Subjective versus objective, polymer bur-based selective carious tissue removal: 1-year interim analysis of a randomized clinical trial

Abstract

We aimed to compare subjective (S) vs. objective (O) selective carious tissue removal using hand-excavation versus a self-limiting polymer bur, respectively. A community-based single-blind cluster-randomized controlled superiority trial was performed. This is a 1-year-interim analysis. 115 children (age 7–8 years) with ≥1 vital primary molar with a deep dentin lesion (>1/2 dentin depth) were included (60 S/55 O). The cluster was the child, with eligible molars being treated identically (91 S/86 O). Cavities were prepared and carious tissue on pulpo-proximal walls selectively removed using hand instruments (S), or a self-limiting polymer bur (Polybur P1, Komet). Cavities were restored using glass-hybrid material (Equia Forte, GC). Treatment times and children’s satisfaction were recorded. Generalized-linear models (GLM) and multi-level Cox-regression analysis were applied. Initial treatment times were not significantly different between protocols (mean; 95%CI S: 433; 404–462 sec; O: 412; 382-441 sec; p = 0.378/GLM). There was no significant difference in patients’ satisfaction (p = 0.164). No pulpal exposures occurred. 113 children were re-examined. Failures occurred in 22/84 O-molars (26.2%) and 26/90 S-molars (28.9%). Pulpal complications occurred in 5(6%) O and 2(2.2%) S molars, respectively. Risk of failure was not significantly associated with the removal protocol, age, sex, dental arch or tooth type (p > 0.05/Cox), but was nearly 5-times higher in multi-surface than single-surface restorations (HR: 4.60; 95% CI: 1.70-12.4). Within the limitations of this interim analysis, there was no significant difference in treatment time, satisfaction and risk of failure between O and S.

Evaluation of dentin features in teeth after caries removal by three techniques (chemomechanical, mechanical with a smart bur, and air-abrasion): an in vitro study

“…In this study, three techniques or methods for caries removal were chosen based on how the caries was removed, where the first method includes mixed chemomechanical action (chemical material: Brix 3000 gel and mechanical blunt spoon excavator), and the second method was pure new mechanical (ceramic smart bur), and third one with more minimal intervention dentistry novel method (air abrasion that used aluminium oxide powder to remove the caries). In addition to the above more literature talks about the efficiency and advantages of these methods in the removal of caries ( Banerjee, Kidd & Watson, 2000a ; Banerjee, Watson & Kidd, 2000b ; De Almeida Neves et al, 2011 ; Hamama, Yiu & Burrow, 2014 ; Muliyar et al, 2014 ; Tan, Hill & Anderson, 2015 ; Schwendicke et al, 2018 ; Marques et al, 2020 ; Showkat et al, 2020 ; Abdelaziz, Badran & Allam, 2022 ; Dhanvijay et al, 2023 ).…”

“…Due to the material’s hardness, which does not permit excessive preparation, their primary benefit is the selective removal of only the affected dentin. After the soft, diseased dentin is out, the instruments will become dull on the firm, healthy dentin ( Marques et al, 2020 ). Although polymer burs take twice as long to eliminate caries as diamond or steel burs, they are more selective in the tissues they remove from the teeth ( Banerjee, Kidd & Watson, 2000a ; Banerjee, Watson & Kidd, 2000b ).…”