Carious lesions can range from early, non-detectable mineral loss, restricted
to enamel, through to lesions that extend into dentine without any surface cavitation, to
cavitated lesions, which destroy the tooth tissue and can be visible as cavities in the
teeth. Cavitated caries lesions generally are non-cleansable and thus active; therefore,
these lesions most commonly need to be restored. Selective removal of carious tissues
is guided by the depth of the lesion, pulpal health, and choice of dental material.
Fluoride is the cornerstone of the non-invasive management of non-cavitated caries
lesions. Still, its ability to promote net remineralisation is limited by the availability of
calcium and phosphate ions. Ideal remineralisation material should diffuse or deliver
calcium and phosphate into the subsurface lesion or boost the remineralisation
properties of saliva and oral reservoirs without increasing the risk of calculus
formation. These options are often no longer feasible for carious lesions where the
tooth tissue surface has become cavitated, as the biofilm is sheltered and cannot be
easily removed or manipulated. In such situations, invasive (restorative) options are
required. With the advent of adhesive restorations and facilitated by the described
changing understanding of the pathogenesis of caries and carious lesions, a paradigm
shift in restorative dentistry occurred. In asymptomatic, vital teeth with deep lesions,
conservative carious tissue removal strategy,s that reduce tissue loss and pulp exposure
risk must be balanced against removing adequate tissue to maximise restoration
longevity. In two stages, the most recent inspiration for stepwise carious removal
originates from the knowhow on Intra lesion changes in deep carious lesions. Natural
enamel and dentin are still the best “dental materials” in existence; therefore, minimally
invasive procedures that conserve a more significant part of the wild, healthy tooth
structure must be considered desirable. Ultraconservative dentistry represents a
significant step forward for the dentist, the profession, and especially the patient. A
changing understanding of the disease of dental caries has initiated a paradigm shift in
the management of carious lesions. Instead of merely removing the symptoms of the
carious lesion, any treatment aims to manage the disease.
Keywords: Cavitated Lesion, Demineralisation, Dental Caries, Fluoride, Minimally Invasive Dentistry, Non-cavitated Lesion, Stepwise Excavation of Caries, Remineralisation, Restoration, The Death Spiral of Teeth, Ultraconservative Treatment.
