Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial
- 489 Downloads
This multicenter randomized controlled clinical trial aimed to compare the outcomes of stepwise excavation (SW) and partial caries removal (PCR) regarding the maintenance of pulp vitality in deep caries lesions over 5 years.
At baseline, 299 permanent molars with deep caries lesions were randomly assigned to control or test groups. The control group received the stepwise excavation treatment (SW), while the test group received partial caries removal from the pulpal wall followed by restoration in a single session (PCR). Treatments were conducted in two centers located in the cities of Porto Alegre (South Brazil) and Brasília (Midwest Brazil). Survival analysis was performed to compare PCR and SW over time (Weibull regression models). The primary outcome of this study was pulp vitality, determined by the combination of the following characteristics: positive response to cold test, negative response to percussion, absence of spontaneous pain, and absence of periapical lesion (radiographic examination).
This 5-year study includes data pertaining to 229 teeth: 121 teeth actually examined at the 5-year appointment, and 108 teeth contributed with data collected in previous follow-ups (18 months or 3 years). Survival analysis showed success rates of 80% in PCR group and 56% in SW group (p < 0.001). Failure was significantly associated with treatment [PCR, HR=0.38; 95%CI=0.23–0.63)] and region [South, HR=2.22; 95%CI=1.21–4.08].
PCR significantly reduced the occurrence of pulp necrosis when compared with SW.
This study supports the PCR as a single-visit technique to manage deep caries lesions in permanent teeth.
KeywordsDental caries Clinical trial Permanent dentition Survival analysis Permanent dental restoration Dental pulp
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study protocol was approved by the Federal University of Rio Grande do Sul Ethics Committee (protocol 18/05), by the Porto Alegre Municipal Ethics Committee (protocol 27/06), by the Conceição Hospital Group Ethics Committee (protocol 070/05), and by the Brasília University Hospital Ethics Committee (protocol 045/2005). All procedures were in accordance with the ethical standards of these research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
All subjects were informed on the research risks and purposes and signed a written informed consent. Patients received dental care by the researchers throughout their participation in the study. No financial incentive was paid for the participants.
- 9.Bjørndal L, Reit C, Bruun G, Markvart M, Kjaeldgaard M, Näsman P et al (2010) Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci 118:290–297CrossRefPubMedGoogle Scholar
- 10.Jardim JJ (2010) Partial caries removal in permanent teeth. Federal University of Rio Grande do Sul, Porto AlegreGoogle Scholar
- 15.Ricketts DN, Kidd EA, Innes N, Clarkson J (2006) Complete or ultraconservative removal of decayed tissue in unfilled teeth. Cochrane Database Syst Rev 3:CD003808Google Scholar
- 22.Maltz M, Henz S, Oliveira E (2004) A microbiological study of conventional and incomplete dentine caries removal. Caries Res 38:367 (abstract n. 30)Google Scholar
- 23.Marchi JJ, Froner AM, Alves HL, Bergmann CP, Araujo FB (2008) Analysis of primary tooth dentin after indirect pulp capping. J Dent Child (Chic) 75:295–300Google Scholar
- 27.Parolo C, Heller D, Bitello L, Podestá K, Souza D, Hashizume L et al (2007) Effectiveness of the stepwise excavation treatment performed by dental students in Porto Alegre, Brazil. Caries Res 41:269 (abstract n. 5)Google Scholar
- 32.Miller RB (2007) Attrition bias. Encyclopedia of Measurement and Statisics. Ed. Neil Salkind. 3 vols. Thousand Oaks: Sage. Vol. 1. Pages 57–60Google Scholar