Stomatology Edu Journal 1/2014

cariology
primary role in protecting the pulp-dentine complex
(14). When using this technique, the practitioner can
arrest the acute progression of the carious lesion,
by modifying the cariogenic environment. The soft
demineralized dentine is changing in most cases,
into a dentine with increased consistency and brownyellow
or dark-brown appearance. The efficiency
of the „stepwise” excavation technique was also
assessed after 6-12 months by other authors (15).
The clinical changes of demineralized dentine
were associated with a high reduction of bacterial
contamination. After 6 months, in 90% of the cases
the consistency of demineralized dentine increased,
while in 20% of the cases there was a complete
sterilization of demineralized dentine. Using a
standardized scale of consistency and color changes,
some authors found the remineralisation of dentine
in 94% of the cases after 2-19 months following the
„stepwise” excavation technique (16). The clinical
and radiographical changes of the demineralized
dentine, following indirect pulp capping with
Ca(OH) 2 and zinc-oxyde-eugenol, after an interval of
6-7 months, were assessed by different authors (4).
The affected dentine became hard dentine in 80%
of the treated teeth, while 16,67% of teeth presented
demineralized dentine with medium consistency.
In the same study, only 3,3% cases were associated
with total absence of remineralisation processes.
The „stepwise” excavation technique is included
in the category of new operatory treatment
options for dental caries, but some authors claim
potential failures in the long-term follow up of the
treated teeth (17). Performing a critical review of
23 studies focused on this technique, the authors
sustain the use of this technique on a large scale
for the treatment of deep acute dental caries. A
similar critical review of such studies concluded
that the „stepwise” excavation technique presents
positive results in the long-term, regarding the
vitality preservation of the pulp-dentine complex
(18).
Conclusion
1. The remineralisation of the affected dentine
from acute carious lesions performed with zincoxide-eugenol
or with calcium-hydroxide liner and
glassionomer cement in „stepwise” excavation
technique was present in 80% of the cases.
2. After 6 months, 90% of the acute carious lesions
treated with calcium-hydroxide liner and zinc-oxideeugenol
in the „stepwise” excavation technique
presented dentine remineralisation.
3. The „stepwise” excavation technique is an
efficient approach in the treatment of acute dental
caries maintaining pulp vitality in 90-100% of the
cases.
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