Minimally Invasive Intervention for Primary Caries Lesions: Are Dentists Implementing This Concept?

Abstract

Contemporary minimally invasive treatment concepts for restorative treatment of primary caries lesions include both delayed intervention and smaller-sized preparations restricted to removal of carious tissue. The aim of this study was to investigate whether these concepts have resulted in a trend towards a more conservative choice made by dentists regarding treatment thresholds and restorative techniques. The results from previously conducted, precoded questionnaires developed by Espelid and Tveit, as well as from a recent Dutch questionnaire, were collected and analysed. A worldwide trend towards more minimally invasive strategies in the operative treatment of caries lesions could not be observed, neither for the initiation of operative treatment nor for the preparation techniques. However, in some countries, changes over time could be assessed, especially in Norway, where a reduction in the proportion of interventions is visible for both occlusal and approximal lesions, indicating that more dentists are postponing interventions until the lesions have progressed to a deeper level. From the Dutch national survey, it could be concluded that operators that intervene at an earlier stage of approximal lesioning (stage ≤4) also intervene at an earlier stage of occlusal caries (stage ≤3) (p = 0.012; OR = 2.52; 95% CI: 1.22-5.22). Generally, it can be concluded that dentists worldwide still tend to operatively intervene at a too early stage of caries, although variations exist between countries. A worldwide shift could be observed in the restorative material applied, since composite resin has almost completely replaced amalgam for restoring primary caries lesions.

Keywords: Minimally invasive dentistry; Primary caries; Questionnaire; Restorative dentistry; Treatment planning.

Fig. 1 Illustration of the different stages of approximal caries progression (stages 1-6)

Fig. 2 Illustration of the different stages of occlusal caries progression (stages 1-5)

Fig. 1

Cross table of the number of Dutch respondents selecting specific thresholds for operative treatment in occlusal and approximal caries cases. As the stages at either end of the spectrum were very rarely chosen, these were merged with the adjoining stages for the table. However, the individual numbers are shown in parentheses in the cells showing the total numbers.

Fig. 2

Scatterplot of the percentage of respondents intervening at stage 3 occlusal caries (x axis) and the percentage of respondents choosing only caries removal as the preparation technique (y axis).

Fig. 3

Scatterplots from different studies for restorative threshold (%), minimally invasive preparation technique (%) and the preferred restorative material (%) against the year the questionnaire was administered. a, b For each study, the proportion of dentists reporting restorative intervention at or before stage 3 occlusal caries lesions (a) and approximal stage 4 lesions (b) is shown. c, d For each study, the proportion of dentists preferring only occlusal caries removal (c) and an approximal saucer-shaped preparation (d) is shown. e, f For occlusal (e) and approximal (f) cavities, the proportion of dentists preferring a composite resin or amalgam restoration is shown.