Selective Removal of Carious Tissue.

Describing and quantifying how much carious tissue should be removed prior to placing a restoration has been a long-debated issue stretching back as far as G.V. Black's "complete caries removal," now known as non-selective carious tissue removal. Originating in the 1960s and 1970s, from the differentiation between different layers of carious dentine, an outer contaminated ("infected") layer and an inner demineralised ("affected") layer, the former of which needed to be removed during cavity preparation and the latter not, selective carious tissue removal was born. Currently, it is termed selective removal to firm dentine. This chapter describes different selective carious tissue removal techniques (to firm, to leathery, to soft dentine) and how they can be achieved appropriately with conventional and novel techniques. Selective removal to firm dentine is recommended for shallow or moderately deep lesions, while for deep lesions (extending close to the pulp) in teeth with vital pulps, selective removal to soft dentine is recommended to avoid pulpal exposure and to preserve the health of the pulp. Leaving soft carious dentine beneath a restoration does, however, raise certain issues regarding how we truly assess pulpal health, what would other dental practitioners think if the patient moved practice, and how do we monitor such sealed residual caries in the future. These issues will all be discussed in this chapter but should at present not preclude dental practitioners from adopting such a minimally invasive evidence-based approach to carious tissue removal.