ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Incomplete Removal Of Dental Caries Results In Reduced Pulpal Damage With No Effect On Caries Progression
Clinical Question In patients with extensive caries encroaching the dental pulp, does incomplete removal of caries result in caries progression as opposed to complete removal?
Clinical Bottom Line Incomplete caries removal leads to less chances of pulpal damage and has no effect on progression of caries compared to complete caries removal. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16856019Ricketts/2006patients with primary or permanent decayed unfilled teethSystematic review of Randomized and non-randomized controlled clinical trials
Key resultsThe above literature reviewed two stepwise excavation studies and two ultra conservative caries removal studies, and reported that partial caries removal in symptomless, primary or permanent teeth reduced the risk of pulp exposure. There was no detriment to the patient in terms of pulpal symptoms in this procedure and no reported premature loss or deterioration of the restoration.
Evidence Search Search ("Dental Caries"[Mesh] AND "Dental Restoration, Permanent"[Mesh]) AND "Dental Pulp"[Mesh] Limits: English, Systematic ReviewsSearch ("Dental Caries"[Mesh] AND "Dental Restoration, Permanent"[Mesh]) AND "Dental Pulp"[Mesh]
Comments on
The Evidence
The evidence is strong since it was based on studies of varying designs (randomized, quasi-randomized and non-randomized controlled clinical trials) and different patient groups (deciduous and permanent teeth), that compare minimal with complete caries removal prior to restoration.
Applicability Subjects are representative of any dental patients and treatment feasible in any dental practice
Specialty/Discipline (General Dentistry)
Keywords Dental caries, Dental restoration, Dental pulp, caries removal
ID# 603
Date of submission: 04/02/2010spacer
E-mail Tranat@livemail.uthscsa.edu
Author Andy Tran
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Bennett T. Amaechi, BDS, MSc, PhD
Faculty mentor/Co-author e-mail Amaechi@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by John Rugh (San Antonio, Texas) on 03/25/2014
A 2013 update (PMID: 23543523) of the original Ricketts 2006 review reported here further supports the conclusions of this CAT. This updated Cochrane review included 4 new trials. There remain concerns about the lack of long-term followup data.
by Susannah Payne, Kevin Clark, Karim Allahdina (San Antonio, TX) on 01/07/2013
A PubMed search was conducted January 2013 and a more recent publication of a randomized controlled trial with 213 subjects was found. PubMed ID 22983407 article supported the original CAT bottom line.
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