Neglected causing pulp inflammation which requires Endodontic treatment.

Neglected damaged teeth are more difficult to treat.

the small spot of caries is not treated then it’s only a matter of time before it
penetrates the solid tissues of the tooth and gives way to infection via root
canals. These cases cause the patient to have to go for more than one dental appointment.

In worst cases the caries may damage pulp causing pulp inflammation which
requires Endodontic treatment.  Complex
caries occurs when one allows caries to spread deeper into the tooth, causing a
longer and complex treatment to occur.

Treatment requires:

1. Gaining access to the caries

2. Removal of caries at the enamel-dentin junction

3. Removal of caries over the pulp. Using
low speed burs, or hand excavators. Due to complex caries, it can be a stepwise
excavation. Where caries removal is accomplished over two visits and the
interval between visits can vary.

4. During complex caries where caries is deep we might
need pulp capping, the purpose is to maintain pulp
vitality. It is needed when there is pulp exposure, done directly or
indirectly. Materials used are calcium hydroxide, MTA and Biodentin. Calcium
hydroxide encourages reparative dentin formation and kills of remaining

5. Restoration

Only some of soft dentin is removed
during first visit, the lesion is then restored. At the second visit, tooth is
reopened and the soft caries can be removed, and tooth is restored definitively

A successful pulp capping: Maintain pulp
vitality, not cause any pain or sensitivity, minimal pulp inflammatory