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Endodontics · single question

On excavating this patient's caries you find the lesions are DEEP and approaching the pulp, with no signs of irreversible pulpitis. What is the most appropriate management?

  1. Selectively remove caries, intentionally LEAVING caries-affected dentin over the pulpal floor, place a liner/base (e.g., glass ionomer), then restore
  2. Remove all the caries and place the final restoration without any liner
  3. Extract the tooth and place an implant
  4. Remove ALL caries and all affected dentin; if the pulp is exposed, achieve hemostasis, place calcium hydroxide, and restore
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Correct answer: A. Selectively remove caries, intentionally LEAVING caries-affected dentin over the pulpal floor, place a liner/base (e.g., glass ionomer), then restore

  • A. Correct. Current evidence favors SELECTIVE (partial) caries removal in deep lesions without irreversible pulpitis: leave a layer of caries-affected dentin over the pulp to AVOID pulp exposure, seal with a liner/base (glass ionomer or calcium hydroxide) and restore. The sealed environment arrests the lesion and lets the pulp lay down reparative dentin.
  • B. Placing a final restoration over a near-pulp deep cavity with no protective liner risks pulpal irritation and is inappropriate.
  • C. A restorable tooth with reversible pulp status should be preserved, not extracted.
  • D. Removing ALL affected dentin in a deep lesion is now considered OVER-treatment because it needlessly risks pulp exposure; conservative selective removal has higher pulp-survival success. (Calcium hydroxide direct capping is only after an actual exposure.)

Note: CORRECTION/teaching: modern minimally-invasive caries management = selective removal leaving affected dentin to prevent pulp exposure, then liner + restoration (indirect pulp treatment).

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