Randomized Clinical Trials on Deep Carious Lesions: 5-Year Follow-up.

Area of Science:

• Dentistry
• Endodontics
• Cariology

Background:

• Deep caries treatment presents a clinical dilemma regarding optimal strategies for maintaining pulp vitality and preventing apical pathology.
• Previous short-term studies compared stepwise carious tissue removal with nonselective removal, with or without pulp exposure.

Purpose of the Study:

• To report the 5-year outcomes of patients previously treated for deep carious lesions.
• To compare the long-term success rates of stepwise versus nonselective carious tissue removal in maintaining pulp vitality.

Main Methods:

• A long-term follow-up study analyzed 239 out of 314 patients from previous randomized clinical trials.
• Patients had radiographically defined deep carious lesions with a radiodense zone between the lesion and the pulp.
• Outcomes were assessed based on sustained pulp vitality, absence of apical radiolucency, and pain, including pulp exposures as failures.

Main Results:

• The stepwise removal group showed a significantly higher success rate (60.2%) compared to the nonselective removal group (46.3%) at 5 years (P=0.031).
• Pulp exposure rates were significantly lower in the stepwise group (21.2%) versus the nonselective group (35.5%) (P=0.014).
• Even excluding pulp exposures, stepwise removal demonstrated a significant benefit in maintaining pulp vitality (P=0.045).

Conclusions:

• Stepwise carious removal is a superior strategy for treating deep caries in adult teeth, leading to a higher proportion of sustained pulp vitality at 5-year follow-up.
• Conventional pulp-capping procedures following pulp exposure in deep carious lesions in adults have a highly dubious prognosis.
• The findings support stepwise removal as the preferred treatment to optimize long-term outcomes and preserve pulp vitality.