Complete, Selective, and Stepwise Carious Tissue Removal for Deep Carious Lesions in Vital Permanent Teeth: A Systematic Review and Meta-Analysis.

Background/

Objectives

This systematic review compared complete (CCR), selective (SCR), and stepwise (SWR) carious tissue removal in vital permanent teeth with deep carious lesions.

Methods

PubMed/MEDLINE, Embase, Scopus, the Cochrane Library, and B-on were searched through 20 January 2026. Randomized trials were assessed with RoB 2, grouped by trial family, and analysed by distinct outcomes. Direct random-effects models were fitted only with at least three informative independent families, using REML and modified Knapp-Hartung inference. The protocol was registered in PROSPERO (CRD420261321894).

Results

Eleven reports from seven families were included. For SCR versus SWR, intraoperative exposure occurred in 0/295 versus 12/288 teeth (pooled RR 0.11, 95% CI 0.003-4.64; p = 0.127; three families), and late pulpal failure at 12-24 months occurred in 11/254 versus 22/243 teeth (pooled RR 0.50, 95% CI 0.01-21.53; p = 0.510; I-squared = 72.2%; three families). Both outcomes had very low-certainty evidence. Other direct contrasts were study-specific, and the exploratory network was too sparse for reliable inference.

Conclusions

Evidence was insufficient to demonstrate a difference or establish superior long-term pulpal or restorative outcomes.