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Which caries removal method to select?

Jacqueline Fraser1, Andrew MacInnes2

  • 1Dental Core Trainee 3 in Restorative Dentistry and Research, Glasgow Dental Hospital, Glasgow, UK. jacquelinefraser95@gmail.com.

Evidence-Based Dentistry
|January 22, 2024
PubMed
Summary
This summary is machine-generated.

Selective or stepwise caries removal is recommended for deep cavities in permanent teeth, offering better outcomes than non-selective removal. Selective removal shows short-term advantages, while long-term results are comparable across methods.

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Area of Science:

  • Dentistry
  • Cariology
  • Restorative Dentistry

Background:

  • Deep caries in permanent teeth presents a clinical challenge regarding the extent of carious tissue removal.
  • Traditional non-selective caries removal may increase the risk of pulpal exposure and compromise restoration longevity.
  • Conservative approaches like selective and stepwise caries removal aim to preserve pulp vitality and improve treatment outcomes.

Purpose of the Study:

  • To systematically review and compare the effectiveness of non-selective, selective, and stepwise caries removal in permanent teeth with deep carious lesions.
  • To evaluate clinical outcomes such as restoration longevity, marginal integrity, and pulp vitality based on different caries removal strategies.

Main Methods:

  • Systematic literature search of PubMed/MEDLINE and Web of Science databases (January 2008 - January 2023) for English-language randomized controlled trials.
  • Inclusion criteria: RCTs comparing total vs. selective/stepwise removal in permanent teeth with deep caries, minimum 6-month follow-up.
  • Data extraction and risk of bias assessment followed PRISMA guidelines and Cochrane Risk of Bias Tool.

Main Results:

  • Five randomized controlled trials (2010-2021) met the eligibility criteria, with follow-up ranging from 1 month to 5 years.
  • Three studies reported statistically significant differences favoring selective or stepwise removal in longevity, marginal integrity, and success rates.
  • Selective removal demonstrated a lower risk of pulpal exposure in the short term (1.5 years), with results similar to non-selective removal at 5 years.

Conclusions:

  • Non-selective caries removal is not recommended for deep carious lesions due to invasiveness and risk of pulpal exposure.
  • Selective and stepwise caries removal are considered conservative and effective approaches for managing deep caries in permanent teeth.
  • Selective removal appears to be the optimal short-term management option, while long-term success rates are comparable across conservative methods.