Deep Carious Lesions 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).

Spontaneous space closure after extraction of permanent first molars in children and adolescents: a systematic review and meta-analysis.

Extraction of the permanent first molars is sometimes necessitated in children and adolescents due to deep carious lesions or developmental defects. To estimate the prevalence of spontaneous space closure after extraction of permanent first molars and identify factors associated with it. Unrestricted searches in five databases for human studies until February 2024. Longitudinal before-and-after (cohort) human studies assessing eruption of the permanent second molars and spontaneous space closure after extraction of the permanent first molar. Study selection, data extraction, and risk of bias assessment were performed in duplicate. Random-effects meta-analyses of average spontaneous space closure prevalences and odds ratios (OR) with their 95% confidence intervals (CI) were performed, followed by meta-regression/sensitivity/reporting biases' analyses and evaluation of our confidence in effect estimates. Sixteen reports pertaining to 15 studies (1 prospective /14 retrospective) were included covering 1159 patients (ages 5.5-15.0 years [mean 10.0 years]; 45% male on average) and 2310 permanent second molars. The prevalence of spontaneous space closure was higher in the maxilla (nine studies; 85.3%; 95% CI = 73.7%-92.3%) than the mandible (11 studies; 48.1%; 95% CI = 34.5%-62.0%) to a significant extent (nine studies; OR = 7.77; 95% CI = 4.99-12.11; P < 0.001). For both maxillary/mandibular second molars, Demirjian category E was associated with increased space closure odds than earlier/later stages (P < 0.05). Spontaneous space closure in the mandible was seen more often for patients ages 8-10 years (compared with older patients; three studies; OR = 3.32; 95% CI = 1.73-6.36; P < 0.001) and when the mandibular permanent third molar was present (four studies; OR = 2.28; 95% CI = 1.67-3.09; P = 0.003). Additional analyses failed to find any significant modifying factors. The quality of evidence was very low in all instances due to the inclusion of retrospective studies with methodological issues. Existing evidence indicates that spontaneous space closure in children and adolescents after extraction of the permanent first molar is seen more often in the maxilla than the mandible. Extraction of the permanent first molar at the Demirjian stage E of the second molar and presence of the lower permanent third molar is associated with increased odds of space closure, but uncertainty persists, due to methodological issues of existing studies. PROSPERO (CRD42023395371).

Tactile sensation in relation to roughness and reflection of active initial lesions in primary (deciduous) and permanent dentition in vitro

ObjectivesThis study evaluated whether a relationship exist between tactile sensation, roughness and reflection intensity in active enamel lesions of primary (deciduous) and permanent dentition. MethodsFreshly extracted teeth of the primary (n=29) and permanent (n=60) dentition of patients who underwent serial extractions under general anesthesia due to multiple deep caries lesions showing active lesions (International Caries Detection and Assessment System scores of 2) were selected. The mean linear (Ra), area-related (Sa), volume-related (Vmc) roughness and vertical reflection intensity (VRI) of sound (S) and carious (C) areas were determined by using a 3D-laser-scanning-microscope and a multi-sensor microscope with two different chromatic-confocal optics. Furthermore, two blinded examiners evaluated the roughness by tactile examination using three different explorers (S23H,405CP11, S3C). ResultsMean differences (95%CI) between S and C for teeth of the primary dentition were: Ra:-1.9(-2.3;-0.4)µm, Sa:-31.8(-1.8;0.0)µm, Vmc:-1.8(-1.6;-0.0)ml/m2, VRI:29(20;43) and for teeth of the permanent dentition: Ra:-4.0(-2.5;-1.0)µm, Sa:-4.8(-3.0;-1.1)µm, Vmc:-4.6(-3.4;-0.5)ml/m2, VRI:34(19;44) differing significantly between S and C (p<0.05,Wilcoxon test). No significant difference was observed between 1st and 2nd dentition (p>0.05, Kruskal-Wallis test) as well as commercial and experimental optic (p>0.05). The highest positive predictive value (PPV) was achieved by examiner 1 with explorer S3C (1st dentition 67%;2nd dentition 100%;pooled dentition 88%)), while examiner 2 revealed the highest PPV with explorer S23H (89%;86%;88%). ConclusionDifferences in roughness and reflectance between sound and caries-active enamel surfaces could be evaluated in both primary and permanent dentition. These differences could also be reliably detected using three different explorers with good validity. However, the most predictive explorer seems to differ between examiners. Clinical SignificanceIn both primary (deciduous) and permanent dentition active caries lesions exhibit significantly higher roughness and lower vertical reflection intensity compared with sound enamel. These differences are detectable by blind tactile examination and objective methods such as 3D-laser-scanning or multi-sensor microscopy, highlighting their utility in caries diagnosis in both dentitions.

Influence of Academic Training and Professional Experience on the Management of Deep Caries Lesions.

Managing caries lesions that affect the inner third of the dentin is crucial to ensuring pulp vitality; the clinician must make decisions that will affect the vitality of the tooth. Our purpose is to understand the behavior of Spanish dentists in treating deep cavities and to examine whether variations exist based on their academic training and/or years of professional experience. This study was approved by the ethics committee of the Balearic Islands CEI-IB. A survey was conducted using the SurveyMonkey platform with 11 questions, the first 4 of which focused on defining the characteristics of the respondents. The following six concerned a clinical case of deep caries in tooth number 4.7, and the last regarded the opinion of the actual treatment of the case. The survey was sent by email in April 2022. The results were analyzed with the SPSS 29.0 program using the chi-square test. A total of 347 responses were obtained (93.95%), and those surveyed stated that they apply minimal intervention concepts in their treatments, with 90.49% performing conservative dentistry treatments daily. A total of 56.48% of the respondents had bachelor's degrees, 12.39% had graduated, 33.14% had a postgraduate degree, 38.90% had a master's degree, and 17% had a doctorate. Most (40.63%) had been in professional practice for 16-30 years. Significant differences were identified regarding years of professional experience in terms of decision-making in methods of treatment and the choice of materials used for pulp protection. Likewise, significant differences were found regarding the academic training of the respondents, the cavity cleaning method selected, and the use of chemical substances for removing carious dentin. We can conclude that academic training and years of professional practice influence decision-making at some points in treating deep caries lesions.

Recommended procedures for managing carious lesions in primary teeth with pulp involvement—a scoping review

BackgroundManaging dental caries in primary teeth with pulp involvement is a significant challenge. Clinical guidelines offer recommendations for effective management.AimTo identify and analyze policies, guidelines, and recommendations for treating primary teeth with pulp-involved carious lesions, highlighting existing research gaps and setting the foundation for future research.MethodsA comprehensive search was conducted across databases (PubMed, Scopus, Embase, GIN, and LILACS) and grey literature sources (Trip and ProQuest) to identify guidelines, consensus, policy, and position statements on primary teeth pulp therapy and extraction thresholds. Two independent reviewers screened the abstracts and titles, followed by full-text screening.ResultsAfter removing duplication, of the 1098 records, 14 were selected for analysis. This review examined various treatments for deep caries lesions in primary teeth, including indirect/direct pulp capping, pulpotomy, pulpectomy, lesion sterilization/tissue restoration, and extraction. Time search was restricted to documents published from 30th January 2008 to 30th January 2024, offering insights into evolving clinical practices.ConclusionTreatment for carious lesions in primary teeth involving the pulp depends on clinical indications and may involve minimally invasive techniques. Recommended options are indirect pulp capping, pulpotomy, and pulpectomy, while direct capping and tooth removal are discouraged. Further research is needed to address gaps, improve guideline development, and enhance consistency of recommendations.

The effectiveness of partial pulpotomy compared with full pulpotomy in managing deep caries in vital permanent teeth with a diagnosis of non-traumatic pulpitis.

Pulpitis may be pain free or alternatively characterized by mild to severe pain and associated symptoms. Evidence has recently emerged that patients presenting with carious pulp exposure range of symptoms can be treated effectively with pulpotomy. The current systematic review aimed to answer the following research question: "In patients with deep caries lesions in permanent teeth associated with no symptoms, reversible pulpitis or signs and symptoms indicative of irreversible pulpitis (P), is partial pulpotomy (I) as effective as full pulpotomy (C), in terms of a combination of patient and clinical reported outcomes (O), with "tooth survival" as the most critical outcome? The systematic literature search was conducted in the following electronic databases: OVID, Scopus, PubMed (Including MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL) supplemented with Grey literature and hand searching of relevant journals. The English language clinical trials comparing the patient and clinical reported outcomes between partial and full/complete were included. After a structured literature search, two authors independently performed study selection, extracted data and performed a risk of bias assessment; a third reviewer resolved disagreements. As there were only two studies with different exclusion criteria, no meta-analysis was performed and the quality of evidence was assessed by the GRADE approach. After study selection a total of two randomised clinical trials with a total of 156 teeth were included both for the management of teeth with irreversible pulpitis. There were no studies for asymptomatic teeth or teeth with reversible pulpitis. A "Low" risk of bias was noted for both studies with a high level of overall evidence. A meta-analysis was not carried out due to differences in inclusion criteria between the studies related principally to caries depth. Both studies reported a high rate of clinical success for pulpotomy with a pooled unadjusted success rate for full pulpotomy of 90% and 83% partial pulpotomy of at 1-year; however, no significant difference between the treatments was noted in either study. There was significantly reduced postoperative pain reported in the full pulpotomy group over 1-week compared with the partial pulpotomy in one but not in the other study. Pulpotomy as a definitive treatment modality is as effective in managing teeth exhibiting signs and symptoms indicative of irreversible pulpitis and challenges the established protocols to manage this condition. Although based on only two RCTs with a limited number of patients, no difference was shown in terms of clinical or radiographic outcome or postoperative pain between groups. Further well designed randomised clinical trials of longer duration are required in this area to improve the evidence available. There is no consistent difference in patient-reported pain between partial and full pulpotomy at day 7 postoperatively and the clinical success rate was similar after 1 year for both treatment modalities.

Assessment of the postoperative hypersensitivity following partial caries removal with application of nanosilver fluoride in deep carious lesions - A randomized controlled clinical trial

Assessment of the postoperative hypersensitivity following partial caries removal with application of nanosilver fluoride in deep carious lesions - A randomized controlled clinical trial

The use of silver diamine fluoride to prevent/treat enamel carious lesions: a narrative review.

This comprehensive literature review examines the use of silver diamine fluoride (SDF) for the prevention and treatment of enamel carious lesions. SDF has been approved by different international drug associations as a caries-preventing agent to be used on deep carious lesions (dentin). However, SDF can cause staining of exposed tooth structures. Furthermore, the effect of SDF on the bond of adhesives to the tooth structure is still being determined. This review explores various studies on the use of SDF to treat enamel carious lesions, highlighting its effectiveness and preventive action. The literature suggests that SDF inhibits bacterial growth, promotes remineralization, and does not negatively affect adhesive retentions. Potassium iodide (KI) or glutathione (GSH) can reduce staining and discoloration. However, the reviewed studies have limitations. Further research, including well-designed clinical trials, is necessary to validate the findings and evaluate the long-term implications of SDF treatment. Conclusion: Despite the above-mentioned limitations, SDF shows potential as a therapy for enamel caries prevention, remineralization, and use as an adjuvant to other dental treatments, warranting further investigation and the refinement of application methods.

Long-Term Evaluation of Pulp Vitality Preservation in Direct and Indirect Pulp Capping: A Retrospective Clinical Study.

Background: This retrospective clinical study aimed to assess dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. Methods: A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), direct pulp capping with Mineral Trioxide Aggregate cement; Group (2), direct pulp capping with a resin-based glass ionomer; Group (3), direct pulp capping with TheraCal; Group (4), indirect pulp capping with a three-step total-etch adhesive system; and Group (5), indirect pulp capping with a two-step self-etch adhesive system. Results: A 72.5% success rate was achieved overall. A statistically significant difference was found when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively. For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis (p = 0.035), while bleeding after exposure appeared independent (p = 0.053). Patient age was significantly related to the maintenance of pulp vitality (p = 0.013). A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered (p = 0.017). For the indirect pulp-capping treatments, a significant correlation between patient age (p = 0.021) and the adhesive system (p = 0.019) with pulp necrosis was described. Conclusions: The pulp-capping material, patient age, and the width of the pulp exposure before the procedure should be carefully considered when performing direct pulp-capping treatments. The performance of the etch-and-rinse adhesive systems was superior to the self-etch system during the indirect pulp-capping procedures.

CONSORT statement adherence and risk of bias in randomized controlled trials on deep caries management: a meta-research

BackgroundRecently, trials have supported changes in deep caries management. However, reporting might lack details, affecting interpretation and implementation. Thus, we aimed to evaluate the adherence to the CONSORT statement and the risk of bias of randomized controlled trials (RCTs) on deep caries management published in pediatric dental journals.MethodsWe searched PubMed for RCTs in six pediatric dental journals between 2010 and 2022, focusing on deep caries lesion management. Adherence to the CONSORT guideline and the risk of bias were assessed using a modified tool with 19 items; each scored from 0 to 2 (maximum of 38 points), and the Cochrane risk-of-bias (RoB 2) tool. We performed descriptive and regression analyses (α = 5%).ResultsWe analyzed 127 RCTs. The mean (standard deviation) CONSORT adherence score was 21.1 (6.7). Notably, 96.1% of the studies received a score of 2 for the "intervention" item, whereas 83.5% scored 0 for the "estimated effect size”. The risk of bias assessment revealed that 40.2% of the RCTs were at high risk, 59% were at low risk, and 0.8% were at low risk. RCTs with a high risk of bias had lower CONSORT scores (p<0.001) than those with low or some concerns. RCTs published in journals without the endorsement of the CONSORT statement had lower scores than those in journals with the endorsement of the CONSORT statement. Older RCTs (6-10 years old and more than 10 years old) showed significantly lower CONSORT statement compliance than trials published recently within 5 years.ConclusionAdherence to the CONSORT was relatively low among the investigated RCTs. Moreover, lower adherence to the CONSORT was associated with a higher risk of bias.Trial RegistrationThis study protocol was prospectively registered on the Open Science Framework - DOI (10.17605/OSF.IO/V6SYZ).

Clinical conduct of dentists in the treatment of deep dental carious lesions

Different techniques are employed to contain the carious process: non-invasive, microinvasive, and invasive, and with restorative needs. Thus, it is essential that dentists are duly updated regarding scientific evidence and perform with skill and precision the techniques proposed as treatment, being aware of the consequences and risks, and aiming at the most conservative therapy. Objective: To identify the clinical practices for the treatment of deep carious lesions used by dental surgeons of the Family Health Strategy (FHS) program of a Brazilian city. Material and methods: This was a quantitative and cross-sectional study carried out with 43 dental surgeons from the FHS program in the city of Sobral, State of Ceará, Brazil, using a Google Forms online questionnaire, containing questions related to the clinical criteria used during caries removal, deep dentin caries removal techniques, lining materials, survival rate of some treatments, in addition to sociodemographic data and questions regarding professional qualification. Results: Among those interviewed, 62.8% were aged between 25 and 30 years. Most dentists (58.7%) considered that the cavity floor should be hard at the end of the carious dentin removal, which demonstrates the non[1]adherence to Selective Carious Tissue Removal (SCTR) protocols. Only 25.6% considered SCTR a treatment with a chance of success and a 2-year survival rate greater than 80%. More than half of the interviewees (51.2%) disagreed with the maintenance of carious tissue in the axial/pulp walls of deep cavities to preserve pulp vitality. More invasive treatments were preferred in a greater proportion by dentists who work exclusively in the public sector (66.7%) compared to those who also work in the private sector (17.6%) [p=0.002], with an evident need for cariology education workshops and more studies on the topic. Conclusion: The dentists who participated in the study showed little adherence to less invasive techniques in the treatment of deep carious lesions.

Restorations performance after selective caries removal to soft dentine: 18-month follow-up of a controlled clinical trial

ObjectiveThis randomized controlled clinical trial aimed to evaluate the clinical performance of composite resin restorations placed after selective caries removal to soft dentin (SCRSD) or stepwise excavation (SW) over an 18-month period. MethodsInclusion criteria were patients with permanent molars and/or premolars presenting deep caries lesions (≥50 % of the dentin thickness). Teeth were submitted to SCRSD (n = 76) or SW (n = 76). Evaluations were performed based on FDI (World Dental Federation) criterion. Survival analysis was performed to estimate the survival of restorations and its association with clinical variables and socio-demographic characteristics (adjusted Weibull regression model). The study was registered on Registro Brasileiro de Ensaios Clínicos (ReBEC 65ntbc). ResultsThe follow-up period ranged from 6 to 18 months (mean ± SD 16.3 ± 3.4 months). Patients' ages ranged from 9 to 55 years (mean ± SD 29 ± 10.5 years). A total of 135 teeth (SCRSD = 72; SW = 63) from 101 patients were evaluated. There were 4 failures in the SCRSD group (2 loss of restoration in need of replacement and 2 marginal fractures in need of repair) and 2 in the SW group (fracture in need of repair). The association between explanatory variables and restoration failure showed similar success rates for SW (99.4 %) and SCRSD (97.9 %) (p = 0.16). Patients presenting gingivitis (≥20 % of sites with gingival bleeding) had 8.50 times more risk for failure than those with <20 % of bleeding sites (p = 0.03). ConclusionThis study showed that placing a composite resin restoration over soft dentin (after SCRSD) did not affect its clinical performance after 18 months. Clinical significanceSCRSD is a feasible treatment option for the management of deep caries lesions in permanent teeth as it preserves tooth vitality and tooth structure without compromising restoration longevity.

Discriminatory performance of the pulpal inflammatory biomarkers; Interleukin-8 and TNF-α in patients with symptoms indicative of reversible and irreversible pulpitis: A diagnostic accuracy study.

The success of vital pulp treatment (VPT) procedures is dependent on an accurate diagnosis of the pulpal inflammatory condition. Compared with current subjective pulpal diagnostic tests, inflammatory molecular biomarkers involved in the pathogenesis of pulpitis represent potential objective indicators of the degree of pulpal inflammation. Therefore, the aim of this study was to quantify level of inflammatory biomarkers - Interleukin 8 (IL-8) and TNF-α in patients diagnosed with reversible pulpitis (RP), irreversible pulpitis (IR) and normal pulp (NP) and investigate their diagnostic accuracy in differentiating between healthy and inflamed conditions. This prospective, cross-sectional study enrolled 72 patients aged 14-53 years with extremely deep carious lesions after establishing a clinical diagnosis of RP (n = 42), symptomatic IR (n = 22) and NP (n = 8). 50 μL of pulpal blood sample was collected from all the patients using a micropipette after pulpal exposure. The level of IL-8 and TNF-α was assessed in pg/mL using enzyme-linked immunosorbent assays. Mann-Whitney U test was applied to establish the association between IL-8/TNF-α level and degree of pulp inflammation. Receiver operating curve (ROC) analysis was carried out to calculate area under the curve (AUC) for RP versus IR. Cut-off values were established using Youden's index. IL-8 and TNF-α levels differed significantly between RP and IR groups (p ≤ .001). The median value of IL-8 in RP and IP groups was 259.8 pg/mL [187.5-310.0] and 1357.8 pg/mL [1036.7-2177.6] respectively. The AUC-ROC curve for RP versus IR was 0.997 with 95.5% sensitivity and 99.76% specificity. The median value of TNF-α in RP and IR groups was 75.4 pg/mL [62.7-95.8] and 157.6 pg/mL [94.1-347.3]. The AUC-ROC curve for TNF-α was 0.812 with a sensitivity and specificity of 59.1% and 92.1%, respectively. IL-8 and TNF-α levels were below detection levels for all NP samples. This study showed that pulpal blood could provide an excellent medium for establishing pulpal diagnosis under extremely deep carious lesions. The selected cytokines, IL-8 and TNF-α, demonstrated excellent discriminatory performance for reversible and irreversible pulpitis. Future studies should correlate the IL-8/TNF-α levels with VPT treatment outcomes.

Stepwise caries intervention: An approach precursive to endodontic intervention – A case series

Abstract Stepwise caries excavation, being conceptualized for quite a time now, aims at phasic and thoughtful excavation of the diseased tissue, with a simultaneous attention to the fundamental principles of restorative dentistry. It has gained a humongous momentum conventionally, as the clinicians have eagle-eyed minimally invasive approaches for every possible treatment modality. The attempted case series showcases six cases of deep carious lesion managed by two-step caries excavation protocol in healthy patients diagnosed with chronic symptomatic reversible pulpitis, conclusively holding the longest favorable follow-up of over 3 years. This technique has a paramount clinical potential, conditional on appropriateness of case selection and clinical technique.

In Vitro Evaluation of Sealing Ability of Biodentine and TheraCal PT in Primary Molars.

A major objective in the management of deep carious lesions involving proximal surfaces of primary molars is to control marginal leakage. This could occur due to dimensional changes or failure in the adaptation of pulp capping materials to the prepared cavity. Evaluation of microleakage is important for assessing the success of newer pulp capping materials. Biodentine exhibits good sealing ability but possesses longer setting times and handling difficulties, which might delay the placement of the final restoration. The sealing ability of newer dual-cure calcium silicate-based material in TheraCal PT in class II cavities of primary molars is not known. Hence, the current study aimed to evaluate and compare the microleakage of Biodentine and TheraCal PT in primary molars. Extracted, noncarious primary molars (n = 28) were collected, and standardized class II cavities were prepared and restored with Biodentine (group I) and TheraCal PT (group II). Following this type, IX glass ionomer cement (GIC) was placed and polished. Microleakage was assessed using the dye penetration method, and data obtained through stereomicroscopic analysis were statistically analyzed. The mean microleakage score observed in group I was 2.0 ± 1.3 MPa, and in group II was 1.0 ± 1.1 MPa. Comparable sealing ability was observed between both groups (p = 0.061). TheraCal PT could be used as a suitable alternative to Biodentine for use in vital pulp therapeutic procedures in children to reduce the treatment time and improve sealing ability. Anusha B, Shivashankarappa PG, Mohandoss S, et al. In Vitro Evaluation of Sealing Ability of Biodentine and TheraCal PT in Primary Molars. Int J Clin Pediatr Dent 2024;17(2):158-161.

Ways of Maintaining Pulp Vitality: Narrative Literature Review

Background: Dental caries is a prevalent global health issue, affecting a significant portion of the population and impacting social and personal well-being. Traditional methods focused on aggressive caries removal, but recent advances emphasize the importance of preserving pulp vitality through minimal invasive techniques. Objective: To evaluate the efficacy of various vital pulp therapy techniques including indirect and direct pulp capping and pulpotomy, and to analyze the effectiveness of new biomaterials in preserving dental pulp vitality in teeth affected by caries or trauma. Methods: A systematic literature review was conducted using the Islamabad Medical and Dental College library and online databases such as PubMed and Google Scholar. The review included peer-reviewed articles that discussed vital pulp therapy, materials used in pulp capping, and their outcomes. Articles were selected based on inclusion and exclusion criteria with no date restrictions, focusing solely on literature published in English. Results: The review identified 32 relevant studies, indicating a shift towards less invasive procedures that prioritize dental pulp preservation. Innovations in biomaterials such as Mineral Trioxide Aggregate (MTA), Biodentin, and resin-based MTA have shown to enhance healing outcomes and are increasingly preferred over traditional materials like Calcium Hydroxide due to their superior properties and clinical results. Conclusion: Vital pulp therapies are crucial for managing teeth with deep carious lesions or trauma, offering a conservative alternative to more invasive treatments. These therapies are instrumental in maintaining the structural integrity and health of natural teeth, thus reducing the need for extensive dental procedures and promoting overall oral health.

Single visit indirect pulp capping with Biodentine: clinical case report

Introduction. Dental caries is the most widespread dental disease worldwide; it affects population of different ages. If not treated promptly or addressed improperly, dental caries progresses in a deep cavity, with potential signs of pulp inflammation. The minimal invasive principles of treatment of deep carious lesions provide guidelines for the preservation of the dental pulp, techniques known as vital pulp therapies. Among these techniques, indirect pulp capping is a method that has shown high clinical rates of success over time, if performed properly. The applied bioactive dental material plays an important role. The aim of this clinical case report is to describe a clinical case of single-visit indirect pulp capping with Biodentine, along with the algorithm of diagnosis of the pulp health status and treatment used in deep caries lesion in a permanent tooth. Materials and methods. Description of a clinical case of a permanent upper molar with a deep carious lesion, treated by single-visit indirect pulp capping with Biodentine. Clinical and radiological methods of investigations were used; the patient was assessed after 3 and 6 months after the applied treatment. Results. The main complaint of sensitivity to sweet stimuli presented by the patient attenuated shortly after receiving the treatment. After 3 and 6 months, the tooth is asymptomatic; the clinical and radiological findings show no evidence of pulp inflammation. Conclusions. Biodentine showed successful results when used as a bioactive dental material for indirect pulp capping.

Complete versus incomplete caries removal procedures and their effects on dental pulp in primary teeth - An in vivo study.

Dental caries results from an ecologic shift within the dental biofilm from a balanced population of microorganisms to an acidogenic, aciduric, and cariogenic microbiological population developed and maintained by frequent consumption of fermentable dietary carbohydrates. Total caries removal (TCR) of deep lesion may result in pulpal exposure requiring more invasive treatment. Hence, current pediatric dentistry has shifted to minimally invasive treatment that avoids more complex, time-consuming procedure, and the child's discomfort. The aim of this study is to evaluate and compare clinical performance and radiographic changes after complete and incomplete caries removal procedures. The study was conducted on 60 primary molars in children aged 6-9 years. Selected 60 primary molars were randomly divided into two groups. Group 1 (PCR): infected dentin was removed, while the affected dentin was maintained on the pulpal wall. Group 2 (TCR): both infected and affected dentin were removed through low-speed carbide bur and hand excavator. Teeth were evaluated at 4 and 6 months clinically and radiographically. The proportion was compared using Fisher's exact test. The Statistical Package for the Social Sciences version 21 was used for analysis. The level of significance was kept at 5%. The clinical and radiographic success rates of ICR and CCR in primary teeth with deep carious lesions were high and did not differ significantly, indicating that the retention of carious dentin does not interfere with pulp vitality. Thus, ICR is a reliable minimally invasive approach that might replace the CCR in primary teeth when correctly indicated.

An in vitro assessment of the residual dentin after using three minimally invasive caries removal techniques

To evaluate the efficiency and effectiveness of three minimally invasive (MI) techniques in removing deep dentin carious lesions. Forty extracted carious molars were treated by conventional rotary excavation (control), chemomechanical caries removal agent (Brix 3000), ultrasonic abrasion (WOODPECKER, GUILIN, China); and Er, Cr: YSGG laser ablation (BIOLASE San Clemente, CA, USA). The assessments include; the excavation time, DIAGNOdent pen, Raman spectroscopy, Vickers microhardness, and scanning electron microscope combined with energy dispersive X-ray spectroscopy (SEM–EDX). The rotary method recorded the shortest excavation time (p < 0.001), Brix 3000 gel was the slowest. DIAGNOdent pen values ranged between 14 and 18 in the remaining dentin and laser-ablated surfaces recorded the lowest reading (p < 0.001). The Ca:P ratios of the remaining dentin were close to sound dentin after all excavation methods; however, it was higher in the ultrasonic technique (p < 0.05). The bur-excavated dentin showed higher phosphate and lower matrix contents with higher tissue hardness that was comparable to sound dentin indicating the non-selectiveness of this technique in removing the potentially repairable dentin tissue. In contrast, the MI techniques exhibited lower phosphate and higher organic contents associated with lower microhardness in the deeper dentin layers. This was associated with smooth residual dentin without smearing and patent dentinal tubules. This study supports the efficiency of using MI methods in caries removal as conservative alternatives to rotary excavation, providing a promising strategy for the clinical dental practice.

Comparative Evaluation of a New Tricalcium Silicate Cement With Calcium Hydroxide as Direct Pulp Capping Agents: A Clinical Study.

Background and objectives Direct pulp capping (dPC) is a therapeutic process that involves the application of a protective chemical to an exposed pulp with the intent to facilitate the restoration and preservation of its vitality and function. Despite numerous proposed solutions, researchers have yet to find a dependable, non-absorbable bioactive pulp capping substance that constantly activates cellular healing processes, consequently preserving pulpal vitality over an extended period of time. The objective of this study was to assess and contrast the efficacy of a novel tricalcium silicate cement and calcium hydroxide in preserving the long-term health of the dental pulp following dPC using clinical and radiographic observations. Materials and methods A total of 60 individuals with symptoms of reversible pulpitis associated with deep carious lesions were chosen for dPC in the study. Two groups comprising 30 patients each underwent dPC using the novel tricalcium silicate cement (experimental group) and calcium hydroxide (control group) out of the total number of patients. A thin protective covering of self-curing glass ionomer base was applied on top of the capping material. The dentist provided instant permanent restoration employing direct posterior composite resin. Follow-up examinations were conducted three, six, nine, and 12 months after the procedure, during which assessments were performed using clinical and radiographic parameters. Results The minimum age of the study group was 16, and its maximum age was 34 (22.35 ± 2.3 years). The control group consisted of 12 males and 18 females, while the Biodentine group consisted of 13 males and 17 females. The age and gender distribution were determined to have insignificant statistical differences across the groups. The pain score exhibited statistical significance at both the three-month and six-month follow-up visits (p < 0.05). The pain score at the 12-month follow-up was 0.38 ± 0.52 in the case group and 0.42 ± 0.61 in the control group (p = 0.79). The average Periapical Index (PAI) score for the Dycal and Biodentin groups after the 12-month follow-up was 1.38 ± 0.97 and 1 ± 0.3, respectively. This difference was found to be statistically significant (p = 0.044). In addition, there was a statistically significant difference in the PAI score at the three-month, six-month, and nine-month follow-ups (p < 0.01). During the entirety of the follow-up duration, one individual in the Biodentine group had tenderness upon percussion, a negative reaction for pulp vitality, pulpal changes, and a widening of the periodontal space. Statistically significant differences were observed in pulpal changes and tenderness on percussion during the nine-month and 12-month follow-up periods (p < 0.05). After 12 months, the rate of success in the group treated with Dycal was 91.3%, while the success percentage in the group treated with Biodentine was 98.55%. This difference in outcomes was determined to be statistically significant (λ2 = 5.46; p = 0.019). Conclusion The study findings indicate that Biodentine, a novel tricalcium silicate cement, outperforms calcium hydroxide in preserving pulp vitality over the long term following dPC. The Biodentine group attained an overall success rate of 98.55%, whereas the Dycal group had a success rate of 91.3% following 12 months of subsequent follow-up visits.