Does selective caries removal in combination with antimicrobial photodynamic therapy affect the clinical performance of adhesive restorations of primary or permanent te eth? A systematic review with meta-analysis

Abstract

Antimicrobial photodynamic therapy (aPDT) is an adjunct to a selective caries removal (SCR) technique for deep caries lesion treatment. The knowledge about chemical and structural changes affecting the remaining dentin surface after the use of this therapy is still unknown. Objective: to answer the following question: Does the SCR technique in combination with aPDT affect the clinical performance of adhesive restorations in deep carious lesions of primary or permanent teeth? Study design: a systematic review was conducted. Five databases, supplemented by trial registers, google scholar, manual search, personal communications, and grey literature were investigated. Randomized clinical trials were included. Two independent reviewers selected the studies, extracted qualitatively the data, and evaluated the risk of bias (using Cochrane Collabo-ration’s tooland Robot Reviewer program). The certainty of the evidence was accessed based on The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A meta-analysis of comparable data was performed with RevMan software 5.3. Results: A total of 39 articles and 3 studies were found. The final selection included 3 articles with a total of 82 participants. No studies were found on permanent teeth. The studies presented low risk of bias. Considering the treatment in the experimental (SCR + aPDT) or control groups (SCR), no difference on clinical performance of adhesive restorations in deep caries of primary teeth was observed after 6 months (p = 0.78; CI −0.01 (−0.09, 0.07)) or 12 months (p =0.75; CI −0.02 (−0.12, 0.08)). All outcomes presented moderate certainty of evidence mainly due to the small sample size that downgrade the GRADE scores. Conclusions: based on moderate certainty of the evidence, the clinical use of aPDT as an adjuvant of SCR has potential indication for treatment in deep caries of primary teeth. However, studies with more follow up and on permanent teeth are missing with the necessity for further research.

Effect of Laser Irradiation Modes and Photosensitizer Types on Antimicrobial Photodynamic Therapy (aPDT) for Streptococcus sobrinus in the Crown Dentin of Bovine Teeth: An Experimental In Vitro Study

“…However, the bactericidal effect of bio-inductive materials on cariogenic bacteria is unknown because there was no report examining the antimicrobial properties of bio-inductive materials. Meanwhile, the bactericidal effect of aPDT on cariogenic bacteria has attracted much attention, and many basic and clinical studies have been conducted [ 17 , 18 , 19 ]. Although the results of these studies all suggested that aPDT was effective in the treatment of dental caries, the kinds of photosensitizers and types and wavelengths of light sources used in these studies varied widely.…”

Comparative Meta-Analysis of Minimally Invasive and Conventional Approaches for Caries Removal in Permanent Dentition

“…Nowadays, minimally invasive dentistry should be a guide mark to restore dental caries and there are new procedures that offer advantages over conventional methods. Although selective procedures are well documented in the literature, with respect to deciduous teeth, there are few investigations about these techniques in permanent dentition [ 14 ]. Since both dentitions present differences, such as size of teeth or regenerative potential, they should be studied separately.…”