Outcomes of the conventional and biological treatment approaches for the management of caries in the primary dentition

Abstract

Background In the last few years, conventional restorations including complete removal of carious tissue (CT) with or without pulp therapy for the treatment of carious lesions (CL) in primary teeth have been challenged and a more biological approach has been suggested. This approach involves the use of less invasive techniques which alter the environment of the CL isolating it from the cariogenic biofilm and substrate. Two of these treatment approaches that are becoming increasingly widely accepted and used in paediatric dentistry are the Hall Technique and indirect pulp capping (IPC). Aim To investigate the outcome of the conventional versus the biological approaches for the treatment of deep CL in the primary teeth in children, delivered in a specialist paediatric dentistry training environment. Design This was a retrospective cohort study of 246 children aged 4–9 years, treated with either approach, conventional and biological, in two UK specialist hospital settings. Data were extracted from clinical dental records and post‐operative radiographs of patients treated during the period 2006–2012. The outcome of the treatment in this study was categorised into three main categories: clinical, radiographic, and final outcome. Clinical and final outcomes were further described as success, minor, and major failure. Results In total, 836 primary teeth were included. In the conventional approach, 324 teeth had complete CT removal and 104 teeth had a pulpotomy. In the biological approach, 388 teeth had Hall Technique preformed metal crowns (PMC) placed and 20 teeth received indirect pulp capping. PMC were the restoration of choice for most of the cases where a pulpotomy had been carried out, and resin composite was most frequently used restorative material for the complete CT removal group. The majority of the primary teeth treated with either approach remained asymptomatic after a follow‐up period of up to 77 months, 95.3% in the conventional and 95.8% in the biological. No significant association was found between the final outcome and the approach used for treatment, age of the patient, gender and number of carious surfaces or tooth type. Conclusion Both the conventional and biological treatment approaches had similar final outcomes and were equally successful for management of CL in the primary dentition.

The impact of dental caries and its treatment by conventional or biological approaches on the oral health‐related quality of life of children and carers

“…This can be explained by the fact that the two treatment approaches demonstrated similar successful outcomes as demonstrated in several specialist‐based RCTs and cohort studies. A recent study reported 95.8% and 95.3% of the primary teeth that were restored using the conventional and biological approaches, respectively, remained asymptomatic over 6‐year follow‐up. This high success rate would contribute to the improvement of the overall health status and quality of life of the participants reported in this study.…”

“…From the child and carer perspectives, the conventional and biological approaches were equally associated with significant improvement in the child and family's oral health‐related quality of life in this study. This can be explained by the fact that the two treatment approaches demonstrated similar successful outcomes as demonstrated in several specialist‐based RCTs and cohort studies. A recent study reported 95.8% and 95.3% of the primary teeth that were restored using the conventional and biological approaches, respectively, remained asymptomatic over 6‐year follow‐up.…”

“…Few studies have directly compared the conventional and the biological approaches for the treatment of carious primary teeth in children. We have previously reported similar clinical outcomes, with both approaches when carried out by specialists for management of carious lesions in the primary dentition. However, this is the first study to report the impact of the conventional and biological restorations on the child and family's quality of life.…”

“…Conventional restorations have been the traditional approach for restoring carious primary teeth for decades but the biological approach which is less invasive is gaining popularity. Few studies have directly compared the conventional and the biological approaches for the treatment of carious primary teeth in children. We have previously reported similar clinical outcomes, with both approaches when carried out by specialists for management of carious lesions in the primary dentition.…”

“…Currently, two treatment approaches are proposed for the restoration of carious primary teeth in the UK; the conventional and the biological. Conventional restoration includes complete removal of carious tissue followed by placing a suitable filling material with or without pulp therapy, whereas the biological approach involves the isolation of the carious lesion from the biofilm using for example sealants, the Hall Technique, and indirect pulp capping.…”