Non-Cochrane · intervention · PM41134397
Efficacy of different cavity liners compared to no cavity lining in managing deep caries in vital permanent teeth - a systematic review.
Kosan Esra, Kosan Deniz, Sturm Richard, et al. · Clinical oral investigations · 2025 · PubMed · doi:10.1007/s00784-025-06479-y
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
8
current version
GRADE rated
5
No studies
1
Included studies
12
linked below
No studies 1 · 12.5%Ungraded 2 · 25%Very low 2 · 25%Low 3 · 37.5%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 | Patients with deep caries lesions in mature or immature permanent posterior teeth (Class I and II), with no symptoms or reversible pulpitis | Patients with deep caries in vital permanent teeth, ages 6-76 years (4/12 studies included children); 12 RCTs, ~1184 treated teeth |
| Intervention | A specific cavity liner (any material) applied before final restoration | Cavity liners: calcium hydroxide/Dycal, resin-modified calcium silicate/TheraCal LC, glass-ionomer cement, hydraulic calcium silicate (Biodentine/MTA), flowable composite, ion-releasing resin (Activa BioACTIVE), potassium nitrate-polycarboxylate cement, and SDF pre-treatment (n=12) |
| Comparison | No liner (original protocol); expanded during scoping to also include a different liner material | No liner (~6 studies) or a different liner material (~6 studies) (n=12) |
| Outcomes | Combination of patient- and clinically-reported outcomes; primary/critical outcome: failure (tooth survival); also postoperative hypersensitivity, secondary caries, restoration longevity, OHRQoL | Failure, tooth survival, postoperative hypersensitivity, secondary caries prevention, restoration longevity (n=12); OHRQoL not reported by any included study |
| Study designs | Randomized controlled trials (RCTs) and comparative clinical trials (CCTs) | RCTs (n=12) |
| Timing | Clinical/radiological outcomes >=12 months; pain-related outcomes 7 days-3 months; OHRQoL >=6 months | Follow-up 12-36 months for clinical outcomes; 7 days-3 months for postoperative pain/hypersensitivity |
Search date: 30 August-30 October 2023; update 1 December 2024-1 February 2025. Databases: Cochrane CENTRAL; PubMed (including MEDLINE); Ovid; plus manual journal searches and grey literature (OpenGrey, Google Scholar, Open Access Theses and Dissertations)
Questions and results
Cavity liner (calcium hydroxide, glass-ionomer cement, resin-modified calcium silicate/TheraCal LC, hydraulic calcium silicate/MTA or Biodentine, flowable composite, or other liner material) vs No cavity liner or a different liner material
Population: Patients with deep caries lesions in mature or immature permanent (posterior) teeth, with no symptoms or reversible pulpitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment failure >=12 months The evidence is very uncertain about the effect of cavity liners on treatment failure; no significant difference between lined and unlined (or differently lined) restorations was found (very low certainty). Source: Table 2 (GRADE evidence profile), 'Treatment failure' row; Results 'Grading of evidence using GRADE' / 'Rating the body of evidence' · same question in other reviews | No significant difference; 96.5% of treated teeth remained vital | 12 studies · 1184 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Tooth survival >=12 months Cavity liners may make little or no difference to tooth survival (99.4% survival across groups; low certainty). Source: Table 2 (GRADE evidence profile), 'Tooth survival' row; Results 'Grading of evidence using GRADE' / 'Rating the body of evidence' · same question in other reviews | No significant difference; 99.4% survival in all groups | 12 studies · 1184 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Restoration longevity >=12 months Cavity liners may make little or no difference to restoration longevity (high success across groups; low certainty). Source: Table 2 (GRADE evidence profile), 'Restoration longevity' row; Results 'Grading of evidence using GRADE' / 'Rating the body of evidence' · same question in other reviews | No significant difference; high success in all groups | 8 studies · 889 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Postoperative hypersensitivity 7 days to 3 months The evidence is very uncertain whether cavity liners reduce postoperative hypersensitivity; no significant difference was found overall (very low certainty). Source: Table 2 (GRADE evidence profile), 'Postoperative hypersensitivity' row; Results 'Grading of evidence using GRADE' / 'Rating the body of… · same question in other reviews | No significant difference; minimal pain reported | 9 studies · 1000 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Oral health-related quality of life (OHRQoL) >=6 months No included study reported oral health-related quality of life (a planned outcome), so no evidence is available. Source: Methods 'Original review question' and 'Definition of failure' (planned outcome, OHRQoL follow-up >=6 months); not reported in Results or… · same question in other reviews | no estimate extracted | 0 studies | No studies |
Secondary caries prevention >=12 months Cavity liners may make little or no difference to secondary caries prevention (~100% prevention across groups; low certainty). Source: Table 2 (GRADE evidence profile), 'Secondary caries prevention' row; Results 'Grading of evidence using GRADE' / 'Rating the body of… · same question in other reviews | No significant difference; ~100% prevention | 10 studies · 1009 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative hypersensitivity Potassium nitrate liner vs polycarboxylate cement (Hodosh et al.) | Postoperative hypersensitivity reduction Significant reduction with potassium nitrate; p<0.05 (p<0.01 in subgroup section) | 1 study | Ungraded |
Postoperative hypersensitivity TheraCal LC vs Dycal (Bayoumy et al.) | Patients pain-free at 12 months 100% (TheraCal) vs 81% (Dycal); p<0.05 | 1 study | 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 | Yes | no |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Yes | Partial Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: N/A | NRSI: N/A · RCT: N/A | no |
| 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 | Moderate | Moderate | yes |
Included primary studies 12
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Baraka 2022 Twelve-month randomized controlled trial of 38% silver diamine fluoride with or without potassium iodide in indirect pulp capping of young… DOI:10.1016/j.adaj.2022.08.008 | 1 other review | not stated | not extracted yet | not extracted yet |
| Ahmed 2024 3-year randomized clinical trial to evaluate the performance of posterior composite restorations lined with ion-releasing materials. PMID:38418863 | this review only | not stated | not extracted yet | not extracted yet |
| Banomyong 2011 Posterior resin composite restorations with or without resin-modified, glass-ionomer cement lining: a 1-year randomized, clinical trial. PMID:25427330 | this review only | not stated | not extracted yet | not extracted yet |
| Banomyong and Messer 2013 Two-year clinical study on postoperative pulpal complications arising from the absence of a glass-ionomer lining in deep occlusal… PMID:23355492 | this review only | not stated | not extracted yet | not extracted yet |
| Bayoumy 2021 Clinical and microbiological evaluation of calcium silicate versus calcium hydroxide in two-step indirect pulp treatment: A randomized… DOI:10.4103/jioh.jioh_33_20 | this review only | not stated | not extracted yet | not extracted yet |
| Efes 2006 Two-year clinical evaluation of ormocer and nanofill composite with and without a flowable liner. PMID:16708724 | this review only | not stated | not extracted yet | not extracted yet |
| Gurcan and Seymen 2019 DOI:10.23804/ejpd.2019.20.02.04 | this review only | not stated | not extracted yet | not extracted yet |
| Hashem 2015 Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial. PMID:25710953 | this review only | not stated | not extracted yet | not extracted yet |
| Hodosh 1991 Maintenance of pulpal vitality using potassium nitrate-polycarboxylate cement cavity liner. PMID:1882043 | this review only | not stated | not extracted yet | not extracted yet |
| Pereira 2017 No additional benefit of using a calcium hydroxide liner during stepwise caries removal: A randomized clinical trial. PMID:28343596 | this review only | not stated | not extracted yet | not extracted yet |
| Singh 2019 Effect of Different Liners on Pulpal Outcome after Partial Caries Removal: A Preliminary 12 Months Randomised Controlled Trial. PMID:31096259 | this review only | not stated | not extracted yet | not extracted yet |
| Torres 2020 The influence of a liner on deep bulk-fill restorations: Randomized clinical trial. PMID:32835711 | 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).
| Review | Shared studies | Jaccard |
|---|---|---|
| A systematic review on the effect of silver diamine fluoride for management of dental caries in permanent teeth. (2023) | 1 | 0.04 |