Failure of incompletely excavated teeth—A systematic review

Abstract

ObjectivesWhen 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. DataClinical 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. SourcesElectronic databases were screened and studies cross-referenced. Language was restricted to English and German. Grey literature was not evaluated. Results19 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. ConclusionsAfter 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. Clinical SignificanceGrowing evidence indicates that one-step incomplete excavation seems suitable to treat deep caries lesions, and might have advantages compared to two-step incomplete or complete caries removal. However, it is too early to recommend certain clinical strategies.