Manejo de lesões de cárie profunda com e sem envolvimento pulpar em dentes permanentes

: uma revisão sistemática

Abstract

Introduction: Dental caries is a multifactorial disease, which can be defined as a non-transmissible, biofilm and sugar-dependent dysbiosis that results in the loss of minerals from dental hard tissues. In situations of deep carious lesions, without symptoms of pulpal pathology, teeth should be treated in an attempt to preserve their vitality. There are different ways to remove carious tissue, and total or selective removal may be indicated. Objective: Through a systematic review of clinical studies, the level of scientific evidence related to treatment options for deep caries lesions in permanent teeth was sought to guide the clinician in deciding the treatment technique. Materials and methods: The literature considered for this systematic review is based on PRISMA guidelines and aimed to answer the following specific question constructed in PICO format: "In permanent teeth with deep lesions (P), which would be the best treatment for a clinical success (O) selective removal of carious tissue (I) or total (C)?" An electronic search was conducted in Pubmed, Web Of Science databases in order to identify clinical studies comparing total removal versus selective removal in a minimum follow-up period of six months. After establishing the search strategy, the studies were selected, with the inclusion and exclusion criteria, the extracted data was completed by two independent reviewers and any disagreements between the reviewers were discussed with a third reviewer. Study selection was confirmed using Rayyan's Intelligent Systematic Review Plattaform tool and methodological quality using the Rob2 tool. Data obtained from the included studies were extracted and analysed using a continuous random effects model meta-analysis. The primary variable used was treatment longevity versus the type of decayed tissue removal. Results: 105 articles were identified during the search. After the exclusion of duplicates, 95 studies were assessed taking into account the title and the abstract, where 20 were eventually selected for full reading with the purpose of assessing their eligibility. A total of 5 studies were included for analysis in this systematic review. Conclusion: Selective removal of decayed tissue was found to be more favourable for treatment longevity up to 1 year 6 months. However, at 5 years follow-up there is no difference between selective removal and total removal in treatment longevity. Therefore, choosing selective removal avoids pulpal exposure, which is a benefit. There is no conclusion whether selective removal is more successful when done in one or more sessions.

Date of Award	25 Jul 2023
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Anna Moura (Supervisor) & Tamara Kerber Tedesco (Co-Supervisor)