Minimal Versus Complete Caries Removal in Deeply Carious Primary Molars

Objectives: to compare the post-operative pulpal symptoms (Spontaneous pain, pain on percussion, swelling, sinus or fistula), incidence of pulp exposure, child acceptance, chair time and radiographic success between minimal and complete caries removal techniques.
Methods: 70 children (4-8 years) with 87 asymptomatic deeply carious primary molars (radiographic extension of caries ≥ 1/3 dentin thickness) were divided into two groups: study group (35 children, 43 molars) with minimal caries removal technique (MCR) [only soft demineralized dentin along the lateral walls of the cavity was removed] and control group (35 children, 44 molars) with complete caries removal (CCR) along the lateral and pulpal walls of the cavity was done. In case of pulp exposure, formecresol pulpotomy was performed. For both groups, tooth was restored with stainless steel crown. Incidence of pulp exposure, chair time and child acceptance using 5 points Likert scale were recorded at treatment visit and children were followed up for 9 months.
Results: None of the treated molars in MCR showed any clinical/radiographic signs of pulpal involvement. In CCR, 3 children reported spontaneous pain and one child presented with clinical evidence of abscess at 3 months, and another molar failed radiographically on 6 months. Total survival rates were 100% and 88% for MCR and CCR, respectively. In MCR, pulp exposure did not occur while in CCR, pulp exposure occurred in 14 out of the 44 treated molars (31.8%). MCR resulted in higher acceptance scores compared to CCR (p=0.029). The mean chair time was 11.3 ± 2.5 for MCR and increased by 2 folds for CCR (28.6 ± 6.8 minutes).
Conclusions: MCR showed a clinical feasibility for treating deep carious lesions in primary teeth. MCR maintained the pulp vitality and showed no symptoms of pulpal involvement and required less chair time than CCR which resulted in greater children acceptance to receive the treatment.