Abstract
Background: the aim of this study was to assess the 2-year pulp survival of deep carious lesions in teeth excavated using a self-limiting protocol in a single-blind randomized controlled clinical trial. Methods: At baseline, 101 teeth with deep carious lesions in 86 patients were excavated randomly using self-limiting or control protocols. Standardized clinical examination and periapical radiographs of teeth were performed after 1- and 2-year follow-ups (REC 14/LO/0880). Results: During the 2-year period of the study, 24 teeth failed (16 and 8 at T12 and T24, respectively). Final analysis shows that 39/63 (61.9%) of teeth were deemed successful (16/33 (48.4%) and 23/30 (76.6%) in the control and experimental groups, respectively with a statistically significant difference (z score = 2.3, p = 0.021). Of teeth with severe and mild symptoms at T0, 42.9% and 36.7% respectively failed at T24 (p > 0.05). Within the self-limiting group, there was a lower success in premolars compared to molars (p < 0.05). Conclusion: after 2 years, there was a statistically significant higher pulp survival rate of teeth with deep carious lesions excavated using self-limiting protocols in patients with reversible pulpitis. Molars showed higher success than premolars in teeth excavated using the self-limiting protocol. There was no statistically significant association between the outcome and the severity of symptoms at T0 (ClinicalTrials.gov NCT03071588).
Highlights
Worldwide, dental caries is the most prevalent chronic condition among people [1]
The pulp exposure is unavoidable when caries penetrates the entire thickness of dentine radiographically in “extremely deep carious lesions” [2]
Management options of deep carious lesions usually vary from vital pulp therapies (VPT) such as indirect pulp capping, direct pulp capping, pulpotomies to pulpectomy followed by root canal treatment, depending on the extent of caries penetration, inflammatory condition of pulp and restorability of the tooth [2]
Summary
Deep carious lesions are lesions approaching the pulp and radiographically penetrating three quarters of dentine thickness with a risk of pulp exposure during carious tissue removal. Management options of deep carious lesions usually vary from vital pulp therapies (VPT) such as indirect pulp capping, direct pulp capping, pulpotomies to pulpectomy followed by root canal treatment, depending on the extent of caries penetration, inflammatory condition of pulp and restorability of the tooth [2]. The development of adhesive restorative materials in addition to a better knowledge of the caries process advocates minimally invasive cavity design and a more conservative approach, reducing the risk of pulp exposure and subsequent root canal treatment [5,6]. In symptomatic or reversibly inflamed teeth with deep carious lesions, selective carious tissue removal to soft or firm dentine in one stage and stepwise excavation of the carious dentine biomass is indicated and potentially preserves pulp sensibility and function [9,10]
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