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Contemporary management of deep caries in primary teeth: a systematic review and meta-analysis

  • Systematic Review
  • Published:
European Archives of Paediatric Dentistry Aims and scope Submit manuscript

Abstract

Purpose

To systematically evaluate the available evidence regarding contemporary management of deep caries in vital primary teeth. This review was carried out to facilitate the development of European Academy of Paediatric Dentistry (EAPD) guidelines on deep caries management of primary teeth in paediatric dentistry.

Methods

A systematic electronic literature search was conducted to locate studies reporting on interventions and medicaments used for the treatment of deep caries in vital primary teeth. To facilitate this, the Cochrane Library (1992 to up to December 6th, 2020), MEDLINE (PubMed, 1946 to December Week 1, 2020), Ovid MEDLINE (In-Process & Other Non-Indexed Citations, December 6th, 2020); EMBASE (Embase.com, 1974 to December 6th, 2020) and LILACS (1982 to December 6th, 2020) were accessed. Hand search of reference lists of included articles, as well as handbooks and grey literature search was also performed. Study screening was done in duplicate and study inclusions were agreed upon by all authors. Data extraction, and methodological quality and risk of bias assessment were carried out in duplicate for each of the included studies. Overall success rate of each intervention and medicament within the intervention was reported. Meta-analysis was also performed for high-quality studies reporting similar interventions and comparable outcomes in homogeneous population.

Results

A total of 1332 papers were identified. Following the primary and secondary assessment process, 36 papers were included in the review. Of these, 8 papers were deemed to represent 4 individual studies, leaving a total of 32 unique studies eventually included in the final analysis. These studies were further categorized into three main vital pulp treatment methods for analysis: indirect pulp capping (IPC), direct pulp capping (DPC), and pulpotomy (PP). Overall, IPC, DPC and PP interventions have high success rates with the reported clinical success rates higher than radiographic success rates. Medicaments used for IPC and DPC have similar success rates. Mineral trioxide aggregate (MTA), ferric sulfate (FS) and formocresol (FC) PP showed similar success rates, and which were all higher than calcium hydroxide (CH). Majority of included studies (n = 22; 63%) were rated low in terms of their potential risk of bias, 6 studies were rated high (17%), and 7 studies were of unclear risk (20%).

Conclusion

Within the limitations of the studies included, IPC, DPC, and PP can be recommended as effective treatment modalities for primary teeth with deep caries under specific conditions.

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Authors and Affiliations

  1. Department of Pediatric Oral Health and Orthodontics, University Center of Dental Medicine, Basel, Switzerland

    Eirini Stratigaki

  2. Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore

    Huei Jinn Tong

  3. Department of Paediatric Dentistry, Athens School of Dentistry, National & Kapodistrian University of Athens, Athens, Greece

    Kyriaki Seremidi & Sotiria Gizani

  4. Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland

    Dimitrios Kloukos

  5. Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force and VA General Hospital, Athens, Greece

    Dimitrios Kloukos

  6. School of Dental Medicine, Qatar University, QU Health, Doha, Qatar

    Monty Duggal

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  1. Eirini Stratigaki
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  2. Huei Jinn Tong
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  4. Dimitrios Kloukos
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  6. Sotiria Gizani
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Contributions

This systematic review is commissioned by the European Academy for Paediatric Dentistry, to facilitate the development of European Academy of Paediatric Dentistry (EAPD) guidelines on deep caries management of primary teeth in paediatric dentistry. ES, HJT, KS, MD and SG were involved in formulating the search terms and strategy. Literature search was conducted by DK. Data analysis and synthesis were carried out by all authors. Meta-analysis was carried out by DK. All authors wrote and critically revised the work for content.

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Correspondence to Sotiria Gizani.

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Stratigaki, E., Tong, H.J., Seremidi, K. et al. Contemporary management of deep caries in primary teeth: a systematic review and meta-analysis. Eur Arch Paediatr Dent 23, 695–725 (2022). https://doi.org/10.1007/s40368-021-00666-7

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