Non-Cochrane · intervention · PM42782997
Complete, Selective, and Stepwise Carious Tissue Removal for Deep Carious Lesions in Vital Permanent Teeth: A Systematic Review and Meta-Analysis.
Laville Emile, Rodrigues Alexandra Pinto, Mascarenhas Paulo · Dentistry journal · 2026 · PubMed · doi:10.3390/dj14090610
Findings
33 findings
| Population | ||||
|---|---|---|---|---|
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Restorative failure 18 months · Recchi 2024; sensitivity | HR 3.846 [0.585, 25] Very low Downgraded: risk of bias, imprecision 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Intraoperative pulp exposure Intraoperative · ICC 0.05 sensitivity | RR 0.11 [0.003, 4.54] GRADE not reported 3 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Late pulpal failure 36 months · Maltz 2012 | HR 0.21 [0.07, 0.63] Moderate Downgraded: risk of bias 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Intraoperative pulp exposure Intraoperative · ICC 0.2 sensitivity | RR 0.11 [0.003, 4.85] GRADE not reported 3 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Late pulpal failure 12–24 months · Consistency model; exploratory network | RR 0.66 [0.15, 2.87] GRADE not reported 5 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Late pulpal failure 12–24 months · ICC 0.05 sensitivity | RR 0.5 [0.01, 21.52] GRADE not reported 3 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Intraoperative pulp exposure Intraoperative · Primary direct random-effects, ICC 0.10 | RR 0.111 [0.00264, 4.64] -37 [-42, 152] per 1000 Very low Downgraded: risk of bias, imprecision 3 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Intraoperative pulp exposure Intraoperative · No continuity correction; modified Knapp–Hartung | RD -0.036 [-0.083, 0.012] GRADE not reported 3 studies |
| Vital permanent teeth with deep carious lesions (children, adolescents and adults) | Selective carious tissue removal (SCR) | Stepwise carious tissue removal (SWR) | Late pulpal failure 12-24 months · Dental clinical trials (Europe, Africa, South America, Asia) · Exploratory network: unrelated mean-effects (inconsistency) model | RR 0.50 [0.10, 2.60] GRADE not reported 3 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Late pulpal failure 60 months · Maltz 2018 | HR 0.38 [0.23, 0.63] Moderate Downgraded: risk of bias 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Late pulpal failure 12–24 months · ICC 0 sensitivity | RR 0.5 [0.01, 21.52] GRADE not reported 3 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Intraoperative pulp exposure Intraoperative · Exact conditional CMH common effect | OR 0 [0, 0.344] GRADE not reported 3 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Late pulpal failure 12–24 months · Primary direct random-effects, ICC 0.10 | RR 0.499 [0.0116, 21.5] -45 [-90, 909] per 1000 Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Intraoperative pulp exposure Intraoperative · ICC 0 sensitivity | RR 0.11 [0.003, 4.44] GRADE not reported 3 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Restorative failure 60 months · Jardim 2020 | HR 0.83 [0.41, 1.69] Very low Downgraded: risk of bias, imprecision 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Late pulpal failure 12–24 months · ICC 0.2 sensitivity | RR 0.5 [0.01, 21.53] GRADE not reported 3 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Restorative failure 12–24 months · Recchi 2024; study-specific | RR 1.75 [0.32, 9.49] Very low Downgraded: risk of bias, imprecision 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Overall complications 12 months · Labib 2019; composite | HR 0.67 [0.24, 1.85] GRADE not reported 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Restorative failure 12–24 months · Maltz 2013; double-zero sensitivity | RD 0 [-0.038, 0.034] GRADE not reported 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Restorative failure 12–24 months · Labib 2019; double-zero sensitivity | RD 0 [-0.056, 0.056] GRADE not reported 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Stepwise carious tissue removal | Intraoperative pulp exposure Intraoperative · Conventional Knapp–Hartung | RR 0.11 [0.063, 0.196] GRADE not reported 3 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Complete carious tissue removal | Late pulpal failure 12–24 months · Unrelated mean-effects model; exploratory network | RR 5 [0.11, 234.07] GRADE not reported 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Complete carious tissue removal | Intraoperative pulp exposure Intraoperative · Ahmed 2021; study-specific | RR 0.07 [0.004, 1.12] Very low Downgraded: risk of bias, imprecision 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Complete carious tissue removal | Intraoperative pulp exposure Intraoperative · Khokhar 2018; study-specific | RR 0.04 [0.002, 0.63] Very low Downgraded: risk of bias, imprecision 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Complete carious tissue removal | Late pulpal failure 12–24 months · Rando-Meirelles 2013; double-zero sensitivity | RD 0 [-0.324, 0.324] GRADE not reported 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Complete carious tissue removal | Late pulpal failure 12–24 months · Ahmed 2021; study-specific | RR 5 [0.25, 99.95] Very low Downgraded: risk of bias, imprecision 1 study |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Complete carious tissue removal | Late pulpal failure 12–24 months · Consistency model; exploratory network | RR 1.14 [0.12, 10.85] GRADE not reported 5 studies |
| Patients with vital permanent teeth and deep carious lesions | Selective carious tissue removal | Complete carious tissue removal | Late pulpal failure 18 months · Khokhar 2018; conditional on no exposure | RR 4.18 [0.5, 34.73] GRADE not reported 1 study |
| Patients with vital permanent teeth and deep carious lesions | Stepwise carious tissue removal | Complete carious tissue removal | Intraoperative pulp exposure Intraoperative · Bjørndal 2010; study-specific | RR 0.61 [0.39, 0.94] Low Downgraded: risk of bias, imprecision 1 study |
| Patients with vital permanent teeth and deep carious lesions | Stepwise carious tissue removal | Complete carious tissue removal | Late pulpal failure 12–24 months · Unrelated mean-effects model; exploratory network | RR 0.96 [0.08, 12.03] GRADE not reported 1 study |
| Patients with vital permanent teeth and deep carious lesions | Stepwise carious tissue removal | Complete carious tissue removal | Late pulpal failure 12–24 months · Bjørndal 2010; study-specific | RR 0.96 [0.45, 2.04] Very low Downgraded: risk of bias, imprecision 1 study |
| Patients with vital permanent teeth and deep carious lesions | Stepwise carious tissue removal | Complete carious tissue removal | Late pulpal failure 12–24 months · Consistency model; exploratory network | RR 1.73 [0.23, 13.24] GRADE not reported 5 studies |
| Patients with vital permanent teeth and deep carious lesions | Stepwise carious tissue removal | Complete carious tissue removal | Late pulpal failure 60 months · Bjørndal 2017 | HR 0.667 [0.455, 1.053] Low Downgraded: risk of bias, imprecision 1 study |
Included primary studies 11
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Jardim 2020 Restorations after selective caries removal: 5-Year randomized trial. PMID:32585263 | 2020 | 2 other reviews | not stated | not extracted yet |
| Khokhar 2018 Outcomes of Partial and Complete Caries Excavation in Permanent Teeth: A 18 Month Clinical Study. PMID:30166846 | 2018 | 1 other review | not stated | not extracted yet |
| Labib 2019 Selective versus stepwise removal of deep carious lesions in permanent teeth: a randomised controlled trial from Egypt-an interim analysis. PMID:31530615 | 2019 | 1 other review | not stated | not extracted yet |
| Maltz 2018 Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial. PMID:28988345 | 2018 | 1 other review | not stated | not extracted yet |
| Ahmed 2021 Comparison of Partial and Complete Caries Excavation in Permanent Teeth: An 18 Months Follow-up DOI:10.53350/pjmhs211551214 | 2021 | this review only | not stated | not extracted yet |
| Bjorndal 2010 Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp… PMID:20572864 | 2010 | this review only | not stated | not extracted yet |
| Bjorndal 2017 Randomized Clinical Trials on Deep Carious Lesions: 5-Year Follow-up. PMID:28410008 | 2017 | this review only | not stated | not extracted yet |
| Maltz 2012 Randomized trial of partial vs. stepwise caries removal: 3-year follow-up. PMID:22983407 | 2012 | this review only | not stated | not extracted yet |
| Maltz 2013 Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results. PMID:23207420 | 2013 | this review only | not stated | not extracted yet |
| Rando-Meirelles 2013 Twenty-Four Months Of Follow-Up After Partial Removal Of Carious Dentin: A Preliminary Study DOI:10.4172/2161-1122.1000162 | 2013 | this review only | not stated | not extracted yet |
| Recchi 2024 Restorations performance after selective caries removal to soft dentine: 18-month follow-up of a controlled clinical trial. PMID:38797489 | 2024 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients of any age with vital permanent teeth with deep carious lesions (at least middle third of dentin), without irreversible pulpitis, necrosis or apical disease | Children, adolescents and adults with deep lesions (middle third to three quarters of dentin) mainly in permanent molars and premolars; Europe, Africa, South America and Asia (n=7 trial families) |
| Intervention | Complete (CCR), selective (SCR) or stepwise (SWR) carious tissue removal | SCR (n=6 families), SWR (n=4 families), CCR (n=4 families) |
| Comparison | Another of CCR, SCR or SWR (direct comparison of at least two) | SCR vs SWR (n=3 families), SCR vs CCR (n=3 families), SWR vs CCR (n=1 family) |
| Outcomes | Intraoperative pulp exposure; late pulpal failure; restorative failure; composite clinical-radiographic outcomes (descriptive) | Intraoperative pulp exposure and late pulpal failure at 12-24 months pooled for SCR vs SWR; other contrasts, restorative failure and adjusted 36-60-month HRs reported study by study; composite outcome descriptive |
| Study designs | Randomized clinical trials | 11 reports from 7 randomized trial families |
| Timing | Post-treatment outcomes with at least 12 months of follow-up; exposure intraoperative | Intraoperative; 12-24 months; adjusted time-to-event estimates at 18, 36 and 60 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | No | no |
| 3Choice of study designs explained | No | Yes | no |
| 4Comprehensive literature searchcritical | No | Partial Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | Yes | no |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |