Clinical outcomes of selective removal to soft dentin versus firm dentin for deep caries lesions: a randomized controlled trial up to 5 years

Objectives: This study aimed to compare the success of selective removal to soft dentine (SRSD) with or without calcium silicate (CS) and selective removal to firm dentine (SRFD) in permanent dentition. Materials and methods: Between November 2018 and March 2020, 165 posterior deep caries lesions in 134 patients were included in the study and randomly assigned into test (n = 101) and control (n = 64) groups. The control group (n = 46) received the treatment of SRFD with CS, while the test group was further randomized into two groups to receive SRSD with CS (n = 45) and SRSD without CS (n = 45). An additional group (PE) consisted of teeth with exposed pulps during caries removal (n = 29). The primary outcome of the study was to assess the vitality of the teeth based on clinical and radiographic examination after five years. The secondary outcome of the study was to evaluate the influence of baseline variables and CS application on treatment outcome. The success rates of different treatment strategies were compared (Pearson chi-squared and Log-rank tests). The impact of baseline variables and treatment strategies on failure and dentin bridge formation was analyzed using binary logistic regression model. Results: The success rate for SRSD with or without CS (94.1–100%) was significantly higher compared to SRFD (75.8%) and PE (81.8%) after five years (P = 0.012). Failure was less likely for premolars. Cavity type and depth had an influence on dentin bridge formation. Conclusion: A five-year follow-up in this study demonstrated better clinical outcome for SRSD with or without CS compared to SRFD technique, irrespective of age, pre-op sensitivity, cavity type, radiographic depth and activity of the caries. Application of CS after SRSD in deeper cavities provided better healing in terms of dentin bridge formation. Clinical relevance: SRSD might be more advantageous over SRFD for the management of deep caries lesions.