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

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

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Publication Article, peer reviewed scientific
Title Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy
Author(s) 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
Date 2010
English abstract
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.
DOI http://dx.doi.org/10.1111/j.1600-0722.2010.00731.x (link to publisher's fulltext)
Host/Issue European Journal of Oral Sciences;3
Volume 118
ISSN 0909-8836
Pages 290-297
Language eng (iso)
Subject(s) Medicine
Research Subject Categories::ODONTOLOGY
Handle http://hdl.handle.net/2043/10151 (link to this page)

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