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Randomized Controlled Trial
. 2021 Feb;25(2):645-652.
doi: 10.1007/s00784-020-03536-6. Epub 2020 Aug 28.

Selective vs stepwise removal of deep carious lesions in primary molars: 24 months follow-up from a randomized controlled trial

Karim Elhennawy  1 , Christian Finke  2 , Sebastian Paris  3 , Seif Reda  2 , Paul-Georg Jost-Brinkmann  2 , Falk Schwendicke  4
Affiliations
Randomized Controlled Trial

Selective vs stepwise removal of deep carious lesions in primary molars: 24 months follow-up from a randomized controlled trial

Karim Elhennawy et al. Clin Oral Investig. 2021 Feb.

Abstract

Objectives: For well-defined deep (> 2/3 dentin extension) carious lesions, selective (SE) or stepwise (SW) carious tissue removals have been recommended, while there is limited comparative evidence for both. We compared SE and SW over 24 months in a randomized controlled trial.

Methods: A two-arm superiority trial was conducted comparing SW/SE in primary molars without pulpal symptoms but well-defined deep lesions. Seventy-four children (1 molar/child) aged 3-9 years were recruited. In a first step, peripheral carious tissue was removed until hard dentin remained, while in proximity to the pulp, leathery dentin was left. An adhesive compomer restoration was placed and restorations re-examined after 6 months. In SW, re-entry and removal to firm dentin was conducted pulpo-proximally, followed by re-restoration. Molars were re-evaluated for a total of 24 months. Our primary outcome was success (absence of restorative/endodontic complications or pulp exposures). Secondary outcomes included total treatment and opportunity costs and restoration quality, assessed using modified USPHS criteria.

Results: After 24 months, 63 molars (31 SE, 32 SW) were re-assessed. Four failures occurred (2 exposures in SW; 2 pulpal complications in SE, 1 of them leading to extraction, p > 0.05). Restoration integrity was satisfying in both groups (USPHS A/B/C in 21/8/0 SE and 23/7/0 SW, p > 0.05). Treatment and opportunity costs were significantly higher in SW than SE (mean 171 ± 51 vs. 106 ± 90; p < 0.001).

Conclusions: After 2 years, SE and SW showed similar efficacy for managing deep carious lesions in primary molars. The higher costs for SW should be considered during decision-making.

Clinical significance: In primary molars with well-defined deep carious lesions SE was less costly and similarly efficacious like SW. From a cost and applicability perspective, SW may need to be indicated restrictively, e.g., for very deep (> 3/4 dentin extension) lesions only.

Trial registration: ClinicalTrials.gov Identifier: NCT02232828.

Keywords: Caries; Costs; Dentin; Partial removal; Restoration; Two-step removal.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the study
See this image and copyright information in PMC

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