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Restoration Performance After Selective Caries Removal to Soft Dentine
TAKE-HOME MESSAGE
- Recent evidence suggests that the complete removal of carious dentine may not be clinically necessary and may cause more damage to the remaining tooth structure and pulpal health. This randomised controlled clinical trial evaluated the clinical performance of composite resin restorations placed after selective caries removal to soft dentine (SCRSD) or stepwise excavation (SW) over an 18-month period in 135 permanent molars and/or premolars presenting deep caries lesions (≥50% of the dentine thickness) that were evaluated using the FDI criteria. There were four failures in the SCRSD group and two in the SW group. The success rates for SW (99.4%) and SCRSD (97.9%) were similar. Patients with more than or equal to 20% of sites with gingival bleeding had an 8.50 times higher risk of restoration failure than those with less than 20% of bleeding sites.
- Clinicians may choose SCRSD as a viable treatment option for managing deep caries lesions in permanent teeth, as it preserves the tooth vitality and structure without compromising the longevity of composite resin restorations, especially in young patients with healthy gingival tissues.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVE
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.
Additional Info
Disclosure statements are available on the authors' profiles:
Restorations performance after selective caries removal to soft dentine: 18-month follow-up of a controlled clinical trial
J Dent 2024 May 24;[EPub Ahead of Print], AF Recchi, RS Azambuja, LS Alves, M Maltz, JJ JardimFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The main purpose of this study was to compare the performance of composite restorations placed over soft dentin with that of composite restorations placed after stepwise complete caries removal performed over two appointments. There were 76 teeth in each treatment group, and evaluations were performed according to the FDI criteria. Only a few failures were observed over a period of 18 months: two marginal fractures and two restoration losses in the soft dentin group and two fractures in the complete caries removal group. There was no statistical difference in the number of failures between the groups. Another finding was a higher failure rate in sites with gingival bleeding, although a rubber dam was used during placement.
The results of this study support the findings of several studies published over the last few decades, which indicated that some carious dentin can be left in the deep areas of the preparation, particularly when it is performed to avoid pulp exposure. It should be mentioned that the procedure for the control group — stepwise caries removal — is not common in private practice (at least in the US), as the reimbursement for a composite restoration is usually by surface and does not increase if multiple appointments are needed. The procedure involves one appointment to excavate most of the caries, cover the remaining caries with a calcium hydroxide liner, and perform temporization with a glass ionomer cement. In the second appointment, all of the remaining caries are removed, and the tooth is restored in the usual manner with a composite resin. This is one limitation of the study, and the other is the relatively short duration of follow-up. However, as there is less chance of pulp exposure in the stepwise procedure, it is likely that a complete and immediate caries removal would have resulted in a worse outcome in the control group.