Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy

Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (−22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.

Reit, Claes,1946Gothenburg University,Göteborgs universitet,Institutionen för odontologi,Institute of Odontology(Swepub:gu)xreicl (author)
Bruun, Gitte (author)
Markvart, MereteKarolinska Institutet (author)
Kjaeldgaard, Marianne (author)
Nasman, PeggyKarolinska Institutet (author)
Thordrup, Marianne (author)
Dige, Irene (author)
Nyvad, Bente (author)
Fransson, HelenaMalmö högskola,Odontologiska fakulteten (OD)(Swepub:mau)odheol (author)
Lager, AndersMalmö högskola,Odontologiska fakulteten (OD)(Swepub:mau)odanla (author)
Ericson, DanMalmö högskola,Odontologiska fakulteten (OD)(Swepub:mau)oddaer (author)
Petersson, KerstinMalmö högskola,Odontologiska fakulteten (OD)(Swepub:mau)odkepe (author)
Olsson, Jadranka (author)
Santimano, Eva M. (author)
Wennström, Anette,1975Gothenburg University,Göteborgs universitet,Institutionen för odontologi,Institute of Odontology(Swepub:gu)xweane (author)
Winkel, Per (author)
Gluud, Christian (author)
Göteborgs universitetInstitutionen för odontologi (creator_code:org_t)

About the subject

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Dentistry

By the university: University of Gothenburg; Malmö University; Karolinska Institutet

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