Is a calcium hydroxide liner necessary in the treatment of deep caries lesions? A systematic review and meta‐analysis

Abstract

The aim of this systematic review and meta‐analysis was to evaluate whether the use of calcium hydroxide (CH) liner improves the clinical success in the treatment of deep caries lesions of primary and permanent teeth. The review was reported in accordance with the PRISMA Statement. Only studies that evaluated deep carious lesions treated with and without a CH liner were included. The required outcomes had to be obtained by clinical, radiographic or laboratory evaluations. Statistical analyses were performed with the RevMan 5.2 program (The Cochrane Collaboration, Copenhagen, Denmark) for randomized clinical trials with at least 12 months of follow‐up, using fixed‐effect models at a significance level of P < 0.05. The literature search was performed in eight databases: PubMed (MEDLINE), Lilacs, IBECS, BBO, Web of Science, Scopus, SciELO and The Cochrane Library. A total of 17 studies were included (15 in primary teeth, two in permanent teeth). The overall risk difference for CH versus adhesive system in primary teeth was 0.06 [95% CI −0.01 to 0.13], and the overall risk difference for CH versus GIC was 0.10 [95% CI −0.01 to 0.22], with no significant differences between materials. CH liner did not influence the clinical success of treatment for deep caries lesions of primary or permanent teeth. Although the present analysis demonstrated that use of CH liner in deep caries lesions was unnecessary, the evidence was of moderate to very low quality; thus, further well‐designed, randomized and controlled clinical trials are necessary to provide stronger recommendations.

Treatment preferences for deep caries lesions among Australian dentists

“…While there was a general preference among respondents of the current study to place a liner, a recent systematic review has shown that the evidence is inconsistent in terms of postoperative sensitivity with use of liners under resin‐bonded restorations . Another recent systematic review on whether calcium hydroxide liner is required for deep caries lesions confirmed these findings that treatment of the deep caries lesion is not a material‐dependant technique . This is also in line with the latest consensus recommendations which stated that there is no evidence to recommend a specific material .…”

“…13 Another recent systematic review on whether calcium hydroxide liner is required for deep caries lesions confirmed these findings that treatment of the deep caries lesion is not a material-dependant technique. 30 This is also in line with the latest consensus recommendations which stated that there is no evidence to recommend a specific material. 5 The great variance in the type of lining materials chosen by Australian dentists suggests the need to disseminate the current thinking in this space to the wider audience.…”

Proteção da vitalidade dentino-pulpar em odontopediatria: uma revisão de literatura

“…Há um consenso de que o principal objetivo do hidróxido de cálcio é provocar a remineralização e, consequentemente, proteção da polpa 33,37,39 . Contudo, dentes tratados com cimento de ionômero de vidro modificado por resina (CIV-MR) ou com hidróxido de cálcio resultaram em uma espessura de dentina reparativa similar 9,40 .…”

“…Rosa et al 37 constataram que existem poucos indícios para apoiar o uso de hidróxido de cálcio como agente forrador. Na dentição decídua, o nível de indicação foi equilibrado ao ser comparado com o CIV-MR, e baixo quando comparado com materiais inertes ou sistemas adesivos.…”

“…Inicialmente a técnica era realizada em duas sessões e com a utilização de um material protetor, geralmente o cimento de ionômero de vidro convencional ou cimento de hidróxido de cálcio 36 . Entretanto, a necessidade da reabertura da cavidade demonstrou-se desnecessária e uma revisão sistemática recente demonstrou a capacidade de recuperação da lesão sem Proteção da vitalidade dentino-pulpar em odontopediatria: uma revisão de literatura um material forrador, podendo ser utilizado apenas o sistema adesivo, evidenciando que a própria dentina é o melhor material protetor 37 .…”