Ali AH, et al. - Authors conducted a single-blind randomized controlled clinical trial in patients with deep caries and symptoms of reversible pulpitis to compare the outcomes from a self-limiting excavation protocol using chemomechanical Carisolv gel/operating microscope (self-limiting) vs selective removal to leathery dentin using rotary burs (control). They followed this by pulp protection with mineral trioxide aggregate (MTA) and restoration with glass ionomer cement and resin composite, all in a single visit. As per data, the pulp survival rate was increased by the self-limiting caries excavation protocol under magnification vs rotary bur excavation.

Methods

• Experts evaluated the pulp sensibility and periapical health of teeth after 12 mo, in addition to the differences in bacterial tissue concentration postexcavation.
• They assessed the apical radiolucencies using cone beam computed tomography/periapical radiographs (CBCT/PAs) taken at baseline 0 mo (M0) and 12 mo (M12).

Results

• Findings suggested that in total, 101 restorations in 86 patients were placed and paired subsurface, and deep (postexcavation) dentin samples were obtained.
• As per the results, DNA was extracted and bacteria-specific 16S ribosomal RNA gene quantitative polymerase chain reaction was performed.
• Researchers did not note any significant difference in bacterial copy numbers normalized to mass of dentin (“bacterial tissue concentration”) between the self-limiting (96.3% reduction) and control protocols (97.1%,P=0.33).
• They noted the probability of 12-mo success to be 4 times (odds ratio [OR] = 4.33; confidence interval [CI], 1.2–15.6;P=0.025) higher in the self-limiting protocol vs the control (conventional excavation technique), with pulp survival rates of 73.3% and 90%, respectively (P=0.049).
• Data demonstrated that 4 times higher probability of success was seen in molars compared to premolars (OR, 4.17; CI, 1.17–14.9;P=0.028), and symptom severity did not statistically predict outcome (OR, 0.41; CI, 0.12-13.9,P=0.153).
• Significantly more periapical (PA) lesions were detected by CBCT than PA radiographs at the baseline visit (P < 0.001) .