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Selective removal compared to complete removal for deep carious lesions.

Francisca Verdugo-Paiva1, Paula Zambrano-Achig2, Daniel Simancas-Racines3

  • 1Centro Evidencia UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile. ORCID: 0000-0003-0199-9744.

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Selective caries removal may reduce root canal treatments and pulp exposure risk in deep caries, though evidence certainty is low. Further research is needed to confirm benefits for pulp disease and restoration longevity.

Keywords:
EpistemonikosGRADEminimally invasive dentistrycaries removal

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Area of Science:

  • Dentistry
  • Evidence-based dentistry
  • Caries management

Background:

  • Conventional dental caries management involves total removal of decayed tissue.
  • Conservative (selective) caries removal techniques are gaining traction due to concerns about conventional methods.
  • The effectiveness of selective caries removal remains a subject of debate.

Purpose of the Study:

  • To evaluate the effectiveness of selective caries removal compared to conventional methods.
  • To assess the impact of selective caries removal on the need for root canal treatment and pulp health.
  • To determine the risk of restoration failure and pulp disease signs associated with selective caries removal.

Main Methods:

  • A comprehensive search was conducted in the Epistemonikos database, a large repository of systematic reviews.
  • Data from seven relevant systematic reviews, comprising seven randomized controlled trials, were analyzed.
  • A meta-analysis was performed, and findings were summarized using the GRADE approach to assess evidence certainty.

Main Results:

  • Selective caries removal may reduce the incidence of root canal treatments.
  • The risk of pulp exposure in teeth with deep caries might be lowered by selective removal.
  • Evidence regarding the reduction of pulp disease symptoms and restoration failure is very low certainty.

Conclusions:

  • Selective caries removal shows potential benefits in reducing the need for root canal treatment and preventing pulp exposure in deep caries cases.
  • However, the current evidence supporting these benefits is of low certainty.
  • More high-quality research is required to definitively establish the efficacy of selective caries removal in preventing pulp disease and restoration failure.