Falk Schwendicke1, Christian H Splieth2, Peter Bottenberg3, Lorenzo Breschi4, Guglielmo Campus5,6, Sophie Doméjean7,8, Kim Ekstrand9, Rodrigo A Giacaman10, Rainer Haak11, Matthias Hannig12, Reinhard Hickel13, Hrvoje Juric14, Adrian Lussi15, Vita Machiulskiene16, David Manton17, Anahita Jablonski-Momeni18, Niek Opdam19, Sebastian Paris20, Ruth Santamaria2, Hervé Tassery21,22, Andrea Zandona23, Domenick Zero24, Stefan Zimmer25, Avijit Banerjee26. 1. Department of Operative Dentistry, Charité - Universitätsmedizin, Berlin, Germany. falk.schwendicke@charite.de. 2. Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany. 3. Oral Health Research Group, Vrije Universiteit Brussel, Brussel, Belgium. 4. Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna - Alma Mater Studiorum, Bologna, Italy. 5. Department of Restorative, Preventive and Paediatric Dentistry, Zahnmedizinische Kliniken (ZMK), University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland. 6. Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy. 7. Département d'Odontologie Conservatrice, Univ Clermont Auvergne, UFR d'Odontologie; Centre de Recherche en Odontologie Clinique EA 4847, F-63100, Clermont-Ferrand, France. 8. CHU Estaing Clermont-Ferrand, Service d'Odontologie, F-63001, Clermont-Ferrand, France. 9. Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 10. Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile. 11. Department of Cariology, Endodontology and Periodontology, University Leipzig, Leipzig, Germany. 12. Clinic of Operative Dentistry and Periodontology, Saarland University, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. 13. Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany. 14. Department of Paediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia. 15. School of Dental Medicine, University of Bern, Bern, Switzerland and Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre, Freiburg, Germany. 16. Clinic of Dental and Oral Pathology, Faculty of odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania. 17. Centrum van Tandheelkunde en Mondzorgkunde, UMCG, Groningen, Netherlands. 18. Philipps-University Marburg, Dental School, Department of Orthodontics, Marburg, Germany. 19. Radboud University Medical Centre, Department of Dentistry, Radboud Institute for Health Sciences, Nijmegen, The Netherlands. 20. Department of Operative Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany. 21. Faculté d'Odontologie Marseille, Preventive and Restorative Department, Marseille cedex, Aix-Marseille-Université, Marseille, France. 22. EA 4203 Laboratory, Université de Montpellier, Montpellier, France. 23. Department of Comprehensive Care, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA. 24. Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, School of Dentistry Indiana University, Indianapolis, IN, USA. 25. Department of Operative and Preventive Dentistry, Faculty of Health, Dental School, Witten/Herdecke University, Witten, Germany. 26. Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.
Abstract
OBJECTIVES: To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. METHODS: Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. RESULTS: Managing an individual's caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual's caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. CONCLUSIONS: An individualized and lesion-specific approach is recommended for intervening in the caries process in adults. CLINICAL SIGNIFICANCE: Dental clinicians have an increasing number of interventions available for the management of dental caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients' expectations, clinicians' expertise, and the individual clinical scenario all need to be considered during the decision-making process.
OBJECTIVES: To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. METHODS: Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. RESULTS: Managing an individual's caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual's caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. CONCLUSIONS: An individualized and lesion-specific approach is recommended for intervening in the caries process in adults. CLINICAL SIGNIFICANCE: Dental clinicians have an increasing number of interventions available for the management of dental caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients' expectations, clinicians' expertise, and the individual clinical scenario all need to be considered during the decision-making process.
Authors: Peter Grieco; Ashiana Jivraj; John Da Silva; Yukinori Kuwajima; Yoshiki Ishida; Kaho Ogawa; Hiroe Ohyama; Shigemi Ishikawa-Nagai Journal: Ann Transl Med Date: 2022-01
Authors: Falk Schwendicke; Tanya Walsh; Thomas Lamont; Waraf Al-Yaseen; Lars Bjørndal; Janet E Clarkson; Margherita Fontana; Jesus Gomez Rossi; Gerd Göstemeyer; Colin Levey; Anne Müller; David Ricketts; Mark Robertson; Ruth M Santamaria; Nicola Pt Innes Journal: Cochrane Database Syst Rev Date: 2021-07-19