European Archives of Paediatric Dentistry

, Volume 17, Issue 5, pp 413–417 | Cite as

Alternative approach for carious tissue removal in primary teeth

  • B. Z. Mello
  • T. C. Stafuzza
  • L. L. R. Vitor
  • D. Rios
  • M. A. Machado
  • T. M. OliveiraEmail author
Case Report



Minimally-invasive techniques for the management of carious dental tissue has been well documented. This study aimed to report on the clinical and radiographic response after partial caries removal on left mandibular primary second molar.

Case report

A 6-year-old boy sought treatment because of pain in the left mandibular primary second molar. The tooth had a deep caries lesion on the occlusal surface, with loss of enamel structure and dentine proximity with the pulp confirmed by periapical radiograph. According to the clinical and radiographic diagnosis, partial caries removal was the treatment of choice. Calcium hydroxide cement was used as pulp capping material.


In this case report, partial caries removal showed satisfactory clinical and radiographic outcomes after 18-month following-up period.


Partial caries removal only is applicable when properly indicated. However, further clinical studies with longer following-up periods are necessary.


Dental pulp capping Dental caries Deciduous Child 


Compliance with ethical standards

This study funded by own financing.

Conflict of interest

There are no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. Al-Zayer MA, Straffon LH, Feigal RJ, Welch KB. Indirect pulp treatment of primary posterior teeth: a retrospective study. Pediatr Dent. 2003;25(1):29–36.PubMedGoogle Scholar
  2. Banerjee A, Watson TF, Kidd EA. Dentine caries excavation: a review of current clinical techniques. Br Dent J. 2000;188(9):476–82.PubMedGoogle Scholar
  3. Bjørndal L, Larsen T, Thylstrup A. A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res. 1997;31(6):411–7.PubMedCrossRefGoogle Scholar
  4. Bressani AEL, Mariath AAS, Haas AN, Garcia-Godoy F, Araujo FB. Incomplete caries removal and indirect pulp capping in primary molars: a randomized controlled trial. Am J Dent. 2013;26(4):196–200.PubMedGoogle Scholar
  5. Casagrande L, Dalpian DM, Ardenghi TM, et al. Randomized clinical trial of adhesive restorations in primary molars. 18-month results. Am J Dent. 2013;26(6):351–5.PubMedGoogle Scholar
  6. Coll JA. Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date? Pediatr Dent. 2008;30(3):230–6.PubMedGoogle Scholar
  7. Dalpian DM, Ardenghi TM, Demarco FF, et al. Clinical and radiographic outcomes of partial caries removal restorations performed in primary teeth. Am J Dent. 2014;27(2):68–72.PubMedGoogle Scholar
  8. Duangthip D, Jiang M, Chu CH, Lo EC. Non-surgical treatment of dentin caries in preschool children—systematic review. BMC Oral Health. 2015;15:44.PubMedPubMedCentralCrossRefGoogle Scholar
  9. Duggal MS, Nooh A, High A. Response of the primary pulp to inflammation: a review of the Leeds studies and challenges for the future. Eur J Paed Dent. 2002;3:111–4.Google Scholar
  10. Farooq NS, Coll JA, Kuwabara A, Shelton P. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatr Dent. 2000;22(4):278–86.PubMedGoogle Scholar
  11. Fernandes AP, Lourenço Neto N, Teixeira Marques NC, et al. Clinical and radiographic outcomes of the use of low-level laser therapy in vital pulp of primary teeth. Int J Pediatr Dent. 2015;25(2):144–50.CrossRefGoogle Scholar
  12. Franzon R, Guimaraes LF, Magalhaes CE, Haas AN, Araujo FB. Outcomes of one-step incomplete and complete excavation in primary teeth: a 24-month randomized controlled trial. Caries Res. 2014;48(5):376–83.PubMedCrossRefGoogle Scholar
  13. Franzon R, Opdam NJ, Guimarães LF, et al. Randomized controlled clinical trial of the 24-months survival of composite resin restorations after one-step incomplete and complete excavation on primary teeth. J Dent. 2015;43(10):1235–41.PubMedCrossRefGoogle Scholar
  14. Fusayama T. Two layers of carious dentin; diagnosis and treatment. Oper Dent. 1979;4(2):63–70.PubMedGoogle Scholar
  15. Fuks AB. Vital pulp therapy with new materials for primary teeth: new directions and treatment perspectives. Pediatr Dent. 2008;30(3):211–9.PubMedGoogle Scholar
  16. Lourenco Neto N, Marques NC, Fernandes AP, et al. Clinical and radiographic evaluation of Portland cement added to radiopacifying agents in primary molar pulpotomies. Eur Arch Paediatr Dent. 2015;16(5):377–82.PubMedCrossRefGoogle Scholar
  17. Lula EC, Monteiro-Neto V, Alves CM, Ribeiro CC. Microbiological analysis after complete or partial removal of carious dentin in primary teeth: a randomized clinical trial. Caries Res. 2009;43(5):354–8.PubMedCrossRefGoogle Scholar
  18. Lula EC, Almeida LJ Jr, Alves CM, Monteiro-Neto V, Ribeiro CC. Partial caries removal in primary teeth: association of clinical parameters with microbiological status. Caries Res. 2011;45(3):275–80.PubMedCrossRefGoogle Scholar
  19. Maltz M, Alves LS, Jardim JJ, dos Moura MS, de Oliveira EF. Incomplete caries removal in deep lesions: a 10-year prospective study. Am J Dent. 2011;24(4):211–4.PubMedGoogle Scholar
  20. Maltz M, Garcia R, Jardim JJ, De Paula LM, et al. Randomized trial of partial vs. stepwise caries removal: 3-year follow-up. J Dent Res. 2012;91(11):1026–31.PubMedCrossRefGoogle Scholar
  21. Maltz M, Alves LS. Incomplete caries removal significantly reduces the risk of pulp exposure and post-operative pulpal symptoms. J Evid Based Dent Pract. 2013;13(3):120–2.PubMedCrossRefGoogle Scholar
  22. Maltz M, Oliveira EF, Fontanella V, Carminatti G. Deep caries lesions after incomplete dentine caries removal: 40-month follow-up study. Caries Res. 2007;41(6):493–6.PubMedCrossRefGoogle Scholar
  23. Manton D. Partial caries removal may have advantages but limited evidence on restoration survival. Evid Based Dent. 2013;14(3):74–5.PubMedCrossRefGoogle Scholar
  24. Miyashita H, Worthington HV, Qualtrough A, Plasschaert A. Pulp management for caries in adults: maintaining pulp vitality. Cochrane Database Syst Rev. 2007;2:004484.Google Scholar
  25. Moretti AB, Sakai VT, Oliveira TM, et al. The effectiveness of mineral trioxide aggregate, calcium hydroxide and formocresol for pulpotomies in primary teeth. Int Endod J. 2008;41(7):547–55.PubMedCrossRefGoogle Scholar
  26. Nooh AM. The relationship between the extent of carious involvement of the marginal ridge and pulpal inflammation in primary teeth. M Dent Sci Dissertation, Leeds: University of Leeds; 1998.Google Scholar
  27. Oliveira TM, Moretti AB, Sakai VT, et al. Clinical, radiographic and histologic analysis of the effects of pulp capping materials used in pulpotomies of human primary teeth. Eur Arch Paediatr Dent. 2013;14(2):65–71.PubMedCrossRefGoogle Scholar
  28. Phonghanyudh A, Phantumvanit P, Songpaisan Y, Petersen PE. Clinical evaluation of three caries removal approaches in primary teeth: a randomised controlled trial. Commun Dent Health. 2012;29(2):173–8.Google Scholar
  29. Pitts NB. Dental cavity: diagnosis and monitoring. 1st ed. São Paulo: Artes Médicas; 2012.Google Scholar
  30. Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE. Partial caries removal may have advantages but limited evidence on restoration survival. Evid Based Dent. 2013;14:74–5.CrossRefGoogle Scholar
  31. Santamaria R, Innes N. Trial shows partial caries removal is an effective technique in primary molars. Evid Based Dent. 2014;15(3):81–2.PubMedCrossRefGoogle Scholar
  32. Santamaria RM, Innes NP, Machiulskiene V, et al. Acceptability of different caries management methods for primary molars in a RCT. Int J Paediatr Dent. 2015;25(1):9–17.PubMedCrossRefGoogle Scholar
  33. Schwendicke F, Dorfer CE, Paris S. Incomplete caries removal: a systematic review and meta-analysis. J Dent Res. 2013;92(4):306–14.PubMedCrossRefGoogle Scholar
  34. Schwendicke F, Tu YK, Hsu LY, Göstemeyer G. Antibacterial effects of cavity lining: a systematic review and network meta-analysis. J Dent. 2015a;43(11):1298–307.PubMedCrossRefGoogle Scholar
  35. Schwendicke F, Schweigel H, Petrou MA, et al. Selective or stepwise removal of deep caries in deciduous molars: study protocol for a randomized controlled trial. Trials. 2015b;16(11):1–10.Google Scholar

Copyright information

© European Academy of Paediatric Dentistry 2016

Authors and Affiliations

  • B. Z. Mello
    • 1
  • T. C. Stafuzza
    • 1
  • L. L. R. Vitor
    • 1
  • D. Rios
    • 1
  • M. A. Machado
    • 1
  • T. M. Oliveira
    • 1
    Email author
  1. 1.Department of Paediatric Dentistry, Orthodontics and Public Health, Bauru School of DentistryUSP-University of São PauloSão PauloBrazil

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