Abstract
Dental caries is a disease of dental hard tissues, considered the most common non-communicable disease worldwide. Conventional treatments for caries removal are often associated with pain and fear, so different therapeutic approaches have been developed towards more conservative and pleasant treatments. This systematic review aimed to assess the efficacy and patient’s acceptance of alternative methods for caries removal compared to conventional methods. The Cochrane Library, Embase, Medline/Pubmed, Web of Science, and Clinical Trials databases were searched. Clinical trials of primary dental caries treated with alternative methods were included. The last search was performed on 5 August 2020. The Population, Intervention, Comparison, and Outcome (PICO) strategy was followed. Thirty-seven clinical trials were included, reporting caries removal using alternative (chemomechanical—Brix 3000, Carie-care, Carisolv and Papacarie, laser—Er:YAG (Erbium-doped Yttrium Aluminium Garnet) and Er,Cr:YSGG (Erbium, Chromium-doped Yttrium, Scandium, Gallium and Garnet), and a system combining air and sono-abrasion—Vector® System) and conventional methods. Alternative methods tended to prolong treatment time and lessen anesthesia need. All treatments were effective in reducing cariogenic flora, and the restoration’s performance did not differ significantly. Chemomechanical solutions seemed to be the best option towards minimally invasive treatments, with good control during application and action and good treatment experiences for patients. Papacarie was demonstrated to be an effective method for caries removal with less pain, and superior acceptance by patients when compared to conventional treatments.
Highlights
Dental caries is a disease of dental hard tissues, being the most common chronic disease amongst all oral conditions [1,2,3,4,5]
The purpose of this study was to carry out a systematic review of the literature to answer the Population, Intervention, Comparison, and Outcome (PICO) question: “In removing dental caries from deciduous and permanent decayed teeth, how efficient are alternative methods for caries removal, comparing to the conventional mechanical methods?” (Table 1)
The present systematic review was performed following the recommendations of Preferred Reporting Items for Systematic Reviews (PRISMA) [23] guidelines, the A MeaSurement Tool to Access Systematic Reviews (AMSTAR) instrument [24] and the Cochrane Handbook of Systematic Reviews of Interventions [25] version 6
Summary
Dental caries is a disease of dental hard tissues, being the most common chronic disease amongst all oral conditions [1,2,3,4,5]. Dental decay has been related to multifactorial etiology, where diet and oral flora play an essential role, being the acid production by microbial metabolism of sugars and the prolonged periods of low oral pH, the critical factors for tooth demineralization. It starts with small surface roughness or sub-surface demineralization, progressing to cavitation [1,5,6,8,9,10,11]. If untreated, it may cause pulp involvement, swelling, abscess, and systemic signs and symptoms [4,8]
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