JADA+ CONTENT
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always,
any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable
consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS






























































Romina Brignardello-Petersen, DDS, MSc, PhD
STEPWISE AND PARTIAL CARIES REMOVAL
PROBABLY HAVE HIGH SUCCESS RATES UP TO 3
YEARS AFTER TREATMENT OF DEEP CARIOUS
LESIONS, BUT PARTIAL CARIES REMOVAL IS MORE
LIKELY TO PRESERVE TOOTH VITALITY
Hoefler V, Nagaoka H, Miller CS. Long-term survival
and vitality outcomes of permanent teeth following
deep caries treatment with step-wise and partial-caries-
removal: a systematic review. J Dent. 2016;54:25-32.
http://dx.doi.org/10.1016/j.jdent.2016.09.009.
Key words. General dentistry; cariology; caries, step-
wise caries removal; partial caries removal; systematic
review.
Clinical relevance. When treating deep carious
lesions, stepwise caries removal* (SCR) and partial caries
removaly (PCR) techniques can be used to reduce the
likelihood of pulp exposure and to prolong tooth vitality.
The extent to which this is achievable is useful infor-
mation for clinicians considering these options.
Study summary. The authors conducted this sys-
tematic review (SR) to assess the outcomes of SCR and
PCR in permanent teeth with deep carious lesions.
Reviewers searched for any clinical studies assessing
either of the interventions or comparing them in 4
electronic databases and included 2 randomized trials
and 3 case series.z Studies included 426 teeth (259 that
underwent SCR and 167 that underwent PCR), and
researchers followed patients§ up to 10 years. The
researchers showed that there were no restorative failures{
in more than 88% of the treated teeth at 2 or 3 years using
either of the techniques. SCR had no restorative failures
in more than 96% of teeth after 2 years. PCR had no
restorative failures in 67% of teeth after 10 years. The re-
searchers also reported that both techniques were effective
in maintaining pulp vitality in more than 83% of the
treated teeth at 2 or 3 years. The researchers in the
randomized trial that compared both techniques showed
that teeth in patients who underwent SCR were 3.8 times
more likely to lose vitality than were teeth that underwent
PCR.#
Strengths and limitations. Although there were
some limitations with the study search process and how
missing information was addressed,** the authors of
this SR, for the most part, followed appropriate methods.
Unfortunately, all of the included studies were at high
risk of bias, which undermined the credibility of the
results. Reviewers were not able to conduct meta-
analyses owing to the high variability of the studies in
terms of the methods used to measure the outcomes and
the time points at which measurements were obtained.
Nevertheless, the success of the techniques was consis-
tently high in the studies, with rates over 95% up to
3 years and approximately 80% at 5 years, which
increased our confidence in the success of the techniques.
We were moderately confident in the results of the
comparison between SCR and PCR owing to the risk of
bias in the trial that made this comparison. In conclu-
sion, SCR and PCR are likely to have high success rates
up to 3 years after treatment of deep carious lesions, and
PCR is likely to be more effective than SCR at conserving
tooth vitality. n
http://dx.doi.org/10.1016/j.adaj.2017.02.012
Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail
rominabp@gmail.com.
Disclosure. Dr. Brignardello-Petersen did not report any disclosures.
* The authors defined stepwise caries removal as peripheral caries removal
plus provisional restoration plus residual caries removal and definite
restoration after a prespecified time interval.
y The authors defined partial caries removal as peripheral caries removal
plus definitive restoration or peripheral caries removal plus provisional
restoration plus definite restoration after a prespecified time.
z Two studies evaluated SCR, 2 studies evaluated PCR, and 1 study eval-
uated both techniques.
§ In 4 studies, patients were younger than 18 years, and in the remaining
study patients were 18 to 53 years old.
{ The authors defined restorative failures as teeth that required further
treatment owing to secondary caries or tooth fracture or resulted in tooth
extraction for any reason.
# Risk ratio, 3.8; 95% confidence interval, 1.5 to 10.0.
** Reviewers did not search 1 of the major electronic databases or the gray
literature. They did not contact authors of studies for missing information if
needed.
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