Evaluation of Current Caries Removal Strategies

Abstract

Dental caries, which has been defined as an communicable disease for many years, is now defined as a non-communicable disease that occurs due to disruption of the bacterial balance resulting from dynamic changes in the plaque biofilm. Bacterial metabolic activity is known to be effective instead of bacterial transmission in the formation and progression of dental caries. Dental caries is a multifactorial disease that cannot be treated by complete removal of bacteria. For cavitated lesions, selective removal of carious tissues is recommended. In shallow and moderately deep lesions, dentists should aim to remove caries tissue to allow adequate depth for the restorative material. For deep lesions in teeth with vital pulps, leaving soft dentin in pulpo-proximal areas avoids pulp exposure, while peripherally hard tissue is retained to ensure sufficient mechanical support of restoration. In 2015, The International Caries Consensus Collaboration (ICCC), presented updated definitions regarding cariology terminologies. Histological terms used to describe carious dentin tissue (necrotic zone, contaminated zone, demineralized zone, etc.) have been replaced by terms describing their clinical consequences (soft, leathery, firm and hard dentin). Additionally, different clinical recommendations are presented for carious tissue removal and management of cavitated carious lesions. The researchers evaluated the results of studies conducted on the subject in the subsequent years and provided the necessary updates. The aim of this study was to review the current definitions of caries in light of the expert opinions established by the ICCC and to evaluate the current caries removal strategies.

Keywords

• Dental caries
• Dental cavity preparation
• Dental plaque

Güncel Çürük Doku Uzaklaştırma Stratejilerinin Değerlendirilmesi

Abstract

Uzun yıllar boyunca bulaşıcı bir hastalık olarak tanımlanmış olan diş çürüğü, günümüzde plak biyofilminde meydana gelen dinamik değişimler sonucu bakteriyel dengenin bozulmasına bağlı olarak oluşan ve bulaşıcı olmayan bir hastalık olarak tanımlanmaktadır. Enfeksiyöz hastalıkların bilinen patolojik evrelerinden farklı olarak diş çürüğünün oluşma ve ilerlemesinde birçok farklı faktör rol oynamakta ve bakteri bulaşı yerine bakteriyel metabolik aktivitenin etkin olduğu bilinmektedir. Diş çürüğü, günümüzde bakterilerin tamamen uzaklaştırılarak iyileştirilmesi mümkün olmayan bir hastalık olarak kabul edilmektedir. Günümüzde çürük dokuların selektif olarak uzaklaştırılması önerilmektedir. Sığ ve orta derinlikteki lezyonlarda restoratif materyal için yeterli derinliğe izin verecek şekilde sıkı dentine kadar uzaklaştırma önerilirken; vital pulpaya sahip derin çürük lezyonlu dişlerde kavite sınırları sert dentinde olacak şekilde, kavite tabanında pulpayı ekspoze etmeden yumuşak dentinin bırakıldığı selektif uzaklaştırma önerilmektedir. 2015 yılında Uluslararası Çürük Uzlaşı İşbirliği (The International Caries Consensus Collaboration, ICCC) grubu, çürük lezyonlarının yönetiminde farklı stratejiler ile ilgili uzman görüşlerini oluşturmak amacıyla bir toplantı düzenlemiştir. Bu toplantıda çürük ile ilgili terminolojik farklılıkların giderilmesi amacıyla güncel tanımlamalar sunulmuş, çürük dentin dokusunu tanımlamada kullanılan histolojik terimlerin (nekrotik bölge, kontamine bölge, demineralize bölge, vb.) yerine bunların klinik sonuçlarını ifade eden terimlerin (yumuşak, kösele/kayışımsı, sıkı ve sert dentin) kullanılması önerilmiş ve çürük dokuların uzaklaştırılmasında farklı stratejiler tanıtılmıştır. Araştırmacılar, takip eden yıllarda konuyla ilgili yapılan çalışmalara ait sonuçları değerlendirerek güncellemeleri sunmuşlardır. Bu makalede, ICCC tarafından oluşturulan uzman görüşleri ışığında çürük ile ilişkili en son tanımlamalar gözden geçirilmiş, güncel çürük temizleme stratejileri ile ilgili yapılan çalışmalar değerlendirilmiştir.

Keywords

• Diş çürükleri
• Diş kavite preparasyonu
• Diş plağı

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