Caries Clearance Management: A Clinical Diagnostic Restorative Procedure—Case Studies

Background: Traditional visual-tactile methods, radiographic interpretation including CBCT imaging, clinical judgement and supplementary aids such as fluorescence-based devices are pivotal components of the restorative diagnostic process in detecting dental caries and defective or failed restorations. However, when evaluating the restorability of a tooth compromised by extensive and deep caries, whether associated with a failed restoration or not, the conventional approach may not provide sufficient diagnostic information to establish a definitive restorative diagnosis without first removing failing restoration, caries or both. Objective: This manuscript presents caries clearance management (CCM) as a novel comprehensive clinical diagnostic restorative procedure designed to assist dentists in making a final restorative diagnosis regarding the restorability of a tooth compromised by extensive caries, fractured tooth cusp(s) or a failed large direct/indirect restoration without caries or a combination of all of them. Practical implications: CCM involves removing the failed direct/indirect restorations and selective removal of carious tissue while preserving the greatest amount of sound tooth structure as possible. Following this clinical diagnostic procedure and an assessment of dental pulp and periodontium, the clinician proceeds through a decision-making process to determine the final restorative diagnosis. This allows the dentist to advise the patient on a suitable complex restorative treatment plan. Conclusions: The manuscript introduces caries clearance management (CCM) as a structured clinical diagnostic procedure, to assist dentists to determine the restorability of compromised teeth by extensive caries, fractured teeth or failed large direct or indirect restorations.