Influence of the chemomechanical and mechanical carious tissue removal on the risk of restorative failure: a systematic review and meta-analysis

Abstract

Objective: To summarize and evaluate critically the results of clinical trials comparing the risk of failure of restorations after chemomechanical and mechanical carious tissue removal.

Materials and methods: The PubMed/MEDLINE, EMBASE, Scopus, LILACS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, and grey literature were searched to identify studies related to the research question and published up to January 2022. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and the certainty of evidence. Meta-analysis was performed using a random effects model to compare the effect of chemomechanical and mechanical excavation on the outcome (restorative failure), considering the type of carious tissue removal (selective and complete) as subgroups.

Results: From 443 potentially eligible studies, 58 clinical studies were selected for full-text analysis, and 6 were included in the review. There was no statistically significant difference in the risk for failure of restorations performed after chemomechanical and mechanical excavation (RR: 1.26, 95% CI 0.93; 1.72, p = 0.14) either for complete (p = 0.97) or selective (p = 0.11) carious tissue removal. The heterogeneity found was null. The risk of bias was high and the certainty of evidence was low.

Conclusion: Based on the low certainty of evidence, the risk of failure of restorations performed after chemomechanical and mechanical carious tissue removal is similar.

Clinical relevance: Chemomechanical carious tissue removal may be performed before restoration placement, without jeopardizing the short-term longevity. Further studies are required before definitive conclusions can be drawn.

Keywords: Chemomechanical removal; Dental caries; Direct restoration; Evidence-based dentistry; Mechanical removal.