File:Principles and practice of operative dentistry (1920) (14595819279).jpg

Identifier: principlespracti1920mars (find matches)
Title: Principles and practice of operative dentistry
Year: 1920 (1920s)
Authors: Marshall, John Sayre, 1846-1922
Subjects: Dentistry, Operative
Publisher: Philadelphia and London, J.B. Lippincott
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ubsequent cuts of the excavator, so far as possible,follow a line from the centre of the tooth to the periphery, rather thanfrom the periphery to the centre. In the leathery form of carious dentin,many operators advise removing the dentin layer by layer, beginning atthe periphery of the cavity and gradually lifting them out until all of thematerial of this character has been removed. The excavator should be kept sharp, and each cut of the instrumentshould be decided. Scraping of the sensitive dentin is much more painfulthan a firm, decided cut that accomplishes something. The greatest kind-ness that can be shown a patient under these circumstances is to be thorough,but at the same time rapid ; and these conditions are not inconsistent to themind of the bold but conscientious operator. PREPARATION OF CAVITIES. 293 Thorough excavation of a cavity comprehends the removal of all dis-organized and infected dentin. This may not always be done with safety Fig. 373. if I S r? ^ tf f M I ! I H
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Excavators. to the pulp, but, as a general rule, this procedure should be carried out.There is only one way to determine when all infected tissue has been re-moved, and that is by the density of the tissue. All soft, leathery dentin is 294 OPERATIVE DENTISTRY. infected, but Miller has proved that all partially decalcified dentin is notinfected, as the process of decalcification is always in advance of thepresence of the micro-organisms in the tubuli. The meaning of the term thorough excavation would necessarily, then,depend somewhat upon the judgment and experience of the operator asto whether all infected tissue had or had not been removed. The onlysafe method, except in the case of nearly exposed pulps, is to excavateuntil sound, hard dentin has been reached. Partially decalcified dentin may be allowed to remain in the bottom ofthe cavity, as recalcification will usually take place in this tissue, andalso for the reason that it will protect the pulp from thermal shock.^-Thorough dis

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