ObjectivesTo compare the success, survival and costs of selective versus stepwise carious tissue removal (SE/SW) in permanent teeth with deep (>2/3 dentine depth) carious lesions.DesignRandomised controlled, unicentre, clustered two-arm superiority trial.SettingOutpatient clinic of a private university in Cairo, Egypt.ParticipantsOne hundred and fifteen participants (n=132 teeth), aged 18–47 years, from Cairo, Egypt, were enrolled. Premolars/molars with occlusal/occlusal-proximal deep lesions (radiographically >2/3 dentine), sensible pulps, without spontaneous pain, were included.InterventionsPeripheral carious tissue removal to hard dentine was performed. Pulpo-proximally, soft dentine was left. A glass ionomer (GI) restoration was placed. After 3–4 months, teeth were randomly allocated to SE (n=66), with reduction of the GI into a base and no further tissue removal, followed by a composite resin restoration, or SW (n=66), with full removal of the GI, additional excavation until firm dentine pulpo-proximally, followed by a GI-based composite restoration. Mean follow-up was 1 year.Primary and secondary outcome measuresPrimary outcome was success (absence of endodontic/restorative complications). Secondary outcomes were tooth survival and initial and total treatment costs.ResultsZero/five pulp exposures occurred during SE/SW, and seven/five SE/SW teeth required endodontic therapy. Success after 12 months was 89.4% for SE and 84.9% for SW. The estimated mean time free of complications was 23 and 18 months for SE and SW, respectively, without significant differences between SE and SW (p>0.05/Cox). Initial treatment costs were significantly higher for SW (mean (SD): 507.5 (123.4) Egyptian pounds (EGP)) than SE (mean (SD): 456.6 (98.3) EGP), while total costs showed no significant difference (p>0.05).ConclusionWithin the limitations of this interim analysis, and considering the depth of these lesions (>2/3 dentine), SE and SW showed similar risk of failure and overall costs after 1 year.Trial registration numberPACTR201603001396248.

Objective:The motivation of this study was to investigate the effect of grape seed extract on dentin remineralization.Methodology: Sound dentin disks were prepared from the buccal surfaces of human impacted third molars. The specimens were stored in demineralizing solution for 72 hours at room temperature to create artificial carious lesions. They were divided into four groups according to the treatment used; 15% GSE, 1000 ppm sodium fluoride, artificial saliva meanwhile teeth in the fourth group were kept without treatment as a negative control group. An in vitro pH cycling model for eight successive days was done. Subsequently micro-hardness of the specimens and their micromorphological appearance were evaluated using micro-indenter and Environmental scanning electron microscope (ESEM) respectively. Data were statically analyzed. Results:The results indicated that there was a significant increase in dentin micro-hardness values of GSE and NaF groups in comparison to the demineralized and artificial saliva groups. The ESEM micrographs confirmed the micro-hardness results.Conclusions: GSE is a promising natural remineralizing agent for treatment of the demineralized dentin.

Background: Bioactive glass (BAG) remineralization is a promising method for dental hard tissue regeneration. The aim of this study was to evaluate the microhardness of incipient enamel-like lesions with or without preconditioning by air abrasion using polyacrylic acid (PAA)-BAG before application of NovaMin remineralizing agent. Materials and Methods: Forty extracted human molars were selected, sectioned mesiodistally obtaining buccal and lingual halves, and embedded in resin molds. Specimens were randomly assigned to four groups ( n = 10) according to the remineralization protocol: G1 (control, artificial saliva), G2 (preconditioning), G3 (NovaMin), and G4 (preconditioning and NovaMin). Enamel windows 4 mm × 4 mm were done on the buccal and lingual surfaces. Specimens were immersed in a daily renewed demineralizing solution to create white spot lesions. Remineralizing agents were applied according to the manufacturer's instructions, and specimens were stored in a daily renewed artificial saliva. Microhardness was assessed using Vickers hardness number (VHN) at baseline (positive control), after demineralization (negative control), and after 24-h and 1-month remineralization. Results: The preconditioning/NovaMin group after 1 month showed a statistically significant high VHN, with no statistically significant difference between it and the positive control. This was followed by the NovaMin group after 1 month, while the lowest VHN was found in the demineralized group, with no statistically significant difference between it and the preconditioning group, whether after 24 h or 1 month. Conclusions: Enamel preconditioning with PAA-BAG air abrasion play a major role in enhancement of remineralization when it is accompanied with NovaMin. Furthermore, an extended period of time had helped to attain more benefits from NovaMin remineralization. Clinical Significance: Enamel remineralization with NovaMin after conditioning by bioactive glass air abrasion, provides the patients with a fast and durable treatment of incipient enamel lesions, which would reduce the possibility of future progression of demineralization and caries occurrence.