Selective versus stepwise removal of deep carious lesions: A meta-analysis of randomized controlled trials

BACKGROUND/PURPOSE: Stepwise removal (SWR) and selective removal (SCR) are proposed techniques to treat deep carious lesions, but it is currently uncertain which technique is better. This meta-analysis aimed to compare the therapeutic effects of SCR and SWR for deep carious lesions in both primary and permanent teeth. MATERIALS AND METHODS: PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP databases were searched until June 9, 2021. Success was the primary outcome. Secondary outcomes included pulp exposure, tooth extraction, pulp necrosis, pulpitis, and endodontic treatment. The effect size of each outcome was tested for heterogeneity. The source of heterogeneity was explored by meta regression analysis. Subgroup analysis and sensitivity analysis were conducted for the outcomes. RESULTS: Nine studies of 1550 patients with 1929 deep carious teeth were included. SCR had a significantly higher success rate than SWR (pooled relative risk [RR] = 1.123, 95% confidence interval [CI] = 1.056–1.194, I(2) = 52.3%, P < 0.001). The incidence of pulp exposure was significantly lower in the SCR group than that in the SWR group (pooled RR = 0.266, 95%CI = 0.096–0.740, I(2) = 0.0%, P = 0.011). The incidence of pulp necrosis in the SCR group was approximately 14.2% of that in the SWR group (pooled RR = 0.142, 95%CI = 0.026–0.789, I(2) = 0.0%, P = 0.026). Compared with SWR, SCR reduced the incidence of pulpitis by about 76.3% (pooled RR = 0.237, 95%CI = 0.090–0.623, I(2) = 0.0%, P = 0.003). CONCLUSION: SCR may be a better treatment for deep caries to achieve better outcomes than SWR. Future research on comparing SCR and SWR for different outcomes in deep carious lesions is warranted to confirm our findings.