multicenter trial comparing one-step partial caries removal to complete caries removal for the treatment of deep carious lesions in permanent teeth. (decat : deep caries treatment).

Conditions: Deep Caries

Summary: this clinical trial is a national multicenter randomized controlled trial performed in parallel groups aiming to validate a treatment that preserves pulp vitality of mature permanent posterior teeth through partial removal of carious tissue and restoring tooth structure using a simple filling in one session, thus delaying premature tooth aging. two successive randomizations will be performed (allocation ratio 1:1); firstly for the type of excavation carried out (partial vs. complete caries removal) and secondly for the nature of the adhesive used (antibacterial adhesive vs. non-antibacterial adhesive). the second randomization will not be carried out for teeth requiring endodontic treatment after the first randomization. the study's primary objective will be to compare, at 1 year of follow-up, the efficacy (binary success criteria) of partial caries removal versus complete caries removal in occlusal or proximal deep lesions of mature permanent posterior teeth (bicuspids and molars except third molars). secondary objectives will include the comparison, at 1 year of follow-up, of the efficacy (binary success criteria) of an antibacterial two-step self-etch adhesive versus a traditional non-antibacterial two-step self-etch adhesive. another secondary objective will be to compare, at two and three years of follow-up, the efficacy of partial versus complete caries removal. the primary outcome is the success of the caries removal protocol at one year, measured according to 5 fdi criteria, while the secondary outcome is the contribution of the functional and biological dimensions of the 5 fdi criteria items to determining success or failure of the treatment. the outcome of success will be the same for all objectives, primary and secondary.


Eligibility criteria:
inclusion criteria: randomization n°1 - partial versus complete caries removal patient-related criteria: * patient consulting in one of the multicenter trial centers * male and female aged 8-80 (inclusive), * affiliated to a social security regimen * able to tolerate necessary restorative procedures * provide informed consent * accepts the three-year follow-up period tooth related criteria: * mature permanent posterior tooth * tooth with vital pulp according to pulp-sensitivity tests * tooth with a deep (primary or secondary) at least proximal and/or occlusal carious lesion presenting a residual dentin thickness with no continuity between the carious cavity and the pulp chamber. * in case of proximal lesions, the proximal cervical limit must allow proper placement of a waterproof dental dam (confirmed by a bitewing x-ray radiograph) * tooth requiring a direct partial restorative treatment. randomization n°2 - antibacterial vs. non antibacterial adhesive application tooth has been assigned a treatment by randomization n°1. exclusion criteria: randomization n°1 - partial versus complete caries removal patient-related criteria: * person under guardianship, pregnant or nursing woman, * risk of infectious endocarditis, * patient who has an implanted cardiac pacemaker/defibrillator * patient with severe periodontal disease (pocket depth ≥5mm and/or mobility type iv), * poor oral hygiene (abundance of soft matter within the gingival pocket and/or on the tooth and gingival margin = score 3 \[silness and loe, 1964\], * allergy to any of the materials and/or anaesthetic used, * uncooperative patients. tooth related criteria: * nocturnal pain causing insomnia, * tooth suffering dentin hypersensitivity (sharp sudden pain of short duration pain arising from exposed dentin (erosion and/or gingival recession), typically in response to external stimuli (air blast hypersensitivity \[schiff et al., 1994\], tactile hypersensitivity), * sensitivity to axial or lateral percussion; * radiolucent apical image, * condensing osteitis, * tooth having an external or internal resorption, * tooth having suffered trauma, * tooth with a carious cervical lesion, * tooth with an occlusal wear associated to a dentine exposure, * tooth supporting clasp of a removable partial denture (rpd). * tooth with defects of mineralization that once the treated tooth could come into contact of the carried out restoration randomization n°2 - antibacterial vs. non antibacterial adhesive application - tooth with pulp exposure after randomization n°1 requiring endodontic treatment (pulp exposure \> 2 mm² and/or haemostasis not obtained).

Keywords: deep carious lesion incomplete caries removal antibacterial adhesive system dental composite resin pulp vitality preservation randomized controlled trial