Cochrane · intervention · CD003808
Operative caries management in adults and children
Cochrane Database of Systematic Reviews · 2013 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
10
current version
GRADE rated
9
No studies
1
Included studies
8
as reported
No studies 1 · 10%Ungraded 0 · 0%Very low 1 · 10%Low 1 · 10%Moderate 7 · 70%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with carious teeth, affecting any tooth surface(s), in unrestored primary and permanent teeth | 934 participants with 1372 teeth treated; outcome data for 1191 teeth available for analysis |
| Intervention | Stepwise, partial or no dentinal caries removal prior to restoration | Stepwise excavation (n=4); Partial caries removal (n=3); No dentinal caries removal (n=2) (one three-arm trial, Orhan 2010, compared complete removal with both stepwise and partial) |
| Comparison | Complete caries removal | Complete caries removal (n=8) |
| Outcomes | Exposure of the dental pulp during caries removal; Signs or symptoms of pulpal disease; Progression of caries; Restoration failure (primary); Health economic measures; Oral health related quality of life; Patient/carer and dentist perceptions of treatment; Patient discomfort during treatment (secondary) | Exposure of the dental pulp during caries removal (n=5); Signs or symptoms of pulpal disease at 1 year (n=7); Restoration failure (n=6); Progression of caries (n=0, no studies) |
| Study designs | Parallel group and split-mouth randomised controlled trials (RCTs), including quasi-randomised trials | Randomised controlled trials (parallel group n=6; split-mouth n=2) (n=8) |
| Timing | Mainly 1 year follow-up (outcomes recorded at time points reported in the studies) | 1 year follow-up (primary analysis); 2-year and 5-year data also available for Innes 2007 |
Search date: 2012-12. Databases: The Cochrane Oral Health Group's Trials Register (to 12 December 2012); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 11); MEDLINE via OVID (1946 to 12 December 2012); EMBASE via OVID (1980 to 12 December 2012)
Questions and results
Show all 3 versionsStepwise excavation (two-stage caries removal, re-entry after an interval) vs One stage complete caries removal
Population: Patients with carious teeth, affecting any tooth surface(s), in unrestored primary and permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression of caries | None of the eight included studies reported on the primary outcome of progression of caries. | 0 studies | No studies |
Pulp exposure during caries removal During caries removal · Secondary dentition | RR 0.51 [0.36, 0.72] -159 [-208, -91] per 1000 | 3 studies · 454 participants | Moderate Downgraded: risk of bias |
Signs or symptoms of pulpal disease 1 year | RR 0.78 [0.39, 1.58] -22 [-62, 58] per 1000 | 2 studies · 278 participants | Moderate Downgraded: risk of bias |
Pulp exposure during caries removal During caries removal · Primary dentition | RR 0.31 [0.17, 0.57] -281 [-338, -175] per 1000 | 2 studies · 173 participants | Moderate Downgraded: risk of bias |
Pulp exposure during caries removal During caries removal | RR 0.44 [0.33, 0.60] -193 [-233, -139] per 1000 | 4 studies · 627 participants | Moderate Downgraded: risk of bias |
Partial caries removal (single stage; residual dentinal caries sealed into the tooth definitively) vs Complete caries removal
Population: Patients with carious teeth, affecting any tooth surface(s), in unrestored primary and permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pulp exposure during caries removal During caries removal | RR 0.23 [0.08, 0.69] -169 [-201, -68] per 1000 | 2 studies · 141 participants | Moderate Downgraded: risk of bias |
Signs or symptoms of pulpal disease 1 year | RR 0.27 [0.05, 1.60] -34 [-45, 28] per 1000 | 3 studies · 172 participants | Low Downgraded: risk of bias, imprecision |
Failure of restorations 1 year | RR 0.33 [0.01, 7.62] -41 [-61, 414] per 1000 | 1 study · 32 participants | Very low Downgraded: risk of bias, imprecision |
No dentinal caries removal (caries sealed under a preformed metal crown or restoration without removing dentinal caries) vs Complete caries removal
Population: Patients with carious teeth, affecting any tooth surface(s), in unrestored primary and permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failure of restorations 1 year (2-year and 5-year data also available for Innes 2007) | RR 0.08 [0.02, 0.26] -340 [-363, -274] per 1000 | 1 study · 132 participants | Moderate Downgraded: risk of bias |
Signs or symptoms of pulpal disease 1 year | RR 0.20 [0.02, 1.72] -40 [-49, 36] per 1000 | 1 study · 132 participants | Moderate Downgraded: risk of bias |