Avoiding endo

The loss of tooth tissue and its subsequent replacement has always posed a challenge for both the clinician and the bio-material scientist. Whether lost by caries or as a result of the mechanical removal of diseased dentine, the substitution of dentine and enamel adequately to protect and support the tooth from further compromise and prevent sequelae leading up towards endodontic treatment, is a desirable feature in a successful restoration.

The importance of caries risk assessment has been well documented and in conjunction with preventative features is an integral part of the management process which influences the long term outcome. However the clinician is often faced with a situation as seen in figure 1 where the caries is deep within the dentine in close proximity to the pulp and restorative intervention is required.

The issue here for both the clinician and the patient is the predictability and indeed the desirability to maintain pulpal health and vitality and therefore an accurate diagnosis of the pulpal status is advantageous. However the methods commonly available for such evaluations may not be totally reliable. The partial removal of the caries mechanically has been well documented and this can help prevent iatrogenic trauma to the pulp. Use of a dentine and subsequent enamel substitute is required to restore the cavity and currently a single material may not fulfil all the desired properties required.