In deep cavities stepwise excavation of caries can preserve the pulp.

DATA SOURCES: Medline and the Igaku Chuo Zasshi (Japanese) databases, the reference list of identified studies and personal reprint collections of authors were searched.

STUDY SELECTION: Randomised controlled trials (RCT), controlled clinical trials (CCT) and case series conducted in permanent teeth were included.

DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted the data using specially designed forms. A qualitative synthesis is presented.

RESULTS

Ten English and three Japanese studies were finally included (two RCTs, five CCTs and six case series).

CONCLUSIONS

From this review, stepwise excavation can be concluded as effective for pulp preservation in extremely deep caries where there are no clinical symptoms of irreversible pulpitis. Calcium hydroxide and other materials, such as antimicrobials and polycarboxylate cement combined with tannin fluoride preparation, have been shown to be effective in reducing bacteria after stepwise excavation. Further clinical trials with high levels of study design in this research field are needed to identify the best possible methods for removing carious dentine during stepwise excavation.