Treatment Of Deep Carious Lesions Research Articles

Vital Pulp Therapy of Young First Permanent Molars: A Retrospective Study on Radiographic Findings 24 Months Post-treatment.

With success rates comparable to that of root canal treatment, vital pulp therapy (VPT) has gained clinical interest and has been used in the management of young permanent teeth with inflamed pulps. The aim of the present study was to retrospectively evaluate the radiographic success of VPT in young first permanent molars 24 months post-treatment and correlate findings with tooth and treatment-related characteristics. Dental records of all patients with first permanent molars which received VPT in the Department of Paediatric Dentistry (National and Kapodistrian University of Athens) were retrieved. Demographic characteristics and data regarding the treatment performed were recorded. Patients' radiographs were evaluated at 6, 12 and 24 months post-treatment by two qualified paediatric dentists blinded regarding the treatment performed. Radiographic success, reasons for failure and continuation of root development were evaluated. Differences were tested using the Χ2 and Student's t-test, and possible correlations were determined by calculating the odds ratio. Overall radiographic success rate at 24 months was 77%, ranging between 50% for direct pulp capping and 92% for full pulpotomy. Differences were not statistically significant. Continuation of root development was recorded in almost 1/3 of the teeth and completion in almost 1/5. No statistically significant association was recorded between the outcome and any tooth and treatment-related variables. VPT seems to be a reliable option in the long term for the treatment of deep carious lesions in young permanent molars.

Treatment of deep carious lesions with mineral trioxide aggregate: clinical case report

Introduction. Deep carious lesions are a dental disease widely spread among population of all ages. From clinical point of view, they have little symptoms and go unnoticed by the patients a long time, until they provoke dental pulp inflammations. If diagnosed and treated properly, the tooth can be treated conservatively with certain techniques of pulp vitality preservation. An important role in this process plays the innate capacity of regeneration of the pulp-dentine complex and the enhanced stimulating properties of new biomaterials used in dentistry. The aim of this clinical case report is to describe the clinical manifestations and the diagnostic algorithm used in deep caries and to establish a clinical guideline of treatment of deep carious lesion with a calcium silicate hydraulic cement. Material and methods. Description of clinical case of a permanent tooth with a deep carious lesion, treated by indirect pulp capping with mineral trioxide aggregate cement. Clinical and paraclinical methods of investigations were used, the patient was evaluated after 6 and 12 months after the received treatment. Results. The sensitivity to cold stimuli presented by the patient before the treatment attenuated shortly after he received dental care. After 6 and 12 months, the tooth is asymptomatic, the clinical findings and paraclinical parameters show no evidence of pulp inflammation. Conclusions. Mineral trioxide aggregate showed long term successful results when used as a biomaterial for vital pulp therapy.

Potentialities of photoactivated disinfection in dentistry

Infection control is an essential part of dental practice. Oral antiseptics should be highly effective against the most common oral pathogens without causing microbial resistance, biocompatible with the human tissues with no interaction with fillings materials. Photoactivated disinfection (PAD) is based on activation of photosensitizers - specific substances releasing active oxygen forms after absorption of the light. The active oxygen forms destroy bacterial cell structures without affecting human cells. The overwhelming majority of Russian and international researchers have reported high effectiveness of PAD in periodontics, implantology and endodontics, whereas the use of PAD in caries treatment and prevention is not so fully understood yet. Earlier studies have demonstrated high sensitivity of cariogenic bacteria to PAD, suggesting it as an additional minimally invasive caries therapy improving treatment effectiveness. PAD spares dental tissues without reduction in the effectiveness of disinfection. It is particularly important in treatment of deep carious lesions and disinfection of thin dentine layer near the pulp. Effectiveness of PAD in caries treatment has been demonstrated for both permanent and deciduous dentition. PAD doesn't affect bond strength to fillings, improves plasticity of dental pulp and dental hard tissues mineralization in children. Effective control of a wide range of bacteria without causing resistance makes PAD a prospective method of treatment and prevention of caries.

Selective removal to soft dentine or selective removal to firm dentine for deep caries lesions ın permanent posterior teeth: a randomized controlled clinical trial up to 2years.

The aim of this randomized clinical trial was to compare selective removal to soft dentin (SRSD) and selective removal to firm dentin (SRFD) in permanent teeth. The primary outcome of the study was to compare the success rates of the two caries removal techniques. The secondary outcome of the study was to investigate whether or not calcium silicate-based material (CS) had an effect on the success rate of the treatment. Between November 2018 and March 2020, patients with deep caries lesions were invited to participate in the study. Posterior teeth (N = 165) with primary caries lesion radiographically extending ¾ of dentin and positive response to cold test were randomly selected. A total of 134 participants meeting the inclusion criteria were randomized to SRSD and SRFD (control) groups. After the caries removal procedure, teeth with exposed pulps were assigned to the pulp exposure (PE) group, and the SRSD group was further divided into test 1 (with CS) and test 2 groups (without CS). Success was defined as a positive response to the cold test, a negative response to percussion, the absence of pain, an abscess, a fistula, and periapical alterations. Fisher-Freeman-Halton exact tests, Kaplan-Meier survival analysis, and the log-rank tests were performed for comparisons between groups. No statistically significant difference was found between the success rates of test 1 (100%) and test 2 (93.5%) groups, whereas the proportion of success in control (82.4%) and PE (84%) groups were significantly lower when compared with test groups (p = 0.024; p < 0.05) at the end of 2-year follow-up. SRSD had a higher success rate when compared to SRFD to treat deep carious lesions after 2years of follow-up. The use of CS material after SRSD as a liner had no effect on the treatment outcome. SRSD with good coronal sealing might be recommended without CS application for the treatment of deep caries lesions in permanent teeth. Clinical trial registration number NCT04052685 (08/09/2019).

Comparison of Dentin Caries Remineralization with Four Bioactive Cements.

The treatment of deep carious lesions involves the use of ion-releasing agents to seal the lesions. These agents release minerals, leading to the remineralization of the remaining demineralized dentin. This study aimed to compare the dentin caries remineralization with bioactive cements. 60 Dentin blocks were prepared from the dentin of human third molars. Artificial carious lesions were induced on the blocks with pH cycling. The samples were divided into five groups (n=12). Dycal, Oxford ActiveCal PC, Biodentine, and ACTIVA BioACTIVE were applied using a mold. One group did not receive any cement. The samples were stored in remineralization solution for 30 days. The cement was removed using a #15 blade, and the dentin surface was evaluated using Energydispersive X-ray Spectroscopy and X-ray Diffraction. One-way ANOVA did not show a significant difference in the weight percentages of calcium and phosphorus and the calcium-to-phosphorus ratios between the groups. The highest and the lowest weight percentages of calcium and phosphorus were observed in Biodentine and control groups, respectively. There were no significant differences in the remineralization properties of bioactive cements. Hydroxyapatite crystals were not formed in any of the adjacent dentin using these cements.

Evaluation of composite restorations in primary molars subjected to selective caries removal associated with antimicrobial photodynamic therapy: A randomized controlled trial.

Antimicrobial photodynamic therapy (aPDT) has been used as an adjunct treatment of deep caries lesions; however, studies on the effects of aPDT on the longevity of restorations are still limited. To evaluate the clinical performance of composite restorations in primary molars subjected to selective caries removal (SCR) associated with aPDT. A randomized clinical trial was designed. Primary molars of patients (mean age 6.15years) with deep caries lesions without signs and symptoms of pulpal involvement were selected. A total of 64 teeth were randomly divided into groups G1 (SCR, 32 teeth) and G2 (SCR+aPDT, 32 teeth) for treatment, restored with composite, and evaluated after a week (T0 ), 6months (T1 ), and 12months (T2 ) according to the criteria of FDI. Groups were compared using the Rao-Scott chi-squared test and the logistic regression analysis for complex designs to account for multiple observations per subject (alpha=0.05). From all FDI criteria evaluated, the marginal adaptation for the SCR+aPDT group was significantly better in comparison with the SCR group at T0 and T2 in the logistic regression analysis (T0: OR=0.151; 95% CI=0.03-0.068, P=.015; and T2: OR=0.201; 95% CI=0.05-0.79, P=.022). The marginal adaptation of primary molar resin restorations was positively affected by aPDT after 12months of follow-up.

Comparison of Clinical Success between Three Different Materials- Direct Pulp Capping of Carious Molars- An In-vivo Study

Aim: To evaluate the clinical success of Calcium Hydroxide (CH), Mineral trioxide aggregate (MTA) and Biodentine as pulp capping materials for Direct pulp capping in carious molars.&#x0D; Materials and Methods: Thirty-six molars of thirty-six patients with deep caries lesions, diagnosed with reversible pulpitis were subjected to direct pulp capping treatment. They were randomly divided into three groups, Biodentine (12 teeth) or MTA group (12 teeth) or CH group (12teeth). Simple randomization of three was employed to allocate the treatment materials. Patients were recalled at one, three and six months to evaluate the clinical success of the treatment outcome.&#x0D; Results: In clinical trial/study, the pulp capping materials gave different success rate, 91.67% success in the Biodentine group, 75% success in the MTA group and 41.67% success in Calcium Hydroxide group.&#x0D; Conclusion: In our study the materials tested at 1 month, 3 month and 6-month follow-up, Calcium Silicate materials are better than calcium hydroxide and comparably Biodentine is better than MTA for Direct pulp capping.&#x0D; Clinical Significance: The findings of this clinical trial could promote the reliability of pulp capping materials for treatment of deep carious lesions by conservative approach rather than opting endodontic management.

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

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

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.

Clinical Performance of MTA Cavity Lining in the Treatment of Deep Caries Lesions

Clinical Performance of MTA Cavity Lining in the Treatment of Deep Caries Lesions

Impact of different restorative treatments for deep caries lesion in primary teeth (CEPECO 1) \u2013 study protocol for a noninferiority randomized clinical trial

BackgroundDue to the lack of evidence to determine the best treatment for deep cavitated caries lesions in primary molars, the search for an effective restorative technique, which results in a minimal discomfort to patients, and reduce the time needed for the treatment, becomes relevant. The objective of this randomized clinical trial was to evaluate if high-viscosity glass ionomer cement (HVGIC) restorations is noninferior to restoration with calcium hydroxide cement associated with HVGIC for treatment of deep lesions in primary molars, as well as the impact of the treatments on cost and discomfort of the patient.MethodsA non-inferiority randomized clinical trial with two parallels arms (1:1) will be conducted. Children with 4 to 8 years will be selected at Clinic of Pediatric Dentistry at Ibirapuera University. 108 teeth will be randomized into two groups: (1) Calcium hydroxide cement associated with HVGIC and (2) HVGIC restoration. Primary outcome will be considered the pulp vitality and to be evaluated after 6, 12, 18 and 24 months by two calibrated examiners. Survival of restorations will also be evaluated in the equal intervals. The duration of dentals treatment and the cost of all materials used will be considered for estimating of cost-efficacy of each treatment. Individual discomfort will be measured after each dental procedure using the Wong-Baker’s Facial Scale. For the primary outcome, Kaplan-Meier survival and the long-rank test will be used to comparison between the groups. Cox regression will be performed to assess the influence of variables on the outcome. For all analyzes, the significance level is set at 5%.DiscussionBased on the philosophy of ART, our hypothesis is that the HVGIC restoration is a possible approach to restore the deep caries lesion with pulp vitality without the use of rubber dam and anesthesia.Trial registrationClinicaltrials.gov registration NCT02903979. Registered on June 9th 2016.

Is a calcium hydroxide liner necessary in the treatment of deep caries lesions? A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to evaluate whether the use of calcium hydroxide (CH) liner improves the clinical success in the treatment of deep caries lesions of primary and permanent teeth. The review was reported in accordance with the PRISMA Statement. Only studies that evaluated deep carious lesions treated with and without a CH liner were included. The required outcomes had to be obtained by clinical, radiographic or laboratory evaluations. Statistical analyses were performed with the RevMan 5.2 program (The Cochrane Collaboration, Copenhagen, Denmark) for randomized clinical trials with at least 12months of follow-up, using fixed-effect models at a significance level of P<0.05. The literature search was performed in eight databases: PubMed (MEDLINE), Lilacs, IBECS, BBO, Web of Science, Scopus, SciELO and The Cochrane Library. A total of 17 studies were included (15 in primary teeth, two in permanent teeth). The overall risk difference for CH versus adhesive system in primary teeth was 0.06 [95% CI -0.01 to 0.13], and the overall risk difference for CH versus GIC was 0.10 [95% CI -0.01 to 0.22], with no significant differences between materials. CH liner did not influence the clinical success of treatment for deep caries lesions of primary or permanent teeth. Although the present analysis demonstrated that use of CH liner in deep caries lesions was unnecessary, the evidence was of moderate to very low quality; thus, further well-designed, randomized and controlled clinical trials are necessary to provide stronger recommendations.

Clinical antibacterial effectiveness and biocompatibility of gaseous ozone after incomplete caries removal.

To evaluate local effect of gaseous ozone on bacteria in deep carious lesions after incomplete caries removal, using chlorhexidine as control, and to investigate its effect on pulp vascular endothelial growth factor (VEGF), neuronal nitric oxide synthase (nNOS), and superoxide dismutase (SOD). Antibacterial effect was evaluated in 48 teeth with diagnosed deep carious lesion. After incomplete caries removal, teeth were randomly allocated into two groups regarding the cavity disinfectant used: ozone (open system) or 2% chlorhexidine. Dentin samples were analyzed for the presence of total bacteria and Lactobacillus spp. by real-time quantitative polymerase chain reaction. For evaluation of ozone effect on dental pulp, 38 intact permanent teeth indicated for pulp removal/tooth extraction were included. After cavity preparation, teeth were randomly allocated into two groups: ozone group and control group. VEGF/nNOS level and SOD activity in dental pulp were determined by enzyme-linked immunosorbent assay and spectrophotometric method, respectively. Ozone application decreased number of total bacteria (p = 0.001) and Lactobacillus spp. (p < 0.001), similarly to chlorhexidine. The VEGF (p < 0.001) and nNOS (p = 0.012) levels in dental pulp after ozone application were higher, while SOD activity was lower (p = 0.001) comparing to those in control pulp. Antibacterial effect of ozone on residual bacteria after incomplete caries removal was similar to that of 2% chlorhexidine. Effect of ozone on pulp VEGF, nNOS, and SOD indicated its biocompatibility. Ozone appears as effective and biocompatible cavity disinfectant in treatment of deep carious lesions by incomplete caries removal technique.

Retrospective analysis of factors associated with the success of stepwise excavation procedure in deep carious lesions

BackgroundRecent scientific evidence regarding the stepwise excavation procedure (SWP) has not addressed the consideration of patient factors when selecting SWP as treatment for deep carious lesions (DCLs). This study assessed patient factors predicting a successful SWP defined as a tooth restored with SWP and did not result in root canal treatment or a dental extraction. MethodsSWPs completed in 626 patients without symptomatic irreversible pulpitis at the University of Iowa College of Dentistry from January 2004 through December 2012 were evaluated. Patient demographic and tooth-specific characteristics were assessed in their relationship with the main outcome. ResultsSWPs had a 75% success rate when evaluated within 36 months of the initial treatment. Findings showed that patients who had successful SWP treatment of DCLs were somewhat younger than patients whose SWP treatment was not successful (mean age, 37.4 years and 40.5 years, respectively; odds ratio, 0.981; 95% confidence interval, 0.967 to 0.994; P = .0058). Patients who returned to their second appointment within 5 to 9 months were more likely to have a successful SWP treatment than those returning sooner than 5 months (odds ratio, 0.338; 95% confidence interval, 0.210 to 0.545; p < .0001). ConclusionTreatment of deep carious lesions with SWP is effective for pulp preservation and patient age may influence the outcome. Practical ImplicationsAlthough a somewhat younger mean patient age was associated with successful treatment of DCLs, SWP can be successful regardless of patient age and clinicians should consider SWP in treating DCLs.

Dentist´s knowledge, attitudes and determining factors of the conservative approach in teeth with reversible pulpitis and deep caries lesions.

BackgroundThe aim of this study was to investigate dentists` knowledge, attitudes and factors regarding the conservative approach in the management of deep caries lesions (DCLs) in teeth with reversible pulpitis.Material and Methods187 dentists were contacted directly or by mail, and 125 (67%) were finally included in the study. Dentists were requested to answer an open/discursive questionnaire about the routine approach to the diagnosis and treatment of DCLs, including knowledge-related attitudinal items.ResultsTotal caries excavation was the preferred treatment option for more than 80% of dentists in case of DCL with reversible pulpitis. Only a small percentage (8%) chose partial caries removal, leaving some carious dentin close to the pulp to avoid pulp exposure. More than a half (51%) of respondents considered that cariogenic microorganisms must be removed or caries would progress. Dentists teaching at the University strongly disagreed with this statement (OR = 4.6; 95% C.I. = 1.3 – 15.8; p = 0.017). Good clinical result was the most chosen reason (83%) to choose a specific treatment. Patient’s oral health (84%) and patient’s age (70%) were the two patient-related factors most taken into account for the choice of treatment.ConclusionsTotal caries excavation is still the most frequently chosen treatment in teeth with DCL and reversible pulpitis. The joint assessment of the answers given by respondents allows to conclude that the new knowledge and concepts about caries lesions and the more conservative approach to DCLs have not still been incorporated by dentists into their usual clinical practice. Key words:Caries, deep caries lesions, dental pulp capping, dental pulp health, dentists, endodontic therapy, reversible pulpitis, treatment decisions.

Criteria and treatment decisions in the management of deep caries lesions: Is there endodontic overtreatment?

BackgroundThe aim of this study was to investigate the diagnostic criteria and treatment decisions in the management of deep caries lesions (DCLs). The null hypothesis tested was that DCLs are managed according to the current scientific evidence.Material and MethodsA total of 288 dentists were contacted directly or by mail, and 125 (43%) were included in the study. Dentists were requested to answer a questionnaire about the routine approach to the diagnosis and treatment of DCLs. Logistic regression analyses were carried out to calculate odds ratios (OR).ResultsPulp sensitivity tests were used by 65% of dentists when assessing pulpal health in cases of DCLs, particularly those who had followed courses in cariology (OR = 3.8; p = 0.005). Dentine hardness was the most frequent criterion used during DCLs excavation (98%). Two thirds of the respondents (65%) removed carious tissue until they felt hard dentine, and feeling hard dentine correlated with caries removal even at the risk of pulpal exposure (OR = 15.8; p = 0.0000). Acute transient pain or sensitivity to cold or heat (reversible pulpitis) were considered by 58% of respondents as a reason to provide endodontic therapy.ConclusionsThe null hypothesis tested is rejected. The evidence-based more conservative approach on the management of DCLs is not being translated to clinical dentistry. Root canal treatment is being indicated in cases of DCLs in which the diagnosis is reversible pulpitis. Likewise, it can be concluded that non-conservative management of DCLs, with endodontic overtreatment, could be occurring. Key words:Deep caries lesions, dental pulp capping, dental pulp health, dentists, endodontic therapy, pulpal diagnosis, reversible pulpitis, treatment decisions.

Randomized Clinical Trial to Evaluate MTA Indirect Pulp Capping in Deep Caries Lesions After 24-Months.

This clinical study aimed to assess the efficacies of mineral trioxide aggregate (MTA) and calcium hydroxide [Ca(OH)2] in the treatment of deep carious lesions by the direct complete caries removal technique. A total of 100 permanent molar/premolar teeth were capped with either Ca(OH)2 (n=49) or MTA (n=51) and restored with composite resin in 73 patients. Periapical radiographs were acquired prior to the treatment as well as at six, 12, and 24 months posttreatment. Two calibrated examiners performed the clinical and radiographic assessment of the periapical pathology and pulpal symptoms. Intergroup comparisons of the observed values were performed using the Fisher exact test. Significance was predetermined at α = 0.05. The recall rates were 100% at six and 12 months posttreatment and 98.6% at 24 months posttreatment. Four teeth capped with Ca(OH)2 (two each at six and 12 months posttreatment) and two capped with MTA (one each at 12 and 24 months posttreatment) received endodontic emergency treatment because of symptoms of irreversible pulpitis, which were clinically and/or radiographically established. There were no significant differences in pulp vitality between the two pulp-capping agents at six, 12, or 24 months posttreatment (p=0.238, p=0.606, and p=0.427, respectively). Both pulp-capping materials were found to be clinically acceptable at 24 months posttreatment.

Stepwise and partial caries removal probably have high success rates up to 3 years after treatment of deep carious lesions, but partial caries removal is more likely to preserve tooth vitality

Hoefler V, Nagaoka H, Miller CS. Long-term survival and vitality outcomes of permanent teeth following deep caries treatment with step-wise and partial-caries-removal: a systematic review. J Dent. 2016;54:25-32. http://dx.doi.org/10.1016/j.jdent.2016.09.009.

Clinical assessment of mineral trioxide aggregate in the treatment of deep carious lesions.

This clinical study aimed to assess the effectiveness of mineral trioxide aggregate (MTA) and calcium hydroxide (Ca[OH]2) in the treatment of deep carious lesions using the direct complete caries excavation technique. Hundred permanent molars/premolars were capped either with Ca (OH)2 (n = 49) or MTA (n = 51) and restored with composite resin in 73 patients. Periapical radiographs were taken prior to the treatment, at 6 months and 12 months. Two calibrated examiners clinically and radiographically assessed the periapical pathology and pulpal symptoms. Inter-group comparisons of the observed values were analyzed using Fisher's exact test. Significance was predetermined at α = 0.05. Recall rates were 100% at 6 and 12 months. Four teeth capped with Ca(OH)2 (two each at the end of 6 and 12 months) and one tooth capped with MTA (at the end of 12 months) received endodontic emergency treatment because of symptoms of irreversible pulpitis that were clinically and/or radiographically established. There was no significant difference between the protection of the tooth vitality and pulp capping agents at 6 and 12 months (P = 0.238, P = 0.606, respectively). Both materials were clinically applicable at the end of 12 months.

General dentists’, pediatric dentists’, and endodontists’ diagnostic assessment and treatment strategies for deep carious lesions: A comparative analysis

BackgroundThere is a large variation among clinicians when managing deep carious lesions (DCLs). The purpose of this study was to assess general dentists’ (GDs), pediatric dentists’ (PDs), and endodontists’ (EDs) diagnostic methods, clinical decision-making considerations, treatment strategies, and knowledge, behavior, and attitudes related to the diagnosis and treatment of DCLs. MethodsA total of 175 GDs, 511 PDs, and 377 EDs responded to a nationwide Web-based survey. ResultsMost EDs (68%) and GDs (47%) practiced complete caries removal. PDs (31%) were more likely than GDs (12%) and EDs (4%) to remove carious tissues partially. Dentin hardness was the most important diagnostic criterion used during caries excavation (GDs, 90%; PDs, 72%; EDs, 88%). Only 30% of GDs, 17% of PDs, and 90% of EDs used diagnostic tests (for example, a cold test) when assessing pupal health. A substantial percentage of respondents considered endodontic treatment as a choice for treating DCLs in asymptomatic teeth in young patients (GDs, 40%; PDs, 30%; EDs, 40%). GDs rarely used a rubber dam when treating these lesions. ConclusionsMost respondents practiced complete caries removal until hard dentin was felt, using hardness as the primary excavation criterion, and did not use pulp diagnostic tests routinely before making decisions about treatment of teeth with DCLs. Practical ImplicationsEfforts should be made to translate the growing body of evidence supporting the use of conservative caries removal criteria to preserve pulpal health and tooth structure integrity when managing DCLs.