Stepwise Caries Removal Research Articles

Which caries removal method to select?

Searches were carried out using PubMed/MEDLINE and Web of Science databases between January 2008 and January 2023. Only articles in English language were included. Boolean operators were used to search: "permanent teeth" OR "permanent tooth" OR "permanent dentition" AND "deep caries" OR "stepwise" AND "partial caries removal OR "stepwise caries removal" OR "pulp vitality" OR "healing rate". Inclusion criteria were randomised controlled trials, which compared the total removal of carious tissue with either a selective or stepwise removal in permanent teeth with deep carious lesions. Criteria also required a follow up of at least 6 months and publications in English. Exclusion criteria were articles in other languages, articles not comparing different types of total or selective caries removal and articles published before January 2008. Data extraction followed PRISMA guidelines. Two reviewers independently screened articles, analysing titles and abstracts using Rayyan's Intelligent Systematic Review Platform. They also collected data and risk of bias assessed using the Cochrane Risk of Bias Tool for Randomised Trials, dividing articles into high risk of bias, few concerns and low risk of bias. A third researcher resolved conflict or doubt in case of divided opinions. In total, 105 articles were identified, and 10 duplicates removed. 95 articles were reviewed by title and abstract and 75 of these did not meet the inclusion criteria. 20 articles were then read, excluding a further 15 due to comparing only partial removal or non-selective caries removal or absence of numerical data. This left 5 articles which met eligibility criteria. These were randomised controlled trials between 2010 and 2021. Follow up ranged from 1 month to 5 years. The inclusion and exclusion criteria in all studies had similar clinical parameters. 3 studies performed management only on permanent molars, whilst the rest also included management on permanent incisors/canines/premolars and molars. Management of caries was divided into non-selective caries removal vs partial caries removal (either selective or stepwise). All but 2 studies included specific information about the materials used. Liners were calcium hydroxide or Dycal, provisional restorations were glass ionomer cements or Ketax Molar and definitive restorations were Herculite Tetric N-Ceram resin, Ivolclar Vivadent or amalgam. Clinical success or failure was measured using pulp vitality, absence of periapical lesions, radiographic analysis and lack of symptoms. Clinical follow up was evaluated by external examiners, although 2 studies did not specify this clearly. There were a variety of tools used for statistical analysis in each study. When comparing non-selective caries removal with either selective or stepwise, 3 studies proposed statistically significant differences in terms of longevity, marginal integrity and success rate of restorations. 1 study stated inexistence of statistically relevant divergences between procedures. Non-selective caries removal is not highly recommended for deep carious lesions and may be considered invasive and risks pulpal exposure. Both selective and stepwise removal are considered conservative approaches. Selective removal is considered the best management option in the short term (with 1.5 years follow up), predominantly related to a lower risk of pulpal exposure. At 5 years, however, the results of selective were similar to those of non-selective, accepting the null hypothesis. There were also no differences in success rates for materials used for definitive restorations.

Silver Diamine Fluoride as Indirect Pulp Capping Agent in Primary Molars: A Case Series

According to the current recommendations of the American Academy of Pediatric Dentistry (AAPD), Indirect Pulp Capping or Indirect Pulp Treatment (IPT) is defined as a procedure that preserves the deepest cavities adjacent to the pulp to prevent pulp exposure. Preserving and protecting the vital pulp through remineralisation of hypomineralised carious dentin poses a significant challenge in restorative dentistry. Traditionally, managing deep caries often led to pulp exposure and subsequent root canal treatment. Selective or stepwise caries removal is based on the concept of halting the progression of carious destruction, allowing for biological repair of the pulp-dentin complex by promoting the formation of tertiary dentin between temporary and definitive restorations. Silver Diamine Fluoride (SDF) has gained popularity due to its unique combination of silver and fluoride, which provides antimicrobial and remineralising properties. In this case series of three cases, three-year-old preschool boy, five year old girl and five year old girl, in whom, deep carious lesions in primary molars were treated using selective caries removal techniques with SDF as an IPT agent, resulting in successful minimally invasive restorative procedures. This case series underscores the importance of employing selective caries removal techniques and the potential use of SDF as an IPT agent in such scenarios to preserve tooth vitality in a less invasive therapeutic approach suitable for the pediatric population.

Effectiveness of vital pulp treatment in managing nontraumatic pulpitis associated with no or nonspontaneous pain: A systematic review.

The exposed pulp has been the topic of numerous studies, but well-designed and well-executed comparative trials on the outcome and treatment of these teeth have been limited. This study was conducted to answer the following questions: in patients with nontraumatic pulpitis associated with no or nonspontaneous pain in permanent teeth, (i) is direct pulp capping or pulpotomy (partial/full) as effective as selective or stepwise caries removal [Population/participants, Intervention(s), Comparator(s)/control, Outcome(s) (PICO) 1], (ii) is pulpotomy (partial/full) as effective as direct pulp capping (PICO 2) and (iii) is pulpotomy (partial/full) as effective as a pulpectomy (PICO 3), in terms of a combination of patient and clinical reported outcomes, with 'tooth survival' as the most critical outcome? A literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials from inception to November 3rd 2021. Grey literature and contents of the major subject journals were examined. Eligibility criteria followed the PICO questions. Two independent reviewers performed study selection, data extraction and appraisal; disagreements were resolved by a third reviewer. The risk of bias was assessed by the revised Cochrane risk-of-bias tool for randomized trials. Three randomized clinical trials (RCTs) were included in the review. No study fulfilled the criteria to answer PICO 1. There were no significant differences in the reported outcomes between investigated treatments in all included RCTs. None of the included studies reported the most critical outcome 'tooth survival'. A high loss of patients during the follow-up period was observed. Although a few studies fulfilled strict eligible criteria, the results of this systematic review clearly highlight a paucity of available evidence. At the present time, clinical decisions cannot be substantiated by direct comparative trials. Based on limited evidence, this systematic review discovered no significant differences in effectiveness between compared vital pulp treatments in managing nontraumatic pulpitis associated with no or nonspontaneous pain. Further high-quality RCTs are necessary to investigate the effectiveness of direct pulp capping or pulpotomy (partial/full) compared to selective or stepwise caries removal. PROSPERO database (CRD42021259742).

Selective stepwise caries removal in primary teeth: a microbiological assessment on surviving microbiota

Partial caries removal performed by the stepwise treatment has a high rate of clinical success and promotes a reduction of microorganisms in carious dentin. However, the adaptive behavior of these cloistered bacteria is not entirely clear. Aim: This study aimed to evaluate the carious dentin and quantify the microorganisms Streptococcus mutans and Lactobacillus acidophilus at the first intervention and after 90 days, assessing the acidogenicity and aciduricity of these bacteria isolated from the lesions. Methods: Twenty patients presenting deep caries lesion in primary molars eligible to receive the stepwise treatment were selected, dentin samples were collected in two different moments: in the first intervention, just after partial caries removal; and in the second intervention, during the reopening of the cavity (90 days after the temporary sealing of the lesion). The samples were processed for microbiological analyses via culture, identification and quantification. The bacteria isolates were subjected to phenotypic tests of acidogenicity and aciduricity. Dentin consistency and color was also recorded by a calibrated examiner. Data were statistically analyzed. Results: There was a reduction in the number of viable microorganisms while dentin rehardening and browning was noted (p<.05), but no change occurred in the acidogenicity and aciduricity properties of Streptococcus mutans and Lactobacillus acidophilus over time. Conclusion: Thus, the stepwise treatment promoted clinical changes as darkening and hardening of carious dentine and promoted a reduction in the number of viable microorganisms, but no influence was found on the phenotypic characteristics of acidogenicity and aciduricity of the species analyzed after 90 days.

What is the best caries removal strategy for primary molars?

Aim This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to compare the efficacy of different caries removal techniques: complete caries removal (CCR), selective caries removal (SCR) and stepwise caries removal (SWR) for deep carious lesions in vital primary teeth.Data sources The design of this review followed the PRISMA guidance ( http://www.prisma-statement.org/ ). Relevant studies were identified using electronic databases (PubMed [Medline], Cochrane Library, EMBASE) and finally reference lists were screened. The US National Institutes of Health Trials Register (NIHTR; http://clinicaltrials.gov ) and World Health Organisation International Clinical Trials Registry Platform (WHO ICTRP; http://apps.who.int/trialsearch ) were used to help assess publication bias, as it was not possible to test funnel plot asymmetry. Duplicates were located and eliminated using EndNote X7 programme.Study selection To be included, studies had to be published RCTs comparing SCR or SWR with CCR as caries removal strategies for deep carious lesions in vital primary teeth. The outcomes were pulp exposure, pulpo-periodontal complications (clinical and radiological failures) and/or restorative failures. RCTs applying these caries removal techniques were excluded if one of the other trial arms did not involve caries removal (that is, Hall Technique, therapeutic sealing of cavity lesions). Initially, 1,374 potentially eligible articles were identified, out of which 15 (English or French language only) were selected for full-text screening, which included ten relevant references corresponding to eight studies.Data extraction and synthesis Two authors independently extracted data using a piloted data extraction sheet, with a third reviewer resolving any disagreements. The authors performed conventional intention-to-treat and per-protocol meta-analyses, and calculated odds ratios (ORs) as effect estimates in the random-effects model, using Revman5.Results The eight included RCTs were conducted between 1977 and 2018. They include 669 patients and 824 teeth, with follow-up ranging from four weeks to 24 months. Collective results showed reduced risk of pulp exposure after SCR (OR: 0.10, 95% CI [0.04, 0.25]) or SWR (OR: 0.20, 95% CI [0.09, 0.44]), compared with CCR. There was a higher risk of composite restorative failure (OR: 2.61, 95% CI [1.05, 6.49]) using United States Public Health Service (USPHS) criteria, after SCR was compared with CCR only in intention-to-treat analysis. However, when comparing the risk of clinical or radiographic failure of pulpo-periodontal complications, no difference was found between SCR, CCR or SWR.Conclusion The conclusions of the paper are that there is a significant decrease in pulp exposure risk with SCR and SWR in comparison with CCR. However, there is a need for further studies with less risk of bias powered to report on the long-term outcomes of pulpo-periodontal health and restoration longevity.

Caries removal strategies for deep carious lesions in primary teeth: Systematic review.

The study aimed to compare the efficacy of three caries removal techniques-complete caries removal (CCR), selective caries removal (SCR), and stepwise caries removal (SWR)-for deep carious lesions in vital temporary teeth by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs). Electronic databases (PubMed [MEDLINE], Cochrane Library, EMBASE) were searched for corresponding references up to 31 May 2019. Possible outcomes were pulp exposure, pulpo-periodontal complications, or restorative failures. Three reviewers independently selected studies, extracted data, and assessed the risk of bias using RoB 2. Meta-analyses for intention-to-treat and per-protocol scenarios were performed using Revman5. Of 1374 potentially eligible articles, ten relevant references corresponding to eight studies were included. Pooled results showed decreased risk of pulp exposure after SCR (OR: 0.10, 95% CI [0.04, 0.25]) or SWR (OR: 0.20, 95% CI [0.09, 0.44]), compared with CCR. There was a higher risk of composite restorative failure (OR: 2.61, 95% CI [1.05, 6.49]) using USPHS criteria, after SCR compared with CCR only in intention-to-treat analysis. Risk of clinical or radiographic failure of pulpo-periodontal complications was unchanged when compared with SCR and CCR or SWR. SCR and SWR may result in lower pulp exposure risk than CCR. RCTs with lower risk of bias, higher power, and longer follow-up are required to choose between these three caries removal techniques for deep carious lesions in vital temporary teeth.

WITHDRAWN: Operative caries management in adults and children.

WITHDRAWN: Operative caries management in adults and children.

Indirect pulp therapy for deciduous teeth with deep caries lesions

Deciduous teeth are the first dentition of humans and play an important role in children's physical and mental development. Dental caries are one of the most common oral diseases in children. According to the data of the World Health Organization, 60%-90% of school children worldwide develop dental caries. In China, dental caries of primary teeth feature high incidence and low rate of visits. Without timely treatment, the deep caries lesions of primary teeth can lead to teeth defect, pulpitis, apical periodontitis, and maxillofacial space infection. Moreover, the premature loss of deciduous teeth can cause malocclusion and eruption disorder of subsequent permanent teeth. These conditions all cause considerable effects on children's oral health and physical and mental development. Performing active and effective measures to treat deciduous teeth with deep caries lesions is important to maintain the integrity and normal physiological function of dentition and facilitate normal eruption of permanent teeth. The current situation of indirect pulp therapy in China was studied in this paper. Basic concepts, including indirect pulp capping, interim therapeutic restoration, partial caries removal, stepwise caries removal, and atraumatic restorative therapy, have been defined by consulting domestic and foreign literature. A theoretical basis for improving the clinical pathway of deciduous teeth with deep caries lesions is provided by explaining the technical connotation and therapeutic importance of indirect pulp therapy in primary teeth.

Management preferences of deep caries in permanent teeth among dentists in Saudi Arabia.

Objective:To report the management preferences of deep caries in permanent teeth among dentists.Materials and Methods:This observational cross-sectional study included a convenience sample of 177 dentists selected from private and public dental clinics in different cities of the Eastern Province of Saudi Arabia. Four clinical scenarios about the absence or presence of pain/symptoms and the risk of pulp exposure in deep caries were presented to the dentists in a pilot-tested questionnaire.Results:Most dentists (82.5%) preferred complete caries excavation when there was no risk of pulp exposure and no pain/symptom was associated with deep caries in permanent teeth. The stepwise technique was the procedure of choice reported by 57.8% of dentists when there was no pain but a risk of exposure was present. In case of no exposure risk but the presence of nonspontaneous pain (pain on thermal testing), complete caries removal was chosen by 55.9% of the respondents. Root canal treatment and stepwise caries removal were preferred by 42.4% and 38.4%, respectively, when there was a risk of exposure and nonspontaneous pain. The risk of exposure (81.4%), the progression of caries (73.4%), and treatment failure (58.8%) were the most common concerns with different caries removal techniques. The hardness was the most commonly used criterion (85.3%) followed by the color of caries (50.3%) during caries excavation.Conclusions:The majority of dentists preferred to completely remove caries in case of no risk of pulp exposure. The dentists should update their knowledge and adopt latest concepts about minimally invasive caries removal approaches.

Stepwise caries removal seems to result in more successful treatments than nonselective caries removal 5 years after treatment

Stepwise caries removal seems to result in more successful treatments than nonselective caries removal 5 years after treatment

No additional benefit of using a calcium hydroxide liner during stepwise caries removal: A randomized clinical trial

BackgroundClinicians often use calcium hydroxide liners during stepwise treatment of advanced caries. In this randomized clinical trial, the authors compared the short-term outcome of stepwise caries removal with and without use of a calcium hydroxide liner in conjunction with provisional resin-modified glass ionomer (RMGI) restorations. MethodsThe authors included in the trial 98 patients aged 15 to 30 years who had a deep carious lesion in a posterior tooth. The authors measured the dentin thickness radiographically and recorded its color, consistency, and moisture, as well as the bacterial count of the lesions. After partial caries removal, the authors assigned patients randomly to have their caries provisionally restored using RMGI with (control group) or without (test group) a calcium hydroxide liner. The primary outcome measure was tooth vitality after 90 days. Secondary outcomes included changes in dentinal, radiographic, and microbiological characteristics of the lesions. ResultsThe authors found no statistically significant difference between the test and control groups in tooth vitality after 90 days. Irrespective of calcium hydroxide liner use, the authors observed darker, harder, drier, and less contaminated dentin after the provisional restorations, but dentin thickness remained unchanged. ConclusionsOn the basis of this 3-month clinical trial’s results, the use of a calcium hydroxide liner during stepwise caries excavation and provisional restoration did not provide any additional benefit. Practical ImplicationsAfter 3 months, using a calcium hydroxide liner does not appear to offer any additional benefit when clinicians use RMGI provisional restorations during stepwise caries removal. Longer studies are needed to confirm these results.

Selective or stepwise removal of deep caries in deciduous molars: study protocol for a randomized controlled trial.

BackgroundFor treating deep caries lesions, selective or stepwise (one- and two-step) incomplete excavation seems advantageous compared with complete caries removal. However, current evidence regarding the success, as defined by not requiring any retreatments, or survival of teeth after different excavations is insufficient for definitive recommendation, especially when treating deciduous teeth. Moreover, restoration integrity has not been comparatively analyzed longitudinally, and neither patients’, dentists’ or parents’ preferences nor the clinical long-term costs emanating from both initial and retreatments have been reported yet.Methods/DesignThe planned study is a prospective multicenter, two-arm parallel group, randomized controlled clinical trial comparing selective and stepwise excavation in deciduous molars with deep, active caries lesions without pulpal symptoms. We will recruit 300 children aged between three and nine-years-old with a minimum of one such molar. Patients participating in another study, or those with systemic diseases, disabilities or known allergies to used materials as well patients with teeth expected to exfoliate within the next 18 months will be excluded. After inclusion, sequence generation will be performed. Initial treatment will follow dental routine. During excavation, leathery, moist and reasonably soft dentin will be left in proximity to the pulp followed by adhesive restoration of the cavity. Afterwards, patients’, dentists’ and parents’ subjective assessment of the treatment will be recorded using visual analogue or Likert scales. Re-examination will be performed after six months, and only then teeth will be allocated to one of the two interventions. Selectively excavated teeth will not be treated further, whilst for stepwise caries removal, a second excavation will be performed until only hard dentin remains. Clinical re-evaluations will be performed after 12, 24 and 36 months. Restorations will be reassessed using modified Ryge criteria. Objectively or subjectively required retreatments will determine success and survival. Retreatments will be evaluated both subjectively and regarding generated costs.DiscussionBased on the results of the trial, decision-making for treating deep caries lesions in deciduous molars based on multiple criteria should be feasible.Trial registrationClinicaltrials.gov identifier: NCT02232828 (registered on 29 November 2014).

Managing caries in primary teeth

N. P. T. Innes and D. J. P. Evans compare the different modern approaches to managing dental caries in primary teeth to those used for the carious permanent dentition. When prevention of dental caries fails, and a child is exposed to the risk of pain and infection, the disease must be managed to reduce this risk. There is growing evidence supporting more ‘biological’ and fewer ‘surgical’ approaches to managing dental caries in primary teeth. These biological methods include partial and stepwise caries removal procedures, as well as techniques where no caries is removed. An overview of clinical trials comparing these biological methods to complete caries removal shows that they perform as well as traditional methods and have the advantage of reducing the incidence of iatrogenic pulpal exposures. The Hall Technique is one biological approach to managing caries in primary molars which involves sealing caries beneath preformed metal (stainless steel) crowns. The crown is cemented over the tooth without caries removal, tooth preparation or use of local anaesthesia. The clinical steps for the Hall Technique are straightforward but, as with all dental care provision, appropriate treatment planning for the procedure requires skill. The Hall Technique offers another method of managing early to moderately advanced, active carious lesions in primary molars, with good evidence of effectiveness and acceptability. This evidence aligns with the positive findings of other studies on biological strategies for managing caries in primary teeth.

Partial caries removal may have advantages but limited evidence on restoration survival

Cochrane Oral Health Group's Trials Register, CENTRAL, Medline via OVID, EMBASE via OVID; no restrictions on language or date of publication. Parallel group and split mouth randomised and quasi-randomised controlled trials comparing stepwise, partial and no dentinal caries removal with complete caries removal in unrestored primary and permanent teeth were included in this review. Title and abstract screening was by two reviewers, with disagreements resolved by a third. Full texts of eligible studies were assessed by the team until consensus, and data extraction was by three reviewers independently and in triplicate. Two reviewers assessed risk of bias. Trial authors were contacted where possible . Eight trials (all assessed as high risk of bias) with 934 participants and 1372 teeth were included in this updated review (Previously complete or ultraconservative removal of decayed tissue in unfilled teeth, Ricketts, 2006) with four new trials being included. There were a number of different comparisons in the trials (stepwise or partial or no dentinal caries removal compared to complete caries removal) with one study including more than one of these comparisons. Four studies investigated primary teeth, three permanent teeth and one included both.For stepwise caries removal, (four studies), there was a 56% reduction in incidence of pulp exposure (RR 0.44, 95% CI 0.33 to 0.60, P < 0.00001) compared to complete caries removal. The mean pulp exposure incidence was 34.7% in the complete caries removal group and 15.4% in the stepwise groups. There was no difference in signs and symptoms of pulp disease (RR 0.78, 95% CI 0.39 to 1.58, P = 0.50).In the two partial caries removal studies, the incidence of pulp exposure reduction was 77% for the partial caries removal group (RR 0.23, 95% CI 0.08 to 0.69, P = 0.009) with a mean pulp exposure incidence of 21.9% in the complete caries removal groups and 5% in the partial caries removal groups. There was insufficient evidence to determine whether or not there was a difference in signs and symptoms of pulp disease (RR 0.27, 95% CI 0.05 to 1.60, P = 0.15), or restoration failure (one study showing no difference and another study showing no failures in either group).There were two very different studies which looked at no dentinal caries removal compared to complete caries removal. There was some evidence of no difference between these techniques for the outcome of signs and symptoms of pulp disease and reduced risk of restoration failure, favouring no dentinal caries removal, from one study. There were no instances of pulp disease or restoration failure in either group from the second study. Meta-analysis of these two studies was not carried out because of the substantial clinical differences between the studies. For management of dentinal caries, both stepwise and partial excavation showed clinical advantage over complete caries removal by reducing the incidence of pulp exposure in symptomless, vital, carious primary as well as permanent teeth. The review found no difference in signs or symptoms of pulpal disease between stepwise excavation and complete caries removal.There was insufficient evidence to determine whether there was a difference in signs and symptoms of pulp disease or a difference in the risk of restoration failure with partial caries removal.For the two no dentinal caries removal studies, the one investigating permanent teeth found no difference in restoration failure and the one investigating primary teeth found a statistically significant difference in restoration failure favouring the intervention.Due to the short term follow-up, low reporting of patient centred outcomes and high risk of bias, further high quality, long-term clinical trials are still required to assess the most effective intervention.

Reentry May Not be Needed After Partial Caries Removal in Mainly Young Permanent Molars With Caries Involving Half or More of the Dentin Thickness

Article Title and Bibliographic Information Randomized trial of partial vs. stepwise caries removal: 3-year follow-up. Maltz M, Garcia R, Jardim JJ, de Paula LM, Yamaguti PM, Moura MS, Garcia F, Nascimento C, Oliveira A, Mestrinho HD. J Dent Res 2012;91(11):1026-31. Reviewer Lars Bjorndal, DDS, PhD, DR ODONT Purpose/Question The study was designed to compare partial caries removal with stepwise excavation in Brazil through a randomized clinical study. The outcome measure was pulp vitality after 3-year follow-up Source of Funding CAPES (Brazil), Brazilian Ministry of Sciences and Technology (Brazil), National Council of Research (Brazil), Research support Fund of Rio Grande do Sul (Brazil), DFL (Rio de Janeiro, Brazil), Ivoclar Vivadent (Lichtentstein), SDI (Australia) and Hu-Friedy (USA) Type of Study/Design Randomized clinical trial Level of Evidence Level 1: Good-quality patient-oriented evidence Strength of the Recommendation Grade Not applicable

Modern approaches to caries management of the primary dentition

When prevention of dental caries fails, and a child is exposed to the risk of pain and infection, the disease must be managed to reduce this risk. There is growing evidence supporting more 'biological' and fewer 'surgical' approaches to managing dental caries in primary teeth. These biological methods include partial and stepwise caries removal procedures, as well as techniques where no caries is removed. An overview of clinical trials comparing these biological methods to complete caries removal shows that they perform as well as traditional methods and have the advantage of reducing the incidence of iatrogenic pulpal exposures. The Hall Technique is one biological approach to managing caries in primary molars which involves sealing caries beneath preformed metal (stainless steel) crowns. The crown is cemented over the tooth without caries removal, tooth preparation or use of local anaesthesia. The clinical steps for the Hall Technique are straightforward but, as with all dental care provision, appropriate treatment planning for the procedure requires skill. The Hall Technique offers another method of managing early to moderately advanced, active carious lesions in primary molars, with good evidence of effectiveness and acceptability. This evidence aligns with the positive findings of other studies on biological strategies for managing caries in primary teeth.

Randomized trial of partial vs. stepwise caries removal: 3-year follow-up.

Randomized trial of partial vs. stepwise caries removal: 3-year follow-up.

Operative caries management in adults and children

Operative caries management in adults and children

Randomized Trial of Partial vs. Stepwise Caries Removal

This randomized, multicenter clinical trial evaluated the effectiveness of 2 treatments for deep caries lesions — partial caries removal (PCR) and stepwise excavation (SW) — with respect to the primary outcome of pulp vitality for a 3-year follow-up period. Inclusion criteria were as follows: patients with permanent molars presenting deep caries lesions (lesion affecting ≥ 1/2 of the dentin on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions (radiographic examination). Teeth randomly assigned to PCR (test) received incomplete caries removal and filling in a single session. Outcome success was evaluated by assessment of pulp vitality, determined by pulp sensitivity to a cold test and the absence of periapical lesions. Data were analyzed by a Weibull regression model with shared frailty term (survival analysis). At baseline, 299 treatments were executed: PCR, 152 and SW, 147. By the end of the 3-year follow-up period, 213 teeth had been evaluated. Adjusted survival rates were 91% for PCR and 69% for SW (p = 0.004). These results suggest that there is no need to re-open a cavity and perform a second excavation for pulp vitality to be preserved (Clinical trials registration NCT00887952).