Title: 0573 - Selective Versus Stepwise Carious Tissue Removal: A Randomized Controlled Trial


Mohamed Labib (Presenter)
Misr International University

Olfat Hassanein, Cairo University
Makeen Moussa, Misr International University
Asmaa Yassen, Cairo University
Falk Schwendicke, Charite University


Objectives: For deep carious lesions in teeth with vital asymptomatic pulps, stepwise (SW) or selective carious tissue removal (SCR) is recommended. It is unclear if the additional efforts and costs of SW over SCR are justified. We aimed to compare the time free of endodontic or restorative complications, and to evaluate pain after SCR versus SW in permanent teeth.

Methods: 63 participants (n=70 teeth), aged 18-47 years, attending the outpatient clinic in Misr International University, Egypt,were enrolled. Premolars/molars with occlusal/occlusal-proximal deep carious lesions (radiographically extending into inner 1/3 dentin) and sensible pulps, without permanent pain, were included. Peripheral carious tissue removal to hard dentin was performed, while pulpo-proximally, soft dentin was left and sealed with glass ionomer restorations. After 3-4 months, teeth were randomly allocated to SCR (n=38), with removal of the restoration only, but no further tissue removal, followed by a composite resin restoration; or to SW (n=32), with additional removal until firm dentin remained pulpo-proximally. Our primary outcome was the time free of endodontic or restorative complications. The secondary outcome was pain, recorded using a Visual Analogue Scale (VAS, 0-10) at each visit. Multi-level multivariable Cox-regression-analyses and repeated-measures analysis-of-variance were performed.

Results: Zero and five pulp exposures occurred during SCR and SW, respectively. One SW and three SCR teeth required endodontic therapy during 12(5) months follow-up. The mean (95%CI) time free of complications was 21 (19-23) and 19 (18-21) months for SCR and SW, respectively. Treatment strategy, patients’ age or gender, dental arch or number of surfaces did not have a statistically significant impact (p>0.05/Cox). Pain decreased significantly in both groups compared with baseline (p<0.001/MANOVA), without significant differences between groups (p=0.610).

Conclusions: Within the limitations of this interim analysis, SCR and SW showed similar risk of failure, and were also similarly evaluated by patients.

Trial registration: Pactr.org. Identifier PACTR2016030011396248

Disclosure Statement:
The submitter must disclose the names of the organizations with which any author have a relationship, the nature of the relationship, and the clinical or research area involved. The following is submitted: NONE