Systematic Review of Conservative Operative Caries Management Strategies

Abstract

The relationship between cavity preparation extension and restoration longevity is examined through a systemic review of the available evidence on specific conservative, operative caries‐management strategies. Evidence tables are provided for three specific techniques in the permanent dentition: 1) the proximal “tunnel” restoration, 2) the proximal “box‐only” restoration, and 3) the preventive resin restoration. In the primary dentition, the clinical trials involving the proximal box‐only restoration, most of which involved glass‐ionomer materials, are reviewed. In the permanent dentition, the evidence reveals low effectiveness for “tunnel” restorations, limited but supportive results for proximal‐only restorations, and generally favorable outcomes for the occlusal composite resin‐sealant restoration. The weak link in the latter is the overlying fissure sealant, which requires adequate ongoing maintenance. Conservative operative strategies in the primary dentition have not been uniformly successful, and deleterious material effects dominate restoration performance. This systematic review concludes that operative conservatism per se does not guarantee increased restoration longevity and that all restorations are vulnerable to caries recurrence, material failures, and technical deficiencies. The more successful conservative strategies are expected to enhance tooth longevity, provided concomitant caries control is effective.

Longevity of posterior dental restorations and reasons for failure

“…For resin composites, traditional Class II preparations demonstrated significantly better longevity compared with saucer‐shaped restorations. In a systematic review , McComb claimed that proximal slot preparations without any occlusal dovetail provide similar or greater longevity compared with traditional Class II preparations. Nevertheless, this conclusion was based on just three studies , and none was designed to compare the longevity of restorations in alternative Class II preparations.…”

“…Traditionally, Class II preparations have been made with mechanical retention according to Black's principles . After the introduction of adhesive dental materials, the focus shifted to minimal‐intervention techniques to preserve tooth substance, and new preparation techniques, such as saucer‐shaped or box‐only preparations, have been adopted . Previous studies have shown that the larger the size of the cavity, the shorter the longevity of the restoration , but little is known about the impact of preparation technique (i.e.…”

Arrest of non-cavitated dentinal occlusal caries by sealing pits and fissures: a 36-month, randomised controlled clinical trial

“…Recently, a minimally invasive approach has received great attention worldwide. This more conservative philosophy is based on sound science that spans the breadth of the disease continuum and includes the non‐surgical management of early non‐cavitated carious lesions 13 and the use of effective conservative interventions for dentinal caries 14 . It is also recognised that the appropriate management of dental caries must include the improved diagnosis of early non‐cavitated lesions, and measures for their prevention and arrest.…”

“…However, some dentists continue to recommend surgical intervention for non‐cavitated dentinal occlusal caries 3,4 . This normally puts the affected tooth into a repetitive restorative cycle, increasing the risks for adverse effects to the pulp and adjacent teeth 14 . All these factors contribute to a reduction in the longevity of the tooth and the restoration.…”

Minimally invasive dentistry approach in dental public health

“…The response rate was 840 dentists which represented 89.4% of the total population. Study findings revealed that 96.9% of respondents would restore the lesion when it reached dentin, 79% would restore when the lesion extended to the DEJ, 54.4% would restore the lesion when it was in inner enamel and 31.5% would restore the lesion in outer enamel. Also, 21.8% of respondents reported that they would restore dark fissures without signs of demineralization.…”