Remoção seletiva de tecido cariado em dentes permanentes : revisão sistemática, relato de caso e estudo clínico

Abstract

Dental caries is still the most prevalent oral disease among populations. The evolution of restorative techniques has presenting the tendency to reduce the amount of dental tissue removed, however the amount of dentin that can be left to maintain restorative integrity and oral health is not yet consensus in the literature. The selective removal of carious tissue (SRCT) consists of the maintenance of affected dentin and a dentin with a leathery consistency in the cavity pulp wall, however the adjacent walls must maintain dentine and hard enamel, similar to sound structures to ensure the restoration sealing. This thesis, distributed in 3 chapters, aimed to carry out a systematic review of the scientific literature and meta-analysis on the SRCT effectiveness (Chapter 1), as well as to describe a guide from a case report that clarified the SRCT use in the clinical practice (Chapter 2) and to present the findings found in a randomized controlled clinical study performing SRCT in medium caries lesions in permanent teeth treated with SRCT (Chapter 3). In the systematic review, controlled clinical trials and cohort studies performed on patients with dental caries in permanent teeth were included. A total of 2,333 articles were retrieved, of which 10 were included in the systematic review and 4 in the meta-analysis. The meta-analysis showed no statistically significant difference between the groups in relation to the presence of pulp vitality (RR, 95% CI: 1.04; 0.97 – 1.12). Secondary outcomes, such as microbiological evaluation, restoration quality and dentin deposition, also presented similar results between the groups. However, a higher frequency of pulp exposures with the use of complete removal techniques or stepwise excavation was found. In the case report, an SRCT protocol was developed based on the care given to a patient who presented a deep carious lesion on tooth 17 and absence of painful symptomatology. The six-month follow-up showed the patient with no pain symptoms, absence of periapical lesion or periodontal ligament thickening, in addition to satisfactory restorative treatment. In the clinical trial, 44 teeth with lesions of medium caries were restored. The treatments were evaluated after 6 months and 12 months and the restoration evaluation were done through the Functional Property criterion of the World Dental Federation. All the treatments were considered successful, with no differences between RSTC and control groups. The selective removal of carious tissue has proven to be a safe, effective and cost-effective approach when compared to complete removal.