Failure of incompletely excavated teeth—A systematic review
Available online 15 May 2013
Abstract
Objectives
When
treating deep caries, one- and two-step incomplete caries removal
reduce the risk of pulpal exposure. However, it is currently unclear if
incompletely excavated teeth fail due to pulpal or rather non-pulpal
complications. The present study systematically analysed how
incompletely excavated teeth fail, and if certain tooth- or
treatment-related factors may influence risk of failure.
Data
Clinical
studies investigating clinical or radiologic failure after incomplete
excavation of deep caries (depth >1/2 dentine thickness) were
evaluated. Weighted annual failure rates (AFRs) were used to analyse
frequency and mode of failures. Sub-analyses compared risk of failure in
different groups of possible influencing factors.
Sources
Electronic
databases were screened and studies cross-referenced. Language was
restricted to English and German. Grey literature was not evaluated.
Results
19
studies with a median (Q25/75) follow-up of 24 (12/48) months were
included. AFR was 3.8 (1.4/4.4)%. Eleven studies reported pulpal
complications being the major reason for failure, and only 2 studies
found more non-pulpal than pulpal failures. Sub-analyses found
significantly lower risk of failure for teeth after one- compared with
two-step excavation (Odds ratio [95% CI] = 0.21 [0.08, 0.55]) and teeth
with single- compared with multi-surface cavities (0.33 [0.16, 0.67]).
Risk of bias differed widely between studies, and evidence levels were
graded as very low.
Conclusions
After
incomplete removal of deep caries, pulpal failure was more common. One-
compared with two-step excavation reduces risk of failure, and factors
like number of restored surfaces seem to but influence failure, but
limited evidence permits drawing definitive conclusions.
Comments