Non-Cochrane · intervention · PM34784027
Minimal intervention dentistry for managing carious lesions into dentine in primary teeth: an umbrella review.
BaniHani A, Santamaría R M, Hu S, et al. · European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry · 2022 · PubMed · doi:10.1007/s40368-021-00675-6
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
27
current version
GRADE rated
0
No studies
0
Included studies
35
linked below
No studies 0 · 0%Ungraded 27 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%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 in the primary dentition with untreated dentine carious lesions (ICDAS 4-5) requiring management without local anaesthesia | Children (2-15 years) with dentine caries in primary teeth (18 systematic reviews) |
| Intervention | Minimal Intervention Dentistry: fissure sealants; resin infiltration; 38% SDF; Hall Technique; non-restorative caries control; selective and stepwise caries removal; ART | 38% SDF (8 SRs); Hall Technique (1 SR); selective/stepwise caries removal (1 SR); ART (8 SRs) |
| Comparison | Conventional restoration (non-selective/complete caries removal); vital pulp therapy; placebo; no treatment | No treatment; GIC; 5% NaF varnish; 12% SDF; conventional/complete caries removal; amalgam; composite resin |
| Outcomes | Treatment success; minor and major failure; time to failure/retreatment; discomfort; patient/carer perceptions; oral health-related quality of life; adverse events | Caries arrest; pulp exposure; pulpal disease; restoration survival/failure; pain; discomfort; gingival bleeding; adverse events (black staining) |
| Study designs | Systematic reviews with or without meta-analysis (of RCTs/controlled clinical trials) | 18 systematic reviews (13 with meta-analysis, 5 without), reporting on 95 studies |
| Timing | Not specified | Follow-up 6 months to 5 years |
Search date: August 2020. Databases: MEDLINE; Embase; Cochrane Database of Systematic Reviews; Epistemonikos; Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports; NIHR Journals Library; PROSPERO
Questions and results
38% silver diamine fluoride (SDF) vs No treatment / other preventive agents (GIC, 5% NaF varnish)
Population: Children with dentine carious lesions (ICDAS 4-5) in primary teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrest 18-30 months · 38% SDF vs 5% NaF varnish/water (Trieu et al. 2019 meta-analysis) A second meta-analysis reported odds ratios of 2.44 to 3.63 favouring 38% SDF over fluoride varnish/water for caries arrest (ungraded). Source: Results (Silver diamine fluoride); Table 5 (Trieu et al.) · same question in other reviews | OR (caries arrest) OR 2.44-3.63 (range); 2.44 = Chu estimate including 30% SDF | 3 studies | Ungraded |
Caries arrest 6-48 months · Pooled caries-arrest proportion (Gao et al. 2016 meta-analysis) One meta-analysis reported an overall caries-arrest proportion of 81% (95% CI 68-89%) for 38% SDF in primary teeth (ungraded). Source: Results (Silver diamine fluoride); Table 5 (Gao et al.) · same question in other reviews | Proportion (caries arrest) 81 [68, 89] | 12 studies | Ungraded |
38% SDF applied twice yearly (biannual) vs 38% SDF applied once yearly (annual)
Population: Children with dentine carious lesions (ICDAS 4-5) in primary teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrest 24 months · Biannual vs annual application Twice-yearly 38% SDF was reported to arrest more caries than once-yearly application (24-month rates 91% vs 79%; ungraded). Source: Results (Silver diamine fluoride); Table 5 (Duangthip 2015/2016) · same question in other reviews | Caries arrest rate (%) 91% (twice-yearly) vs 79% (once-yearly) at 24 months | NR | Ungraded |
Hall Technique preformed metal crowns vs Conventional restorations (amalgam, GIC, composite)
Population: Children (3-10 years) with dentine caries in primary molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Discomfort during treatment During treatment The reported estimate for treatment discomfort with the Hall Technique versus conventional restorations was inconclusive (ungraded). Source: Results (Hall Technique); Table 7 · same question in other reviews | RR 1.67 [0.65, 4.25] | 2 studies | Ungraded |
Gingival bleeding (adverse event) Not reported The reported estimate for gingival bleeding with preformed metal crowns was inconclusive (ungraded). Source: Results (Hall Technique); Table 7 · same question in other reviews | RR 1.09 [0.42, 2.86] | 2 studies | Ungraded |
Restoration failure 1-5 years The Hall Technique was reported to reduce restoration and major failure versus conventional restorations (3% vs 37%; ungraded). Source: Results (Hall Technique) · same question in other reviews | 3% (HT) vs 37% (control) | 1 study | Ungraded |
Selective (partial, one-step) removal of carious tissue vs Non-selective (complete) caries removal to hard dentine
Population: Children with dentine caries in primary and permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pulp exposure during caries removal 12 months · Primary and permanent teeth combined (2 studies) Partial caries removal was reported to reduce pulp-exposure risk by 77% versus complete caries removal (RR 0.23; ungraded). Source: Results (Selective removal of carious tissue); Table 9 · same question in other reviews | RR 0.23 [0.08, 0.69] | 2 studies | Ungraded |
Pulp exposure during caries removal 12 months · Primary teeth Population: Children (3-11 years) with symptomless, vital dentine caries in primary molars Partial caries removal reduced the reported risk of pulp exposure versus complete caries removal in primary teeth (RR 0.24; ungraded). Source: Results (Selective removal of carious tissue); Table 8; Table 9 · same question in other reviews | RR 0.24 [0.06, 0.90] | 262 participants | Ungraded |
Pulpal disease (signs/symptoms of pulp necrosis) 12 months · 3 studies (primary and permanent teeth) The reported estimate did not show a clear difference in pulpal disease after partial versus complete caries removal (ungraded). Source: Results (Selective removal of carious tissue); Table 9 · same question in other reviews | RR 0.27 [0.05, 1.60] | 3 studies | Ungraded |
Stepwise excavation (two-step caries removal) vs Non-selective (complete) caries removal to hard dentine
Population: Children (3-11 years) with symptomless, vital dentine caries in primary molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pulp exposure during caries removal 12 months · Stepwise excavation vs complete caries removal (primary teeth) Stepwise excavation reduced the reported risk of pulp exposure by 69% versus complete caries removal (RR 0.31; ungraded). Source: Results (Selective removal of carious tissue); Table 9 · same question in other reviews | RR 0.31 [0.17, 0.57] | 262 participants | Ungraded |
Atraumatic restorative treatment with high-viscosity GIC (class I) vs Amalgam restoration
Population: Children (5-7 years) with caries in primary teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Restoration success/failure 24 months ART with high-viscosity GIC and amalgam had similar class I restoration success at 24 months (ungraded). Source: Results (ART); Table 11 (Mickenautsch) · same question in other reviews | RR 1.07 [0.91, 1.27] | 3 studies | Ungraded |
Restoration success/failure 12 months ART with high-viscosity GIC and amalgam had similar class I restoration success at 12 months (ungraded). Source: Results (ART); Table 11 (Mickenautsch) · same question in other reviews | RR 0.93 [0.83, 1.06] | 3 studies | Ungraded |
Atraumatic restorative treatment with high-viscosity GIC vs Conventional restoration (amalgam / composite resin)
Population: Children with occlusoproximal caries in primary teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Restoration survival 2-3 years · Occlusoproximal cavities (Raggio 2013; Tedesco 2017) Multiple reviews reported similar restoration survival for ART versus conventional restorations in occlusoproximal cavities (ungraded). Source: Results (ART); Table 11 (Raggio; Tedesco 2017) · same question in other reviews | OR OR 0.298-1.267 (Raggio 2013); Tedesco 2017 ORs 0.298/0.710/1.26 (NS) | NR | Ungraded |
Restoration failure 12-24 months Population: Children (3-13 years) with dentine caries in primary teeth, no pulpal involvement ART with GIC was reported to increase the odds of restoration failure versus conventional restoration (OR 1.60; ungraded). Source: Results (ART); Table 11 (Dorri) · same question in other reviews | OR 1.60 [1.13, 2.27] | 6 studies · 1107 participants | Ungraded |
Pain during procedure During procedure Population: Children (3-13 years) with dentine caries in primary teeth, no pulpal involvement The reported estimate for procedural pain with ART versus conventional treatment was inconclusive (ungraded). Source: Results (ART); Table 11 (Dorri) · same question in other reviews | MD -0.65 [-1.38, 0.07] | 6 studies · 1107 participants | Ungraded |
Discomfort during procedure During procedure · Children 6-8 years; ART vs conventional treatment with local anaesthetic Population: Children (6-8 years) with caries in primary teeth The reported estimate for discomfort with ART versus conventional treatment was inconclusive (ungraded). Source: Results (ART); Table 11 (Dorri) · same question in other reviews | OR 0.95 [0.51, 1.79] | 6 studies · 1107 participants | Ungraded |
Multi-surface ART with high-viscosity GIC vs Single-surface ART with high-viscosity GIC
Population: Children with caries in primary molars/teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Restoration survival 3 years · Multi-surface Multi-surface ART/HVGIC restorations had lower reported survival (49% at 3 years) than single-surface restorations (ungraded). Source: Results (ART); Table 11 (van 't Hof) · same question in other reviews | Survival rate (%) 49 | 9 studies | Ungraded |
Mean annual restoration failure rate First 3 years · Single-surface Population: Children (2-9 years) with caries in posterior primary teeth Single-surface ART restorations had a low reported mean annual failure rate (about 5%; ungraded). Source: Results (ART); Table 11 (van 't Hof; de Amorim) · same question in other reviews | Mean annual failure rate (%) 4.7% (van 't Hof 2006) to 5% (de Amorim 2018) | NR | Ungraded |
Restoration survival 3 years · Single-surface Single-surface ART/HVGIC restorations had high reported survival (86% at 3 years), significantly higher than multi-surface restorations (ungraded). Source: Results (ART); Table 11 (van 't Hof; Tedesco 2018) · same question in other reviews | Survival rate (%) 86 | 9 studies | Ungraded |
Restoration survival 2–3 years Population: Children with occlusoproximal caries in primary teeth The reported pooled ART success estimate was 1.04. Source: Table 10; Table 11 · same question in other reviews | Pooled ART success estimate (Raggio 2013; not an odds ratio) 1.04 | 3 studies | Ungraded |
Mean annual restoration failure rate First 3 years · Multi-surface Population: Children (2-9 years) with caries in posterior primary teeth Multi-surface ART restorations had a high reported mean annual failure rate (17%; ungraded). Source: Results (ART); Table 11 (van 't Hof; de Amorim) · same question in other reviews | Mean annual failure rate (%) 17 | NR | Ungraded |
High-viscosity GIC atraumatic restorative treatment vs No control
Population: Children with caries in primary molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Restoration survival 1 year · Multi-surface Multi-surface ART restorations had a reported survival rate of 73% at 1 year. Source: Table 10; Table 11 · same question in other reviews | Survival rate 73 | 9 studies | Ungraded |
Restoration survival 1 year · Single-surface Single-surface ART restorations had a reported survival rate of 95% at 1 year. Source: Table 10; Table 11 · same question in other reviews | Survival rate 95 | 9 studies | Ungraded |
Restoration survival 2 years · Multi-surface Multi-surface ART restorations had a reported survival rate of 59% at 2 years. Source: Table 10; Table 11 · same question in other reviews | Survival rate 59 | 9 studies | Ungraded |
Restoration survival 2 years · Single-surface Single-surface ART restorations had a reported survival rate of 91% at 2 years. Source: Table 10; Table 11 · same question in other reviews | Survival rate 91 | 9 studies | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain during treatment Hall Technique vs non-selective caries removal to hard dentine | Proportion with no/mild pain 89% (HT) vs 78% (control) | 1 study | Ungraded |
Mean number of arrested caries surfaces 38% SDF vs comparators (NaF/no treatment) | Mean arrested caries surfaces (count) 2.5-4.5 (38% SDF) vs 1.3-1.8 (comparators) | 2 studies | Ungraded |
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 | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: Yes · RCT: Yes | RCT: Yes · NRSI: Yes | no |
| 10Funding of included studies reported | Yes | Yes | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: N/A | NRSI: N/A · RCT: N/A | yes |
| 12Impact of risk of bias on the pooled results | N/A | N/A | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | N/A | N/A | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |
Included primary studies 35
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Ersin 2008 matched by author and year (probable) | 2 other reviews | not stated | not extracted yet | not extracted yet |
| Llodra 2005 matched by author and year (probable) | 2 other reviews | not stated | not extracted yet | not extracted yet |
| Ersin 2006 matched by author and year (probable) | 1 other review | not stated | not extracted yet | not extracted yet |
| Fung 2016 matched by author and year (probable) | 1 other review | not stated | not extracted yet | not extracted yet |
| Fung 2018 matched by author and year (probable) | 1 other review | not stated | not extracted yet | not extracted yet |
| Wong 2011 matched by author and year (probable) | 1 other review | not stated | not extracted yet | not extracted yet |
| Yassen 2009 matched by author and year (probable) | 1 other review | not stated | not extracted yet | not extracted yet |
| Carvalho 2010 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| De Menezes 2006 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Deepa 2010 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Fukumoto 1997 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Hilgert 2014 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Hilgert 2017 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Honkala 2003 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Huang 2006 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Innes 2007 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Innes 2011 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Louw 2002 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Lula 2009 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Magnusson 1977 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Mijan 2014 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Molina 2017 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Ohran 2010 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Ribeiro 1999 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Roeleveld 2006 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Santamaria 2014 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Schriks 2003 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Seberol 2013 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Taifour 2002 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Tsutsumi 1981 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Van den Dungen 2004 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Van Gemert-Schriks 2007 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Wang 1984 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Wong 2005 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Yoshida 1976 matched by author and year (probable) | this review only | not stated | 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).