Abstract
There is a lack of evidence about the best approach for cavitated caries lesions with the possibility of pulpal involvement in primary teeth. Thus, the present authors aimed to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth. The search was conducted in MEDLINE/Pubmed and Web of Science databases until May 2020. Studies that compared techniques to manage deep caries lesions with at least 12 months of follow-up were included. The risk of bias was evaluated using the RoB tool. Network meta-analysis and pairwise meta-analyses were conducted considering the treatment clinical success as an outcome, according to the pulp health condition. From 491 potentially eligible studies, 9 were included. For deep caries lesions with pulp vitality, the Hall Technique presented the highest probability of success (78%). In the event of accidental pulp exposure, pulpectomy presented a 76% chance of providing the best clinical results. For pulp necrosis, no difference was observed between a pulpectomy and non-instrumented endodontic treatment (RR = 0.69; 95%CI: 0.21-2.33) Thus, it was concluded that the Hall Technique may be a better option for deep caries lesions with pulp vitality. In cases of accidental pulp exposure of vital teeth during caries removal, a pulpectomy may be considered the best option. However, there are insufficient studies to build up evidence about the best treatment option when irreversible pulpitis or pulp necrosis is present.
Highlights
We considered as the outcome the clinical success of the treatments, which was dichotomized as a success or failure according to what was reported in the primary studies
When vital primary molars with deep caries were considered, the probability rank from network meta-analysis showed that the Hall Technique surpassed the other restorative techniques, such as non-selective and selective caries removal
Few studies have considered this technique for deep caries lesions, the results found corroborate a previous systematic review focusing on cavitated caries without proximity to pulp.[5]
Summary
The objective of the present study was to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth, considering the pulp health condition, by means of systematic review and network meta-analysis
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