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. 2025 Feb;58(2):239-256.
doi: 10.1111/iej.14159. Epub 2024 Oct 30.

Deep caries and pulp exposures management preferences in permanent teeth: A survey amongst Spanish dentists

Laura Bailleul  1 , Laura Ceballos  1 , Sophie Doméjean  2 , Victoria Fuentes  1
Affiliations

Deep caries and pulp exposures management preferences in permanent teeth: A survey amongst Spanish dentists

Laura Bailleul et al. Int Endod J. 2025 Feb.

Abstract

Aim: To assess Spanish dentists' management preferences for deep caries removal and exposed pulps in permanent teeth.

Methodology: A web-based open and anonymous survey was distributed by social media and a specific website for this project amongst dentists practicing in Spain. The questionnaire comprised 40 questions, divided into five sections: (1) demographic data and professional activity; (2) carious tissue removal; (3) decision-making regarding pulp exposure; (4) direct pulp capping and (5) pulpotomy procedures in permanent teeth. Results were descriptively analysed. Logistic regression (95% CI) analyses and X2 tests were carried out.

Results: A total of 538 responses were received. Half the respondents (53.7%) preferred to perform complete caries excavation for shallow and moderate carious dentin lesions, and selective excavation to firm dentin for deep lesions (57.8%). Selective removal to soft dentin and stepwise removal were much less indicated (15.4% and 10.9%, respectively). Exposed pulps in asymptomatic teeth were treated by direct pulp capping (over 80%), decreasing in the presence of reversible pulpitis symptoms (57.1%). If irreversible pulpitis was diagnosed, a pulpectomy would be performed by 53.5% and 89.9% of the respondents in, respectively, immature and mature teeth. Pulpotomy was performed routinely only by 26.4% of the clinicians. Patients' attitudes and priorities were the most relevant criteria when performing direct pulp capping and pulpotomy, together with the history of pain and the presence of bleeding. Regarding the clinical procedure, dry cotton was preferred to obtain haemostasis and Biodentine was the material of election.

Conclusions: Caries removal preferences and management of pulp exposure by dentists practicing in Spain deviated from vital pulp treatment guidelines, mainly regarding indications and case selection. Pulp exposure was managed by direct pulp capping in asymptomatic cases, whilst immature permanent molars favoured the indication of pulpotomy when pulpitis was diagnosed. Most clinicians used hydraulic calcium silicate cement, specifically Biodentine, to perform vital pulp treatments. Postgraduate formation and continuing education in caries lesions management and vital pulp treatments were consistently related to more conservative and updated decisions.

Keywords: permanent teeth; pulp exposure; pulpotomy; survey; vital pulp therapy.

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Conflict of interest statement

There is no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart (n (%)).
FIGURE 2
FIGURE 2
Importance that participants assigned to patient characteristics and clinical criteria when performing direct pulp cappings and pulpotomies. Results are scored between 1 and 5 being 1 ‘not important’ and 5 ‘extremely important’. DK/DA, don't know/don't answer.
See this image and copyright information in PMC

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