Subjective versus objective, polymer bur-based selective carious tissue removal: 2-year randomized clinical trial

Area of Science:

• Dentistry
• Pediatric Dentistry
• Restorative Dentistry

Background:

• Selective carious tissue removal is crucial for preserving pulp vitality in primary teeth.
• Traditional methods rely on subjective assessment by hand instruments.
• Objective methods using specialized burs offer potential for standardization.

Purpose of the Study:

• To compare the effectiveness of subjective selective carious tissue removal (hand instruments) versus objective removal (polymer bur).
• To evaluate the 2-year survival and success rates of restorations in primary molars using these two methods.

Main Methods:

• A single-blind, cluster-randomized controlled trial involving 115 children (7-8 years old) with deep dentin lesions.
• Carious tissue was removed using either hand instruments (subjective) or a self-limiting polymer bur (objective).
• Restorations were evaluated for survival and success using ART criteria over a mean of 22 months.

Main Results:

• No significant difference in success (50/71 vs. 48/65) or survival (70/71 vs. 65/65) was observed between the subjective and objective removal groups.
• Restorative failures predominated over pulpal complications.
• Single-surfaced restorations showed a significantly lower hazard of failure.

Conclusions:

• Subjective selective carious tissue removal using hand instruments is non-inferior to objective removal with a polymer bur in primary teeth.
• Polymer-based burs may be beneficial for achieving standardized excavation.
• Both methods provide comparable long-term outcomes for deep dentin lesions in primary molars.