Selective Caries Removal Research Articles

Minimally invasive caries treatment

The development of minimally invasive caries treatment has dramatically changed dentistry. Instead of traditional, often invasive methods that resulted in significant loss of healthy dental tissue, this approach focuses on preserving the vitality of the pulp and minimizing tissue loss by delaying and scaling back restorative treatments. This involves the use of modern methods, with selective caries removal with or without indirect (pulp) capping being the norm for treating extensive lesions. The philosophy of minimal intervention goes beyond treatment choices to include a holistic approach from diagnosis to follow-up care, emphasizing personalized care based on risk profiles. This paradigm shift has greatly improved the standard of care, but continued attention to the risks of overdiagnosis and overtreatment is necessary to ensure optimal oral health.

Direct Composite Restorations on Permanent Teeth in the Anterior and Posterior Region - An Evidence-Based Clinical Practice Guideline - Part 2: Recommendations for Composite Processing.

Part 2 of this German S3 clinical practice guideline provides recommendations for the process of manufacturing composite restorations. It covers key aspects like caries removal, field isolation, matrix and adhesive techniques, as well as light curing and polishing. The outcomes of interest include survival rates and restoration quality. A systematic literature search was conducted by two methodologists using MEDLINE and the Cochrane Library via the OVID platform, including studies up to December 2021. Additionally, the reference lists of relevant manuscripts were manually reviewed. Six PICO questions were developed to guide the search. Consensus-based recommendations were for- mulated by a panel of dental professionals from 20 national societies and organizations based on the collected evidence and ex- pert opinion. The guideline advocates for one-stage selective caries removal near the pulp and underscores the effectiveness of various isolation techniques, adhesive systems, and the crucial role of light polymerization. The use of anatomically pre- formed sectional matrices and phosphoric acid etching is recommended to enhance restoration quality. Additionally, polish- ing composite restorations is advised to improve surface finish. This guideline provides comprehensive recommendations that inform clinicians on optimizing the composite restor- ation manufacturing processes. The adoption of these best practices can improve the quality and longevity of dental restorations.

Restorations performance after selective caries removal to soft dentine: 18-month follow-up of a controlled clinical trial

ObjectiveThis randomized controlled clinical trial aimed to evaluate the clinical performance of composite resin restorations placed after selective caries removal to soft dentin (SCRSD) or stepwise excavation (SW) over an 18-month period. MethodsInclusion criteria were patients with permanent molars and/or premolars presenting deep caries lesions (≥50 % of the dentin thickness). Teeth were submitted to SCRSD (n = 76) or SW (n = 76). Evaluations were performed based on FDI (World Dental Federation) criterion. Survival analysis was performed to estimate the survival of restorations and its association with clinical variables and socio-demographic characteristics (adjusted Weibull regression model). The study was registered on Registro Brasileiro de Ensaios Clínicos (ReBEC 65ntbc). ResultsThe follow-up period ranged from 6 to 18 months (mean ± SD 16.3 ± 3.4 months). Patients' ages ranged from 9 to 55 years (mean ± SD 29 ± 10.5 years). A total of 135 teeth (SCRSD = 72; SW = 63) from 101 patients were evaluated. There were 4 failures in the SCRSD group (2 loss of restoration in need of replacement and 2 marginal fractures in need of repair) and 2 in the SW group (fracture in need of repair). The association between explanatory variables and restoration failure showed similar success rates for SW (99.4 %) and SCRSD (97.9 %) (p = 0.16). Patients presenting gingivitis (≥20 % of sites with gingival bleeding) had 8.50 times more risk for failure than those with <20 % of bleeding sites (p = 0.03). ConclusionThis study showed that placing a composite resin restoration over soft dentin (after SCRSD) did not affect its clinical performance after 18 months. Clinical significanceSCRSD is a feasible treatment option for the management of deep caries lesions in permanent teeth as it preserves tooth vitality and tooth structure without compromising restoration longevity.

Histological and ultrastructural evaluation of remaining dentin after selective caries removal in primary molars: Ex-vivo study

Aim: In this study, ultrastructural, chemical, and histological analyses of extracted deciduous teeth were performed to analyze the effect of two different types of glass ionomer cements used in association with selective caries removal in deep lesions of deciduous teeth. Methods: A clinical, ex vivo, longitudinal study was conducted. A total of 19 deciduous molars from 9 volunteer patients were used. The teeth were randomly restored with one of two types of glass ionomer cement following the selective caries removal technique. The groups were divided into a control group, which used Fuji IX (GC- Europe, Leuven, Belgium), and a test group, which used Maxxion R (FGM- Joinville, Santa Catarina, Brazil). After exfoliation, the teeth were stored at 4°C and subjected to scanning electron microscopy (SEM), optical microscopy (OM), and energy dispersive spectrometry (EDS). Results: EDS analysis revealed that calcium (Ca) and phosphorus (P) were present in 100% of the specimens in both the control and test groups. Fluoride was found in 60% of the control group specimens and 63% of the test group specimens. OM images showed areas of mineralized dentin in both treatment groups. Conclusions: Selective caries removal for deep lesions in deciduous teeth was shown to be a safe therapeutic protocol, demonstrating signs of dentin mineralization and control of disease progression. Keywords: Carious, Dental Caries Removal; Glass Ionomer Cement; Scanning Electron Microscopy

A scoping review of guidelines on caries management for children and young people to inform UK undergraduate core curriculum development

BackgroundCurrent evidence in cariology teaching is not consistently reflected in paediatric dentistry in the United Kingdom (UK). Many dental schools are not consistently teaching biological approaches to caries management, with outdated or complex methods being taught outwith the purview of general dental practitioners. This scoping review aimed to map current guidelines on the management of caries in children and young people. This is part of a work package to inform the consensus and development of a UK-wide caries management curriculum for paediatric dentistry.MethodsA search of electronic databases for peer reviewed literature was performed using Cochrane Library, MEDLINE via PubMed, TRIP Medical Database and Web of Science. Hand searching was undertaken for grey literature (citations of sources of evidence, websites of global organisations and Google Web Search™ (Google LLC, California, USA). Results from databases were screened independently, concurrently by two reviewers. Full texts were obtained, and reviewers met to discuss any disagreement for both database and hand searching.ResultsThis review identified 16 guidelines suitable for inclusion. After quality appraisal, eight were selected for synthesis and interpretation. Key themes included the shift towards selective caries removal and avoidance of complete caries removal unless in specific circumstances in anterior teeth. For “early lesions” in primary and permanent teeth with and without cavitation, several guidelines recommend biological management including site specific prevention and fissure sealants.ConclusionsThis review mapping current cariology guidelines for children and young people found gaps in the literature including classification of early carious lesions and management of early cavitated lesions. Areas identified for further exploration include integration of biological caries management into treatment planning, selective caries removal and whether pulpotomy is specialist-level treatment, requiring referral. These results will inform consensus recommendations in the UK, using Delphi methods.

Marginal integrity in minimally invasive molar resin composite restorations: Impact of polymerization shrinkage

ObjectivesThis study utilized non-linear finite element (FE) models to explore polymerization shrinkage and its impact on marginal integrity in molars following both selective caries removal (SCR) and conventional treatment. Specifically, we performed 2D in silico simulations to study residual stresses post-resin polymerization shrinkage and their influence on the marginal integrity of various restoration types. MethodsInitially, FE models were developed based on a cohesive zone framework to simulate crack propagation along the bonded interfaces between restoration and tooth structure in SCR-treated molars with class I and class II restorations. The modeled resin composite restorations first underwent polymerization shrinkage and were then subjected to various occlusal loading conditions. Stress magnitudes and distributions were identified to evaluate the margin integrity and predict the mechanism and location of interfacial failure. Results and discussionThe FE models computed polymerization shrinkage stresses of less than 1 MPa, exerting a minor influence on the composite/tooth interface. Occlusal loading, however, significantly impacted the load-bearing capacity of the composite/tooth (c/t) interface, potentially jeopardizing the restoration integrity. Especially under bi-axial occlusal loading, interfacial debonding occurred in the vertical cavity walls of the class I restorations, increasing the risk of failure. Notably, SCR-treated teeth exhibited better margin integrity than restored teeth after complete caries removal (NCR).These findings provide valuable insights into the mechanical behavior of SCR-treated teeth under different loading conditions and highlight the importance of considering the load scenarios that may lead to failure at the c/t interface. By investigating the factors influencing crack initiation and delamination, this novel research contributes to the optimization of restorative treatments and aids in the design of more resilient dental restorations.

Utilization of 3D evaluation for assessing selective caries removal practice in pre-clinical dental students: a pilot study

BackgroundPracticing and assessment of selective caries removal techniques in dental students remain challenges in many dental schools. The aim of this study was to utilize a 3D assessment technique, within a designated acceptable range of deviation, to evaluate the tendency of dental students in performing selective caries removal (SCR). The correlation between 3D assessment results and the conventional rubric rated by an instructor was also determined.MethodsFifth-year dental students (n = 61) performed the SCR task on 3D-printed teeth containing simulated deep caries lesions in occlusal and proximal surfaces. One instructor assessed the results using a conventional analytic rubric. The excavated teeth were additionally evaluated using 3D analysis software with the designated acceptable range of deviations (± 0.5 mm) from the standard cavities. The average root mean square (RMS) value, representing the deviation between student-prepared cavities and the predefined standard cavities, was recorded. A tendency towards over-excavation was defined for RMS values > 0.5 mm, and towards under-excavation for RMS values < 0.5 mm.ResultsThe mean (min-max) of RMS was 0.27 (0.18–0.40) for occlusal and 0.29 (0.20–0.57)for proximal cavities. A tendency of dental students toward over-excavation was observed in both occlusal (74%) and proximal cavities (87%). There was a moderate negative correlation between the RMS values and the traditional rubric scores for both occlusal (R2 = 0.148, P = 0.002) and proximal cavities (R2 = 0.107, P = 0.010).ConclusionsThe 3D evaluation technique effectively revealed specific tendencies in dental students’ caries removal skills. The integration of computerized assessments with traditional methods could potentially assist the instructors in delivering more objective and specific feedback to students. Further research is encouraged to investigate the impact of this assessment technique on improving student performance in selective caries removal skills.

CAD - CAM in Pediatric Dentistry: A brief insight

On introduction of computer aided technology/computer aided manufacturing in pediatric dentistry, treating children has become effortless, mainly children with special health-care needs. This technology aims at the fabrication of restorations with higher strength and better aesthetics by an effortless, quicker and more precise operational process. This technology has proved to be a boon in various fields in pediatric dentistry. The latest trend of minimally invasive dentistry, relies on selective caries removal and restoring it with material which is highly adhesive and aesthetic. CAD-CAM makes use of an optical impression of the required area and occlusion which is taken using hassle-free intra-oral scanners. Machinable high strength composite/ceramic blocks are used which can be polymerized under pressure and temperature. The CAD-CAM technology has its advantage of needing less chair side time, brisk production of restorations with increased precision, eliminating the need for classic methods of impression, high strength and aesthetic restorations and prostheses. CAD-CAM technology can be used for smile designing in patients with developmental defects like Amylogenesis Imperfect, Molar-Incisor Hypo mineralization, etc., prosthetic rehabilitation in patients’ requiring stainless steel crowns and zirconia crowns, restorative procedures like inlays and onlays, naso-alveolar molding etc. Thus, it opens up a sea of possibilities for providing a high quality of treatment for the child with minimal hassle and maximal benefits to the child. Bangladesh Journal of Medical Science Vol.23 (Special Issue) 2024 p.S38-S42

Clinical performance of short fiber reinforced composite and glass hybrid on hypomineralized molars: A 36-month randomized split-mouth study

ObjectivesThis study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal. MethodsThe children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups. ResultsDuring the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002). ConclusionDirect composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization. Clinical significanceSFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars.

Biodentine™ as a temporary filling in deep carious lesions in permanent teeth: a prospective observational 33-month follow-up study.

The study aimed to evaluate temporary fillings using Biodentine™ in asymptomatic deep carious lesions after 12, 24, and 36months in school children from the remote village of Kerung, Nepal. From November 2018 to November 2019, 91 temporary fillings were placed using Biodentine™ (a hydraulic calcium silicate cement) in permanent molars with deep carious lesions of schoolchildren in the remote district of Kerung, Nepal. These restorations were performed after selective caries removal in a non-dental setting with hand instruments and cotton roll isolation, as electric motors and saliva ejection systems were unavailable. In total, 78 single-surface and 13 multi-surface fillings were placed. Clinical and radiographic follow-up periods encompassed 12, 21, and 33months, respectively. After 12months, all single-surface fillings (100%) survived, whilst all multi-surface fillings were partially or entirely lost. The survival rate of single-surface restorations after 21 and 33months was 67.6% and 50%, respectively. Radiographically, no pathology was observed. This study showed that Biodentine could be used in deep carious lesions as a temporary filling in single-surface lesions for at least up to 1year and in a substantial number of cases for up to 21 and 33months.

3-year randomized clinical trial to evaluate the performance of posterior composite restorations lined with ion-releasing materials

To evaluate the impact of using ion-releasing liners on the 3-year clinical performance of posterior resin composite restorations after selective caries excavation with polymer burs. 20 patients were enrolled in this trial. Each patient had two deep carious lesions, one on each side of the mouth. After selective caries removal using polymer bur (PolyBur P1, Komet, Brasseler GmbH Co. KG, Lemgo, Germany), cavities were lined with bioactive ionic resin composite (Activa Bioactive Base/Liner, Pulpdent, Watertown, MA, USA) or resin-modified glass ionomer liner (Riva Light Cure, SDI, Bayswater, Victoria, Australia). All cavities were then restored with nanofilled resin composite (Filtek Z350XT, 3M Oral Care, St. Paul, MN, USA). All the tested materials were placed according to the manufacturers’ instructions. Clinical evaluation was accomplished using World Dental Federation (FDI) criteria at baseline and after 6 months, 1, 2, and 3 years. Data were analyzed using Mann–whitney U and Friedman tests (p < 0.05). The success rates were 100% for all resin composite restorations either lined with ion-releasing resin composite or resin-modified glass ionomer liner. Mann–whitney U test revealed that there were no statistically significant differences between both ion-releasing lining material groups for all criteria during the follow-up periods (p > 0.05). Resin composite restorations showed acceptable clinical performance over 3 years either lined with bioactive ionic or resin-modified glass ionomer liners after selective caries excavation preserving pulp vitality. After the 3-year follow-up period, Activa Bioactive and Riva Light Cure liners were clinically effective and they exhibited with the overlying composite restorations successful clinical performance.Trial registration number: NCT05470959. Date of registration: 22/7/2022. Retrospectively registered.

Which caries removal method to select?

Searches were carried out using PubMed/MEDLINE and Web of Science databases between January 2008 and January 2023. Only articles in English language were included. Boolean operators were used to search: "permanent teeth" OR "permanent tooth" OR "permanent dentition" AND "deep caries" OR "stepwise" AND "partial caries removal OR "stepwise caries removal" OR "pulp vitality" OR "healing rate". Inclusion criteria were randomised controlled trials, which compared the total removal of carious tissue with either a selective or stepwise removal in permanent teeth with deep carious lesions. Criteria also required a follow up of at least 6 months and publications in English. Exclusion criteria were articles in other languages, articles not comparing different types of total or selective caries removal and articles published before January 2008. Data extraction followed PRISMA guidelines. Two reviewers independently screened articles, analysing titles and abstracts using Rayyan's Intelligent Systematic Review Platform. They also collected data and risk of bias assessed using the Cochrane Risk of Bias Tool for Randomised Trials, dividing articles into high risk of bias, few concerns and low risk of bias. A third researcher resolved conflict or doubt in case of divided opinions. In total, 105 articles were identified, and 10 duplicates removed. 95 articles were reviewed by title and abstract and 75 of these did not meet the inclusion criteria. 20 articles were then read, excluding a further 15 due to comparing only partial removal or non-selective caries removal or absence of numerical data. This left 5 articles which met eligibility criteria. These were randomised controlled trials between 2010 and 2021. Follow up ranged from 1 month to 5 years. The inclusion and exclusion criteria in all studies had similar clinical parameters. 3 studies performed management only on permanent molars, whilst the rest also included management on permanent incisors/canines/premolars and molars. Management of caries was divided into non-selective caries removal vs partial caries removal (either selective or stepwise). All but 2 studies included specific information about the materials used. Liners were calcium hydroxide or Dycal, provisional restorations were glass ionomer cements or Ketax Molar and definitive restorations were Herculite Tetric N-Ceram resin, Ivolclar Vivadent or amalgam. Clinical success or failure was measured using pulp vitality, absence of periapical lesions, radiographic analysis and lack of symptoms. Clinical follow up was evaluated by external examiners, although 2 studies did not specify this clearly. There were a variety of tools used for statistical analysis in each study. When comparing non-selective caries removal with either selective or stepwise, 3 studies proposed statistically significant differences in terms of longevity, marginal integrity and success rate of restorations. 1 study stated inexistence of statistically relevant divergences between procedures. Non-selective caries removal is not highly recommended for deep carious lesions and may be considered invasive and risks pulpal exposure. Both selective and stepwise removal are considered conservative approaches. Selective removal is considered the best management option in the short term (with 1.5 years follow up), predominantly related to a lower risk of pulpal exposure. At 5 years, however, the results of selective were similar to those of non-selective, accepting the null hypothesis. There were also no differences in success rates for materials used for definitive restorations.

Is Cavity Lining Really Necessary After Selective Caries Removal in Primary Teeth?

Is Cavity Lining Really Necessary After Selective Caries Removal in Primary Teeth?

Indirect Pulp Capping Treatment Using Calcium Hydroxide with Follow-Up Class 1 Composite Restoration on Tooth 36

One of the treatments for deep carious lesions that have irritated the pulp tissue is treatment pulp capping to maintain pulp vitality. Indirect pulp capping is a treatment procedure that performed on deep caries but does not yet involve pulp exposure. Calcium Hydroxide is such a medicament gold standards that are often used for the treatment of pulp capping because the characteristic is bactericidal or bacteriostatic. This case report describes of the case indirect pulp capping with two visits treatment to the left mandibular first molar. Patients came with the main complaint of pain when drinking cold water or eating. There is no history of spontaneous pain. The tooth was examined for vitality using a sensibility test and the pulp was found to be vital. Treatment is carried out through proceduresindirect pulp capping with two visits using calcium hydroxide and the cavity was irrigated with aquadest and disinfected with 2% chlorhexidine. The cavity was sealed with Glass Ionomer Cement and the final restoration was made using a composite resin restoration. The patient was then followed up for up to 9 weeks for the placement of the permanent restoration. The patient was followed up for up to 9 weeks for the permanent restoration. Indirect pulp capping is one of the treatments that can be chosen in cases of caries with deep cavities that are close to the pulp. This treatment is carried out to prevent the pulp from opening selective caries removal.

Beyond the Clinic: why new bioactive restorative materials have really changed Paediatric Dentistry.

The aim of this paper is to remind how evidence-based paediatric dentistry should not only consider the best available scientific evidence relating to the patient's oral conditions but it should also consider the patient's needs beyond the clinic. In a child-family-oriented approach, the best restorative treatment for a primary tooth could not be the proper one for the child as a whole. Preservation of dental tissues as much as possible, without involving the pulp, is called minimal intervention dentistry (MID) and it is closely related to "selective caries removal" and "bioactive restorative materials". To preserve the vitality of a tooth as much as possible, many tools are available on the market (i.e. silver diamine fluoride, ozone) and this could play an important role in a "tailored fit treatment plan" mindset. Minimally invasive direct restorative strategies in paediatric dentistry, is a predictable evidence-based-restorative option for the treatment of vital primary teeth with no need of local anaesthesia and absolute isolation. Beyond the clinical aspect, the clinician expertise is crucial to evaluate the required materials and tools, not only to perform a minimal invasive paediatric dentistry in a safe, efficient and child-friendly way, but for the wellness of all parties involved. In this life-related paradigm new bioactive restorative materials are among the main protagonists.

Does the liner material influence pulpal vitality in deep carious cavities submitted to selective caries removal? A network meta-analysis review.

To evaluate whether the restorative material in direct contact with the dentin influences pulp vitality in primary and permanent teeth with deep carious lesions restored after selective caries removal (SCR). Systematic searches of databases MEDLINE via PubMed, Scopus and ISI Web of Science were performed for primary and permanent teeth. Inclusion criteria were applied for title and abstract reading of databases search results. After full texts review of included studies, those that did not meet exclusion criteria were excluded from meta-analysis. For meta-analysis, 2 studies were included for permanent teeth and 6 for primary teeth. The failure events reported were meta-analyzed using two statistical methods: standard pairwise meta-analysis (SPMA) and network meta-analysis (NMA). The SPMA identified similar failure occurrence of restorations performed with calcium hydroxide (CH) and other liner materials (RR 0.84, 95% CI 0.41, 1.74; p = 0.64), no significant difference between the use of alternative liners or CH regardless deciduous or permanent teeth (RR 0.79, 95% CI 0.36, 1.71; p = 0.55) and similar risk of failing at different follow-ups for all liner materials tested (RR 0.77, 95% CI 0.35, 1.70; p = 0.52). Probabilistic analysis indicated GIC as liner material with the highest probability of clinical success (SUCRA = 72.76%), and CH ranked as the worst liner material (SUCRA = 21.81%). Pulpal vitality was not affected by material used as liner after selective caries removal in deep carious cavities. Current clinical evidence supports the weak recommendation to not use calcium hydroxide as liner after SCR.

One-year outcome of selective caries removal versus pulpotomy treatment of deep caries: A pilot randomized controlled trial.

This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine. This two-armed, parallel-group, randomized, superiority trial included vital mature permanent teeth with deep primary or secondary caries diagnosed radiographically as being at least 75% into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were blindly allocated to receive either SCR or Pulpotomy using computer-generated randomized patient codes concealed in opaque envelopes. All teeth were reviewed clinically and radiographically at 6 months and 1 year post-treatment. Using a significance level of p < .05, the log rank test and Cox proportional hazards regression were used to compare the outcome of SCR and Pulpotomy and to identify potential prognostic factors, respectively. In all, 58 teeth in the SCR group and 55 teeth in the pulpotomy group completed treatment, after excluding 6 teeth because they did not complete the allocated treatment and another due to severe periodontal disease. At one year, 57/58 (98.3%) teeth from the SCR group and 48/55 (87.3%) teeth from the Pulpotomy group were available for analysis. One tooth in the Pulpotomy group (2.1%) and eight teeth in the SCR group (14.0%) required the further intervention of root canal treatment (p < .05). There were no other significant prognostic factors for survival. Overall, 91.4% of teeth treated with either SCR or Pulpotomy survived without requiring further intervention over a period of one year. No other adverse events occurred over the review period. Within the limitations of this study, Pulpotomy fares better than SCR in preserving the remaining pulp and periapical health. As a treatment modality, Pulpotomy carries greater cost outlay to patient and takes a longer time to complete treatment than SCR. Long-term follow-up is needed to study the pulpal and restorative outcomes of Pulpotomy and SCR.

Outcomes for Stepwise and Selective Caries Removal of Deep Lesions

Outcomes for Stepwise and Selective Caries Removal of Deep Lesions

Assessing the Acceptability of Less Invasive Caries Removal Techniques for treating Deep Carious Lesions: A Conjoint Survey among Dentists Practicing in a Midwestern American State

This study identified factors that influence dentists’ decisions regarding less invasive caries removal techniques such as stepwise removal (SW) and selective removal (SE) using a marketing research technique, conjoint analysis. A survey was sent to 1,434 dentists practicing in Iowa. Dentists were randomly assigned to receive a questionnaire to rate the likelihood they would use either SW/SE in hypothetical clinical scenarios. The scenarios were carefully created by conjoint design and included three relevant attributes: depth of lesion, hardness of carious dentin, and patient age. Descriptive and conjoint analyses were performed to assess trade-offs between these attributes, using SPSS. The study revealed that depth of lesion was the most important factor in the dentists’ decisions (49 importance value) when choosing a SW to treat a deep carious lesion, followed by hardness of carious dentin and patient age (21 importance value). For the SE group, depth of the lesion was also the predominant factor when selecting a treatment. The study also identified that a high proportion of dentists (24.9%) indicated they would never consider using SW or SE under any circumstances. Our survey showed that depth of lesion was the most important reason to select a less invasive caries removal method. The high proportion of dentists indicating they would never consider selective caries removal (SE) techniques suggests that these less invasive options are underutilized.

Knowledge and attitude of dentists toward minimally invasive caries management in Almadinah Almunawwarah province, KSA

ObjectiveOver time, the management of dental caries has shifted towards minimally invasive dentistry (MID) and more conservative and evidence-based strategies. Although most dental schools have begun to incorporate MID caries management strategies in their curriculum; it has yet to be established whether these strategies are being implemented in everyday practice. In this study, we aimed to evaluate the knowledge and attitude of dentists working in Almadinah Almunawwarah province in KSA with regards to the implementation of MID in caries management. MethodsThis was a cross-sectional study which involved sending a self-administered and anonymous questionnaire to dentists practicing in both private and public clinics in Almadinah Almunawwarah, KSA. The questionnaire consisted of four sections: demographic data, dental education, clinical experience, and knowledge and attitude with regards to MID and the management of caries. For statistical analysis, we calculated simple descriptive statistics, including mean and frequency distributions; comparisons were performed using the Chi-squared test. ResultsA total of 130 dentists participated in the study; the majority of respondents were Saudi general dentists working in private dental clinics; there was a similar distribution of males and females and the age of the dentists ranged from 25 to 35 years. With regards to knowledge relating to selective caries removal (SCR), only 20% of subjects responded that SCR is based on lesion depth, while 74.6% reported that carious dentin consistency is important for SCR. Although 60% of respondents reported that they would assess a patient's risk of caries before commencing treatment, only 11.5% would perform risk assessment and non-surgical treatment in the first visit for caries management. Only 4.6% reported that they used the International Caries Detection and Assessment System (ICDAS) II criteria for the diagnosis of caries while 46.2% used the G.V. Black criteria. In addition, 53.8% of participants agreed that caries must be completely removed to prevent the progression of caries. ConclusionDentists in Almadinah Almunawwarah province had reasonable levels of knowledge regarding the importance of MID in caries management. However, they did not fully implement certain concepts, such as caries risk assessment and the recently recommended criteria for the diagnosis of caries, in their everyday clinical practice.