Restorations after selective caries removal: 5-Year randomized trial.

OBJECTIVE: To compare the survival of restorations placed in deep caries lesions after selective caries removal to soft dentin (SCRSD) over a 5-year period. A secondary aim was to investigate whether the material (amalgam or resin composite) affected the survival of restorations. METHODS: This study used data derived from a multicenter randomized controlled clinical trial (Clinical trials registration NCT00887952). Inclusion criteria were: patients with permanent molars presenting occlusal or proximal deep caries lesions (≥1/2 of the dentin thickness on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions. The teeth were randomized into SCRSD and restoration in a single visit or stepwise excavation (SW). Each of these groups was divided according to the filling material: amalgam (AM) or resin composite (RC). Survival analyses were performed to estimate therapy success rates over 5 years (adjusted Weibull regression model). RESULTS: 172 restorations were evaluated, 95 from SCRSD group and 77 from SW group, being 61 AMG and 111 RC. The 5-year survival analysis showed similar success rates for SW (76 %) and SCRSD (79 %) as well as for AM and RC (p > 0.05). CONCLUSION: This study showed that, after a 5-year follow-up period, the presence of decayed tissue beneath restorations in deep caries lesions did not seem to affect restoration survival. Amalgam and resin composite restorations had similar survival rates, irrespective of the caries removal technique used - SCRSD or SW. CLINICAL SIGNIFICANCE: Selective caries removal to soft dentin can be used in the management of deep caries to avoid pulp exposure and preserve tooth structure without affecting restoration longevity.

In vitro study of laser diode 655 nm diagnosis of occlusal caries.

The aim of this in vitro study was to evaluate the performance of a new laser method (DIAGNOdent, KaVo) by comparing it to the visual inspection, conventional bitewing radiography and digital bitewing radiography. Fifty fresh permanent teeth with clinically sound or suspicious fissures were selected. The teeth were submitted to the diagnostic tests by 2 examiners independently after calibration. The laser examination was repeated to assess the reproducibility. The teeth were sectioned right in the spot that showed the highest value by the laser device. Histological examination of sections (40x magnification) served as gold standard. The results showed that: 1) the intra and interobserver agreement for the DIAGNOdent was excellent (values over 0.87); 2) the sensitivity, specificity and predictive values were very high; 3) and the Spearman correlation coefficient of DIAGNOdent was the best one (R = 0.81), followed by visual inspection (R = 0.68).