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ita from 1997 and 2003
tas 6.5% for the total pool
1tal service provided, and
25-year period could not
fil/ appears to be the main
;trategy
leep caries in adults has
·e trial the strength of the
usion criteria. The caries
s were found between all
he follow-up radiographs.
0.67). Moreover, the two
l sequence and allocation
J exposures between the
ssion rates of the caries
j that proper depths had
could be differences in
was 74.1% versus 62.4% in the direct complete excavation group (Table 2). The
biological rationale for this difference could be that the first phase of stepwise
excavation inactivates caries progression. The caries dentin becomes darker, harder
and drier (Massler 1978, Bj0rndal et al.1997, Maltz et al. 2002, Kidd et al. 2008,
Orhan et al. 2008), which makes it easier to remove without exposing the pulp at the
final excavation. It has also been reported that a more dramatic reduction in the
cultivable microflora is noted during stepwise excavation as compared with a direct
complete excavation procedure (Orhan et al. 2008), which may provide some
explanation for the significant difference found in the long-term outcome.
It was expected that the partial pulpotomy procedure in the pulp capping trial had
increased the potential of healing, as observed in young permanent teeth (Mejare &
Cvek 1993, Qudeimat et al. 2007). However, the relatively small number of pulp
exposures makes the confidence intervals wide and definite conclusions concerning
choice of capping procedure could not be drawn from the pulp capping trial (Study
Ill). In this trial the treatment of the cariously exposed adult pulp seemed to be a
greater problem than expected. Irrespective of the capping method the majority of
capped teeth failed (due to pain) before the follow-up examination. At follow-up
32.8% of the capped teeth were successful (pulp vitality without apical radiolucency),
confirming recent findings by Al-Hiyasat et al. (2006), where direct capping with
calcium hydroxide of caries exposures was classified as successful in 33% after a 3-
year period. It has been argued that pulp capping with Mineral Trioxide Aggregate
(MTA) may significantly increase the healing rate, however, in a retrospective
analysis of carious pulp exposures in adults treated with MTA, the pulp survival
proportion was only 56.2% after 2 years (Miles et al. 2010).
vation approach versus a
exposures significantly. At
fference between the two
pulps with sustained pulp
3tion group the proportion
When assessing both trials together (Study Ill) using the primary outcome measure
of sustained pulp vitality without apical radiolucency, no significant difference in
success rate could be found between the stepwise excavation group versus the
direct complete excavation group as a whole (Table 3).
However, investigation of excavation approaches avoiding pulp exposure merits
further study, when the markedly different outcome between teeth with unexposed
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