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Selective versus stepwise removal of deep carious lesions in permanent teeth: a randomised controlled trial from Egypt—an interim analysis
  1. Mohamed E Labib1,
  2. Olfat E Hassanein2,
  3. Makeen Moussa1,
  4. Asmaa Yassen2,3,
  5. Falk Schwendicke4
  1. 1 Operative Dentistry, Misr International University (MIU), Cairo, Egypt
  2. 2 Conservative Dentistry, Cairo University, Giza, Egypt
  3. 3 Restorative Dentistry, British University in Egypt, Cairo, Egypt
  4. 4 Operative and Preventive Dentistry, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
  1. Correspondence to Dr Falk Schwendicke; falk.schwendicke{at}


Objectives To compare the success, survival and costs of selective versus stepwise carious tissue removal (SE/SW) in permanent teeth with deep (>2/3 dentine depth) carious lesions.

Design Randomised controlled, unicentre, clustered two-arm superiority trial.

Setting Outpatient clinic of a private university in Cairo, Egypt.

Participants One hundred and fifteen participants (n=132 teeth), aged 18–47 years, from Cairo, Egypt, were enrolled. Premolars/molars with occlusal/occlusal-proximal deep lesions (radiographically >2/3 dentine), sensible pulps, without spontaneous pain, were included.

Interventions Peripheral carious tissue removal to hard dentine was performed. Pulpo-proximally, soft dentine was left. A glass ionomer (GI) restoration was placed. After 3–4 months, teeth were randomly allocated to SE (n=66), with reduction of the GI into a base and no further tissue removal, followed by a composite resin restoration, or SW (n=66), with full removal of the GI, additional excavation until firm dentine pulpo-proximally, followed by a GI-based composite restoration. Mean follow-up was 1 year.

Primary and secondary outcome measures Primary outcome was success (absence of endodontic/restorative complications). Secondary outcomes were tooth survival and initial and total treatment costs.

Results Zero/five pulp exposures occurred during SE/SW, and seven/five SE/SW teeth required endodontic therapy. Success after 12 months was 89.4% for SE and 84.9% for SW. The estimated mean time free of complications was 23 and 18 months for SE and SW, respectively, without significant differences between SE and SW (p>0.05/Cox). Initial treatment costs were significantly higher for SW (mean (SD): 507.5 (123.4) Egyptian pounds (EGP)) than SE (mean (SD): 456.6 (98.3) EGP), while total costs showed no significant difference (p>0.05).

Conclusion Within the limitations of this interim analysis, and considering the depth of these lesions (>2/3 dentine), SE and SW showed similar risk of failure and overall costs after 1 year.

Trial registration number PACTR201603001396248.

  • caries
  • costs
  • endodontic
  • excavation
  • restorative dentistry
  • pulp vitality

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  • Contributors MEL contributed to conception, design, data acquisition, data interpretation and drafting of the manuscript. FS contributed to design, data acquisition, analysis of data, interpretation of results and critical revision of the manuscript. OEH, MM and AY contributed to conception and design of the study and drafting of the manuscript. All authors gave final approval and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. We acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Funds of Charité – Universitätsmedizin Berlin

  • Competing interests None declared.

  • Patient and public involvement statement Patients or the public were not involved in the design or planning of the study.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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