Incomplete caries removal in deep lesions: a 10-year prospective study

Am J Dent. 2011 Aug;24(4):211-4.

Abstract

Purpose: To follow-up teeth with deep caries lesions submitted to incomplete caries removal over a 10-year period.

Methods: 27 subjects (32 permanent posterior teeth) with deep caries lesions composed the sample. In this single-arm long-term prospective study, the inclusion criteria were risk of pulp exposure during caries excavation, positive response to the cold test, absence of spontaneous pain or sensitivity during percussion, and radiographic absence of a periapical lesion. Subjects were submitted to the following procedures: complete caries removal from the surrounding cavity walls, incomplete caries removal from the pulpal wall, capping with a calcium hydroxide cement, and sealing with a modified zinc oxide-eugenol cement. After 6-7 months, the temporary sealing was removed for methodological purposes (no further excavation was performed), and teeth were capped with a calcium hydroxide cement and filled with resin composite. Clinical and radiographic assessments were conducted after 6-7 months, 1.5, 3, 5 and 10 years. Success was defined as clinical and radiographic signs and symptoms of pulp sensitivity while failure was defined as endodontic treatment need.

Results: Over 10 years, one tooth was excluded from the sample (pulp exposure during treatment), five were lost to recall, 10 had therapy failure (five fractures and four necroses leading to endodontic treatment need, and one extraction) and 16 had therapy success (pulp sensitivity). Overall survival rates were 97%, 90%, 82% and 63% at 1.5-, 3-, 5- and 10-year follow-ups, respectively. Teeth with two or more restored surfaces failed significantly more than teeth with one restored surface (P= 0.01).

MeSH terms

  • Adolescent
  • Calcium Hydroxide / therapeutic use
  • Child
  • Composite Resins / chemistry
  • Dental Caries / diagnostic imaging
  • Dental Caries / pathology
  • Dental Caries / therapy*
  • Dental Cavity Preparation / methods
  • Dental Materials / chemistry
  • Dental Pulp / pathology
  • Dental Pulp Capping / methods
  • Dental Pulp Exposure / prevention & control
  • Dental Pulp Necrosis / etiology
  • Dental Pulp Test
  • Dental Restoration, Permanent
  • Dentin / pathology*
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Methylmethacrylates / therapeutic use
  • Minerals / therapeutic use
  • Prospective Studies
  • Pulp Capping and Pulpectomy Agents / therapeutic use
  • Radiography
  • Root Canal Therapy
  • Survival Analysis
  • Tooth Extraction
  • Tooth Fractures / etiology
  • Treatment Outcome
  • Young Adult
  • Zinc Oxide-Eugenol Cement / therapeutic use

Substances

  • Composite Resins
  • Dental Materials
  • Methylmethacrylates
  • Minerals
  • Pulp Capping and Pulpectomy Agents
  • Zinc Oxide-Eugenol Cement
  • Dycal
  • IRM cement
  • Calcium Hydroxide