Long-term survival and vitality outcomes of permanent teeth following deep caries treatment with step-wise and partial-caries-removal: A Systematic Review.
A systematic review was performed to compare the long-term survival of deep dentine caries-affected permanent teeth treated with partial-caries-removal (PCR) versus similar teeth treated with stepwise-caries-removal techniques (SWT).



Clinical studies investigating long-term PCR and SWT outcomes in unrestored permanent teeth with deep dentine caries were evaluated. Failures were defined as loss of pulp vitality or restorative failures following treatment.



PubMed, Web of Science, Dentistry and Oral Sciences Source, and Central databases were systematically searched.



From 136 potentially relevant articles, 9 publications utilizing data from 5 studies (2 RCTs, and 3 observational case-series) reporting outcomes for 426 permanent teeth over two to ten years were analyzed. Regarding restorative failures, >88% success at two years for both techniques was reported. For loss of pulp vitality, observational studies reported >96% vitality at two years for each technique, while one RCT reported significantly higher vitality (p<0.05) at three years for PCR (96%) compared to SWT (83%). Risk of bias was high in all studies.



Successful vitality and restorative outcomes for both PCR and SWT have been demonstrated at two years and beyond in permanent teeth with deep dentine caries. Partial-caries-removal may result in fewer pulpal complications over a three year period than SWT, although claims of a therapeutic advantage are based on very few, limited-quality studies.



Partial-caries-removal and SWT are deep caries management techniques that reduce pulp exposure risk. Permanent teeth with deep dentine caries treated with either technique have a high likelihood for survival beyond two years.
Division of Restorative Dentistry, Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, KY, United States. Electronic address: vaughan.hoefler@uky.edu.
Vaughan
V
Hoefler
Division of Restorative Dentistry, Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, KY, United States.
Hiroko
H
Nagaoka
Division of Oral Diagnosis, Oral Medicine and Oral Radiology, Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, KY, United States.
Craig S
CS
Miller
D003729:Dental Care; D003731:Dental Caries; D003782:Dental Pulp; D006801:Humans
Deep caries; Excavation; Indirect-pulp-cap; Outcome; Stepwise