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Interventions for treating cavitated or dentine carious lesions (Review)

Schwendicke, F., Walsh, T., Lamont, T., Al-yaseen, W., Bjørndal, L., Clarkson, J.E., Fontana, M., Gomez Rossi, J., Göstemeyer, G., Levey, C., Müller, A., Ricketts, D., Robertson, M., Santamaria, R.M. and Innes, N.P.T. ORCID: 2021. Interventions for treating cavitated or dentine carious lesions (Review). Cochrane Database of Systematic Reviews 7 , CD013039. 10.1002/14651858.CD013039.pub2

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Background Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non‐selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non‐restorative cavity control (NRCC). Objectives To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro‐cavitated lesions, or occlusal lesions that are clinically non‐cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps. Search methods An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies. Selection criteria We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non‐ or micro‐cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions). Data collection and analysis Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta‐analysis to assess and rank the relative effectiveness of different interventions. Main results We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty‐four studies used a parallel‐group design and three were split‐mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non‐cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth. Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing with sealant materials (2); sealant materials versus no sealing (2). Follow‐up times varied from no follow‐up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months. All studies were at overall high risk of bias.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Dentistry
Publisher: Cochrane Collaboration
ISSN: 1469-493X
Date of First Compliant Deposit: 20 July 2021
Date of Acceptance: 19 July 2021
Last Modified: 21 Feb 2024 16:44

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