Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document

M Duggal¹, S Gizani², S Albadri³, N Krämer⁴, E Stratigaki⁵, H J Tong⁶, K Seremidi², D Kloukos^{7

8}, A BaniHani⁹, R M Santamaría¹⁰, S Hu¹¹, M Maden¹², S Amend¹³, C Boutsiouki¹³, K Bekes¹⁴, N Lygidakis¹⁵, R Frankenberger¹⁶, J Monteiro¹⁷, V Anttonnen¹⁸, R Leith¹⁹, M Sobczak²⁰, S Rajasekharan²¹, S Parekh²²

Affiliations

¹ College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
² Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian, University of Athens, Athens, Greece.
³ School of Dentistry, Unit of Oral Health, University of Liverpool, Liverpool, UK.
⁴ Department of Paediatric Dentistry, Justus-Liebig University Gießen, Giessen, Germany.
⁵ Department of Pediatric Oral Health and Orthodontics, University Center of Dental Medicine, Basel, Switzerland.
⁶ Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
⁷ Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland.
⁸ Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force and VA General Hospital, Athens, Greece.
⁹ Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK.
¹⁰ Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany.
¹¹ Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
¹² Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK.
¹³ Department of Paediatric Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen) Medical Centre for Dentistry, Schlangenzahl 14, 35392, Giessen, Germany.
¹⁴ Department of Paediatric Dentistry, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria.
¹⁵ Lygidakis Dental Clinic (Private Dental Practice), 2 Papadiamantopoulou str. & Vasilissis Sofias Ave, 11528, Athens, Greece.
¹⁶ Medical Centre for Dentistry, Department of Operative Dentistry and Endodontics, Phillips-University Marburg, University Medical Centre Giessen and Marburg (Campus Marburg), Georg-Voigt-Str. 3, 35039, Marburg, Germany.
¹⁷ Department of Paediatric Dentistry, Sheffield Teaching Hospitals, Sheffield, UK.
¹⁸ Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.
¹⁹ Dublin Dental University Hospital, Trinity College, Dublin, Ireland.
²⁰ Specialized Dental Practice, Warsaw, Poland.
²¹ Department of Paediatric Dentistry, School of Oral Health Sciences, Ghent University, B-9000, Ghent, Belgium.
²² Department of Paediatric Dentistry, UCL Eastman Dental Institute, London, UK. s.parekh@ucl.ac.uk.

PMID: 36219336
PMCID: PMC9637614
DOI: 10.1007/s40368-022-00718-6

Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document

M Duggal et al. Eur Arch Paediatr Dent. 2022 Oct.

. 2022 Oct;23(5):659-666.

doi: 10.1007/s40368-022-00718-6. Epub 2022 Oct 11.

Authors

Affiliations

¹ College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
² Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian, University of Athens, Athens, Greece.
³ School of Dentistry, Unit of Oral Health, University of Liverpool, Liverpool, UK.
⁴ Department of Paediatric Dentistry, Justus-Liebig University Gießen, Giessen, Germany.
⁵ Department of Pediatric Oral Health and Orthodontics, University Center of Dental Medicine, Basel, Switzerland.
⁶ Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
⁷ Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland.
⁸ Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force and VA General Hospital, Athens, Greece.
⁹ Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK.
¹⁰ Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany.
¹¹ Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
¹² Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK.
¹³ Department of Paediatric Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen) Medical Centre for Dentistry, Schlangenzahl 14, 35392, Giessen, Germany.
¹⁴ Department of Paediatric Dentistry, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria.
¹⁵ Lygidakis Dental Clinic (Private Dental Practice), 2 Papadiamantopoulou str. & Vasilissis Sofias Ave, 11528, Athens, Greece.
¹⁶ Medical Centre for Dentistry, Department of Operative Dentistry and Endodontics, Phillips-University Marburg, University Medical Centre Giessen and Marburg (Campus Marburg), Georg-Voigt-Str. 3, 35039, Marburg, Germany.
¹⁷ Department of Paediatric Dentistry, Sheffield Teaching Hospitals, Sheffield, UK.
¹⁸ Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.
¹⁹ Dublin Dental University Hospital, Trinity College, Dublin, Ireland.
²⁰ Specialized Dental Practice, Warsaw, Poland.
²¹ Department of Paediatric Dentistry, School of Oral Health Sciences, Ghent University, B-9000, Ghent, Belgium.
²² Department of Paediatric Dentistry, UCL Eastman Dental Institute, London, UK. s.parekh@ucl.ac.uk.

PMID: 36219336
PMCID: PMC9637614
DOI: 10.1007/s40368-022-00718-6

Abstract

Purpose: The European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth.

Methods: Three expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified.

Results: There is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates.

Conclusion: The management of deep carious lesions in primary teeth can be challenging and must consider the patient's compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option.

Keywords: Caries; Caries management; Dental materials; Minimal intervention dentistry; Primary molars; Pulp treatment.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

**Fig. 1**
Flowchart of treatment protocol of dentinal caries lesions in primary dentition

See this image and copyright information in PMC

Comment in

Editorial.
Lygidakis NA. Lygidakis NA. Eur Arch Paediatr Dent. 2022 Oct;23(5):657. doi: 10.1007/s40368-022-00755-1. Eur Arch Paediatr Dent. 2022. PMID: 36167924 No abstract available.

References

1. Alaki SM, Abdulhadi BS, AbdElBaki MA, et al. Comparing zirconia to anterior strip crowns in primary anteriorteeth in children: a randomized clinical trial. BMC Oral Health. 2020;20:313. doi: 10.1186/s12903-020-01305-1. - DOI - PMC - PubMed
1. Amend S, Boutsiouki C, Bekes K, Kloukos D, Lygidakis N, Frankenberger R, Krämer N. Clinical effectiveness of restorative materials including new biomaterials for the restoration of carious primary teeth: A systematic review (Part 1). Eur Arch Paediatr Dent. 2022. pp. 1–33. - PMC - PubMed
1. BaniHani A, Santamaría RM, Hu S, Maden M, Albadri S. Minimal intervention dentistry for managing carious lesions into dentine in primary teeth: an umbrella review. Eur Arch Paediatr Dent. 2021 doi: 10.1007/s40368-021-00675-6. - DOI - PMC - PubMed
1. Dorri M, Dunne SM, Walsh T, Schwendicke F. Micro-invasive interventions for managing proximal dental decay in primary and permanent teeth. Cochrane database Syst. 2015 doi: 10.1002/14651858. - DOI - PMC - PubMed
1. Ericson D, Kidd E, McComb D, Mjör I, Noack MJ. Minimally invasive dentistry-concepts and techniques in cariology. Oral Health Prev Dent. 2003;1:59–72. - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

LinkOut - more resources

Full Text Sources
- Europe PubMed Central
- Springer
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document

Affiliations

Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical