Use of bulk fill resin composite and universal adhesive for restoring primary teeth after selective carious tissue removal to soft dentin: A randomized clinical trial.

PURPOSE: To investigate the survival of adhesive restorations after selective carious tissue removal to soft dentin in primary molars. METHODS: This two-arm randomized clinical trial included 62 subjects (5.9 years ± 1.7) and 144 primary molars presenting deep active dentin carious lesions. The sample was randomly assigned based on restorative material: universal adhesive (Scotchbond Universal) plus bulk fill resin composite (Filtek Bulk Fill Posterior Restorative) and resin-modified glass-ionomer cement (Vitremer). Two operators performed all restorative procedures. Restorations were evaluated at 6, 12, and 18 months using the FDI World Dental Federation criteria. Survival estimates for restorations' longevity were evaluated with Kaplan-Meier method. Multivariate Cox regression analysis with shared frailty was used to assess the factors associated with failures (P< 0.05). RESULTS: Restorative material did not influence the restorations' survival (HR 1.56 95% CI 0.78-3.13; P= 0.12). The survival rates at 18 months of follow-up were 62.9% and 76.8% (AFR: 26.6% and 16.1%) for resin-modified glass-ionomer cement and bulk fill resin composite restorations, respectively (long-rank P= 0.14). Boys had higher risk of failure in their restorations (HR: 2.64, 95% CI: 1.29-5.40). Restorations performed by a less experienced operator had 3.26 times more risk of failure (P= 0.001). CLINICAL SIGNIFICANCE: The effectiveness of resin-modified glass-ionomer cement (Vitremer) and bulk fill resin composite (Filtek Bulk Fill Posterior Restorative) restorations after selective removal of carious tissue to soft dentin in primary molars was similar at 18 months of follow-up.

Survival and Associated Risk Factors of Selective Caries Removal Treatments in Primary Teeth: A Retrospective Study in a High Caries Risk Population.

OBJECTIVE: The aim of this retrospective study was to analyze the survival probability of selective caries removal (SCR) treatments in the primary teeth of children with high caries experience and factors potentially associated with treatment failure. METHODS: The sample included SCR treatments conducted in anterior and posterior teeth without sedation or general anesthesia among children attending a university dental service. Kaplan-Meier survival analysis was used to estimate the longevity of restorations and multivariate Cox regression with shared frailty was used to assess risk factors. RESULTS: A total of 284 SCR treatments in 88 children (aged 5.2 ± 1.91 years) with high caries experience (mean dmft/DMFT = 11.1 ± 5.04) were analyzed. The 3-year survival reached 48.8%, with an annual failure rate of 21.2%. Restorative failures (n = 60) were found more frequently compared to pulp complications (n = 12). SCR performed in anterior primary teeth were more prone to failure (hazard ratio = 3.6, 95% CI: 1.94; 6.71). Patients with a higher amount of visible plaque experienced more failures in SCR treatments (hazard ratio 3.0, 95% CI:1.27; 7.07). CONCLUSIONS: In this retrospective study, SCR showed restricted survival when compared to other prospective clinical trials. Patient-related factors, especially the young age and high caries experience of the children, may represent a challenge for restoration survival. Regardless of the caries removal technique or restorative material, cariogenic biofilm has a negative effect on the survival of restorations, probably by acting directly on material deterioration and, particularly, on the development of new caries lesions of rapid progression.

Outcomes of one-step incomplete and complete excavation in primary teeth: a 24-month randomized controlled trial.

AIM: To compare 24-month pulp health outcomes of partial caries removal (PCR) and total caries removal (TCR) with composite restoration in primary molars. METHODS: 48 children aged 3-8 years with at least one molar with a deep carious lesion were included. 120 teeth were randomized to control (TCR; n = 54; 69% class II) and test (PCR; n = 66; 63% class II) groups. Total absence of carious tissue was confirmed using a blunt-tipped probe in the TCR group. For PCR, excavation was stopped when hardened, dried dentin with a leathery consistency was achieved. Pulpotomy was performed in cases of pulp exposure. RESULTS: Pulp exposure occurred in 2 and 27.5% of teeth treated with PCR and TCR, respectively (p < 0.01). The operative time was significantly higher for TCR than PCR. Success rates were 92 and 96% in the PCR and TCR groups, respectively (p = 0.34). The success rate tended to be lower in occlusoproximal (92%) than in occlusal (100%) lesions (p = 0.08). CONCLUSION: The clinical and radiographic success rates of PCR and TCR in primary teeth with deep carious lesions were high and did not differ significantly, indicating that PCR is a reliable minimally invasive approach in primary teeth and that the retention of carious dentin does not interfere with pulp vitality. Moreover, PCR provided other clinically relevant advantages over TCR, especially lower incidence of pulp exposure and lower operative time.

Indirect pulp capping in the primary dentition: a 4 year follow-up study.

PURPOSE: Evaluate clinical and radiographic changes in primary teeth submitted to indirect pulp capping (IPC) over a 48-month-period. METHODS: Twenty seven primary molars with deep caries, but without preoperative signs of irreversible pulpits, were treated with IPC. The teeth were randomly divided into two groups, according to the material used for protection of the dentin-pulp complex. (1) a calcium hydroxide liner (Dycal) and (2) glass ionomer cement (Vitremer). RESULTS: After 48 months, Group-1 showed a success rate of 88.8% and Group-2 of 93%. No statistical significant difference between the groups was observed (P = 0.62). CLINICAL SIGNIFICANCE: The results of this study suggested that indirect pulp capping in primary teeth arrests the progression of the underlying caries, regardless of the material used as a liner.

Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex.

PURPOSE: The purpose of this prospective and randomized in vivo study was to compare the clinical and radiographic outcomes of an adhesive resin system vs a calcium hydroxide liner for protection of the dentin-pulp complex of primary molars treated with indirect pulp treatment. METHODS: Forty-eight primary molars with deep occlusal caries, but without preoperative signs and symptoms of irreversible pulpitis, received indirect pulp treatment and were restored with a composite resin (Z100). The teeth were randomly divided into 2 groups according to the material used for protection of the dentin-pulp complex: (1) adhesive resin system (Scotchbond MultiPurpose); and (2) calcium hydroxide liner (Dycal). These teeth were evaluated clinically and radiographicaly for 2 years. RESULTS: After 2 years, 83% (19/23) of the teeth treated with calcium hydroxide and 96% (24/25) of teeth treated with only the adhesive resin system presented a successful outcome, as determined by clinical and radiographic examination. Interradicular and/or periapical lesions were the most predominant signs of treatment failure, since 3 out of 23 teeth treated with calcium hydroxide and 1 out of 25 teeth treated with only adhesive resin presented this outcome. One tooth treated with the calcium hydroxide liner was diagnosed with internal root resorption at the 18-month examination. Of the 5 teeth diagnosed from radiographs as a failure of the indirect pulp treatment, none presented clinical signs/symptoms of pulpitis or necrosis such as the presence of fistula, enhanced tooth mobility, or pain. CONCLUSIONS: This study demonstrates that protection of the dentin-pulp complex of primary molars with an adhesive resin system results in similar clinical and radiographic 2-year outcomes as compared to calcium hydroxide when indirect pulp treatment is performed in Class I composite restorations.

Analysis of primary tooth dentin after indirect pulp capping.

PURPOSE: The purpose of this study was to evaluate the characteristics of primary molar dentin after indirect pulp capping (ICP) by of color, consistency and microhardness analyses. METHODS: The study design consisted of 3 groups: a test group of 13 primary molars that had been submitted to ICP with either calcium hydroxide or resin-modified glass ionomer cement; a positive control group of 15 sound molars; and a negative control group of 15 molars with deep acute carious lesions. The test group teeth had their restorations and pulp-capping materials removed and their cavity depth measured (mean depth=3-4 mm). In the positive control group, 3- to 4-mm-deep cavities were prepared. In the negative control group, the infected dentin was removed following the same parameters used for dentin excavation in a previous study by the authors. In all groups, the remaining dentin was analyzed according to descriptive standards (consistency and color). Microhardness was performed by a calibrated examiner blinded to the groups. Data were analyzed statistically by 1-way analysis of variance and Tukey's test (P <.01). RESULTS: The dentin of all teeth in the test group became hard. Nine teeth had yellow-clear dentin, and 4 teeth had dark-brown dentin. Microhardness means (+/-SD) were: test group=40.81 (+/-16.28) KHN (Knoop hardness number); positive control group=62.73 (+/-11.24) KHN; and negative control group=19.15 (+/-6.99) KHN. Microhardness assessment showed no statistically significant differences (P <.01) among the groups. CONCLUSION: This study's results suggest a mineral gain by the affected dentin after IPC, regardless of the protective base material.