Partial dentin removal superior to stepwise excavation over long term

By Sarah Guy, medwireNews Reporter

Partial caries removal (PCR) treatment for individuals with deep caries lesions results in significantly improved pulp vitality after 3 years than does stepwise excavation (SW), indicate Brazilian study findings.

"These results suggest that there is no need to re-open a cavity and perform a second excavation for pulp vitality to be preserved," write Marisa Maltz (Federal University of Rio Grande do Sul, Porto Alegre) and colleagues in the Journal of Dental Research.

The team conducted a randomized trial of the two procedures in 233 patients who underwent 299 treatments, 147 with SW and 152 with PCR, between 2005 and 2007. All participants had permanent molars with deep caries lesions (≥1/2 dentin on radiograph) with a positive response to a cold test and absence of spontaneous pain.

All patients underwent lesion excavation followed by either PCR, involving reconstruction of the surrounding walls and pulp lining followed by teeth being filled with composite resin or amalgam, or SW - indirect pulp capping with calcium hydroxide cement and temporary filling, followed by re-opening of the cavity after a median 90 days when the remainder of the decayed dentin was destroyed and teeth restored.

SW "involves less pulp exposure compared with complete caries removal during a single session," remark the researchers, which can retain pulp sensitivity. However, it results in additional costs and discomfort for the patient as it requires two sessions for completion.

Pulp vitality was significantly higher at the 3-year follow up among individuals who had received PCR compared with those who received SW, at 91% versus 69%, report Maltz and co-investigators. The most common reasons for treatment failure in both groups were pulpitis and pulp necrosis.

Pulp survival rates were even lower among SW patients who had not completed the second part of their treatment, at 13%, compared with 88% in those who had.

After adjusting results for region, gender, age, number of restored surfaces, and filling material, having two or more restored surfaces resulted in a 5.24-fold increase in risk for treatment failure, while undergoing PCR rather than SW was associated with a 79% reduction in risk for this outcome.

"This must be considered in the making of treatment decisions, because researchers and clinicians are still reluctant to indicate incomplete caries removal in daily practice," concludes the research team.

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