The aim of this study is to randomly compare selective to nonselective excavation methods in
carious mature permanent teeth with symptoms of reversible pulpitis over 4 years.
Cases will be collected from the initial treatment unit and the undergraduate clinics over a
8 months' period, the minimum sample size required is 120 teeth in 120 patients for an
assumed difference of 20% in the success rate and accounting for 20% wear rate in the follow
up, randomization will be performed using tabular randomization. Intensity of pulp symptoms
will be recorded, patient's description of sensitivity to hot/cold/sweet lasting up to 15-20s
and settling spontaneously are considered mild, while increased pain for more than several
minutes and needing pain killers are considered severe.
Inclusion criteria:
The patient age (16-60) years old
Non -contributory medical history
Deep caries extending>= 2/3 of dentine but not exposing the pulp on the radiograph
The tooth should give positive response to cold testing
Clinical diagnosis of reversible pulpitis
The tooth is restorable, probing pocket depth and mobility are within normal limits
No signs of pulpal necrosis including sinus tract or swelling
No radiographic evidence of periapical changes indicative of apical periodontitis
Preoperative pulpal and periapical diagnosis will be established after clinical examination
including soft tissue palpation, percussion, and cold testing (, and digital periapical and
bitewing radiographs will be taken using film holders and a paralleling technique.
Baseline characteristics of the patient (age, gender) and the treated tooth (number,
position, caries extension) will be recorded. Each tooth will be randomly allocated for the
choice of treatment with selective or nonselective caries excavation according to a random
sequence number generator.
Clinical procedure: The clinical procedure will be performed by one calibrated postgraduate
student under supervision. The tooth will be anesthetized with , rubber dam will be applied
and the tooth crown will be disinfected with 5% NaOCl before caries excavation; The cases
will be divided randomly into:
Group 1: One-stage selective carious-tissue removal to soft or firm dentine, using
carbon-steel rose- head burs (ash instruments) in a slow speed headpiece, the excavation end
point is the detection of leathery dentine using a sharp dental explorer and excavator.
Group 2: Non-selective carious-tissue removal. The tooth will be isolated with rubber dam and
disinfected with NaOCl. Complete caries excavation will be removed from the entire cavity,
inspection under the microscope will be done to identify pulp exposure. If no pulp exposure
is evident Biodentine will be placed and the cavity will be restored with composite. If pulp
exposure occurred, and it is bleeding normally and uniformly red with no zones of
degeneration or necrosis then direct pulp capping will be the choice of the treatment. The
bleeding will be controlled via gentle pressure with a cotton pellet soaked with 2.5% NaOCl
over the pulpal wound for 2 minutes and repeated if required up to 5 times.
In both groups, 2mm of Biodentine will be used and vitrebond will be placed as a liner on
top, this will be followed by etching with 37% orthophosphoric acid, rinsing with water, and
then bonding with adhesive followed by the placement of resin composite. Flowable composites
will be used in deep cavities if needed. Clinical and radiographic success will be evaluated
at 6 months, 1 year, 2 years and 4 years postoperatively.