Nano-bioactive glass-ionomer liner performance in stepwise versus selective caries removal: 18-month clinical trial

Introduction
Deep carious lesions management necessitates minimally invasive methods, such as partial caries excavation and bioactive material re-mineralization, thereby minimizing pulp exposure during caries removal.

Objectives
To compare the clinical performance of nano-bioactive glass-ionomer (N-BAG/GI) liner following selective (SE) versus stepwise (SW) caries removal techniques after 18-month follow-up.

Material and methods
Class I deep carious lesions in 18 permanent molars were included and divided into two equivalent groups, randomly based on caries removal technique: group 1 (SE) and group 2 (SW). During first treatment appointment, both groups were subjected to partial caries removal, application of N-BAG/GIC as a liner, and temporary filling for 3 months. During second treatment visit, temporary filling was reduced pulpally in SE group, leaving 2 mm as a base, and completely removing the liner and remaining carious lesion in SW group, followed by re-application of N-BAG/GIC as liner and base. Finally, all cavities were restored with a nano-filled resin composite using selective enamel etching technique. At baseline (1 week), 3, 12, and 18 months, clinical and digital radiography assessments of the success and failure rates were carried out.

Results
Regarding times of follow-up and technique used, the success rates for SE and SW techniques displayed no significant difference among each of follow-up intervals and between both tested groups. While SE showed non-significantly higher success rates at 12 and 18 months compared with SW.

Conclusions
N-BAG/GIC liner can be effectively used for SE and SW techniques.