The Journal of Contemporary Dental Practice

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 25 , ISSUE 8 ( August, 2024 ) > List of Articles

ORIGINAL RESEARCH

Management of Deep Caries Lesions: A Study among Dentists in the Private Sector of Casablanca, Morocco

Kaoutar Laslami, Soukaina El Kharroubi, Mohamed Moudrif, Ameni Marzougui, Sofia Drouri, Sihame Chemlali, Imane Benkiran

Keywords : Deep carious lesion, Partial caries removal, Pulp capping, Pulp conservation

Citation Information : Laslami K, El Kharroubi S, Moudrif M, Marzougui A, Drouri S, Chemlali S, Benkiran I. Management of Deep Caries Lesions: A Study among Dentists in the Private Sector of Casablanca, Morocco. J Contemp Dent Pract 2024; 25 (8):751-757.

DOI: 10.5005/jp-journals-10024-3716

License: CC BY-NC 4.0

Published Online: 26-11-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim and background: To find out which management methods are preferred by dentists in the private sector of Casablanca for a deep carious lesion or a pulp exposure during carious tissue removal in adult patients. Materials and methods: A questionnaire consisting of 25 questions was sent to 300 randomly sampled dentists in Casablanca. Only specialists in conservative dentistry and endodontics and general practitioners were included. There were three clinical scenarios allowing to approach the therapy recommended by each practitioner according to the proposed pulp diagnosis, these three different scenarios were based on preoperative symptomatology: Healthy pulp, reversible pulpitis, and irreversible pulpitis. Data entry and analysis were carried out using Epi7 and the results were statistically analyzed. Results: The survey was answered by 214 dentists,145 women and 69 men. Approximately 74.3% of the respondents always establish a pulp diagnosis before carious tissue removal. Approximately 56.54% use partial carious tissue removal techniques. During pulp exposure, 79.25% of the practitioners opted, respectively, for a direct pulp capping (DPC) in the case of healthy pulp and 46.7% in the case of reversible pulpitis, while no practitioner chose DPC in the case of irreversible pulpitis. In addition, 3.31, 27.83, and 4.23% opted for pulpotomy in cases of healthy pulp, reversible and irreversible pulpitis, respectively. Glass ionomer cement (GIC) and calcium hydroxide (CH) are the materials of choice for dentists in cases of partial caries removal. In the case of DPC, dentists use CH and Biodentine™ in particular. Conclusions: Partial carious tissue removal techniques are not adopted by the majority of dentists. When faced with irreversible pulpitis, most dentists (93.33%) go directly to endodontic treatment in the case of deep carious lesion without pulp exposure. While 204 dentists (95.33%) preferred root canal treatment (RCT) too in the case of deep carious lesion with pulp exposure. The use of bioactive materials should be encouraged in the management of deep caries lesions and pulp exposure, Biodentine™ and MTA were chosen by 96 of the practitioners. Clinical significance: Traditionally, the treatment of deep caries has been destructive, with removal of all carious dentin; however, the promotion of biologically based minimally invasive treatment strategies has been recommended to selectively (partially) remove caries and reduce the risk of pulp exposure.


PDF Share
  1. Patro S, Meto A, Mohanty A, et al. Diagnostic accuracy of pulp vitality tests and pulp sensibility tests for assessing pulpal health in permanent teeth: A systematic review and meta-analysis. Int J Environ Res Public Health 2022;19(15):9599. DOI: 10.3390/ijerph19159599.
  2. Dima C, Jean-Jacques L, Tchilala B, et al. Gérer l'exposition pulpaire sur une dent permanente. Publié le 06.12.2013. Paru dans Réalités Cliniques 2013;4(15):265–276.
  3. European Society of Endodontology (ESE) developed by: Duncan HF, Galler KM, Tomson PL, et al. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. Int Endod J 2019;52(7):923–934. DOI: 10.1111/iej.13080.
  4. Crespo-Gallardo I, Martin-Gonzalez J, Jimenez-Sanchez Mc, et al. Dentist's knowledge, attitudes and determining factors of the conservative approach in teeth with reversible pulpitis and deep caries lesions. J Clin Exper Dent 2018;10(12):e1205–e1215. DOI: 10.4317/jced.55395.
  5. Wolters WJ, Duncan HF, Tomson PL, et al. Minimally invasive endodontics: A new diagnostic system for assessing pulpitis and subsequent treatment needs. Int Endod J 2017;50(9):825–829. DOI: 10.1111/iej.12793.
  6. Koopaeei MM, Inglehart MR, McDonald N, et al. General dentists’, pediatric dentists’, and endodontists’ diagnostic assessment and treatment strategies for deep carious lesions. J Am Dental Assoc 2017;148(2):64–74. DOI: 10.1016/j.adaj.2016.11.001.
  7. Tan A, Bennett G, Tan J, et al. Diagnostic procedures employed by dental practitioners in Australia with a focus on endodontic diagnostic procedures. Aust Dent J 2017;62(3):337–344. DOI: 10.1111/adj.12511.
  8. Crespo-Gallardo I, Hay-Levytska O, Martin-Gonzalez J, et al. Criteria and treatment decisions in the management of deep caries lesions: Is there endodontic overtreatment? J Clin Exp Dent 2018;10(8): e751–e760. DOI: 10.4317/jced.55050.
  9. Victor DJ, Subramanian S, Gnana PPS, et al. Assessment of matrix metalloproteinases-8 and -9 in gingival crevicular fluid of smokers and non-smokers with chronic periodontitis using ELISA. J Int Oral Health 2014;6(6):67–71. PMID: 25628487.
  10. Zanini M, Meyer E, Simon S. Pulp inflammation diagnosis from clinical to inflammatory mediators: A systematic review. J Endodon 2017;43(7):1033–1051. DOI: 10.1016/j.joen.2017.02.009.
  11. Maltz M, Koppe B, Jardim JJ, et al. Partial caries removal in deep caries lesions: A 5-year multicenter randomized controlled trial. Clin Oral Invest 2018;22(3):1337–1343. DOI: 10.1007/s00784-017-2221-0.
  12. Ortega-Verdugo P, Warren JJ, Kolker JL, et al. Retrospective analysis of factors associated with the success of stepwise excavation procedure in deep carious lesions. J Am Dental Assoc 2018;149(6):442–450. DOI: 10.1016/j.adaj.2018.01.004.
  13. Jardim JJ, Mestrinho HD, Koppe B, et al. Restorations after selective caries removal: 5-Year randomized trial. J Dent 2020;99:103416. DOI: 10.1016/j.jdent.2020.103416.
  14. Labib ME, Hassanein OE, Moussa M, et al. Selective versus stepwise removal of deep carious lesions in permanent teeth: A randomised controlled trial from Egypt—an interim analysis. BMJ Open 2019;9(9):e030957. DOI: 10.1136/bmjopen-2019-030957.
  15. Chai B, Tay B, Chow C, et al. Treatment preferences for deep caries lesions among Australian dentists. Aust Dent J 2020;65(1):83–89. DOI: 10.1111/adj.12740.
  16. Gözetici-Çil B, Erdem-Hepşenoğlu Y, Tekin A, et al. Selective removal to soft dentine or selective removal to firm dentine for deep caries lesions ın permanent posterior teeth: A randomized controlled clinical trial up to 2 years. Clin Oral Invest 2022;27(5):2125–2137. DOI: 10.1007/s00784-022-04815-0.
  17. Ogawa K, Yamashita Y, Ichijo T, et al. The ultrastructure and hardness of the transparent of human carious dentin. J Dent Res 1983;62(1): 7–10. DOI: 10.1177/00220345830620011701.
  18. Chibinski ACR, Reis A, Kreich EM, et al. Evaluation of primary carious dentin after cavity sealing in deep lesions: A 10- to 13-month follow-up. Pediatr Dent 2013;35(3):E107–E112. PMID: 23756304.
  19. Katge FA, Patil DP. Comparative analysis of 2 calcium silicate–based cements (biodentine and mineral trioxide aggregate) as direct pulp-capping agent in young permanent molars: A split mouth study. J Endodon 2017;43(4):507–513. DOI: 10.1016/j.joen.2016.11.026.
  20. Daniele L. Mineral trioxide aggregate (MTA) direct pulp capping: 10 years clinical results. Giornale Italiano di Endodonzia 2017;31(1):48–57. DOI: 10.1016/j.gien.2017.04.003.
  21. Suhag K, Duhan J, Tewari S, et al. Success of direct pulp capping using mineral trioxide aggregate and calcium hydroxide in mature permanent molars with pulps exposed during carious tissue removal: 1-year follow-up. J Endodon 2019;45(7):840–847. DOI: 10.1016/j.joen.2019.02.025.
  22. Cushley S, Duncan HF, Lappin MJ, et al. Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: A systematic review and meta-analysis. Int Endod J 2021;54(4):556–571. DOI: 10.1111/iej.13449.
  23. Lin LM, Ricucci D, Saoud TM, et al. Vital pulp therapy of mature permanent teeth with irreversible pulpitis from the perspective of pulp biology. Aust Endod J 2020;46(1):154–166. DOI: 10.1111/aej.12392.
  24. Taha NA, Abdelkhader SZ. Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis. Int Endod J 2018;51(8):819–828. DOI: 10.1111/iej.12903.
  25. Tan SY, Yu VSH, Lim KC, et al. Long-term pulpal and restorative outcomes of pulpotomy in mature permanent teeth. J Endodont 2020;46(3):383–390. DOI: 10.1016/j.joen.2019.11.009.
  26. Albaiti SS, Albishri RF, Alhowig MT, et al. Partial pulpotomy as an applicable treatment option for cariously exposed posterior permanent teeth: A systematic review of randomized clinical trials. Cureus 2022;14(7):e26573. DOI: 10.7759/cureus.26573.
  27. Li Y, Sui B, Dahl C, et al. Pulpotomy for carious pulp exposures in permanent teeth: A systematic review and meta-analysis. J Dent 2019;84:1–8. DOI: 10.1016/j.jdent.2019.03.010.
  28. Baranwal HC, Mittal N, Yadav J, et al. Outcome of partial pulpotomy verses full pulpotomy using biodentine in vital mature permanent molar with clinical symptoms indicative of irreversible pulpitis: A randomized clinical trial. J Conserv Dent 2022;25(3):317–323. DOI: 10.4103/jcd.jcd_118_22.
  29. Galani M, Tewari S, Sangwan P, et al. Comparative evaluation of postoperative pain and success rate after pulpotomy and root canal treatment in cariously exposed mature permanent molars: A randomized controlled trial. J Endodon 2017;43(12):1953–1962. DOI: 10.1016/j.joen.2017.08.007.
  30. Singh S, Mittal S, Tewari S. Effect of different liners on pulpal outcome after partial caries removal: A preliminary 12 months randomised controlled trial. Caries Res 2019;53(5):547–554. DOI: 10.1159/000499131.
  31. Ricucci D, Rôças IN, Alves FRF, et al. Outcome of direct pulp capping using calcium hydroxide: A long-term retrospective study. J Endodon 2023;49(1):45–54. DOI: 10.1016/j.joen.2022.11.005.
  32. Uesrichai N, Nirunsittirat A, Chuveera P, et al. Partial pulpotomy with two bioactive cements in permanent teeth of 6- to 18-year-old patients with signs and symptoms indicative of irreversible pulpitis: A noninferiority randomized controlled trial. Int Endod J 2019;52(6):749–759. DOI: 10.1111/iej.13071.
  33. Bricker SL, Decker BC, Langlais RP, et al. Oral Diagnosis, Oral Medicine and Treatment Planning. Hamilton: B.C. Decker 2002.
  34. Weine FS. Endodontic Therapy. St. Louis, Mo.: Mosby 2004; p. 630.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.