Self-Limiting versus Conventional Caries Removal: A Randomized Clinical Trial

Area of Science:

• Restorative Dentistry
• Caries Management
• Pulp Biology

Background:

• Deep caries with reversible pulpitis presents a treatment challenge, balancing complete bacterial removal with pulp preservation.
• Conventional rotary bur excavation can lead to over-instrumentation and potential pulp exposure.
• Minimally invasive techniques aim to preserve healthy tooth structure and pulp vitality.

Purpose of the Study:

• To compare the clinical outcomes of a self-limiting caries excavation protocol versus conventional selective dentin removal.
• To assess pulp sensibility, periapical health, and bacterial load after 12 months.
• To evaluate the efficacy of cone beam computed tomography (CBCT) versus periapical radiographs (PAs) in detecting periapical lesions.

Main Methods:

• A single-blind randomized controlled trial involving 86 patients with deep caries and reversible pulpitis.
• Intervention: Self-limiting excavation using chemomechanical gel (Carisolv) and operating microscope.
• Control: Selective removal to leathery dentin using rotary burs, followed by mineral trioxide aggregate (MTA) pulp protection and restoration in a single visit.
• Assessments included pulp sensibility, periapical health (CBCT/PAs), and bacterial tissue concentration via qPCR at 12 months.

Main Results:

• No significant difference in bacterial tissue concentration between the self-limiting (96.3% reduction) and control (97.1%) groups.
• The self-limiting protocol showed a 4-fold higher probability of 12-month success (odds ratio = 4.33) and improved pulp survival rates (90% vs. 73.3%).
• Molars had a significantly higher probability of success than premolars (odds ratio = 4.17). CBCT detected more periapical lesions than PAs at baseline.

Conclusions:

• The self-limiting caries excavation protocol significantly increases the pulp survival rate compared to conventional rotary bur excavation.
• This minimally invasive approach, utilizing chemomechanical agents and magnification, is a viable and effective treatment for deep caries with reversible pulpitis.
• CBCT is superior to PAs for baseline periapical lesion detection in this patient population.