IADR Abstract Archives
Effects of using different criteria for caries removal: A Network-Meta-Analysis
Objectives: Conventionally, caries excavation is performed until only hard dentin remains. Using other, more selective or reliable criteria might be advantageous. We aimed at systematically comparing the effects of using different excavation criteria via network meta-analysis.
Methods: Electronic databases were searched for randomised or non-randomised clinical trials (RCTs/NRCTs) evaluating excavation of cavitated lesions. Criteria were divided into six groups: Excavation until pulpo-proximal dentin on the cavity floor was (1) either hard on probing, (2) slightly softened on probing, (3) not stainable by caries-detector-dye, or until (4) self-limiting polymer burs, (5) fluorescence-assisted devices or (6) chemo-mechanical gels indicated termination of the excavation. Evaluation of risk of failure (pulpal exposure, pulpal and non-pulpal complications), risk of pain/discomfort, excavation time, and number of remaining bacteria were then undertaken using Bayesian network meta-analysis.
Results: 28 studies (19 RCTs, 9 NRCTs) with 1782 patients (2555 lesions), most of them investigating primary teeth, were included. Risk of failure was highest when excavating until only non-stainable dentin remained, and lowest when not attempting to remove all softened dentin. Risk of pain significantly decreased if self-limiting chemo-mechanical excavation or fluorescence-assisted lasers were used instead of excavating until all dentin was hard. When not attempting to remove all softened dentin, the time required for excavation was shortest, whilst the greatest number bacteria remained.
Conclusions: Not attempting to remove all softened or stainable dentin might reduce the risk of failure. Data regarding self-limiting excavation is insufficient for definitive conclusions. Excavation criteria should be validated against clinically relevant outcomes rather than surrogates like numbers of remaining bacteria.
Methods: Electronic databases were searched for randomised or non-randomised clinical trials (RCTs/NRCTs) evaluating excavation of cavitated lesions. Criteria were divided into six groups: Excavation until pulpo-proximal dentin on the cavity floor was (1) either hard on probing, (2) slightly softened on probing, (3) not stainable by caries-detector-dye, or until (4) self-limiting polymer burs, (5) fluorescence-assisted devices or (6) chemo-mechanical gels indicated termination of the excavation. Evaluation of risk of failure (pulpal exposure, pulpal and non-pulpal complications), risk of pain/discomfort, excavation time, and number of remaining bacteria were then undertaken using Bayesian network meta-analysis.
Results: 28 studies (19 RCTs, 9 NRCTs) with 1782 patients (2555 lesions), most of them investigating primary teeth, were included. Risk of failure was highest when excavating until only non-stainable dentin remained, and lowest when not attempting to remove all softened dentin. Risk of pain significantly decreased if self-limiting chemo-mechanical excavation or fluorescence-assisted lasers were used instead of excavating until all dentin was hard. When not attempting to remove all softened dentin, the time required for excavation was shortest, whilst the greatest number bacteria remained.
Conclusions: Not attempting to remove all softened or stainable dentin might reduce the risk of failure. Data regarding self-limiting excavation is insufficient for definitive conclusions. Excavation criteria should be validated against clinically relevant outcomes rather than surrogates like numbers of remaining bacteria.