Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

15 questions · 31 findings · 5 reviews · All outcomes

No studies found 0 · 0%GRADE not reported 31 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Selective or stepwise carious tissue removal vs Non-selective or complete carious tissue removal

Proportion of dentists selecting selective or stepwise removal · Dentists surveyed about deep carious lesions in permanent teeth

In Oen 2007, 18% of surveyed dentists selected selective or stepwise removal.

12 findings from 1 review
Show 9 more findings

Selective carious tissue removal (selective excavation, SE) vs Non-selective or complete carious tissue removal

Pulp exposure during caries removal · Children with dentine caries in primary and permanent teeth

Partial caries removal was reported to reduce pulp-exposure risk by 77% versus complete caries removal (RR 0.23; ungraded).

1 finding from 1 review

Selective carious tissue removal (selective excavation, SE) vs Non-selective or complete carious tissue removal

Pulp exposure during caries removal · Children (3-11 years) with symptomless, vital dentine caries in primary molars

Partial caries removal reduced the reported risk of pulp exposure versus complete caries removal in primary teeth (RR 0.24; ungraded).

1 finding from 1 review

Selective carious tissue removal (selective excavation, SE) vs Non-selective or complete carious tissue removal

Pulpal disease (signs/symptoms of pulp necrosis) · Children with dentine caries in primary and permanent teeth

The reported estimate did not show a clear difference in pulpal disease after partial versus complete caries removal (ungraded).

1 finding from 1 review

Selective or stepwise carious tissue removal vs Non-selective or complete carious tissue removal

Proportion of dentists utilizing SE/SW for deep carious lesions · Dentists managing deep carious lesions in permanent vital teeth

Across nine surveys of 4199 dentists, a pooled 53% (95% CI 44% to 62%) chose selective or stepwise (evidence-based) carious tissue removal for deep lesions in permanent teeth, with very high heterogeneity (I2=96%) and no formal certainty rating (ungraded).

1 finding from 1 review

Selective or stepwise carious tissue removal vs Non-selective or complete carious tissue removal

Barriers and facilitators of SE/SW utilization · Dentists managing deep carious lesions in permanent vital teeth

Dentists' use of selective or stepwise removal was shaped by their age and understanding of caries, professional guidelines, peers and professional identity, financial and regulatory incentives, and beliefs about how treatments perform, identified by thematic analysis mapped to the TDF and Behavior Change Wheel (ungraded).

1 finding from 1 review

Selective or stepwise carious tissue removal vs Non-selective or complete carious tissue removal

Temporal change in the proportion of dentists utilizing SE/SW · Dentists managing deep carious lesions in permanent vital teeth

The proportion of dentists choosing selective or stepwise removal rose significantly over time, by about 1.6% per calendar year (meta-regression, p<0.05), a trend the authors described as borderline (ungraded).

1 finding from 1 review

Minimally invasive caries removal (MIT): selective removal to soft dentin, self-limiting chemomechanical removal, or partial/incomplete caries removal vs Conventional caries removal (CT): selective removal to firm dentin, stepwise excavation, or complete caries removal

Pulp exposure rate · Patients with deep carious lesions in permanent (mainly posterior) teeth

Minimally invasive caries removal was associated with a lower mean pulp exposure rate than conventional removal (1.2% vs 8.1%), but the difference was not statistically significant (Wilcoxon, p = 0.068); certainty of evidence was not graded.

1 finding from 1 review

Minimally invasive caries removal (MIT): selective removal to soft dentin, self-limiting chemomechanical removal, or partial/incomplete caries removal vs Conventional caries removal (CT): selective removal to firm dentin, stepwise excavation, or complete caries removal

Treatment success (caries lesion arrest or restoration survival) · Patients with deep carious lesions in permanent (mainly posterior) teeth

Minimally invasive caries removal showed a marginally higher mean restoration success rate than conventional removal (83.6% vs 75.4%), but the difference was not statistically significant (Mann-Whitney U, p > 0.05); certainty of evidence was not graded.

1 finding from 1 review

Selective caries removal (SCR) + composite resin vs Complete caries removal (CCR) + composite resin

Restoration failure · Children with carious primary teeth after vital or non-vital pulp therapy

In one RCT, selective caries removal had a 3.44 higher probability of failure than complete caries removal.

1 finding from 1 review

Selective caries removal (SCR) + composite resin vs Complete caries removal (CCR) + composite resin

Treatment failure (annual failure rate) · Children with deep dentine caries in primary molars restored with composite resin (indirect pulp treatment; pulpotomy only if pulp exposed…

Complete caries removal with composite resin had an annual failure rate of 6.8% in primary molars (single high-risk-of-bias RCT; low quality of evidence; not GRADE-rated).

2 findings from 1 review

Fluoride concentration relative to the acceptable range (electrometric ion-selective electrode measurement; acceptable range mostly 0.6-0.8 ppmF) vs None (descriptive proportion meta-analysis)

Water samples with fluoride concentration below the acceptable range · Artificially fluoridated public water supply in Brazilian cities (water samples under external control)

In the Northeast Brazilian region, a pooled 79.7% of water samples had fluoride below the acceptable range; ungraded.

2 findings from 1 review

Fluoride concentration relative to the acceptable range (electrometric ion-selective electrode measurement; acceptable range mostly 0.6-0.8 ppmF) vs None (descriptive proportion meta-analysis)

Water samples with fluoride concentration above the acceptable range · Artificially fluoridated public water supply in Brazilian cities (water samples under external control)

In the Southeast Brazilian region, a pooled 11.5% of water samples had fluoride above the acceptable range; ungraded.

2 findings from 1 review

Fluoride concentration relative to the acceptable range (electrometric ion-selective electrode measurement; acceptable range mostly 0.6-0.8 ppmF) vs None (descriptive proportion meta-analysis)

Water samples with fluoride concentration outside the acceptable range · Artificially fluoridated public water supply in Brazilian cities (water samples under external control)

In Brazilian cities using external control, more than half of artificially fluoridated public water supply samples (pooled 56.6%, 95% CI 45.5 to 67.3) had fluoride concentrations outside the acceptable range, with very high heterogeneity (I2=99.5%); ungraded.

3 findings from 1 review

Stepwise excavation (two-stage caries removal, re-entry after an interval) vs Non-selective or complete carious tissue removal

Pulp exposure during caries removal · Children (3-11 years) with symptomless, vital dentine caries in primary molars

Stepwise excavation reduced the reported risk of pulp exposure by 69% versus complete caries removal (RR 0.31; ungraded).

1 finding from 1 review