Stepwise and partial excavation reduced the incidence of pulp exposure in symptomless, vital, carious primary as well as permanent teeth. Therefore these techniques show clinical advantage over complete caries removal in the management of dentinal caries. There was no evidence of a difference in signs or symptoms of pulpal disease between stepwise excavation, and complete caries removal, and insufficient evidence to determine whether or not there was a difference in signs and symptoms of pulp disease between partial caries removal and complete caries removal. When partial caries removal was carried out there was also insufficient evidence to determine whether or not there is a difference in risk of restoration failure. The no dentinal caries removal studies investigating permanent teeth had a similar result with no difference in restoration failure. The other no dentinal caries removal study, which investigated primary teeth, showed a statistically significant difference in restoration failure favouring the intervention.
Due to the short term follow-up in most of the included studies and the high risk of bias, further high quality, long term clinical trials are still required to assess the most effective intervention. However, it should be noted that in studies of this nature, complete elimination of risk of bias may not necessarily be possible. Future research should also investigate patient centred outcomes.
Microbiological analysis after complete or partial removal of carious dentin in primary teeth: a randomized clinical trial.
Since viable bacteria can persist in tooth cavities regardless of the technique used for caries removal, the objective of the present randomized clinical trial was to examine the microflora of primary teeth treated by complete or partial removal of carious dentin. Deciduous molars with acute carious lesions in the inner half of dentin and vital pulp were randomly divided into two groups of 16: complete removal, in which the carious dentin was completely removed with the help of a caries detector dye, and partial removal, in which the carious dentin was completely removed from the dentinoenamel junction and lateral walls, while the necrotic carious dentin from the cavity floor was only removed superficially. Dentin samples were obtained with a sterile No. 3 bur after caries removal and 3-6 months after protection with calcium hydroxide cement and restoration of the cavities with resin composite. The samples were stored in thioglycolate. Decimal dilutions were then prepared and seeded for the enumeration of Streptococcus spp., mutans streptococci, Lactobacillus spp. and total microorganisms. Before sealing, a larger number of microorganisms was detected in teeth submitted to partial caries removal compared to the complete removal group. However, after sealing the level of colonization was similar in the two groups for all microorganisms studied. The results suggest that persistence of bacteria does not seem to be a reason for reopening of cavities in deciduous teeth after partial caries removal.