Failure of incompletely excavated teeth-A systematic review

Objectives: When 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. Data: Clinical 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. Sources: Electronic databases were screened and studies cross-referenced. Language was restricted to English and German. Grey literature was not evaluated. Results: 19 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. Conclusions: After 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 Significance: Growing 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. (C) 2013 Elsevier Ltd. All rights reserved.