Myrna Maria Arcanjo Frota Barros1, Maria Imaculada De Queiroz Rodrigues2, Francisco Wilker Mustafa Gomes Muniz3, Lidiany Karla Azevedo Rodrigues4,5. 1. College of Dentistry, Federal University of Ceará, St. Conselheiro José Júlio, Sobral, Ceará, Brazil. 2. Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, St. Alexandre Baraúna, 949, Rodolfo Teófilo, Fortaleza, Ceará, Brazil. 3. Federal University of Pelotas, St. Gonçalves Chaves, 457, Downtown, Pelotas, Rio Grande do Sul, Brazil. 4. Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, St. Alexandre Baraúna, 949, Rodolfo Teófilo, Fortaleza, Ceará, Brazil. lidianykarla@ufc.br. 5. 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. lidianykarla@ufc.br.
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.
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.
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