Universidad UTE, Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC); Proyecto Epistemonikos.
Proyecto Epistemonikos; Centro Evidencia UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Medwave. 2022 Jan 24;22(1):e8227. doi: 10.5867/medwave.2022.01.8226.
Carious lesions have traditionally been treated by non-selective (complete or total) removal of carious tissue. However, due to its risks and adverse effects, carious tissue removal techniques have been developed, based on the preservation of tooth tissue, including the stepwise removal. The objective of this summary is to clarify the uncertainty about the effectiveness and safety of the stepwise removal technique compared to complete removal.
To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by searching multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from identified reviews, reanalyzed data from primary studies, performed a meta-analysis, and prepared summary tables of results using the GRADE method.
We identified three systematic reviews that included five primary studies, four of them corresponding to randomized trials. We concluded that stepwise removal may reduce the risk of pulp exposure, the risk of signs and symptoms of pulp disease and the risk of restoration failure, but the certainty of the evidence is low.
传统上，龋病的治疗方法是通过非选择性（完全或全部）去除龋坏组织。然而，由于其风险和不良反应，已经开发出了基于保留牙体组织的龋坏组织去除技术，包括逐步去除。本综述的目的是阐明与完全去除相比，逐步去除技术在有效性和安全性方面的不确定性。
为了回答这个问题，我们使用了 Epistemonikos，这是一个最大的健康系统评价数据库，它通过搜索多个信息来源，包括 MEDLINE、EMBASE、Cochrane 等来维护。我们从确定的综述中提取数据，重新分析原始研究的数据，进行荟萃分析，并使用 GRADE 方法编制结果总结表。
我们确定了三项系统评价，其中包括五项原始研究，其中四项是随机试验。我们得出结论，逐步去除可能会降低牙髓暴露的风险、牙髓疾病的体征和症状的风险以及修复失败的风险，但证据的确定性较低。
