Are RMGIC restorations as effective with or without selective caries removal in primary molars?

Area of Science:

• Pediatric Dentistry
• Cariology
• Dental Materials Science

Background:

• Cavitated dentine occlusal carious lesions (International Caries Detection and Assessment System (ICDAS) Grade 5) in primary teeth pose a treatment challenge.
• Resin-modified glass ionomer cements (RMGIC) are utilized for minimally invasive dental treatments.
• The efficacy of sealing these lesions without caries removal versus selective caries removal requires comparative evaluation.

Purpose of the Study:

• To compare the non-inferiority of sealing ICDAS Grade 5 occlusal carious lesions with RMGIC without caries removal versus selective caries removal followed by RMGIC restoration.
• To evaluate the clinical success rates of both treatment modalities over a two-year period.

Main Methods:

• A two-arm, parallel group, tooth-randomised, controlled, non-inferiority clinical trial was conducted.
• Participants were 3-9-year-old children with ICDAS Grade 5 occlusal carious lesions.
• Lesions were either sealed directly with RMGIC or treated with selective caries removal followed by RMGIC restoration. Follow-up examinations occurred at 6, 12, 18, and 24 months.

Main Results:

• At two years, the overall success rate was 48.8% for the sealing group and 76.0% for the restoration group.
• The 'restoration group' exhibited a statistically significant greater cavity volume at baseline (p = 0.01).
• No radiographic lesion progression was observed in either group throughout the follow-up period.

Conclusions:

• Sealing ICDAS Grade 5 occlusal caries with RMGIC without caries removal resulted in significantly lower survival rates at two years compared to selective caries removal.
• Selective caries removal followed by RMGIC restoration appears to be a more effective treatment strategy for these types of lesions in pediatric patients.