Which to choose: complete vs. incomplete caries removal? A Systematic Review
For nearly a century, dental caries has been treated by attempted eradication: Bacteria and all infected dental biomass (1) were removed, and the resulting cavity was subsequently restored. As knowledge and attitudes concerning the dental biofilm and pathogenesis of caries changed, the common treatment procedure for caries lesions was questioned as well. (2)
The complete removal of all carious tooth substance from cavitated lesions is no longer seen as mandatory, and there is growing evidence supporting incomplete removal of carious tissue before the cavity is restored. (4) Theoretically, it is argued, a completely sealed remaining caries lesion should be arrested. Hence, therapy of cavitated lesions may require less focus on complete excavation than on adequate restorations (5, 2)
Purpose of the Review
The aim was to systematically review randomized controlled trials investigating one- or two-step incomplete compared with complete caries removal. Studies treating primary and permanent teeth with primary caries lesions requiring a restoration were analyzed.
The following primary and secondary outcomes were investigated: risk of pulpal exposure, post-operative pulpal symptoms, overall failure, and caries progression.
- Incomplete caries removal seems advantageous, particularly in the treatment of caries in proximity to the pulp, since it significantly reduces the risks of pulpal exposure and post-operative pulpal symptoms compared with complete excavation.
- Effect estimates showed considerable reduction of pulp exposure and post-operative pulpal complications for incomplete excavation compared with complete caries removal.
- Risk of total failure, after exclusion of teeth with exposed pulps, was similar for incompletely and completely excavated teeth.
- It remains unclear whether leaving more carious dentin may be beneficial (fewer pulp exposures and symptoms) or detrimental (higher risk of failure and caries progression).
- There is currently no evidence that incompletely excavated teeth are more prone to complications. However, because of high risk of bias within studies, evidence levels are limited, and further research is required before definitive conclusions can be drawn.
- Fusayama T, Okuse K, Hosoda H (1966). Relationship between hardness, discoloration, and microbial invasion in carious dentin. J Dent Res 45:1033-1046.
- Kidd EA (2004). How ‘clean’ must a cavity be before restoration? Caries Res 38:305-313.
- Kidd EA, Fejerskov O (2004). What constitutes dental caries? Histopathology of carious enamel and dentin related to the action of cariogenic biofilms. J Dent Res 83(Spec No.C):C35-C38.
- Banerjee A, Watson TF, Kidd EA (2001). Dentine caries: take it or leave it? S Afr Dent J 56:189-192.
- Ricketts D (2001). Restorative dentistry: management of the deep carious lesion and the vital pulp dentine complex. Br Dent J 191:606-610.
Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at email@example.com
You are invited to comment on this post and provide further insights by posting in the comment box which you will find by clicking on “Post a reply” below. You are welcome to remain anonymous and your email address will not be posted.