Biological treatment

In most cases of the treatment of deep cavities, a very thin dentine wall (thinner than 0.5 mm) remains that separates the nerve from the soft tissue decay. This wall is extremely vulnerable and during removal of decay, it is often removed as well and the nerve is exposed. In the past, in this case the nerve would be also removed and the root canal filled. Given the consequences of nerve removal, the methodology of biological treatment was developed. It is used for teeth with deep cavities, where the dentine wall is very thin, and teeth where the nerve is open and exposed. A mandatory condition for success of the biological treatment is the lack of spontaneous tooth pain at night. The presence of spontaneous pain indicates that the nerve is infected with bacteria from the saliva and a pulpitis can develop, which makes biological treatment uncertain and with an unpredictable result.
Special preparations with calcium hydroxide – Ca(OH)2 are used in biological treatment.

Calcium hydroxide has the unique ability to stimulate the cells of tooth pulp to produce and deposit a layer of special dentine. In teeth with preserved thin dentine wall, a small amount of Ca(OH)2 is used at the thinnest part of the dentine, followed by a pad and a filling. So the Ca(OH)2 stimulates the formation of a protective dentine over time and the thin dentine wall becomes thicker and it effectively protects the nerve of the tooth.

Uncleaned deep caris/Cleaned caries with macro communication/ Micro communication

In the teeth, where the nerve is visible and exposed (micro communication) the degree of visibility and the state of the nerve are assessed, and if it is possible, Ca(OH)2 is put directly on the micro communication. Then the tooth is restored using glass ionomer cement and the patient is followed up. Based on the discretion of the dentist, X-ray pictures are taken at a certain period of time, which check whether a protective dentine layer has formed. After the formation of a sufficient layer of dentine the top layer of the glass ionomer cement filling is removed and a final restoration of photo- or chemopolymer is made. However, if the biological treatment has been unsuccessful, a pulpitis develops, which requires the removal of a tooth nerve and endodontic treatment.

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