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of tooth treated, the
naire also asked for
employment status,
voted to endodontic
factors in endodontic
requent reason (55%
es and the majority
:ic injury was the only
1rried out retreatment
to persistent apical
1.
Apical I)
rndiolticency
"
(%)
0 0 3 (1)
0 0 6 (1)
0 61 (14)
112 (25)
104 (23)
9~ (22)
2 44 (10)
0 0 16 (4)
0 0 4 (1)
0 1 3 (1)
7 i21 5 (11 452
tient and the aetiology of
ission from International
Treatment of deep caries in adults • an endodontic preventive strategy {Study Ill)
Caries was still the major reason for performing root canal treatments in vital teeth
{Study II), and it seems relevant to investigate the treatment of deep caries as an
endodontic preventive strategy.
The treatment of deep caries lesions represents a dilemma between initiating pulp
invasive procedures or preventing endodontic treatment (Bj0rndal 2008). A deep
carious lesion h.as been defined as a carious lesion where there is a risk of exposing
the pulp during excavation (Fitzgerald & Heys 1991 ). Among general practitioners a
deep caries lesion usually means that 75% or more of the dentin thickness is
involved when examined using x-rays (Bj0rndal & Thylstrup 1998). Findings from
general practice in the USA indicate that radical treatment of deep carious lesions is
preferred (Oen et al. 2007). One final complete excavation is chosen as the first
choice of treatment, followed by endodontic treatment (Oen et al. 2007). Older
studies have shown that the removal of carious dentin using a single excavation in
the primary dentition leads to exposure in about half of the cases (Magnusson &
Sundell 1977). A stepwise excavation of young permanent teeth performed during
two visits seems to lead to fewer pulp exposures (Leksell et al. 1996) than direct
complete excavation. A less invasive stepwise excavation approach in adults has
shown that the caries progression is reduced as evidenced by a decrease of the
cultivable microbial flora, and clinically demonstrated by a darker, dryer and harder
surface of the retained carious dentin (Bj0rndal et al. 1997, Orhan et al. 2008). A
Cochrane review of caries excavation concluded that partial caries removal is
preferable to complete caries removal in terms of risk for pulp exposure (Ricketts et
al. 2006). However, none of the reviewed trials included well-defined deep lesions in
permanent teeth in adults. In three of the trials the material comprised primary teeth
(Magnusson & Sundell 1977, Ribeiro et al. 1999) or young permanent molars (Leksell
et al. 1996). They also comprised different or not well-defined lesion sizes, probably
because the actual aim in two of the trials was related to the quality of the
restorations (Mertz-Fairhurst et al. 1998, Ribeiro et al. 1999). With only four included
trials in the above mentioned Cochrane review, with a high risk of bias, there is a
need to carry out new randomized clinical trials (Ricketts et al. 2006, Kidd et al.
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