Eur Arch Paediatr Dent (2017) 18:423–426
https://doi.org/10.1007/s40368-017-0316-6
CASE REPORT
Partial caries removal increases the survival of permanent tooth:
a 14-year case report
J. C. P. Imparato1 • K. M. S. Moreira2 • I. C. Olegário1 • S. R. E. P. da Silva3
D. P. Raggio1
Received: 27 September 2016 / Accepted: 28 September 2017 / Published online: 30 October 2017
Ó European Academy of Paediatric Dentistry 2017
Abstract
Background Since cases of deep caries lesions may result
in dental extraction due to any absence of endodontic
services, and considering the advantages of conservative
treatment, partial caries removal can be a viable alternative
to the treatment of these lesions.
Case report During the clinical examination, generalised
caries lesions were observed in a 6-year-old boy. In the
maxillary right first permanent molar (tooth 16), without
sensitivity to percussion and/or spontaneous pain, partial
caries removal of deep caries was performed being careful
to avoid pulpal exposure, followed by capping with cal-
cium hydroxide cement and restoration using glass iono-
mer cement.
Follow-up After 14 years, the success of the treatment was
observed by the tooth being symptom-free, the caries
arrested and healthy on periapical radiograph examination
even though the restoration had been lost. Endodontic
treatment was not considered necessary and the dental
survival time was increased, keeping the pulp vitality and
absence of apical pathologies. Therefore, a restoration with
Z350 resin composite was performed to return masticatory
function to the tooth.
& K. M. S. Moreira
kellynhaodonto@yahoo.com.br
1
Orthodontics and Pediatric Dentistry Department, Dental
School, University of São Paulo, São Paulo, Brazil
2
Pediatric Dentistry Department, Piracicaba Dental School,
State University of Campinas, Piracicaba, São Paulo, Brazil
3
Department of Pediatric Dentistry, Pontifical Catholic
University of Campinas, São Paulo, Brazil
•
Conclusion Partial caries removal increased the dental
survival time, avoiding the necessity of endodontic treat-
ment and early dental loss.
Keywords Partial caries removal
Deep dental caries

Dental survival time
Permanent molar
Background
The prevalence of cavited lesions remains high, especially
in developing countries such as Brazil (Fejerskov 1997;
Brazilian Ministry of Health 2010). In the past, the treat-
ment often used for these lesions involved complete caries
removal while the minimal intervention approach was still
being developed (Frencken and Holmgren 1999). Nowa-
days, complete caries removal is highly questionable, since
it increases the risk of pulp exposure in deep caries lesions
(Bjørndal et al. 2010; Ricketts et al. 2013; Maltz and Alves
2013; Schwendicke et al. 2013).
With minimal intervention dentistry approach, clinical
trials have demonstrated the benefits of partial compared
with complete caries removal, primarily for deep caries
lesions, aiming to preserve tooth vitality (Alves et al. 2010;
Bjørndal et al. 2010; Maltz et al. 2012). Partial caries
removal consists of limited excavation of the demineralised
dentine and subsequent tooth sealing (Maltz et al. 2002).
However, an adequate diagnosis is the key factor for the
success of the treatment, since a tooth must not have an
irreversible pulpitis. For that, the dentist needs to analyse
all the symptoms and signs regarding the absence of pulp
involvement, such as presence of spontaneous pain or
sensitivity during percussion and radiographic presence of
a periapical lesion (Maltz et al. 2011).
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Previous researchers have reported that incomplete
caries removal significantly reduces the risk of pulp
exposure and post-operative pulpal symptoms compared
with more invasive treatments (Maltz and Alves 2013).
Thus, there is a better prognosis and consequently an
increase of tooth survival. In addition, the possibility of
completing this treatment in a single session reduces its
cost (Weber et al. 2011).
Since most cases of deep caries lesions may result in
dental extraction because of a lack of endodontic referral
services, and considering the advantages of conservative
treatment, the objective of this study was to report a
14 year follow-up of a partial caries removal in a maxillary
right first permanent molar (16) with deep caries lesion, in
order to increase the survival of the tooth.
Case report
A 6-year-old male patient was examined attending a social
non-profit dentistry emergency project (2002) in a low
socio-economic region at São Luiz do Paraitinga, São
Paulo-Brazil. During the history taking the family reported
no associated systemic disease. Additionally, there were no
other problems found in the extra-oral examination of the
child. During the clinical examination, dental caries lesions
were observed in primary and permanent teeth (Fig. 1). In
tooth 16 without sensitivity to percussion and/or sponta-
neous pulpal pain, partial caries removal was performed
being careful avoid pulpal exposure. In this procedure, only
the soft friable dentine was excavated using hand instru-
ments. No local analgesia or rubber dam was used since the
treatment was carried out in a health dental public centre
where such techniques were not available. Posteriorly,
capping with calcium hydroxide cement (Dycal, Dentsply)
and restoration using glass ionomer cement (Ketac Molar,
3M ESPE) were carried out (Fig. 2). Additionally,
instructions about the oral hygiene and dietary advice were
Fig. 1 a and b Generalized carious lesions in the maxillary and mandibular arches
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Eur Arch Paediatr Dent (2017) 18:423–426
given followed by restoration of all other active carious
lesions.
Follow-up
After 14 years, the success of the treatment was assessed
with 16 being symptom-free, caries arrested and no
apparent pathology clinically or radiographically even
though the restoration had been lost. Endodontic treatment
was not necessary and the tooth survival time was
increased, keeping the pulp vital and without any apical
pathologies. Thus, in this phase, a direct restoration with
Filtek Z350 composite resin (3M ESPE) was performed
(Fig. 3) to restore aesthetics and function of the tooth.
Discussion
The use of minimal invasive techniques related to caries
removal has increased in dentistry, since partial dentine
caries removal has been considered a successful therapy,
keeping the pulp vitality and providing higher survival
rates for the tooth (Maltz et al. 2011). Moreover, micro-
biological evaluations have shown that the removal of all
carious dentine before the placement of the restoration is
not necessary, since lower bacterial levels and the rem-
ineralisation of the affected dentine has been found after
partial caries removal and sealing of the tooth (Maltz et al.
2002, 2012).
Another relevant question in relation to partial caries
removal is the benefit of this conservative approach in
clinical practice, mainly in dental public service clinics,
due to its simplicity and lower operative time compared to
total caries removal (Torabzadeh and Asgary 2013; Fran-
zon et al. 2014), as observed in this study. The clinical and
radiographic results seem to be due to of an adequate
sealing to promote lesion inactivation, tooth
Eur Arch Paediatr Dent (2017) 18:423–426
Fig. 2 a Deep caries lesions in tooth 16. b Partial caries removal. c Capping with a calcium hydroxide cement, and restoration using glass
ionomer cement
Fig. 3 a Clinical aspect of tooth 16 after 14 years. b Periapical radiograph. c Tooth filled with resin composite
remineralisation and not of the capping material used, an
advantage (Falster et al. 2002).
Although the restoration had been lost after a long
time, clinical and radiographic success was observed.
The sealed carious dentine was remineralised and the
tooth had pulp vitality as has been demonstrated by other
researchers (Maltz et al. 2002, 2011). Additionally, the
non-retentive characteristic of the dental cavity favoured
the performance of an adequate brushing by the patient,
keeping the cavity free of biofilm (Pitts 2004; Ekstrand
and Christiansen 2005). Therefore, the inhibition of
caries progression was obtained and the tooth survival
time increased.
Since endodontic treatment of tooth 16 was not needed,
after 14 years following partial caries removal, a direct
restoration with resin composite was performed in order to
reestablish the tooth anatomy and function (Md et al.
2014). Therefore, partial caries removal was shown to be
an effective method to treat deep carious lesions, as
reported in the literature (Maltz and Alves 2013), main-
taining healthy teeth for a longer time, which is the goal of
dentistry.
425
Conclusion
Partial caries removal increases the dental survival time,
avoiding the necessity of endodontic treatment and early
dental loss.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Informed consent Informed consent was obtained from the partici-
pant included in the study.
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