title: Randomized trial of partial vs. stepwise caries removal: 3-year follow-up.
abstract: This randomized, multicenter clinical trial evaluated the effectiveness of 2 treatments for deep caries lesions - partial caries removal (PCR) and stepwise excavation (SW) - with respect to the primary outcome of pulp vitality for a 3-year follow-up period. Inclusion criteria were as follows: patients with permanent molars presenting deep caries lesions (lesion affecting ≥ 1/2 of the dentin on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions (radiographic examination). Teeth randomly assigned to PCR (test) received incomplete caries removal and filling in a single session. Outcome success was evaluated by assessment of pulp vitality, determined by pulp sensitivity to a cold test and the absence of periapical lesions. Data were analyzed by a Weibull regression model with shared frailty term (survival analysis). At baseline, 299 treatments were executed: PCR, 152 and SW, 147. By the end of the 3-year follow-up period, 213 teeth had been evaluated. Adjusted survival rates were 91% for PCR and 69% for SW (p = 0.004). These results suggest that there is no need to re-open a cavity and perform a second excavation for pulp vitality to be preserved (Clinical trials registration NCT00887952).
authors.affiliation: Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. marisa.maltz@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Maltz
authors.forename: R
authors.initials: R
authors.lastname: Garcia
authors.forename: J J
authors.initials: JJ
authors.lastname: Jardim
authors.forename: L M
authors.initials: LM
authors.lastname: de Paula
authors.forename: P M
authors.initials: PM
authors.lastname: Yamaguti
authors.forename: M S
authors.initials: MS
authors.lastname: Moura
authors.forename: F
authors.initials: F
authors.lastname: Garcia
authors.forename: C
authors.initials: C
authors.lastname: Nascimento
authors.forename: A
authors.initials: A
authors.lastname: Oliveira
authors.forename: H D
authors.initials: HD
authors.lastname: Mestrinho
mesh_terms: D000293:Adolescent; D000328:Adult; D058070:Asymptomatic Diseases; D002648:Child; D003731:Dental Caries / Q000628:therapy*; D003737:Dental Cavity Preparation / Q000379:methods*; D003782:Dental Pulp / Q000502:physiology; D003793:Dental Restoration, Permanent / Q000379:methods*; D003804:Dentin / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008963:Molar / Q000473:pathology; D012044:Regression Analysis; D016037:Single-Blind Method; D016019:Survival Analysis; D055815:Young Adult