Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials

Abstract

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 The theory of non-selective caries removal was considered an excessive, unnecessarily invasive option and a form of outdated management, and selective removal was preferred.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.

Comparative Evaluation of the Microleakage of Glass Ionomers as Restorative Materials: A Systematic Review of In Vitro Studies

“…During the setting process, resin composite materials may undergo shrinkage, which causes difficulties in effectively sealing against the tooth surface, potentially leading to the infiltration of bacteria [28]. This phenomenon, known as microleakage, is frequently manifested as marginal staining, postoperative sensitivity, and the development of secondary caries around the restoration site [29].…”

Selective Caries Removal: A Case Report with 21‐Year Follow‐Up

“…Systematic reviews of the literature have concluded that CRCT can be considered an invasive technique with a higher risk of pulpal exposure, making SRCT the best option for treating deep carious lesions in 18-month follow-ups [ 8 , 9 ]. However, there is still significant disagreement among dentists regarding the use of SRCT in deep carious lesions extending to the inner third of dentin without obvious potential pulpal exposure.…”

A Comprehensive Evaluation of Zirconia-Reinforced Glass Ionomer Cement’s Effectiveness in Dental Caries: A Systematic Review and Network Meta-Analysis

“…The initial stages of dental caries typically manifest as white spot lesions, which can progress to discoloration without timely intervention [ 2 ]. Therapeutic restorative treatment is aimed at eliminating the carious lesion and reinstating the tooth’s original contours and contacts [ 3 ]. With the introduction of adhesive restorative materials, clinicians have the opportunity to choose conservative preparations that facilitate the preservation of maximum tooth structure, while also ensuring aesthetic concern, given that the majority of adhesive restorations are designed to match the natural tooth color [ 3 , 4 ].…”

“…Therapeutic restorative treatment is aimed at eliminating the carious lesion and reinstating the tooth’s original contours and contacts [ 3 ]. With the introduction of adhesive restorative materials, clinicians have the opportunity to choose conservative preparations that facilitate the preservation of maximum tooth structure, while also ensuring aesthetic concern, given that the majority of adhesive restorations are designed to match the natural tooth color [ 3 , 4 ]. Dental cements represent restorative materials composed of small biomolecules that demonstrate biocompatibility and contribute positively to tooth structure.…”

“…During the setting process, adhesive materials may undergo either shrinkage or expansion. Materials that undergo shrinkage encounter difficulties in effectively sealing against the tooth surface, potentially leading to the infiltration of bacteria [ 3 ]. This phenomenon, known as microleakage, is frequently manifested as marginal staining, postoperative sensitivity, and the development of secondary caries around the restoration site [ 15 ].…”