Selective removal to soft dentine versus full pulpotomy for management of proximal deep carious lesions - A randomized controlled non-inferiority trial

The management of the deep carious lesion with reversible pulpitis is a dilemma for the dentist. The current study compared selective removal of soft dentine (SRSD) to full pulpotomy for treating proximal deep carious lesions in teeth with reversible pulpitis. Visual-tactile examination and bitewing radiographs were used to determine the depth of carious lesion and American Association of Endodontist recommendations were used to formulate pulp diagnosis. Sixty mandibular molar teeth from healthy patients between the ages of 16-35 years and a diagnosis of proximal deep carious lesion with reversible pulpitis were included. Teeth were randomly allocated to two study groups. SRSD group (n = 30): soft dentine was preserved over the pulpal aspect. A hard setting calcium hydroxide cement liner and resin-modified glass ionomer cement base was applied over the remaining soft carious dentine. Full pulpotomy (FP) group (n = 30): complete caries removal followed by mineral trioxide aggregate (MTA) full pulpotomy was performed. The teeth in both groups were restored with composite resin restoration. The established criteria for outcome assessment of SRSD and pulpotomy were used. Accordingly, only asymptomatic teeth with no radiological evidence of periapical rarefaction were considered successful at the 12-month follow-up. Two-sample t-test, Pearson chi-square test/Fisher exact test and percentage agreement were used for statistical evaluation. According to the per-protocol analysis, the success rate of both SRSD and full pulpotomy treatment was 95.45% and 95.65% respectively and the actual difference between the two treatments was 1% (95% CI (-10, 9)). The data suggests that both treatments (SRSD and FP) appear to have a good success rate (>95%) when used to manage permanent mandibular molar teeth with proximal deep carious lesion and reversible pulpitis. As SRSD is a non-invasive procedure, it should be favoured over FP in these instances.