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Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial

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Abstract

Objective

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.

Methods

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).

Results

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].

Conclusion

PCR significantly reduced the occurrence of pulp necrosis when compared with SW.

Clinical relevance

This study supports the PCR as a single-visit technique to manage deep caries lesions in permanent teeth.

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Funding

This study was supported by CNPq (grant no. 40.3420/04-0), FAPERGS (grant no. 04/1531-8), CAPES (PhD fellowship), and the industries DFL (Rio de Janeiro, Brazil), Ivoclar/Vivadent (Schaan, Liechtenstein), SDI (Bayswater WA, Australia), and Hu-Friedy (Chicago, IL, USA).

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Authors and Affiliations

  1. Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil

    M. Maltz, B. Koppe, J. J. Jardim & M. S. Moura

  2. Department of Restorative Dentistry, School of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil

    L. S. Alves

  3. Department of Dentistry, University of Brasília, Brasília, Brazil

    L. M. de Paula, P. M. Yamaguti, J. C. F. Almeida & H. D. Mestrinho

Authors
  1. M. Maltz
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  2. B. Koppe
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  3. J. J. Jardim
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  4. L. S. Alves
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  5. L. M. de Paula
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  6. P. M. Yamaguti
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  7. J. C. F. Almeida
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  8. M. S. Moura
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  9. H. D. Mestrinho
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Corresponding author

Correspondence to J. J. Jardim.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

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.

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Maltz, M., Koppe, B., Jardim, J.J. et al. Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial. Clin Oral Invest 22, 1337–1343 (2018). https://doi.org/10.1007/s00784-017-2221-0

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  • DOI: https://doi.org/10.1007/s00784-017-2221-0

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