A 12-month Follow-Up Study of Pulp Oxygen Saturation in Deciduous Molars After Selective and Nonselective Carious-Tissue Removal: A Randomized Pilot Trial

Pierre Adriano Moreno Neves; Soraia de Fátima Carvalho Souza; Luciano Casagrande; Fernando Borba de Araujo; Cayara Mattos Costa; Cecilia Claudia Costa Ribeiro

Authors

Pierre Adriano Moreno Neves
Soraia de Fátima Carvalho Souza
Luciano Casagrande
Fernando Borba de Araujo
Cayara Mattos Costa
Cecilia Claudia Costa Ribeiro

Keywords:

Dental Caries, Dental Cavity Preparation, Tooth, Deciduous, Oximetry, Dental Pulp Necrosis

Abstract

Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO₂). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO₂. Pulp exposure and pulp necrosis were primary outcomes, and %SaO₂ was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO₂ pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO₂ minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO₂ seems not to differ between teeth treated with SCR or NSCR.

References

Giacaman RA, Muñoz-Sandoval C, Neuhaus KW, Fontana M, Chatas R. Evidence-based strategies for the minimally invasive treatment of carious lesions: review of the literature. Adv Clin Exp Med 2018; 27(7):1009-16. https://doi.org/10.17219/acem/77022

Lula EC, Almeida LJ, Alves CM, Monteiro-Neto V, Ribeiro CC. Partial caries removal in primary teeth: association of clinical parameters with microbiological status. Caries Res 2011; 45(3):275-80. https://doi.org/10.1159/000325854

Ribeiro CCC, Baratieri LN, Perdigão J, Baratieri NMM, Ritter AV. A clinical, radiographic and scanning electron microscopic evaluation of adhesive restorations on carious dentin in primary teeth. Quint Int 1999; 30:591-9.

Lula EC, Monteiro-Neto V, Alves CM, Ribeiro CC. Microbiological analysis after complete or partial removal of carious dentin in primary teeth: A randomized clinical trial. Caries Res 2009; 43(5):354-8. https://doi.org/10.1159/000231572

Fusayama T, Okuse K, Hosoda H. Relationship between hardness, discoloration, and microbial invasion in carious dentin. J Dent Res 1966; 45(4):1033-46. https://doi.org/10.1177/00220345660450040401

Deyhle H, Bunk O, Müller B. Nanostructure of healthy and caries-affected human teeth. Nanomedicine 2011; 7(6):694-701. https://doi.org/10.1016/j.nano.2011.09.005

Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database Syst Rev 2013; (3):CD003808. https://doi.org/10.1002/14651858.CD003808.pub3

Li T, Zhai X, Song F, Zhu H. Selective versus non-selective removal for dental caries: a systematic review and meta-analysis. Acta Odontol Scand 2018; 76(2):135-40. https://doi.org/10.1080/00016357.2017.1392602

Schwendicke F, Dörfer CE, Paris S. Incomplete caries removal: a systematic review and meta-analysis. J Dent Res 2013; 92(4):306-14. https://doi.org/10.1177/0022034513477425

Kindelan SA, Day P, Nichol R, Willmott N, Fayle SA; British Society of Paediatric Dentistry. UK national clinical guidelines in pediatric dentistry: stainless steel performed crowns for primary molars. Int J Paediatr Dent 2008; 18(Suppl 1):20-8. https://doi.org/10.1111/j.1365-263X.2008.00935.x

Wambier DS, Santos FA, Guedes-Pinto AC, Jaeger RG, Simionato MR. Ultrastructural and microbiological analysis of the dentin layers affected by caries lesions in primary molars treated by minimal intervention. Pediatr Dent 2007; 29(3):228-34.

American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. Chicago, III.: American Academy of Pediatric Dentistry 2021; 399-407.

Hori A, Poureslami HR, Parirokh M, Mirzazadeh A, Abbot P. The ability of pulp sensibility tests to evaluate the pulp status. Int J Paediatr Dent 2011; 21(6):441-5. https://doi.org/10.1111/j.1365-263X.2011.01147.x

Pintor AVB, Mello-Moura ACV, Primo LG, Bedran LR, Nélson-Filho P. Pulp Therapy in Primary Teeth. In: Brazilian Academy of Pediatric Dentistry. Guidelines for Clinical Procedures in Pediatric Dentistry. 3rd. ed. São Paulo: Santos; 2021. [In Portuguese].

Pozzobon MH, Vieira RS, Alves AMH, Reyes-Carmona J, Teixeira CS, Souza BDM, et al. Assessment of pulp blood flow in primary and permanent teeth using pulse oximetry. Dent Traumatol 2011; 27(3):184-8. https://doi.org/10.1111/j.1600-9657.2011.00976.x

Goho C. Pulse oximetry evaluation of vitality in primary and immature permanent teeth. Pediatr Dent 1999; 21(2):125-7.

Gopikrishna V, Tinagupta K, Kandaswamy D. Comparison of electrical, thermal and pulse oximetry methods for assessing pulp vitality in recently traumatised teeth. J Endod 2007; 33(5):531-5. https://doi.org/10.1016/j.joen.2007.01.014

Gopikrishna V, Tinagupta K, Kandaswamy D. Evaluation of efficacy of a new custom-made pulse oximeter dental probe in comparison with the electrical and thermal tests for assessing pulp vitality. J Endod 2007; 33(4):411-4. https://doi.org/10.1016/j.joen.2006.12.003

Munshi AK, Hedge AM, Radhakrishnan S. Pulse oximetry: a diagnostic instrument in pulp vitality testing. J Clin Pediatr Dent 2002; 26(2):141-5. https://doi.org/10.17796/jcpd.26.2.2j25008jg6u86236

Sharma D, Mirsha S, Bannda NR, Vaswani S. In vivo evaluation of customized pulse oximeter and sensitivity pulp tests for assessment of pulp vitality. J Clin Pediatr Dent 2019; 43(1):11-5. https://doi.org/10.17796/1053-4625-43.1.3

Samuel SS, Thomas AM, Namita S. A comparative study of pulse oximetry with the conventional pulp testing methods to assess vitality in immature and mature permanent maxillary incisors. CHRISMED J Health Res 2014; 1(4):235-40. https://doi.org/10.4103/2348-3334.142985

Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res 1999; 33(4):252-60. https://doi.org/10.1159/000016526

Setzer F, Kataoka SHH, Natrielli F, Gondim-Junior E, Caldeira CL. Clinical diagnosis of pulp inflammation based on pulp oxygenation rates measured by pulse oximetry. J Endod 2012; 38(7):880-3. https://doi.org/10.1016/j.joen.2012.03.027

Costa CPS, Thomaz EBAF, Souza SFC. Association between sickle cell anemia and pulp necrosis. J Endod 2013; 39(2):177-81. https://doi.org/10.1016/j.joen.2012.10.024

Bruno KF, Barletta FB, Felippe WT, Silva JA, Alencar AHG, Estrela C. Oxygen saturation in the dental pulp of permanent teeth: a critical review. J Endod 2014; 40(8):1054-7. https://doi.org/10.1016/j.joen.2014.04.011

Fuss Z, Trowbridge H, Bender IB, Rickoff B, Sorin S. Assessment of reliability of electrical and thermal pulp testing agents. J Endod 1986; 12(7):301-305. https://doi.org/10.1016/S0099-2399(86)80112-1

Radhakrishnan S, Munshi AK, Hedge AM. Pulse oximetry: a diagnostic instrument in pulp vitality testing. J Clin Pediatr Dent 2002; 26(2):141-5. https://doi.org/10.17796/jcpd.26.2.2j25008jg6u86236