Ultraconservative caries removal.
Perhaps some of the most compelling evidence
is provided by Mertz-Fairhurst et al.,
who in 1998 presented ten year data on 156
ultraconservative, cariostatic sealed restorations.
50 In this study, teeth with clinical and
radiographic evidence of occlusal caries were
minimally prepared by placing a 45°– 60°
bevel in the enamel, surrounding a frankly
cavitated lesion. The bevel was at least 1 mm
wide and placed in sound enamel. No
attempt was made to remove any carious
dentine and the resultant ‘cavities’ were
restored with acid etched composites and
covered with fissure sealant. Although a
number of these teeth have been lost from the
study due to patients failing to return for
recall, 85 have been followed throughout the
ten years. Various progress reports on the
study sample have shown that sealing caries
into the tooth arrests the progress of the
lesion by effectively eliminating the oral
source of substrate to the bacteria within the
lesion.51-55 Only one restoration appeared to
‘cave-in’, only one succumbed to secondary
caries and 3.5% showed signs of wear. All the
teeth remained symptomless with no signs of
pulpal inflammation or necrosis