Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy

Lars Bjørndal; Claes Reit; Gitte Hoffmann Bruun; Merete Markvart; Marianne Kjaeldgaard; Peggy Näsman; Marianne Thordrup; Irene Dige; Bente Nyvad; Helena Fransson; Anders Lager; Dan Ericson; Kerstin Petersson; Jadranka Olsson; Eva M Santimano; Anette Wennström; Per Winkel; Christian Gluud

doi:10.1111/j.1600-0722.2010.00731.x

Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy

Lars Bjørndal, Claes Reit, Gitte Hoffmann Bruun, Merete Markvart, Marianne Kjaeldgaard, Peggy Näsman, Marianne Thordrup, Irene Dige, Bente Nyvad, Helena Fransson, Anders Lager, Dan Ericson, Kerstin Petersson, Jadranka Olsson, Eva M Santimano, Anette Wennström, Per Winkel, Christian Gluud

Section 05 - Community Dentistry

196 Citations (Scopus)

Abstract

Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (-22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.

Original language	English
Journal	European Journal of Oral Sciences Online
Volume	118
Issue number	3
Pages (from-to)	290-7
Number of pages	8
ISSN	1600-0722
DOIs	https://doi.org/10.1111/j.1600-0722.2010.00731.x
Publication status	Published - 1 Jun 2010

Keywords

Adult
Calcium Hydroxide
Dental Caries
Dental Cavity Lining
Dental Cavity Preparation
Dental Pulp
Dental Pulp Capping
Dental Pulp Exposure
Dental Pulp Test
Dental Restoration, Permanent
Dental Restoration, Temporary
Dentin
Female
Follow-Up Studies
Glass Ionomer Cements
Humans
Male
Middle Aged
Minerals
Periapical Tissue
Pulpotomy
Radiography, Bitewing
Resin Cements
Treatment Outcome

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Bjørndal, L., Reit, C., Bruun, G. H., Markvart, M., Kjaeldgaard, M., Näsman, P., Thordrup, M., Dige, I., Nyvad, B., Fransson, H., Lager, A., Ericson, D., Petersson, K., Olsson, J., Santimano, E. M., Wennström, A., Winkel, P., & Gluud, C. (2010). Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. European Journal of Oral Sciences Online, 118(3), 290-7. https://doi.org/10.1111/j.1600-0722.2010.00731.x

Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. / Bjørndal, Lars; Reit, Claes; Bruun, Gitte Hoffmann et al.
In: European Journal of Oral Sciences Online, Vol. 118, No. 3, 01.06.2010, p. 290-7.

Research output: Contribution to journal › Journal article › Research › peer-review

Bjørndal, L, Reit, C, Bruun, GH, Markvart, M, Kjaeldgaard, M, Näsman, P, Thordrup, M, Dige, I, Nyvad, B, Fransson, H, Lager, A, Ericson, D, Petersson, K, Olsson, J, Santimano, EM, Wennström, A, Winkel, P & Gluud, C 2010, 'Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy', European Journal of Oral Sciences Online, vol. 118, no. 3, pp. 290-7. https://doi.org/10.1111/j.1600-0722.2010.00731.x

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abstract = "Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (-22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.",

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AU - Bjørndal, Lars

AU - Reit, Claes

AU - Bruun, Gitte Hoffmann

AU - Markvart, Merete

AU - Kjaeldgaard, Marianne

AU - Näsman, Peggy

AU - Thordrup, Marianne

AU - Dige, Irene

AU - Nyvad, Bente

AU - Fransson, Helena

AU - Lager, Anders

AU - Ericson, Dan

AU - Petersson, Kerstin

AU - Olsson, Jadranka

AU - Santimano, Eva M

AU - Wennström, Anette

AU - Winkel, Per

AU - Gluud, Christian

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N2 - Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (-22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.

AB - Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (-22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.

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KW - Calcium Hydroxide

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KW - Dental Cavity Lining

KW - Dental Cavity Preparation

KW - Dental Pulp

KW - Dental Pulp Capping

KW - Dental Pulp Exposure

KW - Dental Pulp Test

KW - Dental Restoration, Permanent

KW - Dental Restoration, Temporary

KW - Dentin

KW - Female

KW - Follow-Up Studies

KW - Glass Ionomer Cements

KW - Humans

KW - Male

KW - Middle Aged

KW - Minerals

KW - Periapical Tissue

KW - Pulpotomy

KW - Radiography, Bitewing

KW - Resin Cements

KW - Treatment Outcome

U2 - 10.1111/j.1600-0722.2010.00731.x

DO - 10.1111/j.1600-0722.2010.00731.x

M3 - Journal article

C2 - 20572864

SN - 1600-0722

VL - 118

SP - 290

EP - 297

JO - European Journal of Oral Sciences Online

JF - European Journal of Oral Sciences Online

IS - 3

ER -

Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy

Abstract

Keywords

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