title: Treatment of pulps in teeth affected by deep caries - A systematic review of the literature.
abstract: BACKGROUND
  This systematic review assesses the effect of methods commonly used to manage the pulp in cases of deep caries lesions, and the extent the pulp chamber remains uninfected and does not cause pulpal or periapical inflammatory lesions and associated tooth-ache over time.
  
  
  METHODS
  An electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to March 2013. In addition, hand searches were carried out. Two reviewers independently evaluated abstracts and full-text articles. An article was read in full if at least one of the two reviewers considered the abstract potentially relevant. Altogether, 161 articles were read in full text. Of these, 24 studies fulfilled established inclusion criteria. Based on studies of at least moderate quality, the quality of evidence of each procedure was rated in four levels according to GRADE.
  
  
  RESULTS
  No study reached the high quality level. Twelve were of moderate quality. The overall evidence was insufficient to assess which of indirect pulp capping, stepwise excavation, direct excavation and pulp capping/partial pulpotomy, pulpotomy or pulpectomy is the most effective treatment approach for teeth with deep caries.
  
  
  CONCLUSIONS
  Because of the lack of good studies it is not possible to determine whether an injured pulp by deep caries can be maintained or whether it should be removed and replaced with a root canal filling. Both randomized studies and prospective observational studies are needed to investigate whether a pulp exposed to deep caries is best treated by measures intended to preserve it or by pulpectomy and root filling.
authors.affiliation: Varsaparken, Gothenburg, Sweden. Electronic address: singendo2@gmail.com.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Bergenholtz
authors.affiliation: Varsaparken, Gothenburg, Sweden.
authors.forename: Susanna
authors.initials: S
authors.lastname: Axelsson
authors.affiliation: Varsaparken, Gothenburg, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Davidson
authors.affiliation: Varsaparken, Gothenburg, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Frisk
authors.affiliation: Varsaparken, Gothenburg, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Hakeberg
authors.affiliation: Varsaparken, Gothenburg, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kvist
authors.affiliation: Varsaparken, Gothenburg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Norlund
authors.affiliation: Varsaparken, Gothenburg, Sweden.
authors.forename: Arne
authors.initials: A
authors.lastname: Petersson
authors.affiliation: Varsaparken, Gothenburg, Sweden.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Portenier
authors.affiliation: Varsaparken, Gothenburg, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Sandberg
authors.affiliation: Varsaparken, Gothenburg, Sweden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Tranæus
authors.affiliation: Varsaparken, Gothenburg, Sweden.
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Mejare
mesh_terms: D057087:Dental Atraumatic Restorative Treatment; D003731:Dental Caries / Q000628:therapy; D003782:Dental Pulp; D003785:Dental Pulp Capping; D006801:Humans; D011446:Prospective Studies; D057872:Pulp Capping and Pulpectomy Agents; D011672:Pulpotomy; D017213:Root Caries
chemical_list: D057872:Pulp Capping and Pulpectomy Agents
keywords: Dental pulp disease; Endodontics; Pulp biology; Restorative dentistry