Dental karies är det mest förekommande patologiska tillståndet i världen. Om kariessjukdomen inte behandlas i tid kan det äventyra pulpans vitalitet. En behandlingsmetod som används i syfte att undvika endodontisk behandling är stegvis kariesexkavering (SCR), men vissa SCR-behandlingar kommer inte lyckas och dessa tänder kommer behöva endodontisk behandling vid ett senare tillfälle.
Syfte: Att undersöka överlevnaden för behandlingen stegvis kariesexkavering utförd inom allmän- och privattandvården, genom att analysera över tid. 
Material och metod: Denna retrospektiva studie analyserade longitudinella data från nationella kvalitetsregistret SKaPa (Svenskt Kvalitetsregister för Karies och Parodontit). Datan (n= 15 330) bestod av alla tänder registrerade med SCR-behandling under året 2013 och analyserad upp till 58 månader. Registrering med åtgärdskoder som utgjorde endodontisk behandling eller extraktioner, definierades som misslyckanden. Datamaterialet analyserades med Kaplan-Meiers statistiska test för estimering av överlevnadstiden utefter deskriptiv statistik. 
Resultat: Materialet inkluderade 15 330 behandlingsfall, med registrerade efterföljande besök till år 2017. Efter bortfall kunde 12 444 fall analyseras. Åldern varierade mellan 18–96 år (medelvärde 43 år) och en tand per individ inkluderades. Efter en 4 års uppföljningsperiod 72% (n=8 957) tänder hade inga registreringar på endodontisk behandling eller extraktion.
Konklusion: Studien påvisar en hög lyckandefrekvens för registreringar av stegvis kariesexkavering i en 4-års uppföljningsperiod i svensk allmän- och privattandvårdskliniker. Behandlingens lyckande är åldersberoende och statistiskt signifikant. / Dental caries is the most prevalent pathologic condition in the world. If left untreated, it can endanger the vitality of the pulp. A treatment method aiming at avoiding endodontic treatment is stepwise caries removal (SCR), however some SCR-treatments will not succeed and these teeth will need endodontic treatment at a later stage.
Aim: To investigate survival of SCR-treatment in public and private dentistry settings by time aspect.
Material and method: This retrospective registry study used longitudinal data from the national quality registry SKaPa (Swedish Quality Registry for Caries and Periodontal Diseases). The sample (n=15 330) consisted of all teeth registered with SCR-treatment during the year 2013 and analysed up to 58 months. Registration of intervention-codes that represented endodontic treatments or extractions were defined as failures. The data was analysed using the Kaplan-Meier statistical test to estimate survival time along with descriptive statistics. 
Results: The material consisted of 15 330 treatment cases, with registered subsequent visits to the year 2017. Due to lost cases, 12 444 cases could be analysed. Age ranged between 18–96 years (mean 43 years) and one tooth per individual were included. After a 4-year follow-up period 72% (n=8 957) teeth had no registrations of endodontic treatments or extractions.
Conclusion: This study shows a high success rate for stepwise caries removal registrations in 4-years follow-up in Swedish public and private dentistry settings. The success of this treatment is dependent on the age, which is statistically significant.

The treatment of deep carious lesions (DCLs) represents a challenge for dentists, as these lesions require removal of dentin in proximity to the pulp that represents a higher risk of ending in pulp exposure. There is increasing evidence supporting minimally invasive caries removal methods, such as stepwise excavation procedure (SWP), instead of non-selective (complete) dentin caries removal for the treatment of DCLs. However, recent research has indicated that dentists have not completely adopted less invasive caries removal methods for the management of DCLs. These studies have been primarily conducted in Europe or South America; thus, few studies have been conducted in the United States to understand dentists’ management options of deep carious lesions in permanent teeth. Additionally, the proportion of dentists who would be willing to adopt less invasive carious tissue removal is unknown, especially in the United States. This dissertation consists of three studies that analyzed the effectiveness of SWP, the factors associated with success, an assessment of its costs and the acceptability of this treatment among U.S dentists. Study I assessed the patient factors predicting a successful SWP by retrospectively investigating a sample from the University of Iowa College of Dentistry from January 2004 through December 2012. Study I showed that SWPs showed a 75% success rate when evaluated within 36 months of the initial treatment. Patients who had a successful SWP treatment were slightly younger than patients whose SWP treatment was not successful. Study II performed a cost-effectiveness analysis by comparing SWP vs. the standard caries treatment (complete caries removal). Study II showed that SWP significantly reduced cost, resulting in an average savings of 64% compared to TCR over a 5-year period. Study III consisted of a statewide survey that contacted 1,434 Iowa dentists with the aim of identifying the most important factors that influence dentists’ decisions for DCLs treatment using conjoint analysis. From the total, 36.4% (n=522) clinicians answered the survey. One of the main study findings was that among the three factors (hardness of dentin, depth of the lesion and patient age) depth of the lesion was the most important factor influencing dentists’s decision when selecting a less invasive caries removal method. Study III did not find any significant association between years of practicing dentistry, type of practice and practice setting regarding being willing to select a less invasive caries removal method. In conclusion, this dissertation has demonstrated that the stepwise caries removal is a cost-saving and highly successful treatment for the management of deep caries lesions. Studies I and II have shown that this method has a high clinical success rate and less long-term treatment costs. Regarding the acceptability of SWP among clinicians, this dissertation has shown that most dentists in Iowa would consider less invasive caries methods for a DCL; however, these techniques have not been completely adopted and accepted among American dentists. Thus, dentists should be trained in less invasive caries methods, given instruction about which criteria they should use to assess a DCL, and provide them with the best evidence-based strategies for managing deep lesions. The findings of this dissertation should engage stakeholders to provide dentists with professional incentives for using these techniques. Specifically, our results support the idea that SWP minimizes costs while providing the appropriate patient care.