Abstract
Aim: Minimal intervention seeks to prevent and detect oral diseases at the earliest stage in order to minimize invasive treatment. The aim of this study was to compare the clinical and radiographic outcomes of permanent molar teeth with deep lesions treated by complete or partial removal of carious dentin after follow-up over a 24-month period. Methods: A total of 20 adolescents from Piracicaba, Sao Paulo, Brazil were screened; 11 had at least one deep carious lesion in permanent molars. Adolescents in whom 18 permanent molars required attention were randomly allocated to receive interventions. In the control group, nine teeth were submitted to complete removal of carious dentin, protection with calcium hydroxide and glass ionomer cement and restoration with resin composite. In the experimental group nine teeth were submitted to partial removal of carious dentin, protection with glass ionomer cement and restoration with resin composite. Radiographic examination and pulp vitality tests were performed 12-24 months after cavity sealing and the teeth were not reopened. Results: Complete data were available for 16 teeth. One volunteer in the experimental group felt pain during the pulp vitality test after 12 months; however, there was spontaneous remission of symptoms and no image suggestive of periapical lesion. No teeth presented unsatisfactory clinical and radiographic response to treatment. Conclusions: The results suggest that partial removal of carious dentin in a single session in permanent teeth could be indicated to maintain pulp vitality since no unsatisfactory clinical and radiographic results were shown.
Highlights
With the development of new adhesive materials and a more conservative approach, a new era of minimally invasive dentistry has dawned [1]
Considering that after sealing, the level of colonization in partial caries removal is similar to that in complete caries removal for all microorganisms [13,14,15] and carious lesions can be arrested if the restoration margins remain sealed [16,17], the aim of this study was to compare the clinical and radiographic outcomes of permanent molar teeth with deep lesions after partial caries removal in a single session, or complete caries removal and definitive restoration, during followup over a 24-month period
Adolescents were not admitted to the study if any of the following exclusion criteria were present: proximal, bucco lingual or palate lingual lesions and radiographic images suggesting periapical lesion in the tooth under study; spontaneous pain or exaggerated sensitivity response to vitality tests; insufficient address or unwillingness to return for follow-up
Summary
With the development of new adhesive materials and a more conservative approach, a new era of minimally invasive dentistry has dawned [1]. Known as Minimal Intervention Dentistry (MID), in practice, it seeks to prevent and detect oral diseases at the earliest stage in order to minimize invasive treatment; and where clinical intervention is indicated, the least invasive restorative technique is used [2]. Maintenance of pulpal vitality is the primary objective of conservative treatment of deep carious lesion [3] with partial caries removal being one of the possibilities of achieving this goal. There are many possibilities for intervening in this continuing process in order to arrest or reverse lesion progression [4] and one of these could be to modify the biofilm [5]. At an advanced stage of caries a cavitated carious lesion can retain the biofilm and careful brushing cannot remove it. The role of operative dentistry is to restore the integrity of the tooth so that the patient can clean effectively [6]
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