J Am Dent Assoc. 2019 May 27. pii: S0002-8177(19)30134-5. doi: 10.1016/j.adaj.2019.02.018. [Epub ahead of print]
xAbstract
BACKGROUND:
The
authors conducted a systematic review of randomized controlled trials
comparing the risk of experiencing restoration failure in primary teeth
after complete and selective carious tissue removal of soft dentin.
METHODS:
The
authors searched electronic databases (PubMed [MEDLINE], Scopus,
Cochrane Central Register of Controlled Trials) and the
ClinicalTrials.gov Web site with manual searching and cross-referencing
for trials reporting restoration failure after follow-up of 6 months or
longer. Two reviewers independently selected studies, extracted data,
and assessed the risk of bias and quality of evidence using the Grading
of Recommendations Assessment, Development, and Evaluation approach. The
authors performed intention-to-treat and per-protocol meta-analyses and
calculated odds ratios (OR) as effect estimates in the random-effects
model.
RESULTS:
From 327 potentially eligible studies,
the authors selected 23 for full-text screening and included 4. Results
showed increased risk of experiencing restoration failure
(intention-to-treat analysis, OR [95% confidence interval] 1.74 [1.01 to
3.00], and per-protocol analysis, OR [95% confidence interval] 1.79
[1.04 to 3.09]) after selective carious tissue removal of soft dentin.
The risk of bias was high, and the quality of evidence was low.
CONCLUSIONS:
Selective
carious tissue removal of soft dentin may increase the risk of
experiencing restoration failure in primary teeth. However, the evidence
level is insufficient for definitive conclusions.
PRACTICAL IMPLICATIONS:
Patients
with restorations performed after selective carious tissue removal of
soft dentin should have shorter recall visit intervals to evaluate the
restorations' quality and control caries disease, allowing for more
conservative approaches, such as repair, in cases of defective
restorations.
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