Complete Caries Removal Research Articles

Pulp survival and postoperative treatment needs following selective vs. total caries removal in mature permanent teeth with reversible pulpitis: A randomized clinical trial

ObjectivesTo compare pulpal survival and treatment needs following selective and total caries removal in mature permanent teeth. MethodsThe design was a parallel double blind, randomized clinical trial. Mature teeth with caries radiographically extending ≥ 2/3 of dentine and without spontaneous pulpitis were included. Teeth were allocated to either selective (SCR) or total caries removal (TCR) using block randomization technique. In the SCR group, caries removal to firm dentine was followed by placement of Biodentine and composite restoration. In TCR group caries removal was to hard dentine; with immediate management by vital pulp therapy (VPT) using Biodentine in case of pulp exposure. Preoperative pain levels were recorded. Teeth were followed up after 6 and 12 months. Data were analyzed using Chi square test and regression analysis. Results124 teeth with a diagnosis of reversible pulpitis were treated (63 in SCR, 61 in TCR). 17/ 61 teeth (28%) in the TCR had pulp exposure, managed by VPT and were successful at recall. Pulp survival was significantly higher in TCR compared to SCR at 6 months (100 % vs 93.65%, p =0.04 respectively) and at 12 months (98.4% vs 82.5, P= 0.003 respectively). Multivariate analysis revealed the type of procedure (SCR vs TCR) and the preoperative pain levels (above or below 5/10) as significant prognostic factors. The odds of failure increased significantly for teeth treated with SCR (OR 27.6, 3.6–212.4, p=0.001) and if preoperative pain levels were ≥5/10 (OR 0.2, 0.04-0.8, P=0.024). ConclusionSelective caries removal for deep carious lesions in mature teeth failed to reveal overt pulp exposures in more than one quarter of cases and led to significantly lower pulp survival over one year, when compared with complete caries removal and immediate VPT. Clinical significanceIn deep carious lesions of mature permeant teeth with revrsible pulpitis, total caries removal to hard dentine is recommended for a predictable pulp survival. Clinical trial registrationThis trial was registered at CliniclTrials.gov (NCT05144711).

Comparing efficacies of various papain-based enzyme agents and 2.4% sodium hypochlorite gel in chemomechanical caries removal: a randomized controlled trial

ObjectiveThis study aimed to evaluate and compare the efficacies of Papacarie Duo gel, Brix 3000, Selecti-Solve gel, 2.4% sodium hypochlorite gel, and conventional rotary-mechanical method in caries removal and to evaluate the patient comfort.MethodsIt was a single-blinded, randomized, parallel-group, active-controlled trial with five arms. It was conducted at the Department of Restorative Dentistry and Endodontics, Damascus University. Seventy-five specimens were randomly allocated into five groups: chemomechanical caries removal (CMCR) using Selecti-Solve gel (G1), BRIX3000 (G2), Papacarie DUO gel (G3), or 2.4% sodium hypochlorite gel (G4), and caries excavation using conventional rotary-mechanical method (G5) (control group). The trial considered healthy patients aged 18–40. Permanent molars with class I carious lesions extending to the middle third of dentin with no pulpal and/or periodontal pathology were included. The efficacy of caries removal was considered the primary outcome measure, and the secondary outcome measures were treatment time, volumetric measurement of the cavity, and pain assessment.ResultsThe majority (73.30%) of cases from BRIX3000 and conventional rotary-mechanical method groups showed complete caries removal (p = 0.982). The mean time of caries removal was the highest (17.45 ± 4.42) in the 2.4% sodium hypochlorite gel group (p < 0.05), and the lowest (6.33 ± 1.69) was in the conventional rotary-mechanical method group (p < 0.05). The mean cavity volume was the highest (18.97 ± 9.76) in the Papacarie DUO gel group, and the lowest (14.87 ± 4.76) was in the 2.4% sodium hypochlorite gel group (p = 0.506). The conventional rotary-mechanical group exhibited the highest mean score (5.40 ± 1.72) of pain (p < 0.05). However, the mean score (2.67 ± 1.11) of pain reported reduced in the BRIX3000 group.ConclusionsCMCR agents could be a potential substitute for conventional rotary instrumentation methods, taking into account the long working time.

A scoping review of guidelines on caries management for children and young people to inform UK undergraduate core curriculum development

BackgroundCurrent evidence in cariology teaching is not consistently reflected in paediatric dentistry in the United Kingdom (UK). Many dental schools are not consistently teaching biological approaches to caries management, with outdated or complex methods being taught outwith the purview of general dental practitioners. This scoping review aimed to map current guidelines on the management of caries in children and young people. This is part of a work package to inform the consensus and development of a UK-wide caries management curriculum for paediatric dentistry.MethodsA search of electronic databases for peer reviewed literature was performed using Cochrane Library, MEDLINE via PubMed, TRIP Medical Database and Web of Science. Hand searching was undertaken for grey literature (citations of sources of evidence, websites of global organisations and Google Web Search™ (Google LLC, California, USA). Results from databases were screened independently, concurrently by two reviewers. Full texts were obtained, and reviewers met to discuss any disagreement for both database and hand searching.ResultsThis review identified 16 guidelines suitable for inclusion. After quality appraisal, eight were selected for synthesis and interpretation. Key themes included the shift towards selective caries removal and avoidance of complete caries removal unless in specific circumstances in anterior teeth. For “early lesions” in primary and permanent teeth with and without cavitation, several guidelines recommend biological management including site specific prevention and fissure sealants.ConclusionsThis review mapping current cariology guidelines for children and young people found gaps in the literature including classification of early carious lesions and management of early cavitated lesions. Areas identified for further exploration include integration of biological caries management into treatment planning, selective caries removal and whether pulpotomy is specialist-level treatment, requiring referral. These results will inform consensus recommendations in the UK, using Delphi methods.

Marginal integrity in minimally invasive molar resin composite restorations: Impact of polymerization shrinkage

ObjectivesThis study utilized non-linear finite element (FE) models to explore polymerization shrinkage and its impact on marginal integrity in molars following both selective caries removal (SCR) and conventional treatment. Specifically, we performed 2D in silico simulations to study residual stresses post-resin polymerization shrinkage and their influence on the marginal integrity of various restoration types. MethodsInitially, FE models were developed based on a cohesive zone framework to simulate crack propagation along the bonded interfaces between restoration and tooth structure in SCR-treated molars with class I and class II restorations. The modeled resin composite restorations first underwent polymerization shrinkage and were then subjected to various occlusal loading conditions. Stress magnitudes and distributions were identified to evaluate the margin integrity and predict the mechanism and location of interfacial failure. Results and discussionThe FE models computed polymerization shrinkage stresses of less than 1 MPa, exerting a minor influence on the composite/tooth interface. Occlusal loading, however, significantly impacted the load-bearing capacity of the composite/tooth (c/t) interface, potentially jeopardizing the restoration integrity. Especially under bi-axial occlusal loading, interfacial debonding occurred in the vertical cavity walls of the class I restorations, increasing the risk of failure. Notably, SCR-treated teeth exhibited better margin integrity than restored teeth after complete caries removal (NCR).These findings provide valuable insights into the mechanical behavior of SCR-treated teeth under different loading conditions and highlight the importance of considering the load scenarios that may lead to failure at the c/t interface. By investigating the factors influencing crack initiation and delamination, this novel research contributes to the optimization of restorative treatments and aids in the design of more resilient dental restorations.

Comparative Efficacy of Smart Burs vs Conventional Burs in Removing Infected Dentin and Preserving Affected Dentin in Primary Teeth: A Randomised Control Study

Introduction: With the advent of time, the removal of caries has shifted from hand instruments to rotary instruments. A disadvantage of conventional burs is that they non selectively lead to over-preparation. A new polymer bur can be substituted to eliminate these undesirable effects. Aim: To compare and evaluate the efficacy of smart burs and conventional burs in removing infected dentine while preserving affected dentin in carious lesions in primary teeth. Materials and Methods: This was a double-blinded randomised controlled trial conducted in the Department of Paediatric and Preventive Dentistry at Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India over a period of three months, from August 2023 to October 2023. A total of 40 children aged 6-12 years were selected and evaluated for caries removal efficacy using visual and tactile criteria, which were further confirmed by dye application and numerically scored. Group 1 included 20 children who underwent caries excavation with smart burs, while Group 2 included 20 children who underwent the procedure with diamond points. Statistical analysis was conducted using descriptive and inferential statistics, specifically the Chi-square test. Results: A total of 40 children aged 6-12 years were divided into two groups: Group 1 comprised 11 boys and 9 girls, whereas Group 2 included 10 boys and 10 girls. Of these, 12 cases (60%) showed complete caries removal after the first application of dye, regardless of which burs was used. However, 4 cases (20%) showed some residual caries when using smart burs, while 6 cases (30%) exhibited residual caries with diamond points at the base of the cavity preparation. Additionally, there were 4 cases (20%) with caries present at the base and/or in one wall of the cavity preparation when using smart burs, compared to 2 cases (10%) with conventional burs. Nonetheless, there was no statistically significant difference between the smart burs and the conventional diamond points regarding caries removal. Conclusion: It can be concluded that smart burs are equally effective in removing soft caries compared to conventional methods. Although the results were statistically insignificant, polymer burs were found to be more convenient and can be considered a viable alternative to conventional caries removal techniques.

Selective Removal to Soft Dentine versus Full Pulpotomy for Management of Proximal Deep Carious Lesions: A Randomized Controlled Non-Inferiority Trial

The management of the deep carious lesion with reversible pulpitis is a dilemma for the dentist. The current study compared selective removal to soft dentine (SRSD) and full pulpotomy (FP) for treating proximal deep carious lesions in teeth with reversible pulpitis. Visual-tactile examination and bitewing radiographs were used to determine the depth of carious lesion, and American Association of Endodontists recommendations were used to formulate pulp diagnosis. Sixty mandibular molar teeth from healthy patients between the ages of 16–35 years and a diagnosis of proximal deep carious lesion with reversible pulpitis were included. Teeth were randomly allocated to two study groups. SRSD group (n = 30): soft dentine was preserved over the pulpal aspect. A hard-setting calcium hydroxide cement liner and resin-modified glass ionomer cement base were applied over the remaining soft carious dentine. FP group (n = 30): complete caries removal followed by mineral trioxide aggregate FP was performed. The teeth in both groups were restored with composite resin restoration. The established criteria for outcome assessment of SRSD and pulpotomy were used. Accordingly, only asymptomatic teeth with no radiological evidence of periapical rarefaction were considered successful at the 12-month follow-up. Two-sample t test, Pearson χ² test/Fisher’s exact test, and percentage agreement were used for statistical evaluation. According to the per-protocol analysis, the success rate of both SRSD and FP treatment was 95.45% and 95.65%, respectively, and the actual difference between the two treatments was 1% (95% CI: [−10, 9]). The data suggests that both treatments (SRSD and FP) appear to have a good success rate (>95%) when used to manage permanent mandibular molar teeth with proximal deep carious lesion and reversible pulpitis. As SRSD is a noninvasive procedure, it should be favored over FP in these instances.

Outcome of Partial Pulpotomy in Immature Permanent Teeth with Symptomatic Irreversible Pulpitis: A Prospective Case Series Assessment

IntroductionThe aim of this prospective case series was to assess the clinical and radiographic outcome of partial pulpotomy in caries-exposed symptomatic, vital, immature, permanent molars. MethodsThirty-four immature molars with deep caries and symptoms of irreversible pulpitis were treated by partial pulpotomy and ProRoot MTA as a capping material. After complete caries removal, the inflamed part of the pulp was removed. Complete hemostasis was achieved using a sterile cotton pellet moist initially with sodium hypochlorite 1.5% and then with sterile saline. ProRoot MTA (Dentsply Sirona, Charlotte, NC) was placed as a capping material onto the remaining pulp tissue. The cavity was sealed using a light-curing resin-modified Ca(OH)2 cavity liner, and patients were referred to a pediatric dentist for permanent restoration. Descriptive statistics and cross tabulations were performed including variables examined before, during, and after the procedure. ResultsAll examined teeth presented a favorable clinical and radiographic outcome with normal periapical tissues, complete apical closure, and formation of a dentinal bridge beneath the capping material. Signs of partial pulp chamber calcification were only detected in 2 cases. Postoperatively, most patients did not report any pain (23/34, 67.7%), whereas the rest reported minor intensity pain (11/34, 32.3) and the use of analgesic or anti-inflammatory drugs only for 1 day (10/34, 29.4%). ConclusionsPartial pulpotomy seems to provide a universally successful outcome when managing symptomatic vital immature teeth with no signs of complications and completion of apical closure. It could be a viable treatment of choice in cases of caries-exposed vital immature teeth with symptoms of irreversible pulpitis.

Factors Affecting the Decision-making of Direct Pulp Capping Procedures among Dental Practitioners: A Multinational Survey from 16 Countries with Meta-analysis

IntroductionDirect pulp capping (DPC) procedures require the placement of a bioactive material over an exposure site without selective pulp tissue removal. This web-based multicentered survey had 3 purposes: (1) to investigate the factors that affect clinicians’ decisions in DPC cases, (2) to determine which method of caries removal is preferred, and (3) to evaluate the preferred capping material for DPC. MethodsThe questionnaire comprised 3 sections. The first part comprised questions regarding demographic features. The second part comprised questions on how treatment plans change according to factors such as nature, location, number and size of the pulp exposure, and patients’ age. The third part composed of questions on the common materials and techniques used in DPC. To estimate the effect size, the risk ratio (RR) and 95% confidence interval (CI) were calculated using a meta-analysis software. ResultsA tendency toward more invasive treatment was observed for the clinical scenario with carious-exposed pulp (RR = 2.86, 95% CI: 2.46, 2.32; P < .001) as opposed to the clinical scenario with 2 pulp exposures (RR = 1.38, 95% CI: 1.24, 1.53; P < .001). Complete caries removal was significantly preferred to selective caries removal (RR = 4.59, 95% CI: 3.70, 5.69; P < .001). Among the capping materials, calcium silicate-based materials were preferred over calcium hydroxide-based materials (RR = 0.58, 95% CI: 0.44, 0.76; P < .05). ConclusionsWhile carious-exposed pulp is the most important factor in clinical decisions regarding DPC, the number of exposures has the least impact. Overall, complete caries removal was preferred over selective caries removal. In addition, the use of calcium silicate-based materials appears to have replaced calcium hydroxide-based materials.

Bacterial Colonization and Proliferation in Primary Molars following the Use of the Hall Technique: A Confocal Laser Scanning Microscopy Study.

Restorative dentistry aims to create a favorable environment to arrest caries with minimal operative intervention. The Hall technique (HT) involves the seating and cementation of stainless steel crowns (SSC) on primary molars without any tooth preparation, caries removal, or local anesthesia. In this manner, it entombs bacteria and arrests caries' progress. We compared bacterial distribution and quantity among primary molars affected with caries and restored with SSC using the HT (n = 10), the conventional technique (CT; n = 10), or not restored at all (control; n = 10). The teeth were contaminated with Enterococcus faecalis to mimic the clinical situation in the oral cavity and then incubated for 21 days. They were then cut mesiodistally and evaluated with confocal laser scanning microscopy. Total bacterial load (live + dead) in the mesial and distal areas of the crown showed no significant difference between the groups (p = 0.711), but there were significantly more dead than live bacteria in the CT and control groups versus the HT group (p = 0.0274 and p = 0.0483, respectively). Inside the pulp chamber and the crown area, the total bacterial load was significantly higher in the HT compared to the CT group (p < 0.001). Significantly more dead than live bacteria were observed in all tooth areas treated with the HT (p = 0.0169). Bacterial penetration depth was significantly correlated with bacterial load (p = 0.0167). In conclusion, although more bacteria were present in teeth that had undergone the HT versus those treated with the CT, they were mainly unviable. Additionally, the CT and the HT showed a similar performance in terms of marginal leakage, indicating that complete caries removal is not essential to achieve good sealing.

The Practices of Treating Deep Carious Lesions Compared with the Dental Curriculum in Turkish Dentistry

Objective: The aim of this cross-sectional study is to investigate Turkish dentists’ opinions and preferences regarding the management of deep carious lesions and compare them with modern dental education concepts as provided by dental schools. Methods: Questionnaire 1 and Questionnaire 2 were sent separately to dental practitioners via the Turkish Dental Association and to university department heads of restorative dentistry. The data obtained were analyzed using chi-square tests and one-way ANOVA tests (p &lt; 0.05). Results: Regarding Questionnaire 1, most of the dentists (89.3%) responded that caries lesions should be removed completely up to the hard cut-off condition of the cavity floor. There was a statistically significant difference between female and male dentists’ preferences on less invasive treatment (p &lt; 0.05). Female dentists prefer less invasive treatment compared with male dentists (p = 0.002). Relatively older dentists (mean age = 41.8) are more inclined towards complete caries removal even if pulp exposure is likely (p = 0.040). The results of Questionnaire 2 reveal that there is no association between the time spans of education at dental schools and their caries removal approach curriculum (p &gt; 0.05). Most department heads of restorative dentistry prefer to apply complete caries removal (78.5%, n = 51). Conclusion: Despite today’s curriculum encouraging less invasive caries removal techniques, most dentists prefer more invasive treatment options. Continuous education of contemporary dentistry could update these clinical treatment attitudes of dentists and improve their clinical practice.

Treatment of Deeply Carious Vital Primary Molars by Complete Caries Removal Using Three Different Bioactive Materials: A Pilot Study

Treatment of Deeply Carious Vital Primary Molars by Complete Caries Removal Using Three Different Bioactive Materials: A Pilot Study

Knowledge, Attitude and Practice regarding dental pulp treatment in teaching sector of South Punjab

Objective: This study had four-fold objective; to evaluate the dentists’ choice about removal of caries, to know the preferred material for direct and indi¬rect pulp capping and to find out the influence of clinical experience, post-graduation and workplace on treatment modalities. Methodology: A cross-sectional study was performed on 460 dentists belonging to dental colleges of South Punjab. Non-probability convenience sampling was done. Information about work experience, post-graduation and workplace, caries removal, direct and indirect pulp capping material was collected. SPSS version 22 was used to analyze data. Frequencies, percentages and association of treatment options with other variables were found out. Results: Out of 429 participants, 50% selected to remove total caries and restore temporarily in first visit then permanent filling in second. Calcium hydroxide was the most preferred material (61%) for direct pulp capping, whereas for indirect, it was a combination of CH, GIC and adhesive, also opted by post-graduates significantly more than graduates (p=0.02). No association of work experience and post-graduation had no association with questions about treatment modalities (p = 0.19 and 0.16 respectively). In private sector, first treatment option and a combination of CH, GIC, adhesive and composite for indirect capping was opted significantly more than public sector (p=03 and p=02 respectively), whereas, for direct capping CH was opted significantly more in public than private (p=0.01). Conclusion: The preferred treatment was the complete caries removal and temporary filling in first visit followed by per¬manent filling in second. Calcium hydroxide was the material of choice for pulp capping, also significantly more in public sector than private. In deep cavities, the combination of CH and GIC was preferred for lining under composite resin. The work experience and post-graduation of dentists had no significant influence on treatment options or material used for pulp capping. Keywords: Biodentine, pulp capping, calcium hydroxide, mineral trioxide aggregate

Which is the most effective biomaterial in indirect pulp capping? 4- year comparative randomized clinical trial.

The aim of this study is to compare the clinical outcomes of Mineral Trioxide Aggregate (MTA) and calcium hydroxide pulp capping after complete caries removal. In 73 regular patients (47 women, 26 men; age 20.65±3.02 years), having at least one deep carious lesion was recruited. Following complete caries removal, the pulp was indirectly capped with either MTA(n=51) or calcium hydroxide (n =49), randomly. Final restoration with a resin-based composite in a single session was performed. Clinical parameters including pulp vitality, sensitivity to cold or heat stimulants, percussion tests and discomfort during chewing and color were recorded after 6 months, 1 year, 2- year, 3- year and 4- year. Data were analysed statistically (p<0.05). After 4- year, the survival rates were 86% (for MTA), and 82.9% (for calcium hydroxide). Totally, 8 teeth from calcium hydroxide group and 7 teeth from MTA group were endodontically treated. No significant difference was detected between the groups in terms of pulp vitality (p=0.613). Grey discoloration rate was 63% in MTA group. Both pulp-capping materials, MTA and calcium hydroxide showed similar clinically successful performance in terms of pulp vitality in the treatment of deep dentin caries lesions after 4- year.

Biology of selective caries removal: a systematic scoping review protocol

IntroductionPrimary goal of restorative caries therapy is to preserve pulp vitality and the dentition. Whereas the conventional approach of complete caries removal aims at the elimination of all affected substances...

Management preference of deep carious lesion in permanent mature teeth among dentists in Riyadh city

Introduction: The management of deep caries lesion can be accomplished by complete caries excavation, partial caries removal, and stepwise excavation techniques. Dentists do not agree on a single management due to available evidence about the effectiveness of different treatment options of deep carious lesion that are inconsistent. Aim: The aim is to investigate the attitude and behavior of management preference of deep caries in mature permanent teeth among dentists in Riyadh city. In addition, to compare these findings with academic standards, World Dental Federation and International Caries Consensus cooperation (ICCC). Materials and Methods: A randomized cross-sectional study was conducted in which 540 questionnaires were distributed to dentists in Riyadh city. The questionnaire included four clinical scenarios to investigate the participant's attitude and behavior of management preference of deep carious lesion of permanent teeth in Riyadh city in 2019. Results and Discussion: Response rate was 74%. Findings illustrate that 86.8% of participants preferred complete caries excavation in case of deep caries with no pain nor risk of pulpal exposure. 41.3% of the participants preferred complete caries excavation in case of deep caries with no pain but risk of pulpal exposure presence. 64.8% participants preferred complete caries excavation in case of deep caries with pain on provocation and no risk of pulpal exposure. 58.3% participants preferred root canal treatment in case of deep caries with pain on provocation and with risk of pulpal exposure. About 76.80% of participants believed that after 2 years from complete caries removal, a high success rate (more than 80%) will result. Conclusion: The majority of participants prefer more invasive approaches in the treatment of deep carious lesions and unaware of the minimally invasive dentistry.

Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care

BackgroundDental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth.MethodThis is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes.DiscussionSCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making.Trial Registration Trial registry: ISRCTN. Trial registration number: ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search.

Comparison of Partial and Complete Caries Excavation in Permanent Teeth: An 18 Months Follow-up

Objective: To compare performance and survival of composite restorations in primary teeth using partial caries removal (PCR) versus complete caries removal (CCR). Methodology: In this trial, 70 permanent molars having deep caries lesions were selected and divided equally into CCR and PCR groups. The study duration was Jan-2018 to Jan-2020. In CCR group, complete dentin removal was done and confirmed by applying dentin detector dye for 10 seconds. In PCR group, visual &amp; tactile criteria were followed for dentin removal. After dentin removal all cavities were filled using RMGIC cement resin. Follow-up was done at 06, 12 and 18 months. Results: Mean age in CCR group was 23.4+5.5 years and 25.6+4.9 years in PCR group. Male patients were 19 and 17 in CCR and PCR groups respectively (p= 0.59). Regarding lesion type, 25 patients in CCR were having occlusal and 5 having Occluso-proximal lesion. In PCR group, 27 teeth were diagnosed with occlusal lesion and 3 with occluso-proximal lesion (p=0.44). At 18 months’ follow-up, success rate was 100% in CCR group and 93.3% in PCR group (p=0.49). Pulp exposure occurred in 23.3% procedures in CCR group and none in PCR group. Conclusion: Partial caries removal has nearly similar success rates as that of complete caries removal and is associated with significantly less pulp exposure rate as compared to CCR. Keywords: Deep carious lesions, Partial caries removal, Complete caries removal, Randomized clinical trial

Treatment of symptomatic, deep, almost cariously exposed lesions using ozone

The aim of this controlled randomized crossover study was to assess post-treatment pain and the need for root canal treatment after the use of a traditional caries removal method followed by restoration, or after an ozone method of more conservatively managing the deep caries and a restoration. 84 participants (42 males and 42 females, mean age ± SD = 23.9 ± 2.0 years) were randomly allocated to receive either a traditional (n = 42, 21 males and 21 females) or ozone (n = 42, 21 males and 21 females) method. The ozone method only differed from the traditional method by leaving the deep leathery caries on the pulpal floor and then treating this with 20 s of ozone from the healozone X4 (Curozone, Germany). All caries was removed in the traditional group. A conventional glass ionomer cement (Riva Self Cure High Viscosity, SDI, Australia) was placed followed by a bonded composite resin restoration (Filtek Z250 Universal Restorative, 3 M ESPE, USA) in each cavity. The visual analogue scale was used to assess pain scores before treatment and after 24 h. The participants were then followed up for 2 years to assess the need for root canal treatment. Statistical significance levels were set at α ≤ .05. Both groups were associated with significant reduction of pain scores 24 h after treatment (p < .0001). The ozone treatment was associated with less pain 24 h after treatment (p < .0001) and less need for root canal treatment (p = .014), after 2 years follow up, than the conventional treatment. In conclusion, treatment of symptomatic, deep carious lesions by ozone following partial removal of caries was accompanied with less pain and occurrence of RCT after treatment compared to traditional complete caries removal.

Deep carious lesions management in children and adolescents: a questionnaire survey among dentists practicing paediatric dentistry in France

While many questionnaire surveys have been undertaken worldwide to investigate practices toward deep carious lesion (DCL) management in adults, very few are related to children and adolescents. The present cross-sectional study aimed to assess DCL management in children and adolescents among dentists practicing paediatric dentistry in France (Fr-DPPDs). The secondary objective was to compare practices between Fr-DPPDs and dentists registered in the European Academy of Paediatric Dentistry (EAPD). A questionnaire was electronically administrated to members of the CEOP (College des Enseignants en Odontologie Pediatrique), the SFOP (Societe Francaise d’Odontologie Pediatrique), and the EAPD. Descriptive analyses, Chi-square and McNemar tests, ANOVA, crude and adjusted binary logistic regression analyses were performed. A total of 99 Fr-DPPDs and 146 EAPD members answered the questionnaire. Among the Fr-DPPDs, the preferred caries removal (CR) methods were the complete CR in one step for primary teeth and mature permanent teeth (respectively, 70% and 48%) and in two steps for immature permanent teeth (39%). EAPD members were more likely, than Fr-DPPDs, to choose selective CR versus complete CR in primary teeth (odds ratio = 2.60; 95% CI 1.39–4.85). Moreover, for primary or immature permanent teeth, general practitioners were less likely to choose selective CR than specialists and exclusive practitioners in paediatric dentistry, (p < 0.001). Tooth type [primary, permanent (immature or mature)] seemed to influence DCL management. Fr-DPPS should prioritise pulpal vitality when managing DCL.

Clinical &amp; Radiographic Evaluation of Complete Pulpotomy In A Tooth with Irreversible Pulpitis: A Case Report

Management of deep caries has traditionally been with complete caries removal followed by root canal therapy. Minimally invasive procedures like Pulpotomy have come to the forefront ever since the introduction of highly biocompatible calcium silicate based materials even in mature teeth. There is increasing evidence of success with pulpotomy in mature,irreversibly inflamed teeth provided the case selection is accurate ,proper asepsis is maintained, and hemostasis is achievable. This case report demonstrates clinical and radiographic success of a case with signs and symptoms of irreversible pulpitis ,treated by a conservative procedure of complete pulpotomy. Keywords: Pulpotomy; vital pulp therapy; mineral trioxide aggregate; chronic irreversible pulpitis; mature tooth; complete pulpotomy