Tratamento de lesões profundas de cárie : um ensaio clínico randomizado comparando tratamento expectante com remoção parcial da dentina

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

2011

RESUMO

This randomized multicenter clinical trial evaluated the effectiveness of an alternative treatment on deep caries lesion¿s compared to stepwise excavation (SW) after three years follow up. Treatment consisted on partial caries removal (PDR) followed by tooth¿s restoration in one session. Methods: Inclusion criteria were: patients with permanent molars presenting deep carious lesions (lesion reaching inner half dentin on the radiographic examination); positive response to cold test; absence of spontaneous pain; negative sensitivity to percussion and absence of periapical lesion detected on radiographic exam. Teeth randomly assigned to PDR (test) received incomplete caries removal and filling in one session (resin or amalgam). Teeth assigned to SW (control) received indirect pulp capping with calcium hydroxide cement, temporary filling with a modified zinc oxide-eugenol cement. After 60 days the cavity was reopened, the remaining decayed dentine was removed and teeth were filled with composite resin or amalgam. Outcome evaluated was pulp vitality, determine by sensitivity to cold test and the absence of periapical alterations on radiographic exam. Data were submitted to Kaplan Meier, log rank test and Cox regression analysis. Results: At baseline, 299 treatments were executed, 152 PDR and 147 SW. At three years follow up, 209 teeth had been evaluated. A success rate of 94% for PDR and 78% for SW was demonstrated (p<0.000). Failure reasons were: pulpitis (4), pulp necrosis (1) for PDR group, and pulpitis (11), necrosis (5), pulp exposure followed by endodontic treatment (2), osteitis (1), tooth extraction (1) and tooth fracture (1) for SW. Variables associated with treatment success were type of treatment (PDR) and number of surfaces involved in the restoration ¿ one surface more favorable than 2 or more surfaces. Results suggest that there is no need to reopen cavity and perform a second excavation to preserve pulp vitality.

ASSUNTO(S)

dental caries clinical trial dentes : permanentes permanent teeth stepwise excavation treatment survival analysis cárie dentária : tratamento

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