Partial caries removal in symptomless teeth reduces the risk of pulp exposure

Abstract

Data sources: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, PubMed and Embase databases were searched. The reference lists in relevant papers were checked.

Study selection: Studies chosen were randomised controlled trials and controlled clinical trials that compared minimal (ultraconservative) caries removal with complete caries removal in unrestored permanent and deciduous teeth.

Data extraction and synthesis: Outcome measures recorded were exposure of the nerve of the tooth (pulp) during caries removal, patient experience of symptoms of pulpal inflammation or necrosis, progression of caries under the filling, and time until the filling was lost or replaced. Because of the heterogeneity of the included studies, the overall estimate of effect was calculated using a random-effects model.

Results: Four studies met the inclusion criteria, comprising two stepwise excavation studies and two ultraconservative caries removal studies. Partial caries removal in symptomless, primary or permanent teeth reduces the risk of pulp exposure. No detriment to the patient was found in terms of pulpal symptoms in this procedure and there was no reported premature loss or deterioration of the restoration.

Conclusions: Partial caries removal in symptomless, primary or permanent teeth reduces the risk of pulp exposure. We found no detriment to the patient in terms of pulpal symptoms in this procedure. Therefore, partial caries removal is preferable to complete caries removal in the deep lesions in order to reduce the risk of carious exposure. There is insufficient evidence, however, to know whether it is necessary to re-enter and excavate further - although studies that have not re-entered do not report adverse consequences.