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Interventions for treating cavitated or dentine carious lesions.
Falk Schwendicke1, Tanya Walsh2, Thomas Lamont3
1Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany.
The Cochrane Database of Systematic Reviews
|July 19, 2021
Summary
Conventional restoration (CR) for cavities may lead to more failures than less invasive methods like selective excavation (SE) and stepwise removal (SW). Less invasive treatments, including the Hall Technique (HT), show promise for reducing failures in primary and permanent teeth.
Area of Science:
- Dental caries management
- Minimally invasive dentistry
- Restorative dentistry
Background:
- Traditional treatment of cavitated or dentine carious lesions involves complete removal of carious tissue and conventional restoration (CR).
- Alternative strategies include selective excavation (SE), stepwise removal (SW), sealing with sealants or preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC).
Purpose of the Study:
- To compare the effectiveness of various interventions for treating carious lesions in primary and permanent teeth with vital pulps.
- To evaluate outcomes including pulp exposure, endodontic therapy, tooth extraction, and restorative complications.
Main Methods:
- Systematic review and network meta-analysis of randomized clinical trials.
- Included studies compared different levels of carious tissue removal (CR, SE, SW, HT, sealing, NRCC) in primary or permanent teeth.
- Primary outcome was treatment failure; data analyzed using odds ratios (OR) with 95% confidence intervals (CI).
Main Results:
- For deep lesions, conventional restoration (CR) showed a higher probability of failure compared to selective excavation (SE), stepwise removal (SW), and Hall Technique (HT).
- In primary dentition, Hall Technique (HT) and selective excavation (SE) had fewer failures than conventional restoration (CR).
- In permanent dentition, selective excavation (SE) and stepwise removal (SW) resulted in fewer failures than conventional restoration (CR).
Conclusions:
- Less invasive treatments like Hall Technique (HT) and selective excavation (SE) demonstrated lower failure rates compared to conventional restoration (CR) in primary teeth.
- Selective excavation (SE) and stepwise removal (SW) also showed reduced failures compared to conventional restoration (CR) in permanent teeth.
- Most included studies exhibited a high risk of bias and limited precision, leading to low or very low certainty of evidence for most comparisons.
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