Effect of Liners on Pulpal Outcome After Partial Caries Removal in Permanent Teeth: A Systematic Review and Meta-Analysis.

Abstract

Partial caries removal reduces the risk of pulp exposure while preserving the tooth structure that is otherwise unnecessarily lost during the cavity preparation. Liners are applied on the dentinal floors to induce the formation of tertiary dentin that effectively blocks the stimuli from reaching the pulp. The present systematic review was conducted to evaluate the effect of liners on pulp vitality after partial caries removal in permanent teeth. This systematic review followed the resources of evidence-based medicine such as the Cochrane Handbook and was conducted as per PRISMA guidelines. The PICOS strategy was designed and included patients with deep carious lesions in permanent teeth with and without application of liner after partial caries removal, with pulp vitality assessment at one year. After applying the inclusion and exclusion criteria, four articles were selected after an initial list of 750 articles. The results of meta-analysis indicated that there was no statistically significant difference between intervention and control groups (OR=1.440; 95% CL= 0.812 to 2.552; P=0.212). According to the Risk of Bias 2 tool, all four studies were classified as "low risk." Certainty of evidence was moderate as per GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). Partial caries removal with and without a liner had similar outcomes on pulp vitality at one year follow up. Role of a liner remains controversial in partial caries removal therapy. On the basis of this systematic review and meta-analysis, it may be inferred that treatment success, as defined by continued pulp vitality, is independent of liner application.