Minimally Invasive Intervention for Primary Caries Lesions: Are Dentists Implementing This Concept?

Abstract

Contemporary minimally invasive treatment concepts for restorative treatment of primary caries lesions include both delayed intervention and smaller-sized preparations restricted to removal of carious tissue. The aim of this study was to investigate whether these concepts have resulted in a trend towards a more conservative choice made by dentists regarding treatment thresholds and restorative techniques. The results from previously conducted, precoded questionnaires developed by Espelid and Tveit, as well as from a recent Dutch questionnaire, were collected and analysed. A worldwide trend towards more minimally invasive strategies in the operative treatment of caries lesions could not be observed, neither for the initiation of operative treatment nor for the preparation techniques. However, in some countries, changes over time could be assessed, especially in Norway, where a reduction in the proportion of interventions is visible for both occlusal and approximal lesions, indicating that more dentists are postponing interventions until the lesions have progressed to a deeper level. From the Dutch national survey, it could be concluded that operators that intervene at an earlier stage of approximal lesioning (stage ≤4) also intervene at an earlier stage of occlusal caries (stage ≤3) (p = 0.012; OR = 2.52; 95% CI: 1.22–5.22). Generally, it can be concluded that dentists worldwide still tend to operatively intervene at a too early stage of caries, although variations exist between countries. A worldwide shift could be observed in the restorative material applied, since composite resin has almost completely replaced amalgam for restoring primary caries lesions.

Are Brazilian dentists and dental students using the ICCC recommendations for caries management?

“…6.7 Recently, a web-based questionnaire survey was conducted in Scandinavia to determine the trend of using MID. 8 The study has shown that dentists from countries with a high socioeconomic level still tend to intervene operatively at a very early stage of caries, although there are variations among the countries evaluated. However, there is no information on this trend in developing countries, such as Brazil.…”

Efficacy of resin infiltrate in noncavitated proximal carious lesions: A systematic review and meta-analysis

“…Aggravating the problem, using rotary burs, and cutting instruments in the conventional invasive treatment of proximal lesions sacrifice substantial amounts of sound tooth structure. This violates the concept of minimally invasive dentistry (MID)[45] which involves excavating the least possible amount of dental tissues. [6] Consequently, resin infiltration was invented.…”

Ex vivo investigation on internal tunnel approach/internal resin infiltration and external nanosilver-modified resin infiltration of proximal caries exceeding into dentin

“…The internationally accepted "gold standard threshold" for minimally invasive operative interventions currently refers to proximal lesions radiographically extending beyond the outer third of dentin (with recommendations aiming at predominantly saucer-shaped preparations as the favored cavity design) [68]. This mainly is owed to the fact of increasing cavitation probabilities of the outer enamel surface [33,34,69], and these breakdowns, in turn, correspond to impaired biofilm removal and decreasing remineralization capabilities (even with patients showing normal salivary function [70]); moreover, it is well-known that lesions extending clearly beyond the enamel-dentin border (> 0.5 mm) are most likely to progress within a period of 3 years [71], and comparable deteriorations have been reported with increasing ICDAS severities [36].…”