A Clinical and Microbiological Study of Deep Carious Lesions during Stepwise Excavation Using Long Treatment Intervals

Aim: To evaluate the clinical changes in dentin of deep carious lesions in young permanent molars, following ozone application with and without the use of a remineralizing solution, using the stepwise excavation. Study design: The sample included 162 first permanent immature molars, showing deep occlusal carious cavities that were indicated for indirect pulp capping. Teeth were divided into 2 main groups according to the method of ozone treatment. Each group was further subdivided equally into test and control subgroups. Following caries excavation, color, consistency and DIAGNOdent assessments of dentin were evaluated after 6 and 12 months. Results: Regarding dentin color and consistency, no significant differences were observed following ozone application, with and without a remineralizing solution. There were no significant differences between ozone treatment, and calcium hydroxide during the different evaluation periods, except in group I cases after 6 months, concerning the dentin color. The DIAGNOdent values were significantly reduced following ozone application, with or without a remineralizing solution, as well as between test and control cases in group I after 6 months. Conclusions: Ozone application through the stepwise excavation had no significant effect on dentin color and consistency in young permanent molars. DIAGNOdent was unreliable in monitoring caries activity.

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Changes in the Cultivable Flora in Deep Carious Lesions following a Stepwise Excavation Procedure

Caries Research ◽

10.1159/000016631 ◽

2000 ◽

Vol 34 (6) ◽

pp. 502-508 ◽

Cited By ~ 101

Author(s):

L. Bjørndal ◽

T. Larsen

Keyword(s):

Carious Lesions ◽

Deep Carious Lesions ◽

Stepwise Excavation

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Stepwise excavation of deep carious lesions in primary teeth

Journal of Dentistry ◽

10.1016/0300-5712(78)90265-8 ◽

1978 ◽

Vol 6 (3) ◽

pp. 273

Author(s):

R.S. Brandt

Keyword(s):

Primary Teeth ◽

Carious Lesions ◽

Deep Carious Lesions ◽

Stepwise Excavation

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Stepwise Excavation Allows Apexogenesis in Permanent Molars with Deep Carious Lesions and Incomplete Root Formation

Caries Research ◽

10.1159/000442392 ◽

2015 ◽

Vol 49 (6) ◽

pp. 637-639 ◽

Cited By ~ 2

Author(s):

Patrícia Hernandéz-Gatón ◽

César Ruiz Serrano ◽

Paulo Nelson Filho ◽

Esther Ruiz De Castañeda ◽

Marília P. Lucisano ◽

...

Keyword(s):

Root Formation ◽

Permanent Teeth ◽

Promising Technique ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Carious Lesions ◽

Deep Carious Lesions ◽

Stepwise Excavation ◽

Permanent Molars

This study evaluated the stepwise excavation technique in 138 permanent molars with deep carious lesions and incomplete root formation within a 24-month clinical and radiographic follow-up period. In 96.7% of the cases, success was observed (no pain, integrity of restoration margins, absence of radiographic alterations and apexogenesis). The cases of failure (3.3%) were due to the loss of the temporary restoration. In conclusion, the stepwise excavation is a promising technique for permanent teeth with deep carious lesions and incomplete root formation as a minimally invasive approach because it allows the preservation of pulp vitality and occurrence of apexogenesis.

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Stepwise Excavation in a Permanent Molar: 17-year Follow-up

Operative Dentistry ◽

10.2341/09-353-s ◽

2010 ◽

Vol 35 (4) ◽

pp. 482-486 ◽

Cited By ~ 3

Author(s):

F. F. Lima ◽

R. C. Pascotto ◽

A. R. Benetti

Keyword(s):

Clinical Relevance ◽

Signs And Symptoms ◽

Permanent Molar ◽

Carious Lesions ◽

Deep Carious Lesions ◽

Stepwise Excavation ◽

Pulp Exposure

Clinical Relevance Due to the risk of pulp exposure in deep carious lesions, stepwise excavation can be a conservative and successful option for selected cases, when signs and symptoms of a normal pulp are present.

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Retrospective analysis of factors associated with the success of stepwise excavation procedure in deep carious lesions

The Journal of the American Dental Association ◽

10.1016/j.adaj.2018.01.004 ◽

2018 ◽

Vol 149 (6) ◽

pp. 442-450 ◽

Cited By ~ 2

Author(s):

Paula Ortega-Verdugo ◽

John J. Warren ◽

Justine L. Kolker ◽

Knute D. Carter ◽

Sandra Guzmán-Armstrong ◽

...

Keyword(s):

Retrospective Analysis ◽

Factors Associated ◽

Carious Lesions ◽

Deep Carious Lesions ◽

Stepwise Excavation

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Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care

BMC Oral Health ◽

10.1186/s12903-021-01637-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jan E. Clarkson ◽

Craig R. Ramsay ◽

David Ricketts ◽

Avijit Banerjee ◽

Chris Deery ◽

...

Keyword(s):

Dental Health ◽

Controlled Clinical Trial ◽

Trial Registry ◽

Posterior Teeth ◽

Carious Lesions ◽

Randomised Controlled Clinical Trial ◽

Deep Carious Lesions ◽

Caries Removal ◽

Randomised Controlled ◽

Selective Caries Removal

Abstract Background Dental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth. Method This is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes. Discussion SCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making. Trial Registration Trial registry: ISRCTN. Trial registration number: ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search.

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