Survival and Associated Risk Factors of Selective Caries Removal Treatments in Primary Teeth: A Retrospective Study in a High Caries Risk Population

Abstract

Objective: The aim of this retrospective study was to analyze the survival probability of selective caries removal (SCR) treatments in the primary teeth of children with high caries experience and factors potentially associated with treatment failure. Methods: The sample included SCR treatments conducted in anterior and posterior teeth without sedation or general anesthesia among children attending a university dental service. Kaplan-Meier survival analysis was used to estimate the longevity of restorations and multivariate Cox regression with shared frailty was used to assess risk factors. Results: A total of 284 SCR treatments in 88 children (aged 5.2 ± 1.91 years) with high caries experience (mean dmft/DMFT = 11.1 ± 5.04) were analyzed. The 3-year survival reached 48.8%, with an annual failure rate of 21.2%. Restorative failures (n = 60) were found more frequently compared to pulp complications (n = 12). SCR performed in anterior primary teeth were more prone to failure (hazard ratio = 3.6, 95% CI: 1.94; 6.71). Patients with a higher amount of visible plaque experienced more failures in SCR treatments (hazard ratio 3.0, 95% CI:1.27; 7.07). Conclusions: In this retrospective study, SCR showed restricted survival when compared to other prospective clinical trials. Patient-related factors, especially the young age and high caries experience of the children, may represent a challenge for restoration survival. Regardless of the caries removal technique or restorative material, cariogenic biofilm has a negative effect on the survival of restorations, probably by acting directly on material deterioration and, particularly, on the development of new caries lesions of rapid progression.

One-year clinical evaluation of class II bulk-fill restorations in primary molars: a randomized clinical trial

“…A retrospective study assessed the potential factors associated with treatment failure of selective caries removal in the primary teeth of children with high caries experience. It demonstrated the association between high dmft and biofilm accumulations and a higher risk of treatment failure 27 . Despite the characteristics of the sample, recurrence of caries was the reason for failure in only two restorations, probably due to all children being included in a program of periodic recalls, reinforcing oral hygiene care and dietary habits.…”

Prevalence of defective restorations and factors associated with re‐intervention in primary teeth: A retrospective university‐based study

“…Based on results, it was suggested that the recommendation to replace or to repair a defective restoration in primary teeth should consider several factors such as type of failure, age (related to tooth exfoliation), oral hygiene standards, and access to fluoride sources of the patients . Previous studies have already shown the detrimental effects of poor oral hygiene and high caries‐risk children on restoration survival of primary teeth …”

“…1 Previous studies have already shown the detrimental effects of poor oral hygiene and high caries-risk children on restoration survival of primary teeth. [28][29][30] Recently, our research group investigated the factors associated with failure of adhesive restorations in primary teeth and whether repair may increase the survival of defective restorations in children at high caries-risk (data submitted for publication). Results demonstrated that the teeth with endodontic treatment and multi-surfaces restorations presented significantly more failures, and repair increased the survival of failed restorations over time, reducing the annual failure rate by 5.5% after 3 years of follow-up.…”

A Survival Analysis of Different Pulp Therapies in Decayed Primary Teeth

“…The survival probability of partial caries removal was verified in 284 cases with high caries experience. Previous restorative treatment in anterior teeth, restorative failures and teeth with visible plaque were related to failure [11].…”