Non-Cochrane · intervention · PM30462676
Scientific evidence for the management of dentin caries lesions in pediatric dentistry: A systematic review and network meta-analysis.
Tedesco Tamara Kerber, Gimenez Thais, Floriano Isabela, et al. · PloS one · 2018 · PubMed · doi:10.1371/journal.pone.0206296
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
5
current version
GRADE rated
5
No studies
0
Included studies
15
linked below
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 4 · 80%Moderate 1 · 20%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children/pediatric patients with dentin caries lesions (without possible pulp involvement) in primary (deciduous) teeth | Children aged 2-10 years with dentin caries in primary teeth (n=15 studies included; 13 in quantitative synthesis) |
| Intervention | All available treatments for dentin caries lesions of primary teeth (restorative approaches including ART and conventional restorative treatment, and non-restorative approaches) | ART; conventional restorative treatment (amalgam, resin composite, compomer, high-viscosity GIC, RMGIC); Hall technique; non-restorative caries treatment; ultraconservative treatment; resin sealing; silver diamine fluoride; sodium fluoride varnish; low-viscosity GIC; interim restorative treatment; stainless-steel crown (n=15) |
| Comparison | Different treatment techniques compared with one another | 1 direct pairwise meta-analysis (sealing vs CRT-resin composite) and 3 network meta-analyses by surface |
| Outcomes | Caries lesion arrestment (CLA) and treatment success rate (SR) | Treatment success rate and caries lesion arrestment (%) (n=4 analyses) |
| Study designs | Prospective clinical studies with >=12 months follow-up comparing different techniques (randomized clinical trials and non-randomized/observational studies of interventions) | 14 randomized controlled trials and 1 practice-based observational study (n=15) |
| Timing | >=12 months follow-up | Follow-up 6 months to ~7 years; 12 months most common (73.3%) |
Search date: December 14, 2017. Databases: MEDLINE/PubMed; Web of Science; Scopus; grey literature (OpenSIGLE/OpenGrey); reference lists of eligible studies
Questions and results
Conventional restorative treatment with resin composite (CRT-RC) vs Sealing (resin sealant over caries)
Population: Children with dentin caries lesions in the outer half of dentin on occlusal surfaces of primary teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment success rate (survival/success of restoration) Mixed follow-up (6 months to 1.5 years; pooled) Conventional restorative treatment with resin composite gave a higher treatment success rate than resin sealing for outer-half occlusal dentin caries in primary teeth (2 studies; low certainty). Source: Results (Network meta-analysis and meta-analysis); Fig 2 (forest plot); Table 5 (Outer half of occlusal surface) · same question in other reviews | RR 1.20 [1.06, 1.37] | 2 studies · 66 participants | Low Downgraded: risk of bias |
Caries lesion arrestment Mixed follow-up (6 months to 1.5 years; pooled) Resin sealing and conventional restorative treatment (resin composite) did not differ significantly for caries lesion arrestment in outer-half occlusal dentin caries of primary teeth (2 studies; low certainty). Source: Results (Network meta-analysis and meta-analysis); Fig 3 (forest plot); Table 5 (Outer half of occlusal surface) · same question in other reviews | RR 1.02 [0.96, 1.08] | 2 studies · 66 participants | Low Downgraded: risk of bias |
Conventional restorative treatment with compomer vs Other network treatments
Population: Primary teeth with dentin caries lesions on occlusal surfaces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment success rate Various follow-up times · Occlusal surface without reported lesion depth CRT with compomer ranked first for treatment success in the occlusal-surface network (low certainty). Source: Results, network meta-analysis; Fig 4; Table 5 · same question in other reviews | RANK 1 | 5 studies | Low Downgraded: risk of bias |
Hall technique vs Other network treatments
Population: Primary teeth with dentin caries lesions on occlusoproximal surfaces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment success rate Various follow-up times · Occlusoproximal surface without reported lesion depth The Hall technique ranked first for treatment success in the occlusoproximal-surface network (low certainty). Source: Results, network meta-analysis; Fig 5; Table 5 · same question in other reviews | RANK 1 | 7 studies | Low Downgraded: risk of bias |
Silver diamine fluoride twice annually vs Other network treatments
Population: Primary teeth with dentin caries lesions on occlusal and smooth surfaces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries lesion arrestment Various follow-up times · Occlusal and smooth surfaces Silver diamine fluoride twice annually ranked first for caries lesion arrestment in the occlusal- and smooth-surface network (moderate certainty). Source: Results, network meta-analysis; Fig 6; Table 5 · same question in other reviews | RANK 1 | 3 studies | Moderate Downgraded: risk of bias |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | Yes | no |
| 4Comprehensive literature searchcritical | Partial Yes | Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | No | no |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Critically Low | no |
Included primary studies 15
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Ersin 2006 A clinical evaluation of resin-based composite and glass ionomer cement restorations placed in primary teeth using the ART approach:… PMID:17082278 | 3 other reviews | Treatment success rate | not extracted yet | not extracted yet |
| Zhi 2012 Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. PMID:22892463 | 3 other reviews | Caries lesion arrestment | not extracted yet | not extracted yet |
| Honkala 2003 The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic. PMID:12752916 | 2 other reviews | Treatment success rate | not extracted yet | not extracted yet |
| Taifour 2002 Effectiveness of glass-ionomer (ART) and amalgam restorations in the deciduous dentition: results after 3 years. PMID:12459617 | 2 other reviews | Treatment success rate | not extracted yet | not extracted yet |
| Duangthip 2016 A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides--18 month results. PMID:26037274 | 1 other review | Caries lesion arrestment | not extracted yet | not extracted yet |
| Hesse 2014 Sealing versus partial caries removal in primary molars: a randomized clinical trial. PMID:24884684 | 1 other review | Treatment success rate (survival/success of restoration) | not extracted yet | not extracted yet |
| Louw 2002 One-year evaluation of atraumatic restorative treatment and minimum intervention techniques on primary teeth. PMID:12494713 | 1 other review | Treatment success rate | not extracted yet | not extracted yet |
| Mijan 2014 The 3.5-year survival rates of primary molars treated according to three treatment protocols: a controlled clinical trial. PMID:23943256 | 1 other review | Treatment success rate | not extracted yet | not extracted yet |
| Santamaria 2014 Caries management strategies for primary molars: 1-yr randomized control trial results. PMID:25216660 | 1 other review | Treatment success rate | not extracted yet | not extracted yet |
| Santos 2012 Paradigm shift in the effective treatment of caries in schoolchildren at risk. PMID:22251037 | 1 other review | Caries lesion arrestment | not extracted yet | not extracted yet |
| Yu 2004 Survival of glass ionomer restorations placed in primary molars using atraumatic restorative treatment (ART) and conventional cavity… PMID:15005472 | 1 other review | Treatment success rate | not extracted yet | not extracted yet |
| Borges 2012 Efficacy of a non-drilling approach to manage non-cavitated dentin occlusal caries in primary molars: a 12-month randomized controlled… PMID:21718373 | this review only | Treatment success rate (survival/success of restoration) | not extracted yet | not extracted yet |
| Innes 2011 Sealing caries in primary molars: randomized control trial, 5-year results. PMID:21921249 | this review only | Treatment success rate | not extracted yet | not extracted yet |
| Roberts 2005 The survival of resin modified glass ionomer and stainless steel crown restorations in primary molars, placed in a specialist paediatric… PMID:15870802 | this review only | not stated | not extracted yet | not extracted yet |
| van den Dungen 2004 [ART or conventional restorations? A final evaluation of proximal restorations in deciduous molars]. PMID:15495501 | this review only | Treatment success rate | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).