Selective versus non-selective removal for dental caries: a systematic review and meta-analysis.

OBJECTIVE: Selective and non-selective methods for caries removal were controversial so far, thus we aimed to compare the efficacy of selective and non-selective caries removal by conducting meta-analysis of randomized controlled trials (RCTs). MATERIALS AND METHODS: Eligible RCTs studies comparing selective caries removal with non-selective caries removal were retrieved by searching PubMed, EMBASE and Cochrane Library till 15 July 2017. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for outcome indictors, including pulpal exposure, pulpal symptoms and failure using Inverse variance-random effects or Mantel-Haenszel-fixed effects models. RESULTS: Totally, seven studies were eligible for the meta-analysis. Compared with the non-selective caries removal group, the risk of pulpal exposure was significantly reduced in the selective caries removal group (OR = 0.11, 95% CI: 0.04-0.30). No significant difference was observed in pulpal symptoms (OR = 0.79, 95% CI: 0.30-2.12) and failure (OR = 1.40, 95% CI: 0.69-2.84) between the groups. CONCLUSIONS: The efficacy of selective caries removal appears comparable to that of non-selective caries removal in children, with similar pulpal symptoms and failure, but selective caries removal may result in a low incidence of pulpal exposure. However, larger-scale RCTs with long-term follow-up are required to confirm this conclusion.