existing restoration.

4. General Principals of Cavity
Preparations According to
G.V. Black
• Establishing the Outline Form.
• Establishing the Resistance Form.
• Establishing the Retention Form.
• Obtaining the Convenience Form.
• Removing any remaining carious dentin.
• Finishing the enamel walls.
• Debridement.

5. EstablishingtheOutlineForm
• It means carrying the margin of the cavity to
the position it will occupy upon completion.
It depends on the following factors:
• Location and Extent of the lesion.
• Healthy tooth structure.
• Material of Restoration.
• Tooth Morphology.

6. Resistance
Form
Is defined as the architectural form given
to a tooth preparation which enables both
the restoration and the remaining tooth to
resist structural failure from occlusal load.

7. Resistance can be
achieved through:-
The walls must be smooth and
thick.
Pulpal and gingival walls must
be horizontal and plain.
The Buccal & lingual walls are
perpendicular to occlusal while
the mesial & distal are divergent
to occlusal.

8. Pulpal Floor mesio-distally is flat and
perpendicular to the long axis of the tooth

9. Retention
Form
• It refers to the features given to the
cavity preparation to prevent
dislodgment of the restoration.

10. Retention Form can be
achieved through:-
 The cavity should be deeper than wide or as deep
as wide.
 Definitive angles.
 Dovetails extend into buccal, lingual and also by
proximal grooves

11. Undercuts,PointsandGrooves
• They are retention means made during cavity
preparations which are usually made in
dentin to avoid undermining the enamel.
• In Class I are made in facial & lingual walls.
• In Class II are made in buccal & lingual walls
of the proximal box.
• In Class V are made in incisal & gingival walls.
• Never in the Axial or Pulpal.

12. • Obtaining the Convenience Form.
• Removing any remaining carious
dentin.
• Finishing the enamel walls.
• Debridement.

13. Treatment of the Moderate
Carious Lesions
• Moderate Lesions: lesions which have
penetrated the enamel or has involved
the dentin but not extended to the pulp.
• These lesions are differentiated from
Deep Lesions, by it’s clinical penetration
into the dentin and proximity to the pulp.

14. Mechanisms of Carious Removal
• First, establish the Outline Form.
• Second:-
• determine the lateral penetration of
caries by using the dental probe.
• All undermined enamel is removed, which in
turn will influence the final outline form.
• When considerable caries dentin is present, it
should be removed either using large round
bur on low speed handpeice or excavator.

15. Mechanisms of Carious Removal
• The color and texture of the remaining
dentin serves as a guide to indicate proper
removal.
• When the carious dentin is gone, the
remaining surface will appear smooth and
semi-polished, even though the dentin may
still be discolored.

16. Cleansing The Prepared Surfaces
• Following cavity preparation the enamel
and dentin surfaces are covered with a thin
layer of debris, which very important to be
removed. What and Why?
• This layer can be removed either by water –
air syringe or by the use of medical
solutions such as H2O2 of 3%.

17. Medicaments for
Protecting Dentino-Pulpo
Complex
For the Moderate Carious Lesion:-
• Cavity Varnish.
• Ca(OH).
• Zinc Oxide Eugenol Cement.
• Zinc Phosphate.
• Poly Caboxylate Cement.
• Glass Inomer Cement.

18. Treatment of the Deep
Carious Lesions

19. Faced With A Deep Caries, The
Operator Has Several Options
• For Emergency care, superficial carious
dentin can be excavated and a temporary
restoration is placed, any sharp edges of
enamel is reduced with a diamond bur to
avoid any injury to the tongue or cheek.
• With favorable prognosis the tooth can be
permanently restored as though it were a
Moderate Lesion.

20. Faced With A Deep Caries, The
Operator Has Several Options
• If the lesion approximates the pulp, the pulp
can be treated and a temporary restoration
is placed, at a later period if the pulp health
permits a final restoration is placed.
• Endodontic treatment can be followed by
structural reinforcement. What is that?
• The tooth can be removed.

21. Faced With A Deep Caries, The
Operator Has Several Options
Indirect Pulp Capping

22. • Is the procedure in which only the gross caries
is removed and leave questionable carious
dentin over the Pulpal area and seal it over.
• All the peripheral carious dentin is removed
with large round bur or an excavator.
• Only teeth with deep caries that are free of
symptoms ( pain , swelling ) should be
selected.

23. • The remaining thin layer of caries in the base
of the cavity is dried and covered with
bactericidal dressing such as Ca(OH) or a
thick mix of ZOE.
• The cavity is sealed with a durable interim
restoration from 6 to 8 weeks.
• During the interim period the dentin
undergoes remineralization and becomes
harder.

24. Faced With A Deep Caries, The
Operator Has Several Options
Direct Pulp Capping

25. • Is the procedure that should be limited
to:-
• Accidental or traumatic exposures ( during
cavity preparations ).
• Pin point carious exposures surrounded by
sound dentin.

26. Steps
• Stop the bleeding.
• Apply Ca(OH) paste or powder over the
Pulpal opening. ( site of exposure ).
• Fill the cavity preparation by a cement
material which should provide a hermetic
seal.

27. Prognosis
• Its preferable to wait for a period of 3
months.
• Remove the cement material and inspect the
site of exposure for secondary dentin
formation.
• If the pulp is vital with absence of
inflammatory signs, the Prognosis is favorable
to restore the tooth permanently.