Self-Limiting versus Conventional Caries Removal: A Randomized Clinical Trial

Abstract

A single-blind randomized controlled clinical trial in patients with deep caries and symptoms of reversible pulpitis compared outcomes from a self-limiting excavation protocol using chemomechanical Carisolv gel/operating microscope (self-limiting) versus selective removal to leathery dentin using rotary burs (control). This was followed by pulp protection with mineral trioxide aggregate (MTA) and restoration with glass ionomer cement and resin composite, all in a single visit. The pulp sensibility and periapical health of teeth were assessed after 12 mo, in addition to the differences in bacterial tissue concentration postexcavation. Apical radiolucencies were assessed using cone beam computed tomography/periapical radiographs (CBCT/PAs) taken at baseline 0 mo (M0) and 12 mo (M12). In total, 101 restorations in 86 patients were placed and paired subsurface, and deep (postexcavation) dentin samples were obtained. DNA was extracted and bacteria-specific 16S ribosomal RNA gene quantitative polymerase chain reaction was performed. No significant difference was found in bacterial copy numbers normalized to mass of dentin ("bacterial tissue concentration") between the self-limiting (96.3% reduction) and control protocols (97.1%, P = 0.33). The probability of 12-mo success was 4 times (odds ratio [OR] = 4.33; confidence interval [CI], 1.2-15.6; P = 0.025) higher in the self-limiting protocol compared to the control (conventional excavation technique), with pulp survival rates of 73.3% and 90%, respectively ( P = 0.049). Molars had a 4 times higher probability of success compared to premolars (OR, 4.17; CI, 1.17-14.9; P = 0.028), and symptom severity did not statistically predict outcome (OR, 0.41; CI, 0.12-13.9, P = 0.153). CBCT detected significantly more periapical (PA) lesions than PA radiographs at the baseline visit ( P < 0.001). In conclusion, the self-limiting caries excavation protocol under magnification increased pulp survival rate compared to rotary bur excavation ( ClinicalTrials.gov NCT03071588).

Self-Limiting versus Rotary Subjective Carious Tissue Removal: A Randomized Controlled Clinical Trial—2-Year Results

“…Although this trial was not powered to investigate the effect of tooth type on the outcome, at two years, in total and within the self-limiting group, a statistically significant predictor of success/failure of the treatment was tooth type where, compared to premolars, a higher odds of success for molars was observed. Similar findings were observed for the 1-year results [ 13 ]. This may be attributed to the fact that molars have a larger pulp which can provide collateral vascular and neuronal innervations to the inflamed areas.…”

“…Chemomechanical Carisolv gel aids the retention of the affected dentine and helps eliminate the infected dentine [ 11 , 12 ]. In combination with an operating microscope, excavation of carious tissue using Carisolv gel has proven to maintain pulp sensibility and reduce the loss of sound tooth structure [ 13 ]. In deep carious lesions in patients presenting with symptoms of reversible pulpitis, the 1- and 2-year clinical outcomes of two alternative excavation protocols were investigated in this randomized controlled clinical trial (RCT).…”

“…The outcome was not predicted by symptom severity. Additionally, periapical lesions detected by cone-beam computer tomography (CBCT) at the baseline visit (T0) were statistically significantly more than that detected by periapical radiographs [ 13 ].…”

Vital Pulp Therapy An insight over the available literature and future expectations

“…Another advantage offered by VPT over conventional RCT is better protective resistance against masticatory forces chemo mechanical Carisolv gel and dental microscope (selflimiting) versus selective removal to dentine using rotary burs, followed by MTA pulpal protection and Glass Ionomer (GI) final restoration. Results showed that after 12 months the probability of success rates was four times higher in cases of self-limiting technique rather than the conventional technique (22). This may indicates that shifting the caries removal from the conventional technique to the self-limiting technique in vital pulp therapy cases could increase success rates.…”

To Fill or do a Root Canal??? That’s the Question

“…In comparison to complete caries removal, partial caries removal at a single visit has emerged as an equally efficacious technique as stepwise technique in very deep carious lesions with poor prognosis (Table 2). No statistical significant superiority has been observed with any of the reviewed materials used for IPC; if the technique and final seal are good -the IPC has a good chance of survival [13,18] Some other outcomes elicited are-CBCT [12,25,27] and higher magnification [27] are better predictors of detection of baseline lesions therefore giving rise to improved prognosis of 38% healed lesions after IPC.…”