Avoiding pulp exposure in deep caries lesions: stepwise excavation technique / Evitando a exposição pulpar em lesões de cárie profunda com tratamento expectante

ABSTRACT In cases of deep caries lesions, total removal of carious tissue can cause accidental pulp exposure, which can be avoided by using the stepwise excavation technique. This consists of the partial excavation of contaminated dentin and the application of a biomaterial, such as calcium hydroxide, with the aim of diminishing progression of the lesion or even arresting it. The aim of the article is to describe a clinical case in which the stepwise excavation technique was performed, relating its advantages, limitations and recommendations. A fourteen-year-old boy reported non-spontaneous pain in tooth 37. The clinical and radiographic examinations indicated an extensive cavity, with a risk of pulp exposure during removal of carious tissue; reversible pulpitis was diagnosed. The stepwise excavation technique was performed. Radiographic examinations performed at 12, 18 and 36 months showed a normal appearance in the apical region and an increase in tertiary dentin was observed. The stepwise excavation technique can be considered a safe therapy, scientifically corroborated, with a high rate of success, however with limited indications, since it requires the teeth to be young and the pulp to present as normal or with reversible inflammation. Indexing terms: Dental caries. Dentin. Calcium hydroxide. RESUMO Nos casos de lesoes cariosas profundas, a remocao total do tecido cariado pode causar uma exposicao pulpar acidental, o que pode ser evitado utilizando-se o tratamento expectante. Este consiste na escavacao parcial da dentina contaminada e aplicacao de um biomaterial, como o hidroxido de calcio, visando a diminuicao da progressao da lesao ou ate mesmo sua paralisacao. Este artigo tem por objetivo descrever um caso clinico no qual o tratamento expectante foi realizado, relatando suas vantagens, limitacoes e indicacoes. Um paciente do sexo masculino, de 14 anos de idade, apresentava dor espontânea no dente 37. Os exames clinico e radiografico indicaram uma lesao extensa, com risco de exposicao pulpar; foi diagnosticada pulpite reversivel. O tratamento expectante foi realizado e exames radiograficos feitos apos 12, 18 e 36 meses indicaram normalidade na regiao apical, com formacao de dentina terciaria. O tratamento expectante pode ser considerado seguro, cientificamente comprovado e com grande indice de sucesso, entretanto com indicacao limitada, visto que requer um dente jovem, com polpa normal ou reversivelmente inflamada. Termos de indexacao: Carie dentaria. Dentina. Hidroxido de calcio.