Interventions to treat cavitations or dentigerous caries lesions
Schwendicke F, Walsh T, Lamont T, Al-yaseen W, BjørndalL, Clarkson JE, Fontana M, Gomez Rossi J, GöstemeyerG, Levey C, MüllerA, Ricketts D, Robertson M Santamaria RM, Innes NPT Interventions to treat cavitating or dentin caries lesions. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD013039. doi: 10.1002 /14651858.CD013039.pub2. Accessed July 29, 2021.
Commentary
This study was aimed at validating the treatment of caries lesions traditionally considered to require restoration, hollowed or micro hollowed lesions, or occlusal lesions that are not clinically hollowed but clinically/radiologically extend into dentin, on primary or permanent teeth with significant (sensitive) pulp.
The main results of the study were reviewed, including 27 studies involving 3350 participants and 4195 teeth/lesions, conducted in 11 countries and published between 1977 and 2020.
Seventeen studies compared conventional treatment (CR) with minimally invasive treatment.
SE (8), SW (4), two HT (2), sealing with sealant material (4) and NRCC (1). Other comparisons were: SE and HT (2); SE versus SW (4); SE versus sealing with sealant material (2); sealant material and no sealing (2).
The duration of follow-up varied from no follow-up (pulp exposure during treatment) to 120 months, with the most common being 12 to 24 months.
All studies had an overall high risk of bias.
・Comparison of sealing with sealant to other interventions in non-cavitated lesions or cavitated but not deep lesions
Sealing with sealant and CR, sealing and SE, or sealing versus no treatment have all been evaluated as evidence of very low certainty.
HT, CR, SE, and NRCC for deep but not cavitated lesions in primary teeth
The probability of failure is higher for CR than for HT and lower for HT than for NRCC; the evidence for the difference between SE and HT or CR and NRCC is insufficient, and these appear to be very low certainty evidence.
CR, SE, and SW for deep lesions
The results show that the probability of failure of CR was higher than SW in permanent teeth, but not in primary teeth.
In permanent and primary teeth, the probability of failure of CR may be higher than SE, both of which are evidence of very low certainty. In particular, two studies compared CR and SE in cavitated lesions and found insufficient evidence of a difference in results.
Some results showed that SW had a higher probability of failure than SE in permanent teeth, but not in primary teeth.
In the case of deep lesions, the network meta-analysis showed the greatest probability of failure for CR compared to SE, SW, and HT.
The authors conclude that
There were fewer failures of HT and SE in the primary dentition and SE and SW in the permanent dentition compared to CR. Most studies showed a high risk of bias and limited precision of estimation due to small sample sizes and usually limited number of failures, and most comparisons were rated as low or very low certainty of evidence.
