Skip to main content

Advertisement

SpringerLink
Log in

Selective, stepwise, or nonselective removal of carious tissue: which technique offers lower risk for the treatment of dental caries in permanent teeth? A systematic review and meta-analysis

  • Review
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

This study aimed to systematically review the literature regarding the risk of selective removal—in comparison with stepwise and nonselective removal—of carious tissue in permanent teeth.

Materials and methods

Controlled clinical trials and cohort studies involving patients with dental caries in permanent teeth were included. Databases used were PubMed, Embase, and Scopus. The test group should be composed of patients undergoing selective removal of carious tissues, and the control group should comprise patients undergoing nonselective removal and/or stepwise removal of carious tissue. Laboratory tests, studies on primary teeth, and studies that used temporary restorations were excluded, as were literature reviews. The primary outcome was overall success of maintaining pulpal health (both clinically and radiographically). Quality of the restoration, pulp exposure, dentin deposition, and microbiological examination were also assessed. A meta-analysis, using the pooled risk ratio (RR) and its 95% confidence interval (CI), was performed to assess the success of maintaining pulpal health, using the different control treatments as a subgroup analysis.

Results

A total of 2333 articles were retrieved, of which 10 were included in the systematic review and four in the meta-analysis. In the qualitative evaluation, the control groups presented a higher risk of pulp exposure in relation to the selective removal. In the meta-analysis, the selective carious tissue removal showed significantly higher overall success (RR, 95% CI 1.11, 1.02–1.21).

Conclusions

The selective carious tissue removal presented higher success of maintaining pulpal health.

Clinical relevance

In permanent teeth, selective carious tissue removal should be performed, as this technique results in lower numbers of pulp complications, such as pulp exposure, as compared with nonselective removal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Manton D (2013) Partial caries removal may have advantages but limited evidence on restoration survival. Evid Based Dent 14:74–75. https://doi.org/10.1038/sj.ebd.6400948

    Article  PubMed  Google Scholar 

  2. Schwendicke F, Frencken J, Innes N (2018) Caries excavation: evolution of treating cavitated carious lesions. Karger Medical and Scientific Publishers, Basel

    Book  Google Scholar 

  3. Schwendicke F, Stolpe M, Meyer-Lueckel H, Paris S, Dorfer CE (2013) Cost-effectiveness of one-and two-step incomplete and complete excavations. J Dent Res 92:880–887. https://doi.org/10.1177/0022034513500792

    Article  PubMed  Google Scholar 

  4. Casagrande L, Seminario AT, Correa MB, Werle SB, Maltz M, Demarco FF, Araujo FB (2017) Longevity and associated risk factors in adhesive restorations of young permanent teeth after complete and selective caries removal: a retrospective study. Clin Oral Investig 21:847–855. https://doi.org/10.1007/s00784-016-1832-1

    Article  PubMed  Google Scholar 

  5. Bitello-Firmino L, Soares VK, Damé-Teixeira N, Parolo CCF, Maltz M (2018) Microbial load after selective and complete caries removal in permanent molars: a randomized clinical trial. Braz Dent J 29:290–295. https://doi.org/10.1590/0103-6440201801816

    Article  PubMed  Google Scholar 

  6. Maltz M, Garcia R, Jardim JJ, Paula LM, Yamaguti PM, Moura MS, Garcia F, Nascimento C, Oliveira A, Mestrinho HD (2012) Randomized trial of partial vs. stepwise caries removal: 3-year follow-up. J Dent Res 91:1026–1031. https://doi.org/10.1177/0022034512460403

    Article  PubMed  Google Scholar 

  7. Pratiwi AR, Meidyawati R, Djauharie N (2017) The effect of MTA application on the affected dentine remineralization after partial caries excavation (in vivo). Journal of Physics: Conf Series 884:012119. https://doi.org/10.1088/1742-6596/884/1/012119

    Article  Google Scholar 

  8. Fusayama T (1997) The process and results of revolution in dental caries treatment. Int Dent J 47:157–166

    Article  Google Scholar 

  9. Innes NP, Frencken JE, Bjorndal L, Maltz M, Manton DJ, Ricketts D, Van Landuyt K, Banerjee A, Campus G, Doméjean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona A, Schwendicke F (2016) Managing carious lesions: consensus recommendations on terminology. Adv Dent Res 28:49–57. https://doi.org/10.1177/0022034516639276

    Article  PubMed  Google Scholar 

  10. Bjørndal L, Larsen T, Thylstrup A (1997) A clinical and micro-biological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res 31:411–417. https://doi.org/10.1159/000262431

    Article  PubMed  Google Scholar 

  11. Bjørndal L, Larsen T (2000) Changes in the cultivable flora in deep carious lesions following a stepwise excavation procedure. Caries Res 34:502–508. https://doi.org/10.1159/000016631

    Article  PubMed  Google Scholar 

  12. Bjørndal L (2008) Indirect pulp therapy and stepwise excavation. Pediat Dent 30:225–229. https://doi.org/10.1016/j.joen.2008.02.035

    Article  Google Scholar 

  13. Maltz M, Koppe B, Jardim JJ, Alves LS, Paula LM, Yamaguti PM, Almeida JCF, Moura MS, Mestrinho HD (2018) Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial. Clin Oral Investig 22:1337–1343. https://doi.org/10.1007/s00784-017-2221-0

    Article  PubMed  Google Scholar 

  14. Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE (2013) Operative caries management in adults and children. Cochrane Database Syst Rev 3. https://doi.org/10.1002/14651858.CD003808.pub3

  15. Li T, Zhai X, Song F, Zhu H (2018) Selective versus non-selective removal for dental caries: a systematic review and meta-analysis. Acta Odontol Scand 76:135–140. https://doi.org/10.1080/00016357.2017.1392602

    Article  PubMed  Google Scholar 

  16. Schwendicke F, Dörfer CE, Paris S (2013) Incomplete caries removal: a systematic review and meta-analysis. J Dent Res 92:306–314. https://doi.org/10.1177/0022034513477425

    Article  PubMed  Google Scholar 

  17. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj 343:d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wells G, Shea B, O’Connell D (2012) The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. Ottawa, ON. http://www.ohri.ca/programs/clinical_epidemiology/oxford_web.ppt. Accessed 12 October 2018

  19. Maltz M, Moura MS, Jardim JJ, Marques C, Paula LM, Metrinho HD (2010) Partial caries removal in deep lesions: 19-30 months follow-up study. Rev Fac Odontol 51:20–23

    Google Scholar 

  20. Maltz M, Jardim JJ, Mestrinho HD, Yamaguti PM, Podestá K, Moura MS, Paula LM (2013) Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results. Caries Res 47:103–109. https://doi.org/10.1159/000344013

    Article  PubMed  Google Scholar 

  21. Orhan AI, Oz FT, Ozcelik B, Orhan K (2008) A clinical and microbiological comparative study of deep carious lesion treatment in deciduous and young permanent molars. Clin Oral Investig 12:369–378. https://doi.org/10.1007/s00784-008-0208-6

    Article  PubMed  Google Scholar 

  22. Orhan AI, Oz FT, Orhan K (2010) Pulp exposure occurrence and outcomes after 1-or 2-visit indirect pulp therapy vs complete caries removal in primary and permanent molars. Pediatr Dent 32:347–355

    PubMed  Google Scholar 

  23. Rando-Meirelles MPM, Tôrres LHN, Sousa M (2013) Twenty-four months of follow-up after partial removal of carious dentin: a preliminary study. Dentistry. 3:2161–1122.1000162. https://doi.org/10.4172/2161-1122.1000162

    Article  Google Scholar 

  24. Kaukua N, Chen M, Guarnieri P, Dahl M, Lim ML, Yucel-Lindberg T, Sundstrom E, Adameyko I, Mao JJ, Fried K (2015) Molecular differences between stromal cell populations from deciduous and permanent human teeth. Stem Cell Res Ther 6:59. https://doi.org/10.1186/s13287-015-0056-7

    Article  PubMed  PubMed Central  Google Scholar 

  25. da Rosa WLO, Lima VP, Moraes RR, Piva E, da Silva AF (2018) Is a calcium hydroxide liner necessary in the treatment of deep caries lesions? A systematic review and meta-analysis. Int Endod J 52:588–603. https://doi.org/10.1111/iej.13034

    Article  PubMed  Google Scholar 

  26. Oliveira EF, Carminatti G, Fontanella V, Maltz M (2006) The monitoring of deep caries lesions after incomplete dentine caries removal: results after 14–18 months. Clin Oral Investig 10:134–139. https://doi.org/10.1007/s00784-006-0033-8

    Article  PubMed  Google Scholar 

  27. Thompson V, Craig RG, Curro FA, Green WS, Ship JA (2008) Treatment of deep carious lesions by complete excavation or partial removal: a critical review. J Am Dent Assoc 139:705–712

    Article  Google Scholar 

  28. Schwendicke F, Göstemeyer G (2016) Understanding dentists’ management of deep carious lesions in permanent teeth: a systematic review and meta-analysis. Implement Sci 11:142–153. https://doi.org/10.1186/s13012-016-0505-4

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kakudate N, Yokoyama Y, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH (2019) Dentists’ practice patterns of treatment for deep occlusal caries: findings from a dental practice-based research network. J Dent 84:76–80

    Article  Google Scholar 

  30. Oen KT, Thompson VP, Vena D, Caulfield PW, Curro F, Dasanayake A, Ship JA, Lindblad A (2007) Attitudes and expectations of treating deep caries: a PEARL Network survey. Gen Dent 55:197–203

    PubMed  Google Scholar 

Download references

Funding

This study was supported by the Brazilian Governmental Agency CAPES by using the Portal de Periódicos CAPES. The first author was supported by a CAPES (National Council for the Improvement of Higher Education) scholarship funded by the Brazilian government during her Ph.D course, when this research was conducted.

Author information

Authors and Affiliations

  1. College of Dentistry, Federal University of Ceará, St. Conselheiro José Júlio, Sobral, Ceará, Brazil

    Myrna Maria Arcanjo Frota Barros

  2. Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, St. Alexandre Baraúna, 949, Rodolfo Teófilo, Fortaleza, Ceará, Brazil

    Maria Imaculada De Queiroz Rodrigues & Lidiany Karla Azevedo Rodrigues

  3. Federal University of Pelotas, St. Gonçalves Chaves, 457, Downtown, Pelotas, Rio Grande do Sul, Brazil

    Francisco Wilker Mustafa Gomes Muniz

  4. Departamento de Odontologia Restauradora, Faculdade de Farmácia, Odontologia e Enfermagem - Universidade Federal do Ceará, Rua Monsenhor Furtado, S/N, Rodolfo Teófilo, Fortaleza, Ceará, 60430-355, Brazil

    Lidiany Karla Azevedo Rodrigues

Authors
  1. Myrna Maria Arcanjo Frota Barros
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Imaculada De Queiroz Rodrigues
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francisco Wilker Mustafa Gomes Muniz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lidiany Karla Azevedo Rodrigues
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lidiany Karla Azevedo Rodrigues.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barros, M.M.A.F., De Queiroz Rodrigues, M.I., Muniz, F.W.M.G. et al. Selective, stepwise, or nonselective removal of carious tissue: which technique offers lower risk for the treatment of dental caries in permanent teeth? A systematic review and meta-analysis. Clin Oral Invest 24, 521–532 (2020). https://doi.org/10.1007/s00784-019-03114-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-019-03114-5

Keywords

Search

Navigation