Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy.
Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (-22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.
Bjørndal
Lars
L
Dental School, University of Copenhagen, Copenhagen, Denmark. labj@sund.ku.dk
Reit
Claes
C
Bruun
Gitte
G
Markvart
Merete
M
Kjaeldgaard
Marianne
M
Näsman
Peggy
P
Thordrup
Marianne
M
Dige
Irene
I
Nyvad
Bente
B
Fransson
Helena
H
Lager
Anders
A
Ericson
Dan
D
Petersson
Kerstin
K
Olsson
Jadranka
J
Santimano
Eva M
EM
Wennström
Anette
A
Winkel
Per
P
Gluud
Christian
C
D000328:Adult; D002126:Calcium Hydroxide / Q000627:therapeutic use; D003731:Dental Caries / Q000000981:diagnostic imaging / Q000628:therapy*; D003736:Dental Cavity Lining; D003737:Dental Cavity Preparation / Q000295:instrumentation / Q000379:methods*; D003782:Dental Pulp / Q000000981:diagnostic imaging / Q000502:physiology; D003785:Dental Pulp Capping / Q000379:methods*; D003789:Dental Pulp Exposure / Q000517:prevention & control; D003791:Dental Pulp Test; D003793:Dental Restoration, Permanent / Q000379:methods; D003794:Dental Restoration, Temporary / Q000379:methods; D003804:Dentin / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005899:Glass Ionomer Cements; D006801:Humans; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000627:therapeutic use; D010486:Periapical Tissue / Q000000981:diagnostic imaging; D011672:Pulpotomy / Q000295:instrumentation / Q000379:methods*; D016300:Radiography, Bitewing; D019279:Resin Cements; D016896:Treatment Outcome
D005899:Glass Ionomer Cements; D008903:Minerals; C451600:OptiBond Solo Plus; D019279:Resin Cements; C110712:ketac-molar; C065770:Herculite XR; C025702:Dycal; D002126:Calcium Hydroxide