Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials
Objective: The goal of this systematic study was to investigate the effectiveness of selective, stepwise, and non-selective removal techniques for caries removal in permanent teeth with deep carious lesions. The primary focus was the results found comparing techniques for caries removal to check whe...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-08-01
|
| Series: | Healthcare |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9032/11/16/2338 |
| _version_ | 1797584576077365248 |
|---|---|
| author | Nicola Figundio Pedro Lopes Tamara Kerber Tedesco Juliana Campos Hasse Fernandes Gustavo Vicentis Oliveira Fernandes Anna Carolina Volpi Mello-Moura |
| author_facet | Nicola Figundio Pedro Lopes Tamara Kerber Tedesco Juliana Campos Hasse Fernandes Gustavo Vicentis Oliveira Fernandes Anna Carolina Volpi Mello-Moura |
| author_sort | Nicola Figundio |
| collection | DOAJ |
| description | Objective: The goal of this systematic study was to investigate the effectiveness of selective, stepwise, and non-selective removal techniques for caries removal in permanent teeth with deep carious lesions. The primary focus was the results found comparing techniques for caries removal to check whether there was pulp exposition; the secondary was the materials used for pulp protection and clinical findings reported within the included studies. Methods: The search was performed in two databases (PubMed/MEDLINE and Web Of Science). The studies included in this systematic review were selected based on eligibility criteria. The inclusion criteria were: (1) randomized controlled trials (RCTs), (2) that compared the total removal of carious tissue with selective removal in permanent teeth with deep carious lesions, (3) with a follow-up period of at least 6 months, and (4) publications in English. Regarding the exclusion criteria, the following were not considered: (1) articles published in other languages, (2) articles that did not compare the different types of total/selective decay removal, and (3) articles published before January 2008. The risk of bias and the quality of the included studies were independently assessed by two reviewers using the RoB 2 tool. Results: 5 out of 105 potentially eligible studies were included. Regarding the teeth included in the study, three articles performed management only on permanent molars, while other studies also performed management on incisors/canines/premolars/molars. Management protocols were divided into nonselective caries removal and partial caries removal (selective/stepwise). The theory of non-selective caries removal was considered an excessive, unnecessarily invasive option and a form of outdated management, and selective removal was preferred. Conclusion: The selective removal technique presented a higher success rate and fewer incidences of pulpal exposure than total removal, after up to 18 months of follow up. Moreover, only one session seemed to be a better management choice compared to two sessions because the cavity re-opening procedure is more prone to pulp exposure and highly depends on patient commitment. Otherwise, at 5 years of follow up, there was no difference between selective removal and total removal in management longevity. In addition, there were also no differences between the success of the materials used for definitive restorations in teeth subjected to any of the techniques evaluated. |
| first_indexed | 2024-03-10T23:54:36Z |
| format | Article |
| id | doaj.art-ad67207a96de48858600dfafae368abd |
| institution | Directory Open Access Journal |
| issn | 2227-9032 |
| language | English |
| last_indexed | 2024-03-10T23:54:36Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Healthcare |
| spelling | doaj.art-ad67207a96de48858600dfafae368abd2023-11-19T01:19:35ZengMDPI AGHealthcare2227-90322023-08-011116233810.3390/healthcare11162338Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical TrialsNicola Figundio0Pedro Lopes1Tamara Kerber Tedesco2Juliana Campos Hasse Fernandes3Gustavo Vicentis Oliveira Fernandes4Anna Carolina Volpi Mello-Moura5Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, PortugalFaculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, PortugalOrthodontics and Pediatric Dentistry, Dental School, University of Sao Paulo, São Paulo 05508-000, SP, BrazilPeriodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USACentre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505 Viseu, PortugalFaculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, PortugalObjective: The goal of this systematic study was to investigate the effectiveness of selective, stepwise, and non-selective removal techniques for caries removal in permanent teeth with deep carious lesions. The primary focus was the results found comparing techniques for caries removal to check whether there was pulp exposition; the secondary was the materials used for pulp protection and clinical findings reported within the included studies. Methods: The search was performed in two databases (PubMed/MEDLINE and Web Of Science). The studies included in this systematic review were selected based on eligibility criteria. The inclusion criteria were: (1) randomized controlled trials (RCTs), (2) that compared the total removal of carious tissue with selective removal in permanent teeth with deep carious lesions, (3) with a follow-up period of at least 6 months, and (4) publications in English. Regarding the exclusion criteria, the following were not considered: (1) articles published in other languages, (2) articles that did not compare the different types of total/selective decay removal, and (3) articles published before January 2008. The risk of bias and the quality of the included studies were independently assessed by two reviewers using the RoB 2 tool. Results: 5 out of 105 potentially eligible studies were included. Regarding the teeth included in the study, three articles performed management only on permanent molars, while other studies also performed management on incisors/canines/premolars/molars. Management protocols were divided into nonselective caries removal and partial caries removal (selective/stepwise). The theory of non-selective caries removal was considered an excessive, unnecessarily invasive option and a form of outdated management, and selective removal was preferred. Conclusion: The selective removal technique presented a higher success rate and fewer incidences of pulpal exposure than total removal, after up to 18 months of follow up. Moreover, only one session seemed to be a better management choice compared to two sessions because the cavity re-opening procedure is more prone to pulp exposure and highly depends on patient commitment. Otherwise, at 5 years of follow up, there was no difference between selective removal and total removal in management longevity. In addition, there were also no differences between the success of the materials used for definitive restorations in teeth subjected to any of the techniques evaluated.https://www.mdpi.com/2227-9032/11/16/2338selective removaltotal removaldeep carious lesiondental restorationpulpal exposuresystematic review |
| spellingShingle | Nicola Figundio Pedro Lopes Tamara Kerber Tedesco Juliana Campos Hasse Fernandes Gustavo Vicentis Oliveira Fernandes Anna Carolina Volpi Mello-Moura Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials Healthcare selective removal total removal deep carious lesion dental restoration pulpal exposure systematic review |
| title | Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials |
| title_full | Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials |
| title_fullStr | Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials |
| title_full_unstemmed | Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials |
| title_short | Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials |
| title_sort | deep carious lesions management with stepwise selective or non selective removal in permanent dentition a systematic review of randomized clinical trials |
| topic | selective removal total removal deep carious lesion dental restoration pulpal exposure systematic review |
| url | https://www.mdpi.com/2227-9032/11/16/2338 |
| work_keys_str_mv | AT nicolafigundio deepcariouslesionsmanagementwithstepwiseselectiveornonselectiveremovalinpermanentdentitionasystematicreviewofrandomizedclinicaltrials AT pedrolopes deepcariouslesionsmanagementwithstepwiseselectiveornonselectiveremovalinpermanentdentitionasystematicreviewofrandomizedclinicaltrials AT tamarakerbertedesco deepcariouslesionsmanagementwithstepwiseselectiveornonselectiveremovalinpermanentdentitionasystematicreviewofrandomizedclinicaltrials AT julianacamposhassefernandes deepcariouslesionsmanagementwithstepwiseselectiveornonselectiveremovalinpermanentdentitionasystematicreviewofrandomizedclinicaltrials AT gustavovicentisoliveirafernandes deepcariouslesionsmanagementwithstepwiseselectiveornonselectiveremovalinpermanentdentitionasystematicreviewofrandomizedclinicaltrials AT annacarolinavolpimellomoura deepcariouslesionsmanagementwithstepwiseselectiveornonselectiveremovalinpermanentdentitionasystematicreviewofrandomizedclinicaltrials |