Randomized Clinical Trials on Deep Carious Lesions : 5-Year Follow-up

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Randomized Clinical Trials on Deep Carious Lesions : 5-Year Follow-up

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Publication Article, peer reviewed scientific
Title Randomized Clinical Trials on Deep Carious Lesions : 5-Year Follow-up
Author Bjørndal, Lars ; Fransson, Helena ; Bruun, Gitte ; Markvart, Merete ; Kjældgaard, Marianne ; Näsman, Peggy ; Hedenbjörk-Lager, Anders ; Dige, Irene ; Thordrup, Marianne
Date 2017
English abstract
Deep caries presents a dilemma in terms of which treatment that will render an optimal prognosis by maintaining pulp vitality with absence of apical pathology. Previously, 2 randomized clinical trials were performed testing the short-term effects of stepwise carious tissue removal versus nonselective carious removal to hard dentin with or without pulp exposure. The aim of this article was to report the 5-y outcome on these previously treated patients having radiographically well-defined carious lesions extending into the pulpal quarter of the dentin but with a well-defined radiodense zone between the carious lesion and the pulp. In this long-term study, 239 of 314 (76.2%) patients were analyzed. The stepwise removal group had a significantly higher proportion of success (60.2%) at 5-y follow-up compared with the nonselective carious removal to hard dentin group (46.3%) ( P = 0.031) when pulp exposures per se were included as failures. Pulp exposure rate was significantly lower in the stepwise carious removal group (21.2% vs. 35.5%; P = 0.014). Irrespective of pulp exposure status, the difference (13.3%) was still significant when sustained pulp vitality without apical radiolucency and unbearable pain was considered (95% confidence interval, 3.1-26.3, P = 0.045). After pulp exposure, only 9% ( n = 4) of the analyzed patients were assessed as successful, indicating that the prognosis is highly dubious following conventional pulp-capping procedures (direct pulp capping or partial pulpotomy) in deep carious lesions in adults. In conclusion, the stepwise carious removal group had a significantly higher proportion of pulps with sustained vitality without apical radiolucency versus nonselective carious removal of deep carious lesions in adult teeth at 5-y follow-up (ClinicalTrials.gov NCT00187837 and NCT00187850).
DOI https://doi.org/10.1177/0022034517702620 (link to publisher's fulltext.)
Link http://journals.sagepub.com/doi/full/10.1177/00220... (external link to publication)
Publisher SAGE Journals
Host/Issue Journal of Dental Research;7
Volume 96
ISSN 0022-0345
Pages 747-753
Language eng (iso)
Subject caries treatment
clinical studies
clinical outcomes
dentin
Endodontics
operative dentistry
Medicine
Research Subject Categories::ODONTOLOGY
Handle http://hdl.handle.net/2043/23305 Permalink to this page
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