Selective Carious Tissue Removal Research Articles

DENTAL REHABILITATION BY THE OCCLUSAL MATRIX TECHNIQUE USING PROVISIONAL RESTORATOR: Case report of a pediatric patient from the city of Mato Verde - MG

The occlusal matrix technique allows the recording of anatomical details of the remaining tooth structure before starting cavity preparation, enabling the reestablishment of the original tooth morphology by means of an occlusal matrix. The objective of this study was to report a clinical case of dental rehabilitation by the occlusal matrix technique using a temporary restorative in pediatric dentistry. This research is an observational descriptive study (committee, nº 6.906.292). The work was conducted in the city of Mato Verde, Minas Gerais, at Faculdade Verde Norte (FAVENORTE). A 7-year-old female patient, together with her guardian, attended the FAVENORTE Dentistry clinic for dental care, complaining that her tooth had some “dark spots”. During the clinical examination, it was observed that tooth 46 had an active carious lesion on the occlusal surface in a region of pits and fissures with shadowing in the underlying dentin (ICDAS – Score 4), but with relatively intact occlusal anatomy. Interproximal radiographic examination showed that the carious lesion was in the dentin, but not close to the pulp. Due to the preservation of the occlusal anatomy of the tooth, the proposed treatment for the patient was the use of the occlusal matrix technique, selective removal of carious tissue, and restoration with composite resin, aiming to restore form and function. The occlusal matrix technique has proven to be an effective and efficient approach in the rehabilitation of carious lesions on occlusal surfaces, especially in pediatric patients. The technique allowed the faithful reproduction of the original anatomy of the tooth, which is essential for the maintenance of masticatory function, esthetics and occlusal integrity.

Therapeutic management of cavitated caries lesion in a patient with sensory processing disorder

Caries disease is still an important public health problem. Although preventing the disease is simple, it is still a challenge due to the interaction of cariogenic factors. One of the forms of treatment is the selective removal of carious tissue, which consists of the total removal of carious tissue from the surrounding walls, preserving the affected tissue in the pulp wall, as it is a tissue capable of remineralization. In the conservative philosophy, there are alternative therapies to the use of manual cutting instruments and the use of rotary instruments - such as the use of chemical agents. These materials help the professional in the selective removal of decayed dentin tissue. The more conservative philosophy is an excellent alternative for patients with Sensory Processing Disorder, as it generates less sound, olfactory, thermal and tactile stimuli – also improving the pain experience. This makes it possible to provide the patient with individualized care, taking into account and respecting their limitations and needs.

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.

Short-Wavelength Infrared Imaging of Infected and Affected Dentin.

Stains produced by bacteria or those found in blood and food byproducts accumulate in highly porous caries lesions. They can interfere with accurate diagnosis and the selective removal of carious tissue during cavity preparations. Short-wavelength infrared (SWIR) imaging studies have shown that stain molecules do not absorb light beyond 1200 nm. The objective of this study was to image affected and infected dentin atSWIR wavelengths. Sections of 3 mm thickness were cut from the extracted teeth with deep dentinal lesions. The sound (normal), affected (stained), and infected (demineralized) dentin on each section were examined with reflected light at wavelengths from 400 to 1700 nm, red and green fluorescence, and with optical coherence tomography (OCT). Microcomputed tomography (microCT) was used to measure the mineral density at each location investigated. Significant (p < 0.05) differences were observed in the reflected light intensity at 400-850 nm and for fluorescence between the sound, affected, and infected dentin. SWIR imaging did not show significant reductions in reflectivity for the affected and infected dentin. SWIR images may be valuable for monitoring the lateral spread of dentinal lesions on the occlusal surfaces of teeth.

Cognitive Biases Influence Clinical Practice of Selective Removal of Carious Tissue by Dentists and Students: An Exploratory Study

Cognitive Biases Influence Clinical Practice of Selective Removal of Carious Tissue by Dentists and Students: An Exploratory Study

Evaluation of antimicrobial photodynamic therapy and minimal intervention associated with deproteinisation in permanent teeth with molar incisor hypomineralisation: study protocol for a clinical, controlled, blinded trial

IntroductionMolar incisor hypomineralisation (MIH) is a qualitative defect of enamel development that occurs in the mineralisation phase. MIH affects one or more permanent molars and, occasionally, permanent incisors. The aim...

Subjective versus objective, polymer bur-based selective carious tissue removal: 2-year randomized clinical trial

ObjectivesWe aimed to compare subjective (S) selective carious tissue removal using hand instruments versus objective (O) removal using a self-limiting polymer bur in a single-blind cluster-randomized controlled superiority trial. Methods115 children (aged 7–8 years) with ≥1 vital primary molar with a deep dentin lesion (>1/2 dentin depth) were included and randomized (60 S/55 O); all eligible molars in a child were treated identically (91 S/86 O). Cavities were prepared and carious tissue on pulpal walls selectively removed using hand instruments (S) or a self-limiting polymer bur (Polybur P1, Komet), followed by restoration using a glass hybrid material (Equia Forte, GC). Treatment time and satisfaction data have been reported in a 1-year-interim report. We here report on 2 year survival (tooth retained with or without further retreatments being needed, or tooth exfoliated), analyzed using multi-level Cox-regression analysis, as well as success (ART criteria 0/1, no pulpal complications, no re-intervention needed, or tooth extraction). Results71 restorations in S and 65 in O were examined after a mean (SD, range) of 22 (11; 3–31) months, of which 50 S and 48 O restorations were successful and 70 S and 65 O survived. The majority of failures were restorative, not pulpal, and distribution of ART codes was not significant different between groups. Risk of failure was not significantly associated with the removal protocol (HR; 95 % CI: 0.95; 0.51–1.78), and also not age, sex or dental arch, while single surfaced restorations showed significantly lower hazard (0.14; 0.06–0.37). ConclusionThere was no significant difference in success or survival between objective and subjective carious tissue removal. Clinical significanceIn primary teeth, subjective selective excavation had no disadvantage compared with objective excavation, which required a separate instrument (polymer-based bur) for carious tissue removal. Polymer-based burs may be particularly useful when standardized excavation is needed.

Influence of the chemomechanical and mechanical carious tissue removal on the risk of restorative failure: a systematic review and meta-analysis.

To summarize and evaluate critically the results of clinical trials comparing the risk of failure of restorations after chemomechanical and mechanical carious tissue removal. The PubMed/MEDLINE, EMBASE, Scopus, LILACS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, and grey literature were searched to identify studies related to the research question and published up to January 2022. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and the certainty of evidence. Meta-analysis was performed using a random effects model to compare the effect of chemomechanical and mechanical excavation on the outcome (restorative failure), considering the type of carious tissue removal (selective and complete) as subgroups. From 443 potentially eligible studies, 58 clinical studies were selected for full-text analysis, and 6 were included in the review. There was no statistically significant difference in the risk for failure of restorations performed after chemomechanical and mechanical excavation (RR: 1.26, 95% CI 0.93; 1.72, p = 0.14) either for complete (p = 0.97) or selective (p = 0.11) carious tissue removal. The heterogeneity found was null. The risk of bias was high and the certainty of evidence was low. Based on the low certainty of evidence, the risk of failure of restorations performed after chemomechanical and mechanical carious tissue removal is similar. Chemomechanical carious tissue removal may be performed before restoration placement, without jeopardizing the short-term longevity. Further studies are required before definitive conclusions can be drawn.

Efecto de los revestimientos en la microfiltración de resina compuesta después de la eliminación selectiva de lesiones cariosas. Un estudio experimental

Objetive: To evaluate microleakage of composite resins (CR) placed over different cavitary liners after managing deep caries lesions through selective removal of soft carious tissue to soft dentin (SRCT-S). Material and Methods: Fifty four human teeth were collected for microleakage testing. Each assay comprised ICDAS 5 or ICDAS 6 carious lesions and sound teeth for controls. Sound teeth were prepared with cavities that mirrored the carious teeth cavities, which were prepared with SRCT-S. Sound and carious teeth were further randomly assigned to one of the three experimental groups: Group A: universal adhesive (UA) + CR, Group B: glass ionomer cement liner + UA + CR, and Group C: calcium hydroxide + UA+ CR. Occlusal microleakage (OM) and cervical microleakage (CM) was classified within one of 5 depth categories. ANOVA and Chi-square tests were computed (p&lt;0.05). Results: OM and CM were similarly distributed across subgroups (p&gt;0.05). All Group C samples with carious lesions presented some degree of microleakage. However, no statistically significant differences were observed between groups and within each group (p&gt;0.05). Conclusion: Teeth restored with CR after SRCT-S using calcium hydroxide as a liner material seem to exhibit higher microleakage than those restored using glass ionomer or UA alone. Further clinical research is needed to deepen these findings. Clinical significance: The application of calcium hydroxide as a liner under a composite resin may reduce the longevity of a restoration after performing selective or partial removal of carious tissues. Clinicians should rethink the need of using calcium hydroxide for this application, albeit the lack of clinical evidence.

Interventions for treating cavitated or dentine carious lesions.

Interventions for treating cavitated or dentine carious lesions.

Paediatric dentistry: Glass ionomer or giomer?

Introduction: Giomers are composed of PRG fillers which in turn contain some ions, in addition to fluoride, which are beneficial to enamel so, it could be used for remineralization. Glass ionomer also contains fluoride and has been a commonly used material for many years. Objective: to analyze information about its chemical composition, physical properties, chemical properties and application of S-PRG technology in comparison with glass ionomer. Methodology: articles were searched in PubMed, Science Direct, Springer and EBSCO. Terms such as S-PRG OR GIOMER, S-PRG AND prevention, glass ionomer AND pediatric dentistry were used. Results: S-PRG has a pre-reactive glass ionomer layer containing reactive ions that acts in contact with water and saliva, thus releasing ions that promote remineralization, bacterial control, etc. It has lower setting shrinkage compared to some ionomers and allows remineralization around the restoration and can be used as a restorative material for primary and permanent teeth. Glass ionomer has an acid-base reaction. By bonding glass ionomer filler to resins, it improves their properties, is successful in the presence of secondary caries and is well accepted as a restorative material after selective removal of carious tissue. Conclusion: Both materials have fluoride releasing and recharging capabilities as well as restorative properties. However, giomer has better esthetic advantages. Further studies are required because giomers are relatively new.

Impact of non-restorative cavity control on proximal carious lesions of anterior primary teeth on the tooth survival and patient-centered outcomes (CEPECO 2): study protocol for a non-inferiority randomized clinical trial

BackgroundStudies have questioned the necessity of restoring cavitated carious lesion on primary teeth, once the control of biofilm is the most important factor to arrest these lesions. This randomized clinical trial aimed to compare the survival of teeth treated with a non-restorative cavity control (NRCC) compared to resin composite restorations (RCR) on proximal carious lesion in anterior primary teeth, as well as the impact of these treatments on patient-centered outcomes.MethodsA randomized clinical trial with two parallels arms (1:1) will be conducted. Children between 3 and 6 years old will be selected from the Center of Clinic Research of Pediatric Dentistry of Ibirapuera University (UNIB), a dental trailer (FOUSP) located on Educational Complex Professor Carlos Osmarinho de Lima, the Pediatric Dentistry Clinic of Santa Cecília University and from the Pediatric Dentistry Clinic of University Center UNINOVAFAPI. One hundred and forty-eight teeth will be randomly distributed in two experimental groups: (1) Selective removal of carious tissue and RCR; or (2) NRCC through cavity enlargement using a metallic sandpaper. The primary outcome will be tooth survival after 6, 12, 18 and 24 months. The duration and the cost of dental treatments will be considered for the estimation of the cost-effectiveness of the evaluated treatments. The discomfort reported by the participants will be measured after each treatment using the FIS scale. The participants’ satisfaction and perception of the parents/legal guardians will be evaluated through questionnaires. For the primary outcome, Kaplan–Meier’s survival and Long-Rank test will be used for comparison between the two groups. All the variables will be modeled by Cox regression with shared fragility. Significance will be considered at 5%.DiscussionThe NRCC could be an option to manage carious lesions on proximal surfaces of primary teeth, and the approach could be well accepted by the children and parents/legal guardians.Trial registration Clinicaltrials.gov registration: NCT03785730, Registered on December 18th 2018, first participant recruited 30/04/2019, https://clinicaltrials.gov/ct2/show/NCT03785730.Ethics Reference No: 91569118.8.0000.5597.Trial Sponsor: Universidade Ibirapuera.The Trial was prospectively registered.

Microhardness of sub-restoration dentine in primary molars after carious tissue removal to soft and firm dentine

To compare the microhardness of sub-restoration dentine after selective carious tissue removal and placing glass ionomer restorative cement. Forty-three primary molars with carious lesions extended to the inner third of dentine in subjects aged 8–12 years were included. The teeth were randomly assigned to the following carious tissue removal conditions: Group 1 - removal to the soft dentine, Group 2 - removal to the firm dentine, and Group 3 - removal to the hard dentine. Following restoration with glass ionomer restorative cement for three to six months, 30 tooth samples underwent microhardness testing performed on sub-restoration dentine and sound dentine. The Wilcoxon signed-rank test was used to compare the microhardness values of sound dentine and sub-restoration dentine within the group. The Kruskal–Wallis test was used to analyse the microhardness of the sub-restoration dentine across the three groups. All 30 teeth available for analysis were asymptomatic, with no signs of pulpitis. The average microhardness values of sub-restoration dentine and sound dentine ranged from 16 to 23 KHN and 20 to 27 KHN, respectively. In each group, the microhardness value of the sub-restoration dentine was significantly lower than that of the sound dentine ( p < 0.01). There were no significant differences in the microhardness values of sub-restoration dentine relative to that sound dentine among three groups ( p = 0.86). The microhardness values of sub-restoration dentine with selective carious tissue removal were comparable to those with complete carious tissue removal after glass ionomer restorative cement placement.

Selective carious tissue removal and glass ionomer liner reduction of pulp stress in bulk fill resin composite restorations.

To evaluate the effect of selective or nonselective carious tissue removal and the use of a resin-modified glass ionomer (RMGIC) liner under bulk fill resin composite restoration on the stress at the pulp chamber, the elastic moduli of hard, firm, soft and intact dentin were calculated using nanoindentation. Post-gel shrinkage of the bulk fill resin composite and RMGIC were determined using the strain-gauge method. Six finite element models were created by using digital radiography with the combination of two study factors: a) carious tissue removal: selective removal or nonselective removal of carious tissue, and b) use of RMGIC liner: with or without 1.0 mm of RMGIC liner. The modified von Mises stresses (mvm) (MPa) were extracted on the nodes of the internal wall of the pulp ceiling chamber at 100 N occlusal loading. Data were analyzed descriptively and recorded quantitively. Both study factors influenced the stress distribution. The mvm stress during the restorative procedure was higher for nonselective carious tissue removal without RMGIC (25.9 MPa) and lower for selective carious tissue removal associated with RMGIC (13.5 MPa). The dentin elastic modulus increased from soft carious (3.6 ± 0.3 MPa) to firm carious (5.2 ± 1.0 MPa) to hard carious (10.9 ± 1.2 MPa) to intact dentin (22.7 ± 3.0 MPa). Molars with carious lesions showed high mvm stress at the pulp ceiling (89.6 MPa) and at fragilized coronal structure remaining. Selective carious tissue removal followed by restoration using a Vitrebond liner and Tetric N-Ceram Bulk fill reduced the stress at the pulp chamber ceiling.

Pulp Vitality and Longevity of Adhesive Restorations Are Not Affected by Selective Carious Removal: A Multicenter Clinical Trial

The aim of this multicenter randomized clinical trial was to evaluate the pulp vitality and survival rate of adhesive restorations performed on posterior deciduous teeth after non-selective (NSCR) or selective (SCR) carious tissue removal over 33 months. One hundred and seven children (average age 4–8 years, SD 1.4) with at least two active moderate cavitated lesions in dentin were included. Teeth were randomized and submitted to NSCR or SCR before composite resin restoration. Restorations were clinically and radiographically assessed at baseline, 6, 12, 18, 24, and 33 months by a blinded, trained, and calibrated operator in each center. The characteristics of the restorations were recorded according to FDI criteria and were considered as restorative failures when scores 4 or 5 were presented. Pulp vitality was measured by clinical and radiographic examinations, and those teeth that presented any signs or symptoms of irreversible pulpitis or pulp necrosis were considered as failure. Data were analyzed by a Cox regression model with shared frailty, considering two outcomes: pulp and restorative. A total of 278 restorations (137 after NSCR and 141 after SCR) were performed at baseline in four different centers and there was no loss in the follow-up period. Survival rate was 97.1 and 87.1% for pulp and for restorative outcome, respectively. The overall annual failure rate was 7%. There were no differences in the failure risk according to the treatment group, center, and all the clinical and demographic variables, regardless of outcome. Composite restorations of active moderate deep carious lesions performed on posterior primary teeth show satisfactory survival for restorative and pulp outcome after a 33-month follow-up, regardless of the technique executed for carious tissue removal.

Improving the Bond Strength of Radiographically Tagged Caries Lesions In Vitro.

After selective carious tissue removal, residual carious lesions remain radiographically detectable. Radiopaque tagging resolves the resulting diagnostic uncertainty but impedes bond strengths of adhesives to tagged dentin. We developed a protocol mitigating these detrimental effects. A 30%/50%/70% SnCl2 solution was dissolved in distilled water or a 30%/50%/90% ethanol solution (E30/60/90) and applied to artificially induced dentin lesions. Tagging effects were radiographically evaluated using transversal wavelength-independent microradiography (n = 6/group). Groups with sufficient tagging effects at the lowest SnCl2 concentrations were used to evaluate how tagging affected the microtensile bond strength of a universal adhesive (Scotchbond Universal) to sound and carious dentin (n = 10/group). Two different protocols for removing tagging material were tested: 15 s phosphoric acid etching and 5 s rotating brush application. Scanning/backscattered electron microscopy (SEM/BSE) and energy-dispersive X-ray spectroscopy (EDS) were used to assess surfaces after tagging and removal. The most promising removal protocol was revalidated microradiographically. Tagging significantly increased the radiopacity, with consistent effects for 30% SnCl2 dissolved in water or E30. Microscopically, tagged surfaces showed a thick carpet of SnCl2, and tagging reduced bond strengths significantly on carious dentin but not on sound dentin (p < 0.01). On carious dentin, removal of tagging material using acid etching and rotating brush was microscopically confirmed. Acid etching also mitigated any bond strength reduction (median: 21.3 MPa; interquartile range: 10.8 MPa) compared with nontagged dentin (median: 17.4 MPa; interquartile range: 20.6 MPa). This was not the case for brushing (median: 13.2 MPa; interquartile range: 13.9 MPa). Acid etching minimally reduced the radiographic tagging effect (p = 0.055). Phosphoric acid etching reduces the detrimental bond-strength effects of tagging without significantly decreasing radiographic tagging effects when using a universal adhesive.

The influence of a liner on deep bulk-fill restorations: Randomized clinical trial

ObjectiveThe aim of this study was to evaluate the influence of a liner on the clinical performance of deep posterior restorations performed with bulk-fill composite. Methods30 subjects received two restorations on deep preparations in posterior teeth, without pulpal exposure, after selective carious-tissue removal in one-stage. The internal walls reached the inner quarter of dentin, but with a radiographically detectable zone of firm dentin remaining. The pulpal protection using a layer of glass ionomer composite liner (Ionoseal, Voco) was applied in just one preparation. The adhesive system Futurabond U (Voco) was applied in all preparations, which were restored with the bulk-fill pure Ormocer nanohybrid composite (Admira Fusion Xtra - Voco), in up to 4 mm thick increments. All restorations were evaluated using the FDI criteria after 7 days, 6, 12 and 24 months postoperatively. ResultsAfter 24-months, 25 patients attended the recall and 50 restorations were evaluated. The Fisher’s statistical analysis (5%) showed no difference between the techniques for the esthetic, functional and biological properties. No postoperative sensitivity was reported for both groups. ConclusionThe application of a liner did not influence the clinical performance of deep restorations with bulk-fill Ormocer composite. Clinical relevanceThe application of a liner with a GIC-based material did not have a significant effect on the clinical performance of bulk-fill restorations and seems to be unnecessary for the material tested.

Consensus recommendations on minimally invasive removal of carious tissue from dentine

The International Caries Consensus Collaboration (ICCC) presented recommendations on terminology, methods of carious tissue removal and managing cavitated carious lesions. It identified 'dental caries' as the disease that dentists should manage by controlling the activity of existing cavitated lesions by preserving as much hard tissue as possible, maintaining pulp sensibility and retaining functional teeth in the long-term. The ICCC recommended the level of hardness as the criterion for determining the clinical consequences of the process of demineralisation and defined new strategies for the selective removal of carious tissue. The starting point is to effectively remove the biofilm from cavitated carious lesions. Only when cavitated carious lesions are either non-cleansable or can no longer be sealed, are restorative interventions indicated, with due regard for the principles of a minimally invasive approach. Applying a restoration facilitates biofilm removal, guards the pulpodental complex and restores form, function and aesthetics.

A Primary Care Randomized Controlled Trial of Hall and Conventional Restorative Techniques.

To investigate treatment outcomes of different restorative techniques undertaken by dental therapists for primary molar carious lesions in a sample of children in New Zealand primary care. This was a randomized controlled trial with children aged 3 to 8 y in New Zealand's Whanganui region. Children meeting inclusion criteria were randomly allocated to treatment with either the Hall technique (HT), in which a stainless-steel crown (SSC) is placed without any carious tissue removal or tooth preparation, or a non-Hall conventional restorative approach (NHT), including tooth preparation with selective carious tissue removal; this included SSC, amalgam, composite, or glass ionomer cement (GIC) restorations. Restorative outcomes after 12 and 24 mo were categorized as success, minor failure, or major failure. Of the 295 eligible children, 149 and 146 were allocated to the HT and NHT groups, respectively, with a total of 570 carious primary molars treated by 13 dental therapists. The participant follow-up rates at 12 and 24 mo were 95% and 91%. SSCs were the most commonly used restoration in the NHT group (60%), followed by GIC (28%). SSCs were the most successful restorations regardless of whether they were placed with the HT or NHT, with success rates of 89% and 92% at 12 mo and 85% and 86% at 24 mo. In the NHT group, the treatment material was a predictor of minor failure at 12 and 24 mo, with significantly more failures with GICs. SSCs placed by dental therapists are a highly successful restoration for the primary dentition, regardless of whether they are placed with the HT or conventionally. The high failure rate of glass ionomer restorations means that they cannot be recommended for widespread use in New Zealand primary care (Australian New Zealand Clinical Trials Registry, ACTRN12614000844640). The findings of this study can be used by policy makers and clinicians when deciding on which materials and which approach to use to maximize success and to minimize retreatment rates when providing restorative treatment for carious primary molars in children's primary oral health care. Results also suggest that undertaking research in the primary care setting may enhance translation of new knowledge and techniques into clinicians' hands.

Subjective versus objective, polymer bur-based selective carious tissue removal: 1-year interim analysis of a randomized clinical trial

We aimed to compare subjective (S) vs. objective (O) selective carious tissue removal using hand-excavation versus a self-limiting polymer bur, respectively. A community-based single-blind cluster-randomized controlled superiority trial was performed. This is a 1-year-interim analysis. 115 children (age 7–8 years) with ≥1 vital primary molar with a deep dentin lesion (>1/2 dentin depth) were included (60 S/55 O). The cluster was the child, with eligible molars being treated identically (91 S/86 O). Cavities were prepared and carious tissue on pulpo-proximal walls selectively removed using hand instruments (S), or a self-limiting polymer bur (Polybur P1, Komet). Cavities were restored using glass-hybrid material (Equia Forte, GC). Treatment times and children’s satisfaction were recorded. Generalized-linear models (GLM) and multi-level Cox-regression analysis were applied. Initial treatment times were not significantly different between protocols (mean; 95%CI S: 433; 404–462 sec; O: 412; 382-441 sec; p = 0.378/GLM). There was no significant difference in patients’ satisfaction (p = 0.164). No pulpal exposures occurred. 113 children were re-examined. Failures occurred in 22/84 O-molars (26.2%) and 26/90 S-molars (28.9%). Pulpal complications occurred in 5(6%) O and 2(2.2%) S molars, respectively. Risk of failure was not significantly associated with the removal protocol, age, sex, dental arch or tooth type (p > 0.05/Cox), but was nearly 5-times higher in multi-surface than single-surface restorations (HR: 4.60; 95% CI: 1.70-12.4). Within the limitations of this interim analysis, there was no significant difference in treatment time, satisfaction and risk of failure between O and S.