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Restorative Dentistry

Does stepwise excavation enhance pulp preservation?


This is a summary of the article published in the Journal of Dentistry: Ways of enhancing pulp preservation by stepwise excavation. A systemic review (February 2011)


The best possible methods and materials in stepwise excavation for deep caries in permanent teeth were investigated.


The  review considers the questions from many aspects including clinical success, effects of reducing cariogenic bacteria, possibility of hardening softened dentin, and likelihood of generating tertiary dentin.


This systematic review includes the use of data from randomized controlled trials, controlled clinical trials as well as from case series in which pulp exposure resulted following the treatment and removal of deep caries. Only studies of caries in permanent teeth were considered. Those involving treatment of primary teeth were excluded.

Key Messages

The research suggests that stepwise excavation is effective for pulp preservation in extremely deep caries that do not show clinical symptoms of irreversible pulpitis.

Calcium hydroxide, as well as antimicrobials and polycarboxylate cement combined with tannin-fluoride preparation, is effective in reducing bacteria and promoting remineralization of the carious dentin that remained after stepwise excavation.

Further clinical trials with a high level of study design should be conducted to identify the best methods of removing carious dentin using stepwise excavation.


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