Is It Ok to Leave Caries?

Take-Home Pearl: Incomplete removal of deep caries is a vable alternative to complete caries removal.

Article Reviewed: Schwendicke F, Dörfer CE, Paris S. Incomplete Caries Removal: A Systematic Review and Meta-Analysis. J Dent Res 2013;92 (April): 306-314.

Objective: To inventory research knowledge about incomplete caries removal methods, for both practical and scientific purposes.

Design: this was systematic review of randomized cotrolled clinical studies of patients with primary dentin caries in permanent or deciduous teeth requiring a restoration. The clinical outcomes recorded included pulp exposure during treatment, postoperative pulpal symptoms, and failure (eg, restoration lost or replaced). Complete and incomplete caries removal techniques were investigated. Incomplete techniques included one-and two-step excavation and indirect pulp capping. If a tooth was re-entered for microbial sampling or dentin evaluation, the treathment was classified as one-step incomplete caries removal rather than stepwise. Noninvasive treatments such as sealing over caries were not included in the analysis. The literature search involved several electronic databases such as Medline. Two calibrated reviewers screened studies for eligibility. The potential for bias in each study was assessed according to Cochrane guidelines.

Results: Over 300 studies were identified as possibly eligible for the review, but most were excluded for various reasons. Ten studies reported in 17 papers were selected. These involved 1257 patients and 1628 teeth and had been conducted in Scandinavia, Turkey, the United States, Brazil and Thailand. A range of materials were used in the restorations. The meta analysis showed a reduction in risk of pulp exposure and postoperative pulpal symptoms for teeth using either one-step or two-step incomplete excavation versus complete caries excavation. The risk of failure was similar for both complete and incomplete excavation, but the data were inconclusive.

Conclusions:Incomplete removal of deep caries is a viable alternative to complete caries removal.

Reviewer's Comments: There is growing evidence supporting incomplete removal of carious dentin before a restoration is placed, on the assumption that a completely sealed lesion will not progress. This review of the literature concluded that incomplete caries removal is supported by extensive resaerch. It results in fewer problems and no more restorative complications than traditional complete caries removal. Incomplete caries removal was effective in both one-step and two-step (or "stepwise") procedures. In the former, a permanent restoration is placed over remaining caries; in the latter, the tooth is re-entered to remove any remaining caries before the permanent restoration is placed.

Reviewer: Edward J. Swift, Jr, DMD, MS


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