OBJECTIVES This study aimed to systematically review the literature regarding the risk of selective removal-in comparison with stepwise and nonselective removal-of carious tissue in permanent teeth. MATERIALS AND METHODS Controlled clinical trials and cohort studies involving patients with dental caries in permanent teeth were included. Databases used were PubMed, Embase, and Scopus. The test group should be composed of patients undergoing selective removal of carious tissues, and the control group should comprise patients undergoing nonselective removal and/or stepwise removal of carious tissue. Laboratory tests, studies on primary teeth, and studies that used temporary restorations were excluded, as were literature reviews. The primary outcome was overall success of maintaining pulpal health (both clinically and radiographically). Quality of the restoration, pulp exposure, dentin deposition, and microbiological examination were also assessed. A meta-analysis, using the pooled risk ratio (RR) and its 95% confidence interval (CI), was performed to assess the success of maintaining pulpal health, using the different control treatments as a subgroup analysis. RESULTS A total of 2333 articles were retrieved, of which 10 were included in the systematic review and four in the meta-analysis. In the qualitative evaluation, the control groups presented a higher risk of pulp exposure in relation to the selective removal. In the meta-analysis, the selective carious tissue removal showed significantly higher overall success (RR, 95% CI 1.11, 1.02-1.21). CONCLUSIONS The selective carious tissue removal presented higher success of maintaining pulpal health. CLINICAL RELEVANCE In permanent teeth, selective carious tissue removal should be performed, as this technique results in lower numbers of pulp complications, such as pulp exposure, as compared with nonselective removal.

中文翻译：

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选择性，逐步或非选择性去除龋组织：哪种技术可降低恒牙龋齿的治疗风险？系统的审查和荟萃分析。

目的本研究旨在系统地回顾有关恒牙龋组织的选择性去除风险的文献（与逐步和非选择性去除的风险比较）。材料与方法包括与恒牙龋齿患者有关的对照临床试验和队列研究。使用的数据库为PubMed，Embase和Scopus。测试组应由接受选择性去除龋组织的患者组成，对照组应包括接受非选择性去除和/或逐步去除龋组织的患者。实验室检查，对乳牙的研究以及使用临时性修复的研究均被排除在外，文献综述也被排除在外。主要结果是维持牙髓健康的整体成功（在临床和影像学上）。还评估了修复体的质量，牙髓暴露，牙本质沉积和微生物学检查。使用不同的对照治疗方法作为亚组分析，使用合并风险比（RR）及其95％置信区间（CI）进行荟萃分析，以评估维持牙髓健康的成功性。结果共检索到2333篇文章，其中10篇纳入系统评价，4篇纳入荟萃分析。在定性评估中，与选择性清除相比，对照组的牙髓暴露风险更高。在荟萃分析中，选择性去除龋齿组织显示出更高的总体成功率（RR，95％CI 1.11，1.02-1.21）。结论选择性龋组织的去除在维持牙髓健康方面取得了更大的成功。