Selective removal of dental caries in permanent teeth: an 18-month clinical trial

This study aimed to evaluate the clinical efficacy of restorations after selective removal of carious tissue (SRCT) in permanent teeth.

A randomized, controlled, and blinded clinical trial was conducted on 74 teeth to compare SRCT with two types of non-selective removal (nSRCT), which served as control groups. For medium-depth lesions (D2) that reached the middle third of the dentin, SRCT was compared with non-selective removal to hard dentine (nSRCT-HD). For deep lesions (D3) extending to the inner third of the dentin, SRCT was compared with stepwise removal of carious tissue (StRCT). Outcomes included pulp sensitivity and restoration quality, assessed using FDI Functional Property criteria. Adjusted analyses were performed using Poisson regression with robust variance to assess the risk ratio (RR) and its respective 95% confidence interval.

A total of 62, 50, and 39 teeth were followed at 6, 12, and 18 months, respectively. Three pulp sensitivity failures occurred at 6 months (2 nSRCT, 1 SRCT), with no additional failures at 12 and 18 months. Regarding quality of restoration, no failure was observed and there was not significant difference between groups up to the 18-month period.

SRCT was clinically effective in both mid-depth (D2) and deep (D3) lesions, addressing pulp sensitivity and restoration quality. In D3 lesions, it minimized the risk of pulp exposure while preserving dentin integrity, while in D2 lesions, it preserved tooth structure without compromising restoration performance.

SRCT is a less invasive strategy, preserves more dental tissue and presents satisfactory results in relation to the preservation of pulp sensitivity and quality of restorations.