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Meta-Analysis
. 2022 Jan 24;22(1):e8227.
doi: 10.5867/medwave.2022.01.8226.

Stepwise removal compared to complete removal for deep carious lesions

[Article in Spanish, English]
María Massón  1 , Andrés Viteri-García  1 , Francisca Verdugo-Paiva  2
Affiliations
Meta-Analysis

Stepwise removal compared to complete removal for deep carious lesions

[Article in Spanish, English]
María Massón et al. Medwave. .

Abstract
in English, Spanish

Introduction: Carious lesions have traditionally been treated by non-selective (complete or total) removal of carious tissue. However, due to its risks and adverse effects, carious tissue removal techniques have been developed, based on the preservation of tooth tissue, including the stepwise removal. The objective of this summary is to clarify the uncertainty about the effectiveness and safety of the stepwise removal technique compared to complete removal.

Methods: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by searching multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from identified reviews, reanalyzed data from primary studies, performed a meta-analysis, and prepared summary tables of results using the GRADE method.

Results and conclusions: We identified three systematic reviews that included five primary studies, four of them corresponding to randomized trials. We concluded that stepwise removal may reduce the risk of pulp exposure, the risk of signs and symptoms of pulp disease and the risk of restoration failure, but the certainty of the evidence is low.

Introduccion: Las lesiones cariosas han sido tradicionalmente tratadas mediante la remoción total (completa o no selectiva) del tejido cariado. Sin embargo, debido a sus riesgos y efectos adversos, se han desarrollado nuevas técnicas de remoción del tejido cariado, basadas en la conservación del tejido dentario, entre ellas la remoción en dos pasos o stepwise. El objetivo de este resumen es aclarar la incertidumbre sobre la efectividad y la seguridad de la técnica de remoción en dos pasos (stepwise) comparado con la remoción total.

Métodos: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metaanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE.

Resultados y conclusiones: Identificamos tres revisiones sistemáticas que en conjunto incluyeron cinco estudios primarios, de los cuales cuatro corresponden a ensayos aleatorizados. Concluimos que la remoción en dos pasos (stepwise) podría disminuir el riesgo de exposición pulpar, el riesgo de aparición de signos y síntomas pulpares y la falla en la restauración, pero la certeza de la evidencia es baja.

Keywords: Epistemonikos; GRADE.; complete caries removal; deep carious lesions; two step caries removal; stepwise removal.

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