Qualitative and quantitative radiographic assessment of sealed carious dentin: a 10-year prospective study

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

OBJECTIVE

This randomized controlled clinical trial aimed to evaluate the clinical performance of composite resin restorations placed after selective caries removal to soft dentin (SCRSD) or stepwise excavation (SW) over an 18-month period.

METHODS

Inclusion criteria were patients with permanent molars and/or premolars presenting deep caries lesions (≥50 % of the dentin thickness). Teeth were submitted to SCRSD (n = 76) or SW (n = 76). Evaluations were performed based on FDI (World Dental Federation) criterion. Survival analysis was performed to estimate the survival of restorations and its association with clinical variables and socio-demographic characteristics (adjusted Weibull regression model). The study was registered on Registro Brasileiro de Ensaios Clínicos (ReBEC 65ntbc).

RESULTS

The follow-up period ranged from 6 to 18 months (mean ± SD 16.3 ± 3.4 months). Patients' ages ranged from 9 to 55 years (mean ± SD 29 ± 10.5 years). A total of 135 teeth (SCRSD = 72; SW = 63) from 101 patients were evaluated. There were 4 failures in the SCRSD group (2 loss of restoration in need of replacement and 2 marginal fractures in need of repair) and 2 in the SW group (fracture in need of repair). The association between explanatory variables and restoration failure showed similar success rates for SW (99.4 %) and SCRSD (97.9 %) (p = 0.16). Patients presenting gingivitis (≥20 % of sites with gingival bleeding) had 8.50 times more risk for failure than those with <20 % of bleeding sites (p = 0.03).

CONCLUSION

This study showed that placing a composite resin restoration over soft dentin (after SCRSD) did not affect its clinical performance after 18 months.

CLINICAL SIGNIFICANCE

SCRSD is a feasible treatment option for the management of deep caries lesions in permanent teeth as it preserves tooth vitality and tooth structure without compromising restoration longevity.

Selective Caries Removal: A Case Report with 21-Year Follow-Up

Dental caries remains the most prevalent chronic disease globally, and its management should adhere to the principles of minimal intervention dentistry. This study reports a series of successful cases involving the selective removal of carious tissue in permanent molars, with follow-up periods of up to 21 years. Six permanent molars with severe and deep carious lesions were treated with selective caries removal and restored with high-viscosity glass ionomer cement. Clinical examination revealed that the teeth were free from pain and sensitivity. Follow-up assessments were conducted at 7 and 21 years posttreatment. Treatment success was defined by the absence of clinical and radiographic signs, symptoms of pulp alterations, and lesion arrest. Successful minimally invasive approaches were observed with selective removal of carious tissue and maintenance of pulp vitality for up to 21 years.

Marginal integrity in minimally invasive molar resin composite restorations: Impact of polymerization shrinkage

OBJECTIVES

This study utilized non-linear finite element (FE) models to explore polymerization shrinkage and its impact on marginal integrity in molars following both selective caries removal (SCR) and conventional treatment. Specifically, we performed 2D in silico simulations to study residual stresses post-resin polymerization shrinkage and their influence on the marginal integrity of various restoration types.

METHODS

Initially, FE models were developed based on a cohesive zone framework to simulate crack propagation along the bonded interfaces between restoration and tooth structure in SCR-treated molars with class I and class II restorations. The modeled resin composite restorations first underwent polymerization shrinkage and were then subjected to various occlusal loading conditions. Stress magnitudes and distributions were identified to evaluate the margin integrity and predict the mechanism and location of interfacial failure.

RESULTS AND DISCUSSION

The FE models computed polymerization shrinkage stresses of less than 1 MPa, exerting a minor influence on the composite/tooth interface. Occlusal loading, however, significantly impacted the load-bearing capacity of the composite/tooth (c/t) interface, potentially jeopardizing the restoration integrity. Especially under bi-axial occlusal loading, interfacial debonding occurred in the vertical cavity walls of the class I restorations, increasing the risk of failure. Notably, SCR-treated teeth exhibited better margin integrity than restored teeth after complete caries removal (NCR). These findings provide valuable insights into the mechanical behavior of SCR-treated teeth under different loading conditions and highlight the importance of considering the load scenarios that may lead to failure at the c/t interface. By investigating the factors influencing crack initiation and delamination, this novel research contributes to the optimization of restorative treatments and aids in the design of more resilient dental restorations.

Cost-effectiveness of selective caries removal versus stepwise excavation for deep caries lesions

A multicenter, randomized controlled clinical trial evaluated the effectiveness of two treatments for deep caries lesions in permanent molars - selective caries removal (SCR) to soft dentin with restoration in a single visit, and stepwise excavation (SW) - regarding pulp vitality for a 5-year follow-up period. The present study aimed to determine the cost-effectiveness of these treatments. Treatments were conducted in two Brazilian cities (Brasília and Porto Alegre). At baseline, 299 permanent molars (233 patients) were treated and 229 teeth (174 patients) were evaluated after 5 years. The discounted cash flow method was adopted. The total cost of each treatment was calculated, and the failure cost (endodontic treatment + restoration) was added to the final cost, according to the 5-year failure rates of each therapy (20% for SCR and 44% for SW). A public health service unit composed of three dentists in 4-hour work shifts was used to calculate the monetary value of the treatments, assuming a total of 528 treatments/month. Considering the 229 teeth evaluated after 5 years (115 SCR and 114 SW), SCR provided savings of 43% (amalgam) and 41% (resin composite) per treatment, compared to SW. The SCR technique provides benefits for public finances (direct economy) and for public health services (increase in the number of treatments performed). Considering that maximizing profit and reducing costs are powerful motivating factors for adopting a certain treatment, this study provides data to better support the decision-making process, regarding the management of deep caries lesions in permanent molars.

Penetration of Silver Diamine Fluoride in Deep Carious Lesions of Human Permanent Teeth: An In Vitro Study

Background

When silver diamine fluoride (SDF) is used in conjunction with conservative caries removal in deep carious lesions, the distribution depth of silver is critical for safety and effectiveness.

Objective

The purpose of this study is to determine the effect of selected caries removal on silver penetration when 38% SDF is applied to deep carious lesions in permanent teeth.

Methods

Extracted permanent teeth with caries extending to the inner third of the dentin were used (N = 18). The periphery of the carious lesion was completely removed to the dentinoenamel junction (DEJ). In group A (n = 9), no further removal of carious tissue was performed, leaving necrotic dentin inner to the DEJ, whereas in group B (n = 9) superficial necrotic dentin was completely removed until leathery, slightly moist, reasonably soft dentin remained. SDF was applied for 3 minutes in both groups. Microcomputer tomography (micro-CT) and field emission scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (FESEM-EDS) were used to measure mineral density and silver distribution. The silver penetration depth/lesion depth (PD/LD) ratio was calculated for each sample. The Mann–Whitney U test was used to compare differences between the two groups.

Results

The micro-CT analysis showed that the PD/LD ratios of group B (1.07–2.29) were marginally greater than those of group A (1.00–1.31). However, a statistically significant difference was not observed (pvalue = 0.5078). When stratified by remaining dentin thickness (RDT), the PD/LD ratios of group B were still greater than those of group A only when RDT was >500 µm. The FESEM-EDS analysis indicated that silver particles precipitated throughout the entire thickness of the carious lesions.

Conclusion

Applying SDF on a deep carious lesion and leaving the necrotic dentin pulpally did not affect silver penetration. However, the extent to which silver penetrates the remaining dentin beneath the lesions is dependent on the amount and characteristics of that dentin.

Loss of dental tissue after restoration or sealing of occlusal carious lesions: 3-4-year results of randomized clinical trials

Context

Although preservation of the tooth structure is quoted as the main advantage of sealing of carious lesions, there are no long-term studies comparing the maintenance of dental tissue after restoration or after caries sealing.

Aim

To measure the radiographically visible loss of dental tissue after conventional restoration and sealing of carious lesions.

Subjects and Methods

This study was a secondary analysis of two randomized controlled clinical trials, one conducted in Brazil and another in Belgium, which evaluated two different therapies for the treatment of occlusal carious lesions in permanent teeth: sealant (SE) without previous carious tissue removal or restoration (RE) with total removal of carious dentin. The greater depth and width of sealed carious lesions and restorations were compared.

Statistical Analysis

The independent t-test was used to compare therapies at different time points, while the paired t-test was used to compare the same therapy over time.

Results

Carious lesions in the RE and SE groups showed similar measurements at baseline (P > 0.05). Over time, significantly greater loss of tooth structure was observed in the RE group than in the SE group. No increase in lesion depth or width was observed in the SE group, suggesting no progression of sealed lesions.

Conclusion

Sealing of carious lesions resulted in greater preservation of dental tissue.

Radiographic modalities for diagnosis of caries in a historical perspective: from film to machine-intelligence supported systems

Radiographic imaging for the diagnosis of caries lesions has been a supplement to clinical examination for approximately a century. Various methods, and particularly X-ray receptors, have been developed over the years, and computer systems have focused on aiding the dentist in the detection of lesions and in estimating lesion depth. The present historical review has sampled accuracy ex vivo studies and clinical studies on radiographic caries diagnosis that have compared two or more receptors for capturing the image. The epochs of film radiography, xeroradiography, digital intraoral radiography, panoramic radiography and other extraoral methods, TACT analysis, cone-beam CT and artificial intelligence systems aiding in decision-making are reviewed. The author of this review (43 years in academia) has been involved in caries research and contributed to the literature in all the mentioned epochs.

Substantial regional differences in the biomechanical behavior of molar treated with selective caries tissue removal technique: a finite element study

OBJECTIVES

Selective caries removal (SCR) is recommended over non-selective removal for managing deep carious lesions to avoid pulp exposure and maintain pulp vitality. During SCR, residual carious dentin is left behind and sealed beneath the restoration. The biomechanical effects of such residual lesions on the restored tooth remain unclear and were assessed using finite element modeling (FEM).

METHODS

Based on μ-CT images of a healthy permanent human third molar, we developed five finite element models. Generic class I and II cavity restorations were modeled where residual lesions of variable sizes were either left or fully removed on occlusal and proximal surfaces. The cavities were restored with adhesive composite. All 3D-FE models were compared with a model of a healthy, non-treated molar. A vertical load of 100 N was applied onto the occlusal surface.

RESULTS

Regardless of the lesion size, in molars with occlusal lesions higher mean stresses were predicted along the filling-lesion interface than in all other models. The smallest occlusal lesion (Ø₁ = 1 mm) resulted in the highest maximum stresses at the filling-lesion interface with large stress concentrations at the filling walls indicating failure risk. In conclusion, lesion site and extent are influencing parameters affecting the filling-lesion interactions and thus the biomechanical behavior of the tooth after SCR.

SIGNIFICANCE

Retaining carious lesions around the pulpal floor affects the deformation and stress states in tooth-filling complexes. The higher stresses observed in molars with occlusal lesions may affect restoration stability and longevity. Suprisingly, more extended occlusal lesions may provide a more favorable tooth performance than less extended ones. In contrast, in molars with proximal lesions the residual lesion had only limited effect on the tooth's biomechanical condition.

Raman spectroscopy for early detection and monitoring of dentin demineralization

Early detection of dental caries and variations in composition/structure of both enamel and dentin represents an important issue in modern dentistry. Demineralization has been associated to teeth discoloration, development of caries, and formation of cavities.

OBJECTIVE

In this study, we systematically monitored the processes of demineralization/remineralization in dentin samples by means of three different spectroscopic techniques, namely, Raman spectroscopy, X-Ray Photo-electron spectroscopy (XPS), and X-Ray Diffractometry (XRD).

METHODS

Bovine dentin samples were first exposed to acidic solutions and their structure systematically monitored as a function of time and pH. Then, the samples were rinsed in artificial saliva to simulate remineralization.

RESULTS

The above three spectroscopic techniques provided quantitative structural information spanning from the nanometer to the millimeter scale of sample penetration depth. An irreversible level of demineralization was reached when dentin was exposed to pH 2 beyond a time threshold of 6h, successive treatments with artificial saliva being unable to restore the mineral fraction. On the other hand, short-term treatments at pH 5 and long-term treatments at pH 6 could partially or completely recover the dentin structure within one week of remineralization treatment.

SIGNIFICANCE

Two specific Raman parameters, namely, the bandwidth of the symmetric phosphate-stretching signal and the mineral-to-matrix intensity ratio, showed strong correlations with XPS and XRD data, and matched laser microscopy observations. Such correlations open the path to apply Raman spectroscopy in monitoring dentin demineralization in vivo and provide quantitative working algorithms for the prevention of oral caries.

Is Fluorescence Technology a Promising Tool for Detecting Infected Dentin in Deep Carious Lesions?

The purpose of this study was to determine if the degree of fluorescence detected by fluorescence-aided caries excavation (FACE) correlates with dentin bacterial microbiome diversity, as assessed by 16S rRNA gene amplicon sequencing, and with traditional tactile dentin caries assessment. Unidentified human teeth were obtained from a dental facility. The included teeth had a carious lesion two-thirds into the dentin, verified by radiography, and were red-fluorescing (RF) using FACE technology (SIROInspect; Sirona, Bensheim, Germany). Two independent examiners performed visual/tactile assessment of the lesions. RF sites were sampled with a sterile spoon excavator and dentin characteristics were evaluated. Once RF dentin was removed, a second sample of pink-fluorescing (PF) dentin was obtained. After excavation with a sterile round bur to nonfluorescing (NF) dentin, a third sample was collected with a slow-speed round bur. The samples were processed at the UNC (University of North Carolina at Chapel Hill) Microbiome Core Facility. Out of 134 extracted teeth collected, 21 fit the inclusion criteria, yielding 61 dentin samples. RF samples had the highest number of observed operational taxonomic units (n = 154), followed by PF (n = 109) and NF (n = 100). RF carious dentin was primarily "soft," and NF dentin was assessed as "hard" 100% of the time by both examiners (rank correlation χ2: p < 0.001). However, approximately one-third of the tactile assessments of hard dentin still displayed some fluorescence, either pink or red. We concluded that the sampled fluorescing (RF and PF) and NF carious dentin layers displayed diverse bacterial taxa, and tactile assessments of soft, leathery, and hard corresponded with RF, PF, and NF.

Restorations after selective caries removal: 5-Year randomized trial

OBJECTIVE

To compare the survival of restorations placed in deep caries lesions after selective caries removal to soft dentin (SCRSD) over a 5-year period. A secondary aim was to investigate whether the material (amalgam or resin composite) affected the survival of restorations.

METHODS

This study used data derived from a multicenter randomized controlled clinical trial (Clinical trials registration NCT00887952). Inclusion criteria were: patients with permanent molars presenting occlusal or proximal deep caries lesions (≥1/2 of the dentin thickness on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions. The teeth were randomized into SCRSD and restoration in a single visit or stepwise excavation (SW). Each of these groups was divided according to the filling material: amalgam (AM) or resin composite (RC). Survival analyses were performed to estimate therapy success rates over 5 years (adjusted Weibull regression model).

RESULTS

172 restorations were evaluated, 95 from SCRSD group and 77 from SW group, being 61 AMG and 111 RC. The 5-year survival analysis showed similar success rates for SW (76 %) and SCRSD (79 %) as well as for AM and RC (p > 0.05).

CONCLUSION

This study showed that, after a 5-year follow-up period, the presence of decayed tissue beneath restorations in deep caries lesions did not seem to affect restoration survival. Amalgam and resin composite restorations had similar survival rates, irrespective of the caries removal technique used - SCRSD or SW.

CLINICAL SIGNIFICANCE

Selective caries removal to soft dentin can be used in the management of deep caries to avoid pulp exposure and preserve tooth structure without affecting restoration longevity.

Surgical Management of Caries Lesions: Selective Removal of Carious Tissues

Traditionally, before placing a restoration, excavation of tissues affected by caries was recommended. The goal was to have all walls of the cavity on sound, hard dentin, even when at risk of pulpal exposure. Current understanding of the caries process indicates that preserving tooth structure can lead to better long-term outcomes. Selective caries excavation refers to preserving tooth structure by delineating excavation in the pulpal and axial wall according to lesion severity and depth as well as pulpal health while keeping all cavity margins on sound tooth structure. Compounding evidence indicates that when a good marginal seal is present, the lesion will arrest.

Effect of Different Liners on Pulpal Outcome after Partial Caries Removal: A Preliminary 12 Months Randomised Controlled Trial

Aim: The aim of this double-blinded parallel randomised controlled trial was to compare the effect of different liners on 12-month pulp health outcomes after partial caries removal (PCR) with composite restorations in permanent molars. Methods: The study was registered at clinicaltrials.gov with registration No. NCT0328695 and conducted in the Department of Conservative dentistry and Endodontics, Post Graduate Institute of Dental Sciences Rohtak with no external financial support. One hundred and ninety-eight participants (116 males, 82 females and age 14–54 years) with vital permanent mature mandibular molars having deep caries involving two-thirds or more of dentin were randomised to calcium hydroxide (CH), resin-modified GIC (RMGIC) and no liner (DC) groups after PCR. After a follow-up time of 12 months, success was defined as positive response to pulp sensibility and absence of periapical alterations. Results: Categorical variables were compared using chi-square test. Two analytical approaches were used, such as intention-to-treat and per-protocol approach. Success rates in per-protocol approach were 96.8, 96.5, and 94.6% for CH, RMGIC and DC groups, respectively with no significant difference between 3 groups (p = 0.811). None of the baseline variables had any significant influence on the treatment success. Conclusion: Partial caries excavation has a high success rate to treat deep carious lesions in permanent teeth after 12 months of follow-up, indicating that the retention of carious dentin does not interfere with pulp vitality or restoration survival. Also, the success of the treatment is independent of the lining material used over the demineralized dentin.

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

Background

The 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 Methods

A 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).

Results

Pulp 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.

Conclusions

The 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.

Microbial Load After Selective and Complete Caries Removal in Permanent Molars: a Randomized Clinical Trial

Abstract The aim of this randomized clinical trial was to compare the remaining microbial load after treatments based on complete and selective caries removal and sealing. Patients with active carious lesions in a permanent molar were randomly allocated into 2 groups: a test group (selective caries removal-SCR; n=18) and a control group (complete caries removal - CCR; n=18). Dentin samples were collected following the excavation and three months after sealing. Streptococcus species, Streptococcus mutans, Lactobacillus species, and total viable microorganisms were cultured to count the viable cells and frequency of species isolation. CCR resulted in significant lower total viable microorganisms counts (p≤0.001), Streptococcus species (p≤0.001) and Lactobacillus species (p≤0.001) initially. However, after sealing, a decrease in total viable microorganisms, Streptococcus species, and Lactobacillus species in the SCR resulted in no difference between the groups after 3 months. In conclusion, selective caries removal is as effective as complete caries removal in reducing dentin bacterial load 3 months after sealing.

A randomized clinical trial on the sealing of occlusal carious lesions: 3-4-year results

This randomized clinical trial aimed to assess the efficacy of sealing occlusal carious lesions in permanent teeth. The sample consisted of 54 occlusal carious lesions in permanent molars and premolars of 49 patients aged 8-43 years (median: 19 years). The inclusion criteria comprised the presence of a cavity with no access allowing biofilm control. The maximum depth of the lesion was the middle third of the dentin thickness, as assessed by bitewing radiography. The teeth were randomly assigned to sealant treatment (n = 28) or restorative treatment (n = 26). Clinical and radiographic examinations were performed after 1 year and after 3-4 years. The outcomes depended on the clinical performance of the sealant/restoration and the control of caries progression observed radiographically. Survival analysis was performed to assess success rates. Over the 3-4 years of monitoring, 2 sealants were totally lost, 1 needed repair, and 1 showed caries progression, totaling 4 failures in the sealant group. In the restoration group, 1 failure was observed (in need of repair). The success rates were 76% and 94% in the sealant and the restoration groups, respectively (p > 0.05). The sealing of occlusal carious lesions in permanent teeth succeeded in controlling caries over a 3-4-year period. However, sealed carious lesions require patient compliance in attending regular follow-ups to control the occurrence of clinical failures of the sealants.

The influence of the lining material on the repair of the infected dentin in young permanent molars after restoration: A randomized clinical trial

Aim:

This study evaluated the impact of liner material on the fluorescence, morphological and mineral characteristics of permanent carious dentin after cavity sealing.

Methods:

Thirty children (11.0 ± 2.7 years old) presenting at least one active deep carious lesion in permanent molars were selected. Fragments of carious dentin were removed from teeth before lining the cavity (baseline samples) with high-viscosity glass ionomer cement (G1) or an inert material (wax - G2). Cavities were restored with composite resin and reopened 60 days later, and other fragments were removed (60-day sample). The laser fluorescence (LF) readings and morphological and mineral changes of both groups were compared.

Results:

After 60 days, forty teeth were available for evaluation. Lower LF means were obtained (Wilcoxon signed-rank test; P < 0.05), and enhanced calcium and phosphorus levels were detected for both groups (t-test, P < 0.05). An uptake of fluorine was observed only in G1 (t-test; P < 0.05). Regardless of the group, baseline samples exhibited clear signs of bacterial invasion, and the collagen fibers were exposed; the 60-day samples showed a better-organized tissue with a more compact intertubular dentin.

Conclusion:

Caries arrestment with dentin reorganization occurs regardless of the lining material placed in contact with the infected dentin.

Occlusal Caries: Biological Approach for Its Diagnosis and Management

The management of occlusal caries still remains a major challenge for researchers as well as for general practitioners. The present paper reviews and discusses the most up-to-date knowledge and evidence of the biological principles guiding diagnosis, risk assessment, and management of the caries process on occlusal surfaces. In addition, it considers the whole spectrum of the caries process on occlusal surfaces, ranging from the molecular ecology of occlusal biofilms to the management of deep occlusal caries lesions. Studies using molecular methods with focus on biofilms in relation to occlusal caries should explore the relationship between the function and the structural composition of these biofilms to understand the role of occlusal biofilms in caries development. State-of-the-art measures to evaluate risk for occlusal caries lesion activity, caries incidence, and progression should include the assessment of the occlusal biofilm and the stage of tooth eruption. Careful clinical examination of non-cavitated lesions, including assessment of the lesion activity status, remains the major tool to determine the immediate treatment need and to follow on the non-operative treatment outcome. Even medium occlusal caries lesions in the permanent dentition may be treated by non-invasive fissure sealing. By extending the criteria for non-invasive treatments, traditional restoration of occlusal surfaces can be postponed or even avoided, and the dental health in children and adolescents can be improved. Selective removal (incomplete) to soft dentin in deep carious lesions has greater success rates than stepwise excavation. Selective (complete) removal to firm dentin has a lower success rate due to increased pulp exposure.

Long-term survival and vitality outcomes of permanent teeth following deep caries treatment with step-wise and partial-caries-removal: A Systematic Review

OBJECTIVES

A systematic review was performed to compare the long-term survival of deep dentine caries-affected permanent teeth treated with partial-caries-removal (PCR) versus similar teeth treated with stepwise-caries-removal techniques (SWT).

DATA

Clinical studies investigating long-term PCR and SWT outcomes in unrestored permanent teeth with deep dentine caries were evaluated. Failures were defined as loss of pulp vitality or restorative failures following treatment.

SOURCES

PubMed, Web of Science, Dentistry and Oral Sciences Source, and Central databases were systematically searched.

STUDY SELECTION

From 136 potentially relevant articles, 9 publications utilizing data from 5 studies (2 RCTs, and 3 observational case-series) reporting outcomes for 426 permanent teeth over two to ten years were analyzed. Regarding restorative failures, >88% success at two years for both techniques was reported. For loss of pulp vitality, observational studies reported >96% vitality at two years for each technique, while one RCT reported significantly higher vitality (p<0.05) at three years for PCR (96%) compared to SWT (83%). Risk of bias was high in all studies.

CONCLUSION

Successful vitality and restorative outcomes for both PCR and SWT have been demonstrated at two years and beyond in permanent teeth with deep dentine caries. Partial-caries-removal may result in fewer pulpal complications over a three year period than SWT, although claims of a therapeutic advantage are based on very few, limited-quality studies.

CLINICAL SIGNIFICANCE

Partial-caries-removal and SWT are deep caries management techniques that reduce pulp exposure risk. Permanent teeth with deep dentine caries treated with either technique have a high likelihood for survival beyond two years.

Minimal intervention dentistry II: part 3. Management of non-cavitated (initial) occlusal caries lesions--non-invasive approaches through remineralisation and therapeutic sealants

Epidemiological data on dental caries show that prevention and treatment needs have evolved significantly over the past two decades. In younger patients the distribution of caries lesions is mainly found on the occlusal surfaces. The treatment approaches utilised by dentists must evolve to integrate preventive and treatment solutions tailored to the care needs, which are straightforward to implement in the dental office and whose effectiveness is underpinned by scientific evidence. This article aims to describe the principles of non-invasive management of non-cavitated (initial) occlusal caries lesions, based on evidence from recent studies published in the international literature.

Glass hybrid, but not calcium hydroxide, remineralized artificial residual caries lesions in vitro

OBJECTIVES

For deep carious lesions, less invasive carious tissue removal is recommended. The resulting residual carious lesions might benefit from remineralization by lining or restoration materials. We aimed to compare mineral gains in artificial residual lesions provided by calcium hydroxide and glass hybrid materials in combination with pulpal fluid simulation.

METHODS

On the coronal aspect of human dentin discs (n = 20), artificial carious lesions were induced using acetic acid. Median mineral loss ΔZ [25th/75th percentiles] of resulting lesions was 1643 [1301/1858] vol% μm. One third of each disc served as baseline sample. The remaining disc was divided into four groups, each being covered with one experimental material (n = 20/group): flowable composite (control (CO)), setting or non-setting calcium hydroxide liner plus flowable composite (CH-S, CH-NS), and glass hybrid (GH). Samples were mounted in a dual-chamber device. Pulpal surfaces were exposed to simulated pulpal fluid at 2.94 kPa. Coronal surfaces were exposed to artificial saliva and rinsed with 200 ppm NaF every 2 weeks. After 12 weeks, mineral loss differences (ΔΔZ) were assessed using transverse microradiography. Electron probe microscopic analysis was used to measure fluoride and strontium concentrations.

RESULTS

Mineral gains were not significantly different between CO (ΔΔZ = 372 [115/501] vol% μm), CH-S (ΔΔZ = 317 [229/919] vol% μm), or CH-NS (ΔΔZ = 292 [130/579] vol% μm; p > 0.05/Wilcoxon test) but significantly increased in GH (ΔΔZ = 1044 [751/1264] vol% μm, p < 0.001). Samples in GH showed fluoride and strontium enrichment deep into the dentin. Such enrichment was not found in CO.

CONCLUSIONS

Within the limitations of this study, GH, but not calcium hydroxide, provided coronal remineralization of residual carious lesions.

CLINICAL RELEVANCE

Glass hybrids might provide additional remineralization of residual carious lesions. The functional implications of this mineral gain need to be evaluated.

Effect of sealing infected dentin with glass ionomer cement on the abundance and localization of MMP-2, MMP-8, and MMP-9 in young permanent molars in vivo

BACKGROUND

The study of MMPs' behavior in carious lesions contributes to the understanding of the mechanisms involved in dentin reorganization after restoration.

AIM

To compare the abundance and localization of MMPs 2, 8, and 9 in infected dentin before and after restoration.

DESIGN

The sample consisted of 23 young permanent molars with active deep carious lesions. Infected carious dentin samples were collected from the same tooth at baseline and 60 days after cavity lining with GIC and composite resin restoration and processed for immunohistochemistry assays. After digital images were obtained, two calibrated operators analyzed the samples according to the immunostaining intensity and the MMPs' localization. Chi-square test was used for statistical analysis.

RESULTS

The intensity of immunostaining for MMP-8 was reduced after 60 days (P = 0.02), and no difference was observed for MMP-2 (P = 0.32) and MMP-9 (P = 0.14). The MMPs' distribution was generalized in the intertubular dentin and absent or located in the intratubular dentin, regardless of the period.

CONCLUSION

The sealing of infected carious dentin in young permanent molars reduced the expression of MMP-8, which is consistent with the initial remodeling process of the dentin matrix.

Clinical, mineral and ultrastructural changes in carious dentin of primary molars after restoration

INTRODUCTION

Partial caries removal has been shown to be an effective method to treat deep carious lesions in deciduous teeth. Nevertheless, the possibility of keeping infected dentin in the cavity still requires additional investigation. The objective of this research was to describe changes in primary infected dentin after restoration with glass ionomer cement.

METHODS

Dentin from 45 primary molars with deep and active carious lesions was evaluated using clinical and laboratory criteria, before and 60 days after restoration. The clinical analysis evaluated dentin colour (CO), dentin consistency (COS) and laser fluorescence (LF). The laboratory procedures assessed bacterial contamination and mineral content (MC), and evaluated the dentin ultrastructure and collagen content. Data on CO, COS, LF and colony forming units were analysed using the Wilcoxon signed-rank test; MC, bacterial counts and collagen evaluations were evaluated using the Student's t-test.

RESULTS

After 60 days, lower values of LF were observed, together with a lower bacterial count, and a higher COS was found, with an increase in calcium, phosphorus and collagen contents. Differences were not detected for CO or for fluorine content. Baseline samples showed enlarged tubules with bacterial invasion; 60-day samples showed better organised tissue, with a more compact intertubular dentin and narrower tubules.

CONCLUSION

It is concluded that appropriate cavity sealing can promote beneficial changes in deep carious lesions of primary teeth, even in the presence of infected dentin.

Caries-removal effectiveness of a papain-based chemo-mechanical agent: A quantitative micro-CT study

The aim of this study was to access the effectiveness and specificity of a papain-based chemo-mechanical caries-removal agent in providing minimum residual caries after cavity preparation. In order to do it, extracted carious molars were selected and scanned in a micro-CT before and after caries-removal procedures with the papain-based gel. Similar parameters for acquisition and reconstruction of the image stacks were used between the scans. After classification of the dentin substrate based on mineral density intervals and establishment of a carious tissue threshold, volumetric parameters related to effectiveness (mineral density of removed dentin volume and residual dentin tissue) and specificity (relation between carious dentin in removed volume and initial caries) of this caries-removal agent were obtained. In general, removed dentin volume was similar or higher than the initial carious volume, indicating that the method was able to effectively remove dentin tissue. Samples with an almost perfect accuracy in carious dentin removal also showed an increased removal of caries-affected tissue. On the contrary, less or no affected dentin was removed in samples where some carious tissue was left in residual dentin. Mineral density values in residual dentin were always higher or similar to the threshold for mineral density values in carious dentin. In conclusion, the papain-based gel was effective in removing carious dentin up to a conservative in vitro threshold. Lesion characteristics, such as activity and morphology of enamel lesion, may also influence caries-removal properties of the method.

Outcomes of one-step incomplete and complete excavation in primary teeth: a 24-month randomized controlled trial

AIM

To compare 24-month pulp health outcomes of partial caries removal (PCR) and total caries removal (TCR) with composite restoration in primary molars.

METHODS

48 children aged 3-8 years with at least one molar with a deep carious lesion were included. 120 teeth were randomized to control (TCR; n = 54; 69% class II) and test (PCR; n = 66; 63% class II) groups. Total absence of carious tissue was confirmed using a blunt-tipped probe in the TCR group. For PCR, excavation was stopped when hardened, dried dentin with a leathery consistency was achieved. Pulpotomy was performed in cases of pulp exposure.

RESULTS

Pulp exposure occurred in 2 and 27.5% of teeth treated with PCR and TCR, respectively (p < 0.01). The operative time was significantly higher for TCR than PCR. Success rates were 92 and 96% in the PCR and TCR groups, respectively (p = 0.34). The success rate tended to be lower in occlusoproximal (92%) than in occlusal (100%) lesions (p = 0.08).

CONCLUSION

The clinical and radiographic success rates of PCR and TCR in primary teeth with deep carious lesions were high and did not differ significantly, indicating that PCR is a reliable minimally invasive approach in primary teeth and that the retention of carious dentin does not interfere with pulp vitality. Moreover, PCR provided other clinically relevant advantages over TCR, especially lower incidence of pulp exposure and lower operative time.

In vitro Induction of residual caries lesions in dentin: comparative mineral loss and nano-hardness analysis

Artificially inducing dentinal lesions mimicking those remaining after selective excavation should allow to investigate the effects and limits of such selective excavation, for example regarding the mechanical properties of treated teeth or the remineralisation of sealed residual lesions. Such analyses might otherwise be limited by the variability of natural lesions or ethical and practical concerns. This study compared different demineralisation protocols for their suitability to induce lesions similar to natural residual caries. Twelve natural deep lesions were excavated until leathery dentin remained, and analysed for their mineral loss (ΔZ), lesion depth (LD), mineral loss ratio (R), the slope of the mineral gradient and their nano-hardness profile. Artificial lesions were induced using four different demineralisation protocols (acetic acid pH = 4.95; 0.1 M lactic acid gel pH = 5.0; 0.5 M ethylenediaminetetraacetic acid pH = 7.2; Streptococcus mutans biofilms) and their depths monitored over different demineralisation times. Lesions with depths most according to those of natural lesions were analysed using transversal microradiography. Lesions induced by acetic acid solution did not significantly differ with regards to LD, ΔZ, R and mineral profile. Seven dentin specimens were subsequently submitted to a moderately acidic (pH = 5.3) methylhydroxydiphosphonate-buffered acetate solution for 12 weeks. Natural and artificial residual lesions were similarly deep (mean ± SD: LD = 626 ± 212 and 563 ± 88 µm), demineralised (R = 19.5 ± 4.7 and 29.8 ± 4.1%), showed a flat and continuous mineral gradient (slope = 0.10 ± 0.05 and 0.13 ± 0.06 vol%/µm) and did not significantly differ regarding their nano-hardness profile. The described protocol induces lesions with mineral content and mechanical properties similar to natural residual lesions.

Cost-effectiveness of caries excavations in different risk groups - a micro-simulation study

BACKGROUND

Whilst being the most prevalent disease worldwide, dental caries is increasingly concentrated in high-risk populations. New caries treatments should therefore be evaluated not only in terms of their cost-effectiveness in individuals, but also their effects on the distribution of costs and benefits across different populations. To treat deep caries, there are currently three strategies: selective (one-step incomplete), stepwise (two-step incomplete) and complete excavation. Building on prior research that found selective excavation generally cost-effective, we compared the costs-effectiveness of different excavations in low- and high-risk patients, hypothesizing that selective excavation had greater cost-effectiveness-advantages in patients with high compared with low risk.

METHODS

An average tooth-level Markov-model was constructed following the posterior teeth in an initially 18-year old male individual, either with low or high risk, over his lifetime. Risk was assumed to be predicted by several parameters (oral hygiene, social position, dental service utilization), with evidence-based transition probabilities or hazard functions being adjusted for different risk status where applicable. Total lifetime treatment costs were estimated for German healthcare, with both mixed public-private and only private out-of-pocket costs being calculated. For cost-effectiveness-analysis, micro-simulations were performed and joint parameter uncertainty introduced by random sampling of probabilities. Cohort analyses were used for assessing the underlying reasons for potential differences between strategies and populations.

RESULTS

Selective excavation was more effective and less costly than both alternatives regardless of an individual's risk. All three strategies were less effective and more costly in patients with high compared with low risk, whilst the differences between risk groups were smallest for selective excavation. Thus, the cost-effectiveness-advantages of selective excavation were more pronounced in high-risk groups, who also benefitted the most from reduced private out-of-pocket treatment costs.

CONCLUSIONS

Whilst caries excavation does not tackle the underlying sources for both the development of caries lesions and the potential differences of individuals' risk status, selective excavation seems most suitable to treat deep lesions, especially in patients with high risk, who over-proportionally benefit from the resulting health-gains and cost-savings.

Radiopaque Tagging Masks Caries Lesions following Incomplete Excavation in vitro

One-step incomplete excavation seals caries-affected dentin under a restoration and appears to be advantageous in the treatment of deep lesions. However, it is impossible to discriminate radiographically between intentionally left, arrested lesions and overlooked or active lesions. This diagnostic uncertainty decreases the acceptance of minimally invasive excavation and might lead to unnecessary re-treatment of incompletely excavated teeth. Radiopaque tagging of sealed lesions might mask arrested lesions and assist in discrimination from progressing lesions. Therefore, we microradiographically screened 4 substances (SnCl2, AgNO3, CsF, CsCH3COO) for their effect on artificial lesions. Since water-dissolved tin chloride (SnCl2×Aq) was found to stably mask artificial lesions, we then investigated its radiographic effects on progressing lesions. Natural lesions were incompletely excavated and radiopaque tagging performed. Grey-value differences (△GV) between sound and carious dentin were determined and radiographs assessed by 20 dentists. While radiographic effects of SnCl2×Aq were stable for non-progressing lesions, they significantly decreased during a second demineralization ( p < .001, t test). For natural lesions, tagging with SnCl2×Aq significantly reduced △GV ( p < .001, Wilcoxon). Tagged lesions were detected significantly less often than untagged lesions ( p < .001). SnCl2×Aq was suitable to mask caries-affected dentin and discriminate between arrested and progressing lesions in vitro. Radiopaque tagging could resolve diagnostic uncertainties associated with incomplete excavation.

Clinical evaluation of a modified silver fluoride application technique designed to facilitate lesion assessment in outreach programs

Background

An advantage of using silver fluoride treatments for carious primary teeth in outreach programs especially where dental resources are limited is that the treatments can be carried out by dental auxiliaries. One limitation to date is that assessments of lesion status have been based on a tactile test where a sharp probe or explorer is drawn across the surface of a lesion to assess its hardness. This is a technique-sensitive step and has the potential for iatrogenic damage, especially when a lesion is deep. This study was undertaken to determine whether an alternative, non-invasive, visual assessment could be a reliable indicator of lesion status. The approach was based on the retention, or otherwise, of a black surface deliberately created at the time of initial treatment.

Methods

A total of 88 lesions in the primary molars of 45 children, aged 5 to 10 years, were treated with a one-minute application of 40% silver fluoride. The surface of the lesions was then deliberately turned black by the application of 10% stannous fluoride as a reducing agent. All lesions were on an approximal or occlusal surface of a first or second primary molar. The presence or absence of a continuous black surface at 6 months and any changes in radiographic depth that had occurred in that period were determined from digitized photographs and bitewing radiographs.

Results

The retention of an uninterrupted black surface was associated with minimal or no caries progression whereas lesions with an incomplete or lost black surface were 4.6 times more likely to have progressed. Use of the Datta and Satten Rank-Sum Test to account for any clustering effect showed that the difference was statistically significant (p < 0.0001). The sensitivity and specificity of the approach were 80% and 81% respectively.

Conclusion

The retention of a continuous black surface after the application of silver fluoride followed by a reducing agent on carious lesions in primary molars can provide a useful visual indicator of lesion progression and so be relevant for use in dental outreach programs.

Minimal intervention dentistry: part 5. Atraumatic restorative treatment (ART)--a minimum intervention and minimally invasive approach for the management of dental caries

While originally developed in response to a need to provide effective restorative and preventive treatment in underserved communities where running water and electricity might not always be available, over the past two decades, the atraumatic restorative treatment (ART) approach has become a worldwide phenomenon; used not only in some of the poorest developing countries but also in some of the most wealthy. The ART approach involves the removal of infected dentine with hand-instruments followed by the placement of a restoration where the adjacent pits and fissures are sealed simultaneously using high viscosity glass-ionomer inserted under finger pressure. Reliable results can only be obtained if the treatment protocol, as described in this article, is closely followed. ART should be considered as a therapeutic option especially in children, anxious patients and those with special needs.

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

DATA SOURCES

Cochrane Oral Health Group's Trials Register, CENTRAL, Medline via OVID, EMBASE via OVID; no restrictions on language or date of publication.

STUDY SELECTION

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.

DATA EXTRACTION AND SYNTHESIS

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 .

RESULTS

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.

CONCLUSIONS

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.

The contemporary approach to tooth preservation: minimum intervention (MI) caries management in general practice

The minimum intervention (MI) approach summarises a clinical, evidence-based rationale for the preventive and cause-related approach to oral diseases in general and to caries in particular. MI oral care with respect to the management of patients suffering from dental caries is a concept based on an updated understanding of the histopathological carious process as well as the development of diagnostic technologies and adhesive, bioactive restorative materials. A patient-centred MI care plan for use in general dental practice is described, detailing the four phases of identifying disease, controlling/preventing disease, refurbishing/repairing tooth surfaces/restorations and recall consultations.

Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results

AIM

The aim of this study was to evaluate the effectiveness of partial removal of carious dentine and restoration in a single session (PDR) and stepwise excavation (SW), both of which are treatments for deep carious lesions, in Public Health Services in Brazil.

METHODS

INCLUSION CRITERIA

patients ≥6 years old, permanent molars with deep caries lesions (having a radiolucency halfway or more into dentine) and pulp vitality but absence of spontaneous pain, positive percussion test, and periapical alterations. The subjects received either PDR (test group) or SW (control group). The radiological and clinical exams were performed after a mean time of 18 months.

OUTCOMES

success was defined as pulp sensitivity to cold test and absence of periapical alterations.

RESULTS

Of the 299 treatments performed, 146 were SW and 153 were PDR; 122 were amalgam restorations and 168 resin-composite restorations. There were no differences between the groups regarding the baseline characteristics (i.e. age, gender and family income). After 18 months, 212 evaluations were performed, which indicated 99 and 86% success rates in the PDR and SW groups, respectively (p = 0.016). Reasons for failure were: PDR - 1 pulpitis; SW - 8 pulpitis; 1 osteitis; 4 necrosis; 1 endodontic treatment. None of the baseline variables were significantly associated with the outcomes.

CONCLUSION

The retention of carious dentine does not interfere in pulp vitality. Data from this 18-month study suggest that the procedure of reopening the cavity to remove the residual infected dentine is not necessary.

Minimal intervention dentistry for managing dental caries - a review: report of a FDI task group

This publication describes the history of minimal intervention dentistry (MID) for managing dental caries and presents evidence for various carious lesion detection devices, for preventive measures, for restorative and non-restorative therapies as well as for repairing rather than replacing defective restorations. It is a follow-up to the FDI World Dental Federation publication on MID, of 2000. The dental profession currently is faced with an enormous task of how to manage the high burden of consequences of the caries process amongst the world population. If it is to manage carious lesion development and its progression, it should move away from the 'surgical' care approach and fully embrace the MID approach. The chance for MID to be successful is thought to be increased tremendously if dental caries is not considered an infectious but instead a behavioural disease with a bacterial component. Controlling the two main carious lesion development related behaviours, i.e. intake and frequency of fermentable sugars, to not more than five times daily and removing/disturbing dental plaque from all tooth surfaces using an effective fluoridated toothpaste twice daily, are the ingredients for reducing the burden of dental caries in many communities in the world. FDI's policy of reducing the need for restorative therapy by placing an even greater emphasis on caries prevention than is currently done, is therefore, worth pursuing.

Dentin caries activity in early occlusal lesions selected to receive operative treatment: findings from the Practitioners Engaged in Applied Research and Learning (PEARL) Network

BACKGROUND

Members of the practice-based research network Practitioners Engaged in Applied Research and Learning (PEARL) Network investigated the dentin caries activity in early occlusal lesions and its relationship to patient age, preoperative tooth sensitivity and radiographic appearance, as well as its influence on preparation depth and volume.

METHODS

PEARL Network practitioner-investigators (P-Is) (n = 45), general dentists who were trained but whose methods were not calibrated, conducted a study regarding postoperative hypersensitivity in resin-based composite restorations. The P-Is enrolled as study participants 613 patients with occlusal carious lesions that, in the P-Is' clinical judgment, required restoration. The P-Is used baseline radiographs to assess the depth and extent of the lesions. Data for 671 restorations included baseline sensitivity; ranking of dentin caries activity on the opening of the enamel; radiographic visibility (n = 652); and measurements of preparation depth, width and length.

RESULTS

P-Is found rapidly progressing dentin caries in 38.5 percent (258 of 671) of lesions and slowly progressing (and potentially inactive dentin) caries in the remainder of the lesions. Rapidly progressing caries was not related to the participant's age or participant-reported preoperative hypersensitivity but was related to the lesion depth as seen radiographically (P < .001) and depth (P < .001) and volume (P < .001) of the preparation. Molars had slightly higher but not statistically significant levels of caries activity.

CONCLUSION

Rapidly progressing dentin caries, while present in only 38.5 percent of lesions, was related to the lesion's radiographic appearance but not to the participant's age or the study tooth's pre-operative sensitivity.

CLINICAL IMPLICATIONS

On the basis of the low level of rapidly progressing dentin caries in this study population and the fact that slowly progressing caries can be inactive or remineralizing, the authors advise sealing versus operative treatment of early or shallow occlusal lesions.

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).

Arrest of non-cavitated dentinal occlusal caries by sealing pits and fissures: a 36-month, randomised controlled clinical trial

OBJECTIVE

This study aimed to evaluate the progression of sealed non-cavitated dentinal occlusal caries in a randomised controlled clinical trial.

MATERIALS AND METHODS

Sixty teeth with non-cavitated dentinal occlusal caries were selected in patients with a high risk for caries. Patients were randomly divided into two groups so that each group included 30 teeth. Patients in the experiment group were given oral hygiene instructions and a fissure sealant. Patients in the control group were given oral hygiene instructions only. Caries progression and sealant loss were monitored over a period of 36 months by clinical and radiographic examinations.

RESULTS

Clinical and radiographic progression of caries was significantly more frequent in the control group than in the experiment group. Three teeth lost their sealant and showed caries progression, but this was apparent only at the 12-month follow-up. At the 24- and 36-month recall appointments, neither sealant loss nor caries progression were observed.

CONCLUSION

The pit and fissure sealant utilised in this study was shown to be effective in arresting carious lesions at 36 months.

Conventional caries removal and sealed caries in permanent teeth: a microbiological evaluation

OBJECTIVES

The aim of this study was to compare microbiological infection after conventional carious dentine removal with incomplete carious dentine removal and sealing.

METHODS

Eighty-seven patients (12-50 years of age) under treatment at the Dental Clinics of the Federal University of Rio Grande do Sul (UFRGS), Brazil, participated in the study. The patients presented 90 posterior permanent teeth with primary caries. The lesions were coronal, active, and reached at least the middle third of the dentine. None of the teeth exhibited spontaneous pain, sensitivity to percussion or apical pathology (detected through radiographic exams). Pulp sensibility was confirmed by the cold test. The lesions were divided into 2 experimental groups: complete caries removal (CCR) based on hardness criteria (n=60 lesions) and incomplete caries removal (ICR) and sealing (n=32 lesions). Microbiological samples were obtained from the initial demineralized dentine, after CCR and after ICR-Seal.

RESULTS

The number of anaerobic and aerobic bacteria, lactobacilli, and mutans streptococci decreased at the end of treatment (p<0.05). Significantly less anaerobic bacteria (p<0.01), aerobic bacteria (p=0.02), and mutans streptococci (p<0.01) growth was observed after ICR-Seal compared to CCR. The difference in lactobacilli was insignificant (p=0.08). The amount of bacteria detected after conventional caries removal was higher than that which remained in sealed caries lesions.

CONCLUSIONS

The results suggest it is not necessary to remove all carious dentine before the restoration is placed because over time, sealing of carious dentine results in lower levels of infection than traditional dentine caries removal.

CLINICAL SIGNIFICANCE

The results of this study indicate that sealed carious dentine was less infected than the remaining dentine left after conventional caries removal and sealing. Our results support treatment of deep carious lesions in one session with incomplete removal of carious dentine.

Efficacy of a non-drilling approach to manage non-cavitated dentin occlusal caries in primary molars: a 12-month randomized controlled clinical trial

BACKGROUND. Despite the efficacy of non-drilling approaches to manage non-cavitated dentin occlusal lesions (NCDOL) in permanent teeth, there is no data validating this type of therapy in the primary dentition. AIM. To compare the efficacy of a traditional fissure sealant in managing NCDOL in primary molars. DESIGN. This study is a randomized controlled clinical trial with a split-mouth design. Thirty schoolchildren with two NCDOL were selected and divided into two groups. The experimental group received a resin-based fissure sealant, whereas the control group was treated with a conventional composite resin. Treatment efficacy was evaluated after 1 year by means of clinical and radiographic examinations. RESULTS. The two treatment modalities were found to be similarly effective in managing DONCL in primary molars. CONCLUSION. For the management of non-cavitated dentin occlusal caries in primary teeth, the invasive approach can be replaced with non-drilling fissure sealing techniques.

Vertical alveolar growth in subjects with infraoccluded mandibular deciduous molars

INTRODUCTION

Our objective was to compare vertical alveolar growth in areas adjacent to infraoccluded deciduous molars with growth in areas of deciduous molars and normal occlusion for a period of at least 1 year by using digital subtraction radiography.

METHODS

This case-control study included 40 pairs of panoramic radiographs of growing patients with infraoccluded deciduous molars and 40 pairs of radiographs of patients without infraoccluded deciduous molars. One radiograph at baseline was obtained at diagnosis, and the other at least 1 year later. The subjects and the controls were matched according to chronologic age and time interval between the 2 radiographs. The 2 groups were compared with regard to vertical alveolar growth and vertical tooth movement. Measurements were assessed by using nonparametric tests (Mann-Whitney and Friedman) and a multiple comparison test. Significance was set at 5%.

RESULTS

A statistically significant difference was observed between the groups with regard to vertical alveolar growth measured on the bone crest between the first permanent molars and second premolars.

CONCLUSIONS

Vertical alveolar growth between the first permanent molar and the second premolar adjacent to the infraoccluded teeth was smaller than in areas adjacent to teeth with normal occlusion.