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  • Conventional versus non-conventional caries removal in deep lesions : a systematic review and meta-analysis
    Publication . Laville, Emile; Rodrigues, Alexandra Pinto
    Introduction: The management of deep carious lesions constitutes a major challenge in dentistry due to the risk of pulp exposure. While complete caries removal has long been considered the standard, conservative approaches, such as selective caries removal and the stepwise technique, have been developed to preserve pulp vitality. Materials and methods: This study aimed to compare complete caries removal (CCR), selective caries removal (SCR), and stepwise removal (SWR) for treating deep carious lesions through a systematic review and meta-analysis. Conducted according to PRISMA and registered in PROSPERO (CRD420261321894), the study included randomised clinical trials identified across several databases. The statistical analysis was performed in “R” using a multivariate random-effects model (metafor), with effect estimation expressed as Risk Ratios (RR) and sensitivity analyses. Results: Nine comparison time points were included in the meta-analysis. No statistically significant difference was observed between the techniques. Compared with complete caries removal, the RR was 1.06 (95% CI: 0.25–4.50) for Selective caries Removal and 1.29 (95% CI: 0.34–4.83) for the Stepwise technique. These results were consistent despite substantial heterogeneity. Discussion: These results do not allow for a clear hierarchy among the techniques but are consistent with the current scientific literature, which indicates that lesion control mainly depends on biofilm activity and the quality of the restorative seal. This absence of difference is probably due to the imprecision of the estimates and the heterogeneity in the available data. Conclusion: Conservative approaches represent a reliable alternative to complete caries removal for managing deep carious lesions, reducing the risk of pulp exposure without compromising clinical success, although the current level of evidence remains insufficient to establish their superiority.
    2026-08-17Dissertação de mestrado Acesso aberto Ver mais