Selective caries removal and indirect pulp capping: clinical cases report
Clinical case reported
DOI:
https://doi.org/10.5335/rfo.v26i1.11815Keywords:
Dental caries. Dental Cavity Lining. Dental Restoration.Abstract
Objective: this article aims to discuss the treatment
of deep caries lesions in permanent molars through
the selective caries tissue removal technique and
composite resin restoration of two clinical cases,
using only an adhesive system (case 1) or an indirect pulp protection of calcium hydroxide cement (case 2). Cases report: the participants were
diagnosed with deep caries lesions, that is, more
than 50% in depth of the dentin involved, which
was confirmed by the interproximal radiography.
In both cases, it was obtained positive response to
cold test, negative response to horizontal and vertical percussion tests, absence of spontaneous pain
and no periapical lesion (periapical radiography),
which completed the requirements for performing
the selective caries removal of soft dentin. These
teeth received adhesive restorations in the same
session, under the softened carious dentin of the
pulp wall that had received calcium hydroxide cement or not, depending on randomization. Both
cases had clinical success in the 18-month follow-
-up, showing pulp vitality and restoration survival.
Final considerations: based on the clinical cases
reported, considering de limitations of this study
model, and in agreement with the literature, the
selective removal of carious tissue can be successfully performed in the treatment of deep carious lesions, respecting all the steps of the technique and
indirect pulp protection seems to be unnecessary.
Keywords: dental caries; dental cavity lining; dental restoration permanent
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References
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2. Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE. 2013.
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carious lesions in primary molars. J Int Assoc Dent Child
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Moura MS, et al. Randomized trial of partial vs. stepwise caries
removal: 3-year follow-up. J Dent Res 2012; 91(11):1026-31.
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Dental Research 2016; 28(2):58-67.
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J Endod 2018; 44(4):529-35.
15. Hashem D, Mannocci F, Patel S, Manoharan A, Watson TF,
Banerjee A. Evaluation of the efficacy of calcium silicate vs.
glass ionomer cement indirect pulp capping and restoration
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19. Falster CA, Araujo FB, Straffon LH, Jacques EN. Indirect
pulp treatment. In: Vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp
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Araujo FB. In: Vivo outcomes of Indirect Pulp Treatment
using a Self-etching Primer versus Calcium Hydroxide over
the Demineralized Dentin in Primary Molars. J Clin Pediatr
Dent 2008; 33(2):45-50.
21. Büyükgüral B, Cehreli ZC. Effect of different adhesive protocols vs calcium hydroxide on primary tooth pulp with different remaining dentin thicknesses: 24-month results. Clin
Oral Invest 2008; 12:91-6.
22. Casagrande L, Faster CA, Hipolito VDi, Goes MFDe, Straffon LH, Nor JE, et al. Effect of adhesive restorations over
incomplete dentine caries removal: 5-year follow-up study in
primary teeth. J Dent Child (Chic) 2009; 76 (2):117-22.
23. Casagrande L, Bento LW, Dalpian DM, García-Godoy F, de
Araujo FB. Indirect pulp treatment in primary teeth: 4-year
results. Am J Dent 2010; 23(1):34-8.
24. Lenzi TL, Pires CW, Soares FZM, Raggio DP, Ardenghi,
TM, Rocha RO. Performance of Universal Adhesive in Primary Molars After Selective Removal of Carious Tissue: An
18-Month Randomized Clinical Trial. Pediatric Dentistry
2017; 39(5):371-6.
25. Singh S, Mittal S, Tewari S. Effect of Different Liners on
Pulpal Outcome after Partial Caries Removal: A Preliminary
12 Months Randomised Controlled Trial. Caries Res 2019;
53:547-54.
26. Azambuja RS, Recchi AF, Maltz M, Jardim JJ. Indirect pulp
protection after selective caries removal: A preliminary 6
months randomised controlled trial. Revista da Faculdade
de Odontologia de Porto Alegre 2020; 61(1):75-84.
27. Maltz M, Leal FL, Wagner MB, Zenkner JEA, Brusius CD,
Alves LS. Can We Diagnose a Patient’s Caries Activity Based on Lesion Activity Assessment? Findings from a Cohort
Study. Caries Res 2020; 54(3):218-25.
28. Barthel CR, Rosenkranz B, Leuenberg A, Roulet JF. Pulp
capping of carious exposures: treatment outcome after 5 and
10 years: a retrospective study. J Endod 2000; 26(9):525-8.
29. Barros MMAF, De Queiroz Rodrigues MI, Muniz FWMG,
Rodrigues LKA. Selective, stepwise, or nonselective removal of carious tissue: which technique offers lower risk for
the treatment of dental caries in permanent teeth? A systematic review and meta-analysis. Clin Oral Investig 2020;
24(2):521-32.
30. Schwendicke F, Göstemeyer G, Gluud C. Cavity lining after
excavating caries lesions: Meta-analysis and trial sequential
analysis of randomized clinical trials. Jornal of Dentistry
2015; 43:1291-7.
31. Corralo DJ, Maltz M. Clinical and Ultrastructural Effects
of Different Liners/Restourative Material on Deep Carious
Dentin: A Randomized Clinical Trial. Caries Res 2013;
47:243-50.
32. Hanabusa M, Mine A, Kuboki T, Momoi Y, Van Ende A, Van
Meerbeek B, et al. Bonding effectiveness of a new ‘multimode’ adhesive to enamel and dentine. Journal of Dentistry
2012; 40:475-84.
33. Perdigão J, Sezinando A, Monteiro PC. Laboratory bonding
ability of a multi-purpose dentin adhesive. Amer j dent 2012;
25(3):153-8.
34. Jardim JJ, Mestrinho HD, Koppe B, de Paula LM, Alves LS,
Yamaguti PM, et al. Restorations after selective caries removal: 5-Year randomized trial. J Dent 2020; 99:103416.
35. Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley
D. CARE Group*. The CARE Guidelines: Consensus-based
Clinical Case Reporting Guideline Development. Glob Adv
Health Med 2013; 2(5):38-43.
2. Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE. 2013.
Operative caries management in adults and children. Cochrane Database Syst Rev. 28:CD003808.
3. Bjørndal L, Thylstrup A. A practice-based study on stepwise excavation of deep carious lesions in permanent teeth:
a 1-year follow-up study. Community Dent Oral Epidemiol
1998; 26:122-8.
4. Mertz-Fairhurst EJ, Curtis JW Jr, Ergle JW, Rueggeberg FA,
Adair SM. Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc 1998; 129(1):55-66.
5. Maltz M, Oliveira EF de, Fontanella V, Bianchi R. A Clinical,
microbiologic, and radiographic study of deep caries lesions
after incomplete caries removal. Quintessence Int 2002;
33:151-9.
6. Magnusson BO, Sundell SO. Stepwise excavation of deep
carious lesions in primary molars. J Int Assoc Dent Child
1977; 8:36.
7. Bjørndal L, Larsen T, Thylstrup A. A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res 1997;
31(6):411-7.
8. Bjørndal L, Reit C, Bruun G, Markvart M, Kjældgaard M,
Näsman P, et al. Treatment of deep caries lesions in adults:
randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci 2010; 118(3):290-7.
9. Bjørndal L, Franszon H, Bruuns G, Markavart M, Kjældgaard M, Näsman P, et al. Randomized Clinical Trials on
Deep Carious Lesions: 5-years Follow-up. J Dent Res 2017;
96(7):747-53.
10. Maltz M, Garcia R, Jardim JJ, de Paula LM, Yamaguti PM,
Moura MS, et al. Randomized trial of partial vs. stepwise caries
removal: 3-year follow-up. J Dent Res 2012; 91(11):1026-31.
11. Maltz M, Koppe B, Jardim JJ, Alves LS, de Paula LM, Yamaguti PM, et al. Partial caries removal in deep caries lesions:
a 5-year multicenter randomized controlled trial. Clin Oral
Invest 2018; 22:1337-43.
112 RFO UPF, Passo Fundo, v. 26, n. 1, p. 106-112, jan./abr. 2021
12. Innes NP, Frencken JE, Bjørndal L, Maltz M, Manton DJ,
Ricketts D, et al. Managing carious lesions: consensus recommendations on terminology. Adv Dent Res 2016; 28(2):49-57.
13. Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton
DJ, Ricketts D, et al. Managing Carious Lesions: Consensus
Recommendations on Carious Tissue Removal. Advances in
Dental Research 2016; 28(2):58-67.
14. Asgary S, Hassanizadeh R, Torabzadeh H, Eghbal MJ. Treatment Outcomes of 4 Vital Pulp Therapies in Mature Molars.
J Endod 2018; 44(4):529-35.
15. Hashem D, Mannocci F, Patel S, Manoharan A, Watson TF,
Banerjee A. Evaluation of the efficacy of calcium silicate vs.
glass ionomer cement indirect pulp capping and restoration
assessment criteria: a randomised controlled clinical trial-2-
year results. Clin Oral Investig 2019; 23(4):1931-9.
16. Bjorndal L. Indirect pulp therapy and stepwise excavation. J
Endod 2008; 34:29-33.
17. Bjørndal L, Ricucci D. Pulp inflammation: from the reversible inflammation to pulp necrosis during caries progression.
In: Goldberg M, editor. The dental pulp biology, pathology,
and regenerative therapies. Berlin (Germany): Springer;
2014. p. 125-39.
18. Ribeiro CC, Baratiere LN, Perdigão J, Baratiere NM, Ritter
AV. A Clinical, radiographic, and scanning electron microscopic evaluation of adhesive restorations on carious dentin in
primary teeth. Quintessence Int 1999; 30:591-9.
19. Falster CA, Araujo FB, Straffon LH, Jacques EN. Indirect
pulp treatment. In: Vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp
complex. Pediatr Dent 2002; 24:241-8.
20. Casagrande L, Bento LW, Rerin SO, Lucas ER., Dalpian DM,
Araujo FB. In: Vivo outcomes of Indirect Pulp Treatment
using a Self-etching Primer versus Calcium Hydroxide over
the Demineralized Dentin in Primary Molars. J Clin Pediatr
Dent 2008; 33(2):45-50.
21. Büyükgüral B, Cehreli ZC. Effect of different adhesive protocols vs calcium hydroxide on primary tooth pulp with different remaining dentin thicknesses: 24-month results. Clin
Oral Invest 2008; 12:91-6.
22. Casagrande L, Faster CA, Hipolito VDi, Goes MFDe, Straffon LH, Nor JE, et al. Effect of adhesive restorations over
incomplete dentine caries removal: 5-year follow-up study in
primary teeth. J Dent Child (Chic) 2009; 76 (2):117-22.
23. Casagrande L, Bento LW, Dalpian DM, García-Godoy F, de
Araujo FB. Indirect pulp treatment in primary teeth: 4-year
results. Am J Dent 2010; 23(1):34-8.
24. Lenzi TL, Pires CW, Soares FZM, Raggio DP, Ardenghi,
TM, Rocha RO. Performance of Universal Adhesive in Primary Molars After Selective Removal of Carious Tissue: An
18-Month Randomized Clinical Trial. Pediatric Dentistry
2017; 39(5):371-6.
25. Singh S, Mittal S, Tewari S. Effect of Different Liners on
Pulpal Outcome after Partial Caries Removal: A Preliminary
12 Months Randomised Controlled Trial. Caries Res 2019;
53:547-54.
26. Azambuja RS, Recchi AF, Maltz M, Jardim JJ. Indirect pulp
protection after selective caries removal: A preliminary 6
months randomised controlled trial. Revista da Faculdade
de Odontologia de Porto Alegre 2020; 61(1):75-84.
27. Maltz M, Leal FL, Wagner MB, Zenkner JEA, Brusius CD,
Alves LS. Can We Diagnose a Patient’s Caries Activity Based on Lesion Activity Assessment? Findings from a Cohort
Study. Caries Res 2020; 54(3):218-25.
28. Barthel CR, Rosenkranz B, Leuenberg A, Roulet JF. Pulp
capping of carious exposures: treatment outcome after 5 and
10 years: a retrospective study. J Endod 2000; 26(9):525-8.
29. Barros MMAF, De Queiroz Rodrigues MI, Muniz FWMG,
Rodrigues LKA. Selective, stepwise, or nonselective removal of carious tissue: which technique offers lower risk for
the treatment of dental caries in permanent teeth? A systematic review and meta-analysis. Clin Oral Investig 2020;
24(2):521-32.
30. Schwendicke F, Göstemeyer G, Gluud C. Cavity lining after
excavating caries lesions: Meta-analysis and trial sequential
analysis of randomized clinical trials. Jornal of Dentistry
2015; 43:1291-7.
31. Corralo DJ, Maltz M. Clinical and Ultrastructural Effects
of Different Liners/Restourative Material on Deep Carious
Dentin: A Randomized Clinical Trial. Caries Res 2013;
47:243-50.
32. Hanabusa M, Mine A, Kuboki T, Momoi Y, Van Ende A, Van
Meerbeek B, et al. Bonding effectiveness of a new ‘multimode’ adhesive to enamel and dentine. Journal of Dentistry
2012; 40:475-84.
33. Perdigão J, Sezinando A, Monteiro PC. Laboratory bonding
ability of a multi-purpose dentin adhesive. Amer j dent 2012;
25(3):153-8.
34. Jardim JJ, Mestrinho HD, Koppe B, de Paula LM, Alves LS,
Yamaguti PM, et al. Restorations after selective caries removal: 5-Year randomized trial. J Dent 2020; 99:103416.
35. Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley
D. CARE Group*. The CARE Guidelines: Consensus-based
Clinical Case Reporting Guideline Development. Glob Adv
Health Med 2013; 2(5):38-43.
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How to Cite
Selective caries removal and indirect pulp capping: clinical cases report: Clinical case reported. (2023). Revista Da Faculdade De Odontologia - UPF, 26(1), 106-112. https://doi.org/10.5335/rfo.v26i1.11815
