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

• Published in: European journal of oral sciences 2010-06, Vol.118 (3), p.290-297
• Main Authors: Bjørndal, Lars, Reit, Claes, Bruun, Gitte, Markvart, Merete, Kjældgaard, Marianne, Näsman, Peggy, Thordrup, Marianne, Dige, Irene, Nyvad, Bente, Fransson, Helena, Lager, Anders, Ericson, Dan, Petersson, Kerstin, Olsson, Jadranka, Santimano, Eva M., Wennström, Anette, Winkel, Per, Gluud, Christian
• Format: Article
• Language: English
• Subjects: Adult; Calcium Hydroxide - therapeutic use; caries removal; carious lesions; Dental Caries - diagnostic imaging; Dental Caries - therapy; Dental Cavity Lining; Dental Cavity Preparation - instrumentation; Dental Cavity Preparation - methods; Dental Pulp - diagnostic imaging; Dental Pulp - physiology; Dental Pulp Capping - methods; Dental Pulp Exposure - prevention & control; Dental Pulp Test; Dental Restoration, Permanent - methods; Dental Restoration, Temporary - methods; Dentin - diagnostic imaging; Dentin - pathology; dentinogenesis; Dentistry; endodontics; Female; Follow-Up Studies; Glass Ionomer Cements; Humans; Male; Middle Aged; mineral trioxide aggregate; Minerals - therapeutic use; Odontologi; outcomes; Periapical Tissue - diagnostic imaging; permanent teeth; pulp exposure; Pulpotomy - instrumentation; Pulpotomy - methods; quality; Radiography, Bitewing; randomized clinical trial; removal; Resin Cements; stepwise excavation; Treatment Outcome
• ISSN: 0909-8836; 1600-0722; 1600-0722
• DOI: 10.1111/j.1600-0722.2010.00731.x

Bjørndal L, Reit C, Bruun G, Markvart M, Kjældgaard M, Näsman P, Thordrup M, Dige I, Nyvad B, Fransson H, Lager A, Ericson D, Petersson K, Olsson J, Santimano EM, Wennström A, Winkel P, Gluud C. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci 2010; 118: 290–297. © 2010 The Authors. Journal compilation©2010 Eur J Oral Sci 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.