Outcomes of One-Step Incomplete and Complete Excavation in Primary Teeth: A 24-Month Randomized Controlled Trial

Abstract

Aim: To compare 24-month pulp health outcomes of partial caries removal (PCR) and total caries removal (TCR) with composite restoration in primary molars. Methods: 48 children aged 3-8 years with at least one molar with a deep carious lesion were included. 120 teeth were randomized to control (TCR; n = 54; 69% class II) and test (PCR; n = 66; 63% class II) groups. Total absence of carious tissue was confirmed using a blunt-tipped probe in the TCR group. For PCR, excavation was stopped when hardened, dried dentin with a leathery consistency was achieved. Pulpotomy was performed in cases of pulp exposure. Results: Pulp exposure occurred in 2 and 27.5% of teeth treated with PCR and TCR, respectively (p < 0.01). The operative time was significantly higher for TCR than PCR. Success rates were 92 and 96% in the PCR and TCR groups, respectively (p = 0.34). The success rate tended to be lower in occlusoproximal (92%) than in occlusal (100%) lesions (p = 0.08). Conclusion: The clinical and radiographic success rates of PCR and TCR in primary teeth with deep carious lesions were high and did not differ significantly, indicating that PCR is a reliable minimally invasive approach in primary teeth and that the retention of carious dentin does not interfere with pulp vitality. Moreover, PCR provided other clinically relevant advantages over TCR, especially lower incidence of pulp exposure and lower operative time.

Effectiveness, Costs and Patient Acceptance of a Conventional and a Biological Treatment Approach for Carious Primary Teeth in Children

“…The discussion about what might be the best treatment approach for restoring active deep CL extending into the dentine in primary teeth within the profession was triggered by research published with contradicting views on each treatment [Innes et al, 2007;Franzon et al, 2014]. However, none of these studies explored the cost effectiveness and acceptance from a child and carers perspective when these 2 approaches were delivered by specialist paediatric dentists.…”

Efectividad de la Remoción Parcial de Caries en Molares Primarios con Lesiones de Caries Profunda. Ensayo Clínico Aleatorizado

“…Nuestros hallazgos concuerdan con lo reportado por Franzon et al (2014) donde las tasas de éxito clínico y radiográfico de ambos tratamiento en dientes primarios con lesiones cariosas profundas fueron altas y no difirieron significativamente. Además concluyen que la RPC es un abordaje mínimamente invasivo fiable en los dientes primarios y que la retención de la dentina cariada no interfiere con la vitalidad pulpar.…”

Survival and Associated Risk Factors of Selective Caries Removal Treatments in Primary Teeth: A Retrospective Study in a High Caries Risk Population

“…Moreover, the cost-effectiveness advantages of selective excavation were more pronounced in high-risk groups [Schwendicke et al, 2014]. Additionally, 1-step SCR reduces patient pain and is a less time-consuming technique, considering the increased risk of pulp exposure of complete caries removal [Franzon et al, 2014], reducing costs and keeping teeth vital for longer [Schwendicke et al, 2013c].…”

“…Recently, an RCT demonstrated high rates of clinical and radiographic success of selective and complete caries removal in primary teeth with deep carious lesions, which did not differ significantly. However, as an additional advantage, 1-step incomplete excavation (selective) requires less treatment time and results in lower levels of discomfort for the patients, which is especially important when treating children [Franzon et al, 2014].…”