Pulp-dentin biology in restorative dentistry. Part 4: Dental caries--characteristics of lesions and pulpal reactions.

The infectious disease dental caries results in lesions that may affect enamel, dentin, pulp, and cementum. If a caries lesion has progressed to the stage at which it requires restorative intervention, it is important that the clinician understand the tissue changes in the dentin that are likely to have taken place during lesion development. Until the present, no major distinction between the restorative treatment of active (rapidly progressing) and arrested (slowly progressing) lesions has been made, despite the fact that the two conditions exhibit major differences in tissue changes in the pulp-dentin complex. Intratubular changes and tertiary dentin formation will affect the outcome of the restorative treatment. In unaffected dentin and in rapidly progressing lesions, permeable tubules persist, and when the preparation of carious teeth results in the opening of unaffected dentin, greater care must be taken in all phases of the restorative procedures than if the dentin is impermeable. An active, deep lesion can be changed to an arrested lesion by a two-step excavation approach. Optimal assessment of the prevailing clinical conditions can only be made on the basis of thorough knowledge of the biology of the pulp-dentin organ.