title: Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy.
abstract: 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.
authors.affiliation: Dental School, University of Copenhagen, Copenhagen, Denmark. labj@sund.ku.dk
authors.forename: Lars
authors.initials: L
authors.lastname: Bjørndal
authors.forename: Claes
authors.initials: C
authors.lastname: Reit
authors.forename: Gitte
authors.initials: G
authors.lastname: Bruun
authors.forename: Merete
authors.initials: M
authors.lastname: Markvart
authors.forename: Marianne
authors.initials: M
authors.lastname: Kjaeldgaard
authors.forename: Peggy
authors.initials: P
authors.lastname: Näsman
authors.forename: Marianne
authors.initials: M
authors.lastname: Thordrup
authors.forename: Irene
authors.initials: I
authors.lastname: Dige
authors.forename: Bente
authors.initials: B
authors.lastname: Nyvad
authors.forename: Helena
authors.initials: H
authors.lastname: Fransson
authors.forename: Anders
authors.initials: A
authors.lastname: Lager
authors.forename: Dan
authors.initials: D
authors.lastname: Ericson
authors.forename: Kerstin
authors.initials: K
authors.lastname: Petersson
authors.forename: Jadranka
authors.initials: J
authors.lastname: Olsson
authors.forename: Eva M
authors.initials: EM
authors.lastname: Santimano
authors.forename: Anette
authors.initials: A
authors.lastname: Wennström
authors.forename: Per
authors.initials: P
authors.lastname: Winkel
authors.forename: Christian
authors.initials: C
authors.lastname: Gluud
mesh_terms: 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
chemical_list: D005899:Glass Ionomer Cements; D008903:Minerals; C451600:OptiBond Solo Plus; D019279:Resin Cements; C110712:ketac-molar; C065770:Herculite XR; C025702:Dycal; D002126:Calcium Hydroxide