Restorative treatments for caries lesions – ADA guideline

Photograph of carious teeth

In this blog we take a look at the latest clinical practice guideline from the American Dental Association on restorative treatments for primary and permanent teeth with moderate and advanced caries.

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Deep caries removal – Selective or stepwise?

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This review comparing stepwise removal (SWR) and selective removal (SCR) of deep carious lesions in primary and permanent teeth included 9 RCTs. The findings suggest that SCR may be more succesful than SWR but they should be interpreted cautiously because of the limited number of studies for some outcomes.

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Deep caries management for immature permanent teeth

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This review of techniques and materials used for the management of deep caries in immature permanent teeth included 12 RCT papers. The findings suggest high success rates for pulpotomy, but only a small number of papers were available for other techniques.

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Top Dental Elf Blogs: Jul – Sep 2021

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Treatments for cavitated dentine caries, topical anaesthetics to reduce injection pain and vital pulp therapy for permanent teeth were out most popular blogs duing July, August and September 2021.

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Treatments for cavitated or dentine carious lesions

tooth diagramme, caries

This Cochrane review of interventions to treat carious lesions conventionally considered to require restorations in primary or permanent teeth with vital pulps included 27 RCTs. Compared with conventional treatment there were lower numbers of failures with the Hall technique and selective excavation (SE) in primary teeth and with SE and stepwise removal in permanent teeth.

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Primary teeth: Efficacy of 3 caries removal strategies

caries upper arch

This review of the efficacy of 3 caries removal strategies (complete, selective and stepwise) in primary teeth included 8 RCTs suggesting a lower risk of pulp exposure with selective and stepwise approaches.

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Calcium hydroxide as lining for deep caries lesions?

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16 low quality RCTs were included in this review of the effect of calcium hydroxide lining on clinical success in treatment of deep carious lesions. 6 RCTs contributed to the meta-analysis suggesting no beneficial effect.

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Stepwise and partial-caries-removal –reduces longer term pulpal complications?

occlusal caries, molar teeth

This review of stepwise or partial caries removal for deep caries suggesting included 5 studies ( 2 RCTs) of limited quality. Findings suggest better pulpal outcomes with these approaches compare with traditional treatment.

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Caries: review suggests complete removal not best approach

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This review of caries excavation strategies identified 28 studies including 19 RCTs. None were considered to be at low risk of bias . The results suggest that not attempting to remove all softened or stainable dentine could reduce the risk of complications

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Stepwise and partial excavation reduces the incidence of pulp exposure in carious primary and permanent teeth

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The traditional management of caries by the removal of all softened demineralised dentine before a filling is placed is being increasingly challenged. This updated Cochrane review aims to assess the effects of stepwise, partial or no dentinal caries removal compared with complete caries removal for the management of dentinal caries in previously unrestored primary and [read the full story…]