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.
Background: The diagnosis of dentin hypersensitivity is done by exclusion. Yet no universally accepted gold-standard treatment, which reliably relieves the pain of dental hypersensitivity in the long term and satisfy both the dentist and the patient, was found. Objective: to compare the effect of photo polymerized versus chemical cured glass ionomer based desensitizing agents in respect to: a) Their ability to occlude the dentinal tubules. b)Their depth of penetration inside the dentinal tubules. Materials and Methods: A total of 20 permenant molars were selected, promximal enamel was removed, EDTA gel (17%) was applied for three min. The prepared fourty surfaces were divided into two groups. Half of both surfaces received different desensitizing agent while the other half was left untreated as a control. Each group was divided into four subgroups, the first subgroup faced abrasion challenge, the second faced thermocycling, third faced both abrasion and thermocycling and the last was left as a control group. An ESEM at 2000 magnification was used to observe the patent dentinal tubules, and a digital Analysis program was used to evaluate the patency. Results: showed that the percent of obliteration of dentinal tubules when the samples faced abrasion only was higher in CGI than RMGI, same result when the samples face termocycling only it was still higher in CGI than RMGI. Whereas there was no statistical significance when the samples received both abrasion and thermocycling. Conclusion: 1-The abrasion resistance and the ability of CGI to withstand thermocycling makes it better in occluding dentinal tubules rather than RMGI. 2-Although the resinous component of RMGI allows better penetration inside the tubules, yet the lower abrasion resistance and poor resistance to thermocycling made the material inferior in maintaining an efficient dentinal tubules seal.
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