Dental practitioners' thresholds for restorative intervention in carious lesions: a survey based systematic review update

Lundbeck, Heather J. ORCID: https://orcid.org/0000-0001-7386-705X, Pitchika, Vinay, Wilson, Paul, Raggio, Daniela P., Galloway, Jennifer ORCID: https://orcid.org/0000-0003-4800-5970, Al-yaseen, Waraf, Dutta, Arindam ORCID: https://orcid.org/0000-0003-4488-0831, Jones, Rhiannon, Bhatia, Shannu ORCID: https://orcid.org/0000-0002-6363-8306, Guest-Rowlands, Glesni ORCID: https://orcid.org/0000-0003-2435-7621, Rowles, Kathryn ORCID: https://orcid.org/0000-0001-8465-2337, Schwendicke, Falk and Innes, Nicola ORCID: https://orcid.org/0000-0002-9984-0012 2025. Dental practitioners' thresholds for restorative intervention in carious lesions: a survey based systematic review update. Caries Research 10.1159/000546194

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Abstract

Introduction: Despite evidence supporting the clinical and cost-effectiveness of minimally invasive dentistry (MID), its adoption by the dental profession has been slow. A systematic review in 2016 found the majority of dentists intervene invasively earlier than necessary. The aim was to update this review of the assessment of dental practitioners’ thresholds for providing restorative treatment for carious lesions given changes in evidence, teaching, and guidelines since 2016. The primary outcome was dental practitioners’ restorative thresholds (the extent of the lesion when they would decide to intervene restoratively). Secondary outcomes were changes over time, caries risk, regional differences, and primary/permanent dentition. Methods: This updated review replicated the methodology for the initial review, following the PRISMA 2020 guidelines (PROSPERO; CRD42023431906). Embase, MEDLINE (via PubMed), and Web of Science databases were searched (2016–2023) for observational studies reporting on dental clinicians’ thresholds for restorative interventions in adults and children without language, time, or quality restrictions. Screening, data extraction, and risk of bias assessment (Modified Newcastle-Ottawa Scale) were carried out independently and in duplicate. Meta-analyses were performed using a random-effects model. No funding sought. Results: Overall, 47 publications (30 from original publication and 17 from updated search) met the inclusion criteria and 65 datasets were included in the meta-analyses: 19 for occlusal lesions (16 pre-2016 and 3 post-2016; n = 11,946) and 46 for proximal lesions (38 pre-2016 and 8 post 2016; n = 20,428). The meta-analyses found that for occlusal lesions confined to enamel, there were fewer practitioners intervening invasively: 5% (95% confidence interval [CI]; 1–20%) post-2016, compared with 15% (95% CI; 9–23%) pre-2016. The opposite was found for proximal lesions with increased intervention levels, 27% (95% CI; 18–40%) for lesions confined to enamel post-2016, compared with 19% (95% CI; 12–29%) pre-2016, and for lesions extending up to the enamel-dentine junction 61% (95% CI; 36–81%) post-2016, compared with 39% (95% CI; 29–51%) pre-2016. There was variance between regions but too few studies to draw conclusions on individual regions. Conclusion: There was a suggestion of less invasive treatment of occlusal lesions over time; however, this was not evident for proximal lesions.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Dentistry
Publisher:	Karger Publishers
ISSN:	0008-6568
Date of First Compliant Deposit:	19 June 2025
Date of Acceptance:	11 February 2025
Last Modified:	20 Jun 2025 10:00
URI:	https://orca.cardiff.ac.uk/id/eprint/179189

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