Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial

Area of Science:

• Dental caries management
• Restorative dentistry
• Endodontics

Background:

• Deep caries lesions pose a risk to pulp vitality.
• Traditional stepwise excavation (SW) involves multiple visits.
• Alternative techniques aim to preserve pulp vitality more effectively.

Purpose of the Study:

• To compare the 5-year outcomes of stepwise excavation (SW) and partial caries removal (PCR) in maintaining pulp vitality in permanent molars with deep caries.
• To evaluate the efficacy of a single-visit PCR technique versus a multi-visit SW approach.

Main Methods:

• A multicenter randomized controlled trial involving 299 permanent molars with deep caries.
• Teeth were assigned to either stepwise excavation (SW) or partial caries removal (PCR) in a single session.
• Pulp vitality was assessed over 5 years using clinical and radiographic criteria; survival analysis (Weibull regression) was employed.

Main Results:

• The 5-year survival analysis revealed significantly higher success rates for PCR (80%) compared to SW (56%) (p < 0.001).
• Treatment type was a significant factor in failure, with PCR showing a reduced hazard ratio for failure (HR=0.38).
• The region of treatment also influenced outcomes, with a higher failure rate in the South region (HR=2.22).

Conclusions:

• Partial caries removal (PCR) significantly reduces the incidence of pulp necrosis compared to stepwise excavation (SW).
• PCR is a viable and effective single-visit treatment for managing deep caries lesions in permanent teeth.
• This approach supports conservative management strategies to maintain natural tooth structure and pulp vitality.