Influence of Selective Caries Removal on Post-Operative Sensitivity in Permanent Molars
DOI:
https://doi.org/10.61919/7a33az38Keywords:
Caries, Dental; Dental Pulp; Postoperative Complications; Randomized Controlled Trial; Resin-Modified Glass Ionomer; Sensitivity, Dental; Tooth, PermanentAbstract
Background: Post-operative sensitivity after restoration of deep carious lesions is a common patient-centered concern that may reduce comfort and satisfaction after dental treatment. Complete caries excavation can increase pulpal irritation in deep lesions, whereas selective caries removal preserves affected dentin near the pulp and may reduce early discomfort. Objective: To compare short-term post-operative sensitivity after selective caries removal versus complete excavation in permanent molars with deep carious lesions. Methods: This randomized controlled trial enrolled 60 adults aged 18–45 years with deep occlusal or occlusoproximal caries in permanent molars. Participants were allocated equally to selective caries removal or complete excavation. All cavities were restored immediately using resin-modified glass ionomer cement under standardized clinical protocols. Post-operative sensitivity was assessed using a visual analogue scale at 24 hours, 72 hours, and 7 days. Biting sensitivity and the association between cavity depth and VAS scores were also evaluated. Results: Selective caries removal produced lower VAS scores than complete excavation at 24 hours (2.1 ± 0.9 vs. 3.8 ± 1.1), 72 hours (1.4 ± 0.7 vs. 2.6 ± 0.9), and 7 days (0.6 ± 0.4 vs. 1.2 ± 0.6). Biting sensitivity was also less frequent after selective removal at 24 hours and 72 hours. Cavity depth showed stronger positive correlations with sensitivity after complete excavation. Conclusion: Selective caries removal reduced early post-operative sensitivity compared with complete excavation in permanent molars, supporting conservative excavation for short-term patient comfort.
References
1. Al-Kaff AA, Alshehri AZ, Alasmari RA, Najd A, Albandari A, Ameera A, et al. Minimally invasive techniques for managing dental caries in children: efficacy, applications, and future directions. 2025;17(7).
2. Asgary S, Nosrat A. Vital pulp therapy: evidence-based techniques and outcomes. Iran Endod J. 2025;20(1):e2.
3. Kosan E, Kosan D, Sturm R, Schwendicke F, Paris S. Efficacy of different cavity liners compared to no cavity lining in managing deep caries in vital permanent teeth: a systematic review. Clin Oral Investig. 2025;29(11):1-24.
4. Abdelwahab DH, Kabil NS, Badran AS, Abd OM, Geleel E, Darwish D. A holistic approach to vital pulp treatment using bioactive materials: review of literature.
5. Soxman JA, MacLean J, Haberland C. Noninvasive and minimally invasive treatment of dental caries. In: Handbook of Clinical Techniques in Pediatric Dentistry. 2021. p. 1-20.
6. Elhennawy K, Finke C, Paris S, Reda S, Jost-Brinkmann PG, Schwendicke F. Selective vs stepwise removal of deep carious lesions in primary molars: 12-month results of a randomized controlled pilot trial. J Dent. 2018;77:72-7.
7. Maashi YAJ, Alharthi SM, Sharahili YAM, Alamrani JNA, Alhawiti AO, Aljohani SSS, et al. Latest approaches to minimally invasive pediatric dentistry: AI-assisted diagnostics techniques, behavior management, preventive interventions, challenges and limitations. 2024;7(S11):2064.
8. Santos PS, Pedrotti D, Braga MM, Rocha RO, Lenzi TL. Materials used for indirect pulp treatment in primary teeth: a mixed treatment comparisons meta-analysis. Braz Oral Res. 2017;31:e101.
9. Thomas DC. Answers to current questions in dentistry, an issue of Dental Clinics of North America. Philadelphia: Elsevier Health Sciences; 2025.
10. Leprince JG, Hardy CM, Daher R. Considerations for the restoration of root canal-treated molars. In: Guide to Molar Endodontics. 2026. p. 185-229.
11. Goncharuk-Khomyn M, Nesterenko M. Fundamentals of aesthetic dental restoration: educational and methodical textbook for practical classes in fundamentals of aesthetic dental restoration for 4th-year students of the dental faculty. 2024.
12. Hasagawa P, Evans BO, Vanzella L, Eckert GJ. Supplement No. 7 September 2016. 2016.
13. Lim ZE, Duncan HF, Moorthy A, McReynolds D. Minimally invasive selective caries removal: a clinical guide. Br Dent J. 2023;234(4):233-40.
14. Ramezanzade S, Bjørndal L, Chen H, Baysan A. Effectiveness of stepwise excavation or selective excavation in comparison with non-selective caries removal in managing deep caries in vital permanent teeth: a systematic review with trial sequential, pairwise, and network meta-analyses. Caries Res. 2025.
15. Fatima N, Mustilwar R, Paul R, Chauhan PS, Mostafa D, Dhopte A. Minimal invasive dentistry: a review. Int J Health Sci. 2022;(I):13062-77.
16. Room FK. Evaluating postoperative pain, cost-effectiveness, and patient acceptability of full pulpotomy compared to root canal treatment in teeth with symptomatic irreversible pulpitis: a preliminary clinical study [dissertation]. Kuala Lumpur: University of Malaya; 2024.
17. Santana ALP, Petta TM, Nunes AKO, Silva RNFG, Pinheiro HHC, Silva CM, et al. Effect of selective caries removal and photobiomodulation on postoperative sensitivity in deep cavities: randomized clinical trial. 2025;40(1):62.
18. Casagrande L, Seminario AT, Correa MB, Werle SB, Maltz M, Demarco FF, et al. Longevity and associated risk factors in adhesive restorations of young permanent teeth after complete and selective caries removal: a retrospective study. 2017;21(3):847-55.
19. Almaeen S. SMART composite restorations of carious primary molar teeth after minimal caries removal [dissertation]. London: University College London; 2022.
20. Najeeb A. Evaluation of caries removal in primary teeth using Cariecare and polymer bur: a comparative in vivo study [dissertation]. Bengaluru: Rajiv Gandhi University of Health Sciences; 2019.
21. Ricucci D, Siqueira JF Jr, Rôças IN, Lipski M, Shiban A, Tay FR. Pulp and dentine responses to selective caries excavation: a histological and histobacteriological human study. J Dent. 2020;100:103430.
22. Bonilla ED, Tom E, Al-Rasheed R, Hayashi M, Ferng D, McClure C. Caries clearance management: a clinical diagnostic restorative procedure—case studies. Prosthesis. 2025;7(5):103.
23. Lokeshwari M. Evaluation of morphological changes and bacterial counts in primary dentin after caries excavation with chemomechanical removal, erbium:YAG laser and rotary instrumentation: an in vitro, SEM and light microscopic evaluation [dissertation]. Bengaluru: Rajiv Gandhi University of Health Sciences; 2018.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Fawad Ali Shah, Aimon Khan, Zoya Nawaz, Makkia Sumbal, Syed Ahmed Omer, Waleed Ajmal (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
© The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
.png)
