Three‐Year Clinical and Economic Evaluation of Selective Caries Removal and Full Pulpotomy for Extensive Caries: An Exploratory Randomised Controlled Trial

Aim The aim of this study was to compare pulp survival following selective caries removal (SCR) and full pulpotomy treatment in teeth with extensive caries over 3 years. Methodology This two‐arm, exploratory randomised controlled trial included vital mature permanent teeth with extensive primary or secondary caries diagnosed radiographically as being at least 75% or more into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were randomly allocated to receive either SCR or full pulpotomy. All teeth were reviewed clinically and radiographically at 6 months, 1 year, and 3 years post‐treatment. Log‐rank tests and Cox proportional hazards regressions were used to compare the outcomes of SCR and pulpotomy, adjusting for clustering using a robust variance estimator. Cost‐effectiveness analysis was carried out using the healthcare system and societal perspectives. Significance level was set at 5%. Results At 3 years, 44/58 teeth (75.9%) in the SCR group and 37/55 teeth (67.3%) in the full pulpotomy group were reviewed. A total of 13 teeth in the SCR group (29.5%) and 4 teeth in the pulpotomy group (10.8%) required further intervention with root canal treatment (RCT) or extraction ( p = 0.039). Survival rates were 74% for SCR and 89% for pulpotomy ( p = 0.041). Overall, 79.0% of teeth treated with either SCR or pulpotomy survived without requiring further intervention over the 3‐year period. In this study with more than two‐thirds of the enrolled teeth classified as extremely deep lesions, pulpotomy was more cost‐effective than SCR in the management of extensive caries above a willingness‐to‐pay threshold of $917 and $928 to avoid one tooth extraction or RCT from the healthcare system and societal perspective, respectively. Conclusion Full pulpotomy demonstrated greater effectiveness than SCR in avoiding further intervention over a 3‐year period in teeth with extensive caries, of which the majority were extremely deep lesions. Further long‐term studies and broader health economic evaluations are warranted to guide clinical decision‐making and policy development. Trial Registration ClinicalTrials.gov identifier: NCT04672070