Management Of Deep Carious Lesions Research Articles

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.

Managing the deep carious lesion biomimetically without pulpal involvement

During the last 20 years, the restorative approach has evolved from the mechanical retention to the advanced adhesion. This transition was fostered by the development and the improvements in the adhesive materials and the increasing demand of the esthetics among the patients. Resultingly, Composites today have become the material of choice for both the anterior as well as posterior restorations. The Science, Principles and the techniques of advanced adhesive dentistry are known as biomimetic dentistry. The major goal of biomimetic dentistry is to preserve the vitality of the pulp and conserve maximum intact tooth structure. The management of deep carious lesions approaching a healthy pulp presents a significant challenge to a clinician. The traditional management of carious lesions dictates the removal of all the infected and affected dentin. Several studies call this approach into question. This article presents a systematic approach to manage the deep carious lesions in the vital teeth preserving its vitality &amp; conserving maximum intact tooth structure for the long term biomimetic function.

A questionnaire-based study on the management of deep carious lesions and exposed pulp among members of the Indian conservative dentistry and endodontic societies

Aim: Lack of unanimity in decision-making regarding the management of deep caries and exposed pulp has been highlighted by several questionnaire-based studies from various geographic regions. There is no research available in the Indian setting. The aim of the present study was to evaluate the perspectives of the Indian Endodontic Society and Indian Association of Conservative Dentistry and Endodontics members using an online questionnaire. Methods: An online structured questionnaire of 17 questions was mailed to 200 members based on the periapical radiographs of two cases (18 and 55 years of age) highlighting deep carious lesions and normal periapex in a mandibular molar. Each case had three hypothetical scenarios based on pulpal symptoms, i.e., asymptomatic pulp, reversible, and irreversible pulpitis, respectively. Results: A response rate of 65.5% (n = 131) was achieved. Nonselective caries removal was chosen by 40% and 36% of the participants in young patients with asymptomatic pulp and reversible pulpitis. On pulpal exposure, direct pulp capping was chosen by a majority of the members (66% and 54%, respectively) in a young patient. For irreversible pulpitis, pulpectomy was favored by 70%. In an older patient, less vital pulp therapy and more pulpectomy were preferred. The symptoms and patient age significantly altered treatment decisions, as determined by Chi-square and Fisher’s exact tests (P &lt; 0.05). Conclusion: There was a lack of agreement in managing deep carious lesions. There was partial awareness of the management of exposed pulp.

Assessment of Decision-Making and Material Selection for Vital Pulp Therapy in Deep Carious Lesions: A Study at the Faculty of Dentistry, King Abdulaziz University.

The purposes of this study were to assess decision-making, material selection, and management of deep carious lesions in permanent teeth requiring vital pulp therapy (VPT); investigate the intradepartmental and interdepartmental consensus in the management of those cases; and correlate this study's results to the current scientific literature, clinical experience, and postgraduate training among staff and postgraduate students at the Faculty of Dentistry,King Abdulaziz University. The survey included faculty from pedodontics, endodontics, and restorative/operative dentistry; postgraduate students; and interns, excluding specific categories such as retired faculty, external trainers, non-faculty hospital specialists, general practitioners, students, interns outside the institution, and other departments. An anonymous electronic questionnaire was developed and validated. Ethical approval was obtained, and the questionnaire was distributed to all 148 English-proficient members of the targeted populationvia email and WhatsApp, accompanied by a cover letter. The questionnaire encompassed demographic, education, experience, assessment, decision-making, and management sections. Data were collected and analyzed using Microsoft Excel, with results presented using categorical variables, Pareto charts, and statistical tests. There were 86 responses, representing 58% of the target population, with the key findings including the prominence of "Pre-operative vitality test result" as the most important factor in assessing deep carious lesions, with no significant differences among specialties. The (one-step and one-visit) management approach was preferred by 50% of participants, with no significant specialty differences. For deep carious lesions without pulpal exposure, glass ionomer (GI)/resin-modified glass ionomer (RMGI) base was the top choice, with no variation among all specialties. In cases with pulpal exposure, the one-visit approach (direct pulp capping (DPC), base, and restoration) was the most favored, with no specialty differences. Material availability significantly influenced decision-making, with no specialty variations. The study highlights the crucial role of pre-operative vitality tests in assessing deep carious lesions for VPT or root canal treatment (RCT). Participants generally favored VPT for cases with normal pulp vitality, with some departmental variation. Controlling bleeding post-pulpal exposure was a central concern. Mineral trioxide aggregate (MTA) was the most commonly used VPT material, followed by Ca(OH)2 and Biodentine. Factors such as treatment access, patient compliance, remaining dentin thickness, and oral hygiene had minimal impact on treatment choice. Limited availability of VPT materials was the primary reason for non-use. The survey's acceptable response rate raises concerns about potential non-response bias, though limitations include a lack of data on non-responders. Nevertheless, the survey's strength lies in its comprehensive coverage of key clinical aspects, engaging professionals from diverse specialties and educational levels who are collectively interested in addressing deep caries cases.

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.

Evaluation of the Antibacterial Effect of Aloe Vera versus Diode Laser in Management of Deep Carious Lesions (In Vivo Study)

Evaluation of the Antibacterial Effect of Aloe Vera versus Diode Laser in Management of Deep Carious Lesions (In Vivo Study)

Success rate of silver nano-particles in comparison to silver diamine fluoride in management of deep carious lesions: a randomized controlled clinical trial

Success rate of silver nano-particles in comparison to silver diamine fluoride in management of deep carious lesions: a randomized controlled clinical trial

The scientific management of deep carious lesions in vital teeth using contemporary materials—A narrative review

AimThe aim of this article is to review the scientific evidence for deep caries removal in permanent vital teeth and the choice of dentine replacement material and restoration of the teeth to maintain long term tooth vitality and function.MethodThe two position statements namely the European Society of Endodontology and the American Association of Endodontists position statements on vital pulp therapy will be scrutinized and compared with regards to the deep caries removal strategy and assessed for evidence of best practice. The properties of materials used to manage vital pulps and the best way to restore the teeth will be reviewed and guidance on the full management of vital teeth will be suggested.ConclusionsPromoting new treatment modalities for reversible and irreversible pulpitis allowing for pulp preservation should be considered. Although debatable, cases with deep caries should be managed by complete non-selective caries removal which will allow for pulpal management if needed and a more predictable outcome can be expected when using the new materials and treatment modalities of vital pulp therapy.

Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document

PurposeThe European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth.MethodsThree expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified.ResultsThere is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates.ConclusionThe management of deep carious lesions in primary teeth can be challenging and must consider the patient’s compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option.

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.

Deep carious lesions and their management among Finnish adolescents: a retrospective radiographic study

ObjectiveThe objective of this retrospective study was to find out (i) the prevalence of deep carious lesions, both untreated and previously treated, among 14- and 15-year olds and (ii) how deep carious lesions were managed in a Finnish public health care setting.Materials and methodsA random sample of 278 patients was taken from 3990 patients at the oral health care of the City of Helsinki. Radiographic subsample consisted of patients with bitewing and periapical radiographs (n = 128, 46% of the total sample). Deep carious lesions (extending to at least the inner half of dentine), deep restorations, direct pulp cappings, root canal treatments, and extractions in permanent premolars and molars were recorded from the radiographs. Patients with untreated deep carious lesions were followed up for 24 months.ResultsIn the total sample 12% had at least one untreated deep carious lesion, 10% at least one deep restoration, and 19% at least one untreated or previously treated deep carious lesion. The follow-up cohort included 48 deep carious lesions in 26 patients. Complete excavation was the most frequently chosen method (81% for lesions reaching the inner half of dentine and 56% the inner third or deeper), followed by stepwise excavation (19% and 37%, respectively).ConclusionsOne-fifth of 14–15-year-olds had at least one untreated or previously treated deep carious lesion. The choice for the carious tissue removal did not follow the current recommendations for less invasive methods.Clinical relevanceContinuing education is needed to improve the diagnostics and management of deep carious lesions.

Comparison of Three Treatment Techniques for Deep Carious Lesions in Primary Teeth: An In Vivo Study.

AimsTo evaluate and compare three different treatment modalities in the management of deep carious lesions in primary molars.Material and methodsA total of 60 primary molars from patients aged 4-9 years were randomly divided into three groups with 20 samples each. Sample in Group I received indirect pulp therapy with Mineral Trioxide Aggregate [MTA] as lining material, Group II received the modified Hall technique, and Group III MTA pulpotomy. The patients were evaluated at 1, 3, 6, and 9 months as per evaluation criteria for success or failure of the same. A Chi-square test was used for proportions and for comparison between groups.ResultsClinically, the success rate for the modified Hall technique and MTA pulpotomy was higher than indirect pulp therapy. Radiographically, the modified Hall technique had the highest success rate of 100 percent among the indirect pulp therapy and MTA pulpotomy. This success rate was however not statistically significant.ConclusionAll three techniques had promising results clinically and radiographically. Since the results were not statistically significant, conservative treatment like Modified Hall's technique can be preferred over the surgical approach [MTA Pulpotomy].Clinical significanceThis study compares newer techniques called Hall's technique with traditional techniques like indirect pulp capping and MTA pulpotomy. Hall's technique is a quick and noninvasive procedure, which involves fitting the crown and seating it over the tooth without any caries removal/ tooth preparation and no local anesthesia is being practiced. In the present study Hall's technique showed higher rates of success compared to the other two procedures.How to cite this articlePoludasu M, Kumar Mallela GM, Puppala R, et al. Comparison of Three Treatment Techniques for Deep Carious Lesions in Primary Teeth: An In Vivo Study. Int J Clin Pediatr Dent 2022;15(S-2):S201-S206.

An investigation into the management of the deep carious lesion by general dental practitioners in the UK.

Objectives As techniques and dental materials have evolved, the management of deep carious lesions has also changed. This study investigated how UK-based general dental practitioners (GDPs) managed deep carious lesions in permanent, vital teeth and factors that influence their choices.Methods This mixed-method study employed an online questionnaire as its primary source of quantitative data collection. The questionnaire enquired about GDPs': a) demographics; b) working environment; and c) whether they had postgraduate training that covered caries management/minimally invasive dentistry (MID). Respondents were presented with a clinical case to elicit qualitative data. Relevant questions were asked in order to examine current practice and explore treatment among the respondents.Results In total, 239 responses were received. Overall, 168 (70% [95% CI 64%, 76%]) of the respondents chose a partial caries removal technique, 155 (69.3% [95% CI 60%, 72%]) used an adhesive restorative material and 205 (85.8% [95% CI 81%, 89%]) advised fluoride adjuncts. However, rubber dam (75; 31.4% [95% CI 26%, 38%]) and saliva testing (17; 7.1% [95% CI 4%, 11%]) were not routinely used. A significant relationship between those who had postgraduate training and those who chose partial caries removal as their treatment choice (χ2 = 6.27; p = 0.01) was noted. Respondents working in an NHS-based practice were significantly (χ2 = 34.98; p <0.001) more likely to restore teeth with amalgam.Conclusions There is an inconsistent management protocol when presented with a deep carious lesion, but partial caries removal is more widely adopted than previously reported. Rubber dam isolation was not routinely used when choosing to restore a deep carious lesion. Those who have had postgraduate training felt more confident in offering MID, so there is a clear need for further education to ensure its engagement.

Novel endodontic simulation trainer for dental pulpotomy and pulp capping

Pulp exposures are the common problems encountered during the management of deep carious lesions in children and adolescents. The clinical skill plays an important role to achieve cooperation, reduced chair side time, and total patient care. This article describes a novel endodontic simulation trainer for dental pulpotomy and pulp capping. The simulator described in the article provides advantages such as life size design, easy to use, and cheaper to fabricate with good functional fidelity. This invention has the advantage that the pellet is replaceable, and so the procedure can be done multiple times simply by replacing it with a new pellet.

Children’s self-reported discomfort of restorative treatments for deep caries lesions in primary teeth: Results from a randomized clinical trial

The aim of this study was to evaluate the impact of different restorative techniques to treat deep caries lesions of primary molars on children’s self-reported discomfort. A randomized clinical trial with two parallel arms (1:1) was conducted in São Paulo, Brazil. 4-8 years-old children with at least one occlusal or occlusoproximal deep caries lesion in primary molars were selected. Molars were randomly allocated into two groups: (1) restoration performed with calcium hydroxide cement followed by high-viscosity Glass Ionomer Cement (CHC+HVGIC), and (2) HVGIC restoration. Immediately after the intervention, children reported the experienced discomfort during restoration to an external examiner using a Wong-Baker face-scale. Children’s self-reported discomfort was analyzed using Poisson regression comparing both groups and assessing other variables’ influence (α=5%). One hundred and eight children fulfilled the eligibility criteria and were randomized in the two groups (n=54). Most of the children who received CHC+HVGIC restorations reported none or minimal discomfort (83.3%). Similar scores (92.6%) were reported for those treated with HVGIC (p=0.758). The mean reported discomfort in children with CHC+HVGIC restorations was 0.37(1.01), and 0.41(1.01) for those with HVGIC restorations. Children’s self-reported discomfort was associated with age, sex, children’s cooperation, and intervention duration. We can conclude that CHC+HVGIC or HVGIC restorations result in none or minimal discomfort in the management of deep caries lesions, being considered a reliable option.

COMPARISON OF TWO AEROSOL-FREE CARIES REMOVAL METHODS - A SPLIT MOUTH RANDOMIZED CLINICAL TRIAL

Objectives: The management of deep caries lesions in immature permanent molars might be challenging in clinical practice. Minimally invasive caries removal methods can maintain apexogenesis by preventing extensive tissue loss. Here we compare the chemo-mechanical caries removal (CMCR) gel and the polymer bur in terms of time spent on caries removal, patient acceptability, and clinical success. Materials and Methods: The teeth of 30 children were randomly divided into two groups. The duration of each method, the level of cooperation during each method, and the child’s choice of caries removal method were recorded. Patients were followed at 6-month intervals for at least 2 years. Results: The difference between the patients’ preferences was not statistically significant, while the average caries removal time of the polymer bur method was significantly shorter (p &amp;lt; 0.05). The rates of apical closure without pathology in CMCR and polymer bur groups were 63.2% and 73.7%, respectively, whereas 10% of each group underwent further treatments due to the clinical and/or radiographic pathology. Conclusions: These methods were thought to serve as an interim treatment in managing immature permanent teeth with deep caries. Furthermore, these methods, which do not involve water cooling, can also minimize the risk of contamination and cross-infection.

Knowledge and Opinions of French Dental Students in Operative Dentistry - Management of Deep Carious Lesions.

A questionnaire survey was recently undertaken among French dental students (FDSs) to investigate their practices, knowledge and opinions in various domains of minimal intervention (MI) in cariology. The present work focuses on management of deep carious lesions (DCLs). The questionnaire was administered (Spring 2018) to all the fifth-year students of the 16 French dental schools. Descriptive analyses were performed. Among 1370 FDSs (response rate: 84.5%), hardness was the most commonly reported criterion for assessing the endpoint of carious tissue removal (53.9%), followed by firm dentin (40.0%). Regarding FDSs' opinion of leaving carious dentine under a restoration, 41.9% of the respondents agreed that carious tissues should always be removed completely. For an asymptomatic tooth with DCLs and exposed pulp, direct pulp capping was mainly chosen (93.9%). In a clinical case correctly diagnosed as a reversible pulpitis by 79.7% of respondents, nearly half of FDSs chose a one-step complete excavation (48.3%) followed by selective excavation (25.1%), then two-step complete excavation (20.9%) and a minority (5.7%) opted for pulpal therapy (biopulpotomy or endodontic treatment). The present results suggest an inadequate dissemination of MI concepts among FDSs towards DCL management. The present results show the need for a harmonisation and a reinforcement of teaching evidence-based MI according to the latest European recommendations.

Strategies of Carious Tissue Removal in Deep Carious Lesions among Dentists in Iraq: Online Based Survey Study

The aim was to find out the preferences of dentists in Iraq regarding strategies of carious tissue removalin management of deep carious lesions (CR) in asymptomatic teeth and how demographics (sex, years ofexperience, qualification, specialty, place of work) influences these preferences. An online questionnaireof two months duration was constructed and distributed randomly via social media (Facebook). Thequestionnaire’ questions investigated the demographics, CR (included non-selective removal to hard dentine(NS), stepwise (SW) and selective (SE) removal). 238 dentists participated in the study, 164 (69%), 56(23.5%) and 18 (7.5%) of respondents prefer NS, SW and SEremoval, respectively. Significantly both GDPand males prefer NS more than Endodontists and females (P&lt;0.05), Percent of respondents work in privateclinics who perform non-selective removal (53.6%) significantly lower than those who work in hospitals(73.6%) (p&lt;0.01). less invasive CR significantly associated with being an endodontist or female or work ina private clinic (OR=2.02, CI 95% 1.02-4.0), (OR=2.04, CI 95% 1.12-3.7) and (OR=2.1, CI 95% 1.0-4.0),respectively. In conclusion Iraqi GDPs prefer invasive strategy of carious tissue removal in management ofdeep carious lesions. Specialty, place of work and sex of respondents affected these choices significantly

Management of deep caries lesions with or without pulp involvement in primary teeth: a systematic review and network meta-analysis

There is a lack of evidence about the best approach for cavitated caries lesions with the possibility of pulpal involvement in primary teeth. Thus, the present authors aimed to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth. The search was conducted in MEDLINE/Pubmed and Web of Science databases until May 2020. Studies that compared techniques to manage deep caries lesions with at least 12 months of follow-up were included. The risk of bias was evaluated using the RoB tool. Network meta-analysis and pairwise meta-analyses were conducted considering the treatment clinical success as an outcome, according to the pulp health condition. From 491 potentially eligible studies, 9 were included. For deep caries lesions with pulp vitality, the Hall Technique presented the highest probability of success (78%). In the event of accidental pulp exposure, pulpectomy presented a 76% chance of providing the best clinical results. For pulp necrosis, no difference was observed between a pulpectomy and non-instrumented endodontic treatment (RR = 0.69; 95%CI: 0.21-2.33) Thus, it was concluded that the Hall Technique may be a better option for deep caries lesions with pulp vitality. In cases of accidental pulp exposure of vital teeth during caries removal, a pulpectomy may be considered the best option. However, there are insufficient studies to build up evidence about the best treatment option when irreversible pulpitis or pulp necrosis is present.

The management of deep carious lesions and the exposed pulp amongst members of two European endodontic societies: a questionnaire-based study.

To investigate and compare views on management of deep caries and the exposed pulp by Endodontic Society members in Ireland (Irish Endodontic Society [IES]) and Italy (Accademia Italiana di Endodonzia [AIE]). Further aims were to investigate the influence of patient-related factors (age, symptoms) and operator-related factors (material choice, antibiotics) on management. A structured online questionnaire containing two cases (an 18- and 45-year-old) and two scenarios (± mild symptoms), including history and radiograph, was sent to IES and AIE members. The answers were analysed using chi-square and Fisher's exact test (P<0.05). In total, 120 dentists participated, representing 49% of the AIE and 48% of the IES membership. Age distribution was similar between the societies; however, most AIE members had no further qualifications (63%), while IES respondents generally had a postgraduate endodontic qualification (71%). AIE respondents carried out a larger volume of vital pulp treatment (VPT) per month, with 69% carrying out over five cases, compared with 22% of IES respondents. The presence of patient symptoms significantly altered treatment planning decisions (P<0.001) with root canal treatment (RCT) more frequently selected in both societies. Patient age significantly influenced treatment choice in the absence (P=0.043) or presence (P=0.012) of symptoms with less VPT advocated in older patients. There were no significant differences in the treatment of a young patient in the presence (P=0.302) or absence of symptoms (P=0.297); however, older patient management differed between the societies for symptomatic (P=0.041) and asymptomatic scenarios (P=0.044) with significantly more RCTs carried out in the AIE than the IES. Hydraulic calcium silicate materials were commonly selected, accounting for 81% of IES and 69% of AIE VPT materials, although younger members of the AIE preferred calcium hydroxide materials. Younger dentists in both societies prescribed less RCT than older age groups. Although VPT is carried out by members of both societies there was no consistency regarding the most appropriate management for the exposed pulp or the VPT material of choice. Patient symptoms and age significantly influence the decision-making process and invasiveness of treatment. Hydraulic calcium silicate materials were the most commonly advocated material in all groups except young AIE members who preferred calcium hydroxide.