Aim: The aim of this study was to evaluate the effectiveness of partial removal of carious dentine and restoration in a single session (PDR) and stepwise excavation (SW), both of which are treatments for deep carious lesions, in Public Health Services in Brazil. Methods: Inclusion criteria: patients ≥6 years old, permanent molars with deep caries lesions (having a radiolucency halfway or more into dentine) and pulp vitality but absence of spontaneous pain, positive percussion test, and periapical alterations. The subjects received either PDR (test group) or SW (control group). The radiological and clinical exams were performed after a mean time of 18 months. Outcomes: success was defined as pulp sensitivity to cold test and absence of periapical alterations. Results: Of the 299 treatments performed, 146 were SW and 153 were PDR; 122 were amalgam restorations and 168 resin-composite restorations. There were no differences between the groups regarding the baseline characteristics (i.e. age, gender and family income). After 18 months, 212 evaluations were performed, which indicated 99 and 86% success rates in the PDR and SW groups, respectively (p = 0.016). Reasons for failure were: PDR – 1 pulpitis; SW – 8 pulpitis; 1 osteitis; 4 necrosis; 1 endodontic treatment. None of the baseline variables were significantly associated with the outcomes. Conclusion: The retention of carious dentine does not interfere in pulp vitality. Data from this 18-month study suggest that the procedure of reopening the cavity to remove the residual infected dentine is not necessary.

Keywords:
Permanent teeth, Restorations, Restorative materials, Caries removal, Clinical trial, Dentine caries
1.
Al-Hiyasat AS, Barrieshi-Nusair KM, Al-Omari MA: The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study. J Am Dent Assoc 2006;137:1699–1705.
2.
Alves LS, Fontanella V, Damo AC, Ferreira de Oliveira E, Maltz M: Qualitative and quantitative radiographic assessment of sealed carious dentin: a 10-year prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:135–141.
3.
Barthel CR, Rosenkranz B, Leuenberg A, Roulet JF: Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study. J Endod 2000;26:525–528.
4.
Bjørndal L, Larsen T, Thylstrup A: A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res 1997;31:411–417.
5.
Bjørndal L, Reit C, Bruun G, 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: Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci 2010;118:290–297.
6.
Bjørndal L, Thylstrup A: A practice-based study on stepwise excavation of deep carious lesions in permanent teeth: a 1-year follow-up study. Community Dent Oral Epidemiol 1998;26:122–128.
7.
Brazilian Institute of Geography and Statistics (IBGE). http://www.ibge.gov.br/home/.
8.
Busnello RG, Melchior R, Faccin C, Vettori D, Petter J, Moreira LB, Fuchs FD: Characteristics associated with the dropout of hypertensive patients followed up in an outpatient referral clinic. Arq Bras Cardiol 2001;76:349–354.
9.
Dammaschke T, Leidinger J, Schäfer E: Long-term evaluation of direct pulp capping – treatment outcomes over an average period of 6.1 years. Clin Oral Investig 2010;14:559–567.
10.
Falster CA, Araujo FB, Straffon LH, Nör JE: Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs. calcium hydroxide for protection of the dentin-pulp complex. Pediatr Dent 2002;24:241–248.
11.
Franzon R, Gomes M, Pitoni CM, Bergmann CP, Araujo FB: Dentin rehardening after indirect pulp treatment in primary teeth. J Dent Child (Chic) 2009;76:223–228.
12.
King JB, Crawford JJ, Lindahl RL: Indirect pulp capping: a bacteriologic study of deep carious dentine in human teeth. Oral Surg Oral Med Oral Pathol 1965;20:663–669.
13.
Lee YL, Liu J, Clarkson BH, Lin CP, Godovikova V, Ritchie HH: Dentin-pulp complex responses to carious lesions. Caries Res 2006;40:256–264.
14.
Leksell E, Ridell K, Cvek M, Mejàre I: Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth. Endod Dent Traumatol 1996;12:192–196.
15.
Lula EC, Monteiro-Neto V, Alves CM, Ribeiro CC: Microbiological analysis after complete or partial removal of carious dentin in primary teeth: a randomized clinical trial. Caries Res 2009;43:354–358.
16.
Magnusson BO, Sundell SO: Stepwise excavation of deep carious lesions in primary molars. J Int Assoc Dent Child 1977;8:36–40.
17.
Maltz M, de Oliveira EF, Fontanella V, Bianchi R: A clinical, microbiologic, and radiographic study of deep caries lesions after incomplete caries removal. Quintessence Int 2002;33:151–159.
18.
Maltz M, Oliveira EF, Fontanella V, Carminatti G: Deep caries lesions after incomplete dentine caries removal: 40-month follow-up study. Caries Res 2007;41:493–496.
19.
Marchi JJ, de Araujo FB, Fröner AM, Straffon LH, Nör JE: Indirect pulp capping in the primary dentition: a 4-year follow-up study. J Clin Pediatr Dent 2006;31:68–71.
20.
Marchi JJ, Froner AM, Alves HL, Bergmann CP, Araújo FB: Analysis of primary tooth dentin after indirect pulp capping. J Dent Child (Chic) 2008;75:295–300.
21.
Massara ML, Alves JB, Brandão PR: Atraumatic restorative treatment: clinical, ultrastructural and chemical analysis. Caries Res 2002;36:430–436.
22.
Massler M: Treatment of profound caries to prevent pulpal damage. J Pedod 1978;2:99–105.
23.
McLachlan JL, Smith AJ, Sloan AJ, Cooper PR: Gene expression analysis in cells of the dentine-pulp complex in healthy and carious teeth. Arch Oral Biol 2003;48:273–283.
24.
Murray PE, Lumley PJ, Smith AJ: Preserving the vital pulp in operative dentistry. 2. Guidelines for successful restoration of unexposed dentinal lesions. Dent Update 2002;29:127–134.
25.
Oliveira EF, Carminatti G, Fontanella V, Maltz M: The monitoring of deep caries lesions after incomplete dentine caries removal: results after 14–18 months. Clin Oral Investig 2006;10:134–139.
26.
Orhan AI, Oz FT, Ozcelik B, Orhan K: A clinical and microbiological comparative study of deep carious lesion treatment in deciduous and young permanent molars. Clin Oral Investig 2008;12:369–378.
27.
Paddick JS, Brailsford SR, Kidd EA, Beighton D: Phenotypic and genotypic selection of microbiota surviving under dental restorations. Appl Environ Microbiol 2005;71:2467–2472.
28.
Parolo C, Heller D, Bitello LF, Podestá K, Souza DCC, Hashizume LN, Maltz M: Effectiveness of the stepwise excavation treatment performed by dental students in Porto Alegre, Brazil. Caries Res 2007;41:269.
29.
Pinto AS, de Araújo FB, Franzon R, Figueiredo MC, Henz S, García-Godoy F, Maltz M: Clinical and microbiological effect of calcium hydroxide protection in indirect pulp capping in primary teeth. Am J Dent 2006;19:382–386.
30.
Ribeiro CC, Baratieri LN, Perdigão J, Baratieri NM, Ritter AV: A clinical, radiographic, and scanning electron microscopic evaluation of adhesive restorations on carious dentin in primary teeth. Quintessence Int 1999;30:591–599.
31.
Ricketts DN, Kidd EA, Innes N, Clarkson J: Complete or ultraconservative removal of decayed tissue in unfilled teeth. Cochrane Database Syst Rev 2006;3:CD003808.
32.
Weerheijm KL, Kreulen CM, de Soet JJ, Groen HJ, van Amerongen WE: Bacterial counts in carious dentine under restorations: 2-year in vivo effects. Caries Res 1999;33:130–134.
© 2012 S. Karger AG, Basel
2012
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