Falk Schwendicke1, Christian Splieth2, Lorenzo Breschi3, Avijit Banerjee4, Margherita Fontana5, Sebastian Paris6, Michael F Burrow7, Felicity Crombie8, Lyndie Foster Page9, Patricia Gatón-Hernández10,11, Rodrigo Giacaman12, Neeraj Gugnani13, Reinhard Hickel14, Rainer A Jordan15, Soraya Leal16, Edward Lo7, Hervé Tassery17, William Murray Thomson9, David J Manton8. 1. Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany. falk.schwendicke@charite.de. 2. Preventive & Pediatric Dentistry, University of Greifswald, Greifswald, Germany. 3. Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna-Alma Mater Studiorum, Bologna, Italy. 4. Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's Health Partners, King's College London, London, UK. 5. Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA. 6. Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany. 7. Faculty of Dentistry, University of Hong Kong, Pokfulam, Hong Kong, SAR, China. 8. Melbourne Dental School, University of Melbourne, Melbourne, Australia. 9. Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand. 10. Department of Dentistry, University of Barcelona, Barcelona, Spain. 11. Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brazil. 12. Cariology Unit, Department of Oral Rehabilitation, University of Talca, Talca, Chile. 13. Department of Pediatric and Preventive Dentistry, DAV (C) Dental College, Yamunanagar, Haryana, India. 14. Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany. 15. Institute of German Dentists, Cologne, Germany. 16. Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasilia, Brazil. 17. Faculty of Dentistry, AMU University, Marseille, France.
Abstract
OBJECTIVES: To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions. METHODS: Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference. RESULTS: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds. CONCLUSIONS: Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions. CLINICAL RELEVANCE: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.
OBJECTIVES: To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions. METHODS: Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference. RESULTS: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds. CONCLUSIONS: Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions. CLINICAL RELEVANCE: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.
Authors: Apoena A Ribeiro; Flávia Purger; Jonas A Rodrigues; Patrícia R A Oliveira; Adrian Lussi; Antonio Henrique Monteiro; Haimon D L Alves; Joaquim T Assis; Adalberto B Vasconcellos Journal: Caries Res Date: 2015 Impact factor: 4.056
Authors: M Duggal; S Gizani; S Albadri; N Krämer; E Stratigaki; H J Tong; K Seremidi; D Kloukos; A BaniHani; R M Santamaría; S Hu; M Maden; S Amend; C Boutsiouki; K Bekes; N Lygidakis; R Frankenberger; J Monteiro; V Anttonnen; R Leith; M Sobczak; S Rajasekharan; S Parekh Journal: Eur Arch Paediatr Dent Date: 2022-10-11