Selective versus stepwise removal of deep carious lesions in permanent teeth: a randomised controlled trial from Egypt—an interim analysis

Abstract

ObjectivesTo compare the success, survival and costs of selective versus stepwise carious tissue removal (SE/SW) in permanent teeth with deep (>2/3 dentine depth) carious lesions.DesignRandomised controlled, unicentre, clustered two-arm superiority trial.SettingOutpatient clinic of a private university in Cairo, Egypt.ParticipantsOne hundred and fifteen participants (n=132 teeth), aged 18–47 years, from Cairo, Egypt, were enrolled. Premolars/molars with occlusal/occlusal-proximal deep lesions (radiographically >2/3 dentine), sensible pulps, without spontaneous pain, were included.InterventionsPeripheral carious tissue removal to hard dentine was performed. Pulpo-proximally, soft dentine was left. A glass ionomer (GI) restoration was placed. After 3–4 months, teeth were randomly allocated to SE (n=66), with reduction of the GI into a base and no further tissue removal, followed by a composite resin restoration, or SW (n=66), with full removal of the GI, additional excavation until firm dentine pulpo-proximally, followed by a GI-based composite restoration. Mean follow-up was 1 year.Primary and secondary outcome measuresPrimary outcome was success (absence of endodontic/restorative complications). Secondary outcomes were tooth survival and initial and total treatment costs.ResultsZero/five pulp exposures occurred during SE/SW, and seven/five SE/SW teeth required endodontic therapy. Success after 12 months was 89.4% for SE and 84.9% for SW. The estimated mean time free of complications was 23 and 18 months for SE and SW, respectively, without significant differences between SE and SW (p>0.05/Cox). Initial treatment costs were significantly higher for SW (mean (SD): 507.5 (123.4) Egyptian pounds (EGP)) than SE (mean (SD): 456.6 (98.3) EGP), while total costs showed no significant difference (p>0.05).ConclusionWithin the limitations of this interim analysis, and considering the depth of these lesions (>2/3 dentine), SE and SW showed similar risk of failure and overall costs after 1 year.Trial registration numberPACTR201603001396248.

Remoção seletiva de tecido cariado: uma revisão integrativa da literatura

“…Além desses resultados, observou-se, ainda, uma taxa elevada da manutenção da vitalidade pulpar quando aplicado a RPTC, o que enfatiza uma melhor preservação do elemento dentário se comparado ao tratamento expectante, possibilitando uma reabilitação mais simples, rápida e acessível aos pacientes. Labib,et al (2019), por meio de um estudo unicêntrico de dois braços, realizado no Egito, compararam o desfecho clínico após a remoção seletiva (RS) e a escavação em etapas (ET) em dentes permanentes. Foram alocados para essa análise, elementos dentários com lesões cariosas envolvendo mais de dois terços da dentina e que apresentavam polpas vitais.…”

Dental Caries and Its Management

“…Any signs or symptoms of a possible pulp pathosis should be evaluated, and a sensibility/vitality test must be performed. Selective removal to firm/hard, dry dentine is carried out centrally, or glass ionomer may be used as a base with no additional tissue removal, followed by a composite resin restoration [ 10 ].…”

“…Unfortunately, many dentists continue to treat dental caries and pulp disease with invasive procedures [9]. However, it will undoubtedly take time for a shift to noninvasive and minimally invasive approaches in everyday clinical practice [5,[10][11][12].…”

Behandlingar av vital pulpa i tänder med djupa karieslesioner

“…Eftersom det finns få direkta jämförande studier av vital pulpabehandling är underlaget för att genomföra hälsoekonomiska bedömningar svagt och få studier har publicerats [27,28,34,35,46,47].…”