Cochrane · intervention · CD003808

Operative caries management in adults and children

Cochrane Database of Systematic Reviews · 2013 · Cochrane Library

Oral Health Dental caries3 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

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

Current version only

Stepwise 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

CD003808.PUB3 (current) · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Progression of caries same question in other reviews	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 same question in other reviews	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 same question in other reviews	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 same question in other reviews	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 same question in other reviews	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

CD003808.PUB3 (current) · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Pulp exposure during caries removal During caries removal same question in other reviews	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 same question in other reviews	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 same question in other reviews	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

CD003808.PUB3 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Failure of restorations 1 year (2-year and 5-year data also available for Innes 2007) same question in other reviews	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 same question in other reviews	RR 0.20 [0.02, 1.72] -40 [-49, 36] per 1000	1 study · 132 participants	Moderate Downgraded: risk of bias

Partial / minimal (ultraconservative) caries removal prior to restoration (predominantly stepwise excavation) vs Complete caries removal prior to restoration (one stage)

Population: Patients with untreated dentinal decay requiring a filling, in unrestored (previously unfilled) primary or permanent teeth

CD003808.PUB2 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Exposure of the nerve of the tooth during caries removal During caries removal (after second-stage re-entry)	RR 0.35 [0.22, 0.56]	2 studies · 237 participants	Ungraded
Progression of caries under the filling	no estimate extracted	0 studies	No studies
Time until the filling is lost or replaced (restoration longevity) Up to 2 years	Only the Mertz-Fairhurst 1987 study investigated this outcome; no restorations were lost or replaced in the first 2 years of the study. No pooled estimate reported.	1 study	Ungraded
Signs and symptoms of pulpal pathology (patient experience of pulpal inflammation or necrosis) 1 year	RR 0.81 [0.20, 3.25]	3 studies · 410 participants	Ungraded

Minimal (ultraconservative) caries removal prior to restoration vs Complete caries removal prior to restoration (one stage)

Population: Patients with untreated dentinal decay requiring a filling, in unrestored (previously unfilled) primary or permanent teeth

CD003808 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Patient experience of symptoms of pulpal inflammation or necrosis	no estimate extracted	NR	No studies
Exposure of the nerve of the tooth (pulp) during caries removal	no estimate extracted	NR	No studies
Progression of caries under the filling	no estimate extracted	NR	No studies
Time until the filling is lost or replaced (restoration longevity)	no estimate extracted	NR	No studies