There is an increasing trend towards less invasive approaches to caries management. The aim of this study was to evaluate the clinical efficacy of 3 caries management options [conventional restorations (CR), the hall technique (HT), and non-restorative caries treatment (NRCT)] for occlusoproximal cavitated lesions in primary molars

Methods

Children aged 3–8 years old with a primary molar tooth with occlusoproximal caries into dentine were recruited. Children were excluded if they had signs or symptoms of pulpal or periradicular pathology (including pain) or systemic conditions requiring special dental considerations. Only 1 tooth per child was included in the study

Treatments were provided by 12 different dentists (seven paediatric specialists and five post-graduate paediatric students). No local anaesthesia was used for the HT and NRCT approaches. Patients in the HT and CR had reviews twice per year while those in the NRCT group had 3 monthly recalls where plaque disclosing and toothbrushing instructions to parents/children for the whole mouth and site specific for the treatment tooth were performed and the information recorded. The study tooth was cleaned and fluoride varnish applied to active lesions. Patients were examined at 1 year.

Restoration loss/need for replacement, reversible pulpitis, and caries progression were considered to be minor failures and irreversible pulpitis, abscess, etc to be major failures.

Results

• 169 patients were recruited.
• At a minimum of 11 months 148 of 169 (87.6%) participants returned for follow up (CR: n = 56 of 65, 86%; HT: n = 44 of 52, 85%; NRCT: n = 48 of 52, 92%)
• There were minor failures in 20 out of 148 (CR = 7%, NRCT = 5%, HT = 1%)
• 9 (out of 148) presented with major failures (NRCT = 4, CR = 5)
• The HT was significantly more successful clinically than NRCT and CR after 1 yr, while pairwise analyses showed comparable results for treatment success between NRCT and CR.

Conclusions

The authors concluded

Overall, these results support the concept of caries control by managing the activity of the biofilm. Children require individual treatment plans, and keeping in mind that there is not one single treatment choice for caries control, clinicians should consider the HT and NRCT as treatment options with positive results for children’s pain perception and parents’ acceptability of techniques. This trial shows better outcomes with the Hall technique a relatively new approach that now has a number of trials supporting its efficacy.

Commentary

Earlier this year this research group published the results of the comparisons between the children’s behaviour and pain perception for this study (Dental Elf -16^th July 2014). This new paper looks at the studies main outcomes at one year. The findings at 1 year suggest that the Hall technique may be superior to other approaches. As further follow up is planned at 2 years it will be interesting to see if these differences persist.

Links

Santamaria RM, Innes NP, Machiulskiene V, Evans DJ, Splieth CH. Caries Management Strategies for Primary Molars: 1-Yr Randomized Control Trial Results. J Dent Res. 2014 Sep 12. pii: 0022034514550717. [Epub ahead of print] PubMed PMID: 25216660.

Dental Elf – 16^th Jul-2014 – Study finds that non-conventional caries management approaches are acceptable to children, parents and dentists

Original trial protocol

The Hall Technique

Dental Elf -17th-Jan-2012 – Hall technique for managing carious primary molars shows good long term outcomes.