Purpose of caries removal and subsequent restoration treatment:
Control the biofilm and caries activity in specific areas.
Utilize adhesive materials to seal the crown part to protect the dentin-pulp complex, terminating caries activity.
Restore the function, form, and aesthetics of the tooth.
In summary, based on evidence-based medicine, the purpose of caries removal is to provide sufficient adhesion for the restoration to prolong its lifespan.
Guiding Principles of Caries Removal:
Preserve demineralized and remineralizable tissue.
Achieve good sealing by bonding the restorative material to the normal dentin of the sidewalls and the normal enamel of the cavity margins.
Avoid discomfort, pain, and dental anxiety by adopting methods that do not cause or alleviate anxiety and pain.
Preserve pulp vitality to avoid removing near-pulp dentin to prevent pulp exposure. If necessary, retain softened dentin near the pulp, which significantly helps extend the tooth’s lifespan and reduce treatment costs.
Maximize the lifespan of the restoration by removing softened dentin to provide sufficient volume and strength for the restoration.
For the last two purposes, protecting pulp health and extending the lifespan of the restoration, comprehensive consideration must be given to the clinical situation to achieve a balance.
How to reduce pain during injection for patients?
Replace the 5ml syringe with a metal syringe or use a painless local anesthesia device like STA. If only a regular metal syringe is available, without advanced devices like STA, apply a topical anesthetic cream or spray on the patient’s mucosa before injection to provide surface anesthesia. Then, gently perform the injection. This method can effectively control pain. During injection, for example, when administering infiltration anesthesia, you can inject just below the mucosa in the vestibular sulcus and slowly push the anesthetic, observing a slight bulging. Withdraw the needle after about ten seconds, allowing the anesthesia to take effect. Then, reinsert the needle and slowly push again. This approach greatly reduces the patient’s experience of pain and fear during injection.
