Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

Moderate 
(more than 2 mm of
dentine remaining)
(L) with glass-ionomer
cement
and
(S) with dentine
desensitiser
(S) with dentine
bonding agent
Minimum 
(just into dentine)
(S) with dentine
desensitiser
(S) with dentine
bonding agent
Table 2.2
Amalgam and resin composite restoration preparation.
Amalgam
restoration
Resin composite
restoration
Deep 
(less than 2 mm of 
dentine remaining)
(L) with glass-ionomer
cement always
and
(S) with dentine desensitiser.
Hard setting calcium
hydroxide may be placed 
in deeper areas if indicated
(L) with calcium hydroxide
and glass-ionomer cement 
in deeper areas if indicated
and
(S) with dentine bonding
agent
(S) 
= Sealer; (L) = Liner; (B) = Base.
POOC02 02/18/2005 04:33PM Page 41

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Stepwise caries removal
Where gross caries is present in a tooth, an assessment should be
made of the likelihood of creating a carious exposure should all caries
be removed. In the situation in which risk of an exposure is high, it is
prudent to remove only the peripheral caries and the majority of
caries on the pulpal floor. A calcium hydroxide dressing (to encour-
age formation of tertiary dentine and kill any remaining bacteria) and
a well-sealed temporary restoration is then placed. Approximately 
3 months later, re-exploration of the cavity is performed and remain-
ing caries removed. Such an approach reduces the incidence of pulpal
exposures and subsequent loss of vitality
24,25
.
Pulp capping
Direct pulp capping
A direct pulp cap is the term for the procedure in which a
dressing/lining (or restorative material) is placed into direct contact
with exposed pulpal tissue. This is usually carried out following a 
carious or traumatic exposure. Calcium hydroxide is most commonly
used; however some workers have directly bonded resin composite
over exposures and mineral trioxide aggregate may show promise as
an alternative (although currently it is relatively expensive).