Interventions for treating cavitated or dentine carious lesions

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, 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

Abstract

Background: Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC).

Objectives: To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro-cavitated lesions, or occlusal lesions that are clinically non-cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps.

Search methods: An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA: We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non- or micro-cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions).

Data collection and analysis: Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta-analysis to assess and rank the relative effectiveness of different interventions.

Main results: We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty-four studies used a parallel-group design and three were split-mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non-cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth. Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing with sealant materials (2); sealant materials versus no sealing (2). Follow-up times varied from no follow-up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months. All studies were at overall high risk of bias. Effect of interventions Sealing using sealants versus other interventions for non-cavitated or cavitated but not deep lesions There was insufficient evidence of a difference between sealing with sealants and CR (OR 5.00, 95% CI 0.51 to 49.27; 1 study, 41 teeth, permanent teeth, cavitated), sealing versus SE (OR 3.11, 95% CI 0.11 to 85.52; 2 studies, 82 primary teeth, cavitated) or sealing versus no treatment (OR 0.05, 95% CI 0.00 to 2.71; 2 studies, 103 permanent teeth, non-cavitated), but we assessed all as very low-certainty evidence. HT, CR, SE, NRCC for cavitated, but not deep lesions in primary teeth The odds of failure may be higher for CR than HT (OR 8.35, 95% CI 3.73 to 18.68; 2 studies, 249 teeth; low-certainty evidence) and lower for HT than NRCC (OR 0.19, 95% CI 0.05 to 0.74; 1 study, 84 teeth, very low-certainty evidence). There was insufficient evidence of a difference between SE versus HT (OR 8.94, 95% CI 0.57 to 139.67; 2 studies, 586 teeth) or CR versus NRCC (OR 1.16, 95% CI 0.50 to 2.71; 1 study, 102 teeth), both very low-certainty evidence. CR, SE, SW for deep lesions The odds of failure were higher for CR than SW in permanent teeth (OR 2.06, 95% CI 1.34 to 3.17; 3 studies, 398 teeth; moderate-certainty evidence), but not primary teeth (OR 2.43, 95% CI 0.65 to 9.12; 1 study, 63 teeth; very low-certainty evidence). The odds of failure may be higher for CR than SE in permanent teeth (OR 11.32, 95% CI 1.97 to 65.02; 2 studies, 179 teeth) and primary teeth (OR 4.43, 95% CI 1.04 to 18.77; 4 studies, 265 teeth), both very low-certainty evidence. Notably, two studies compared CR versus SE in cavitated, but not deep lesions, with insufficient evidence of a difference in outcome (OR 0.62, 95% CI 0.21 to 1.88; 204 teeth; very low-certainty evidence). The odds of failure were higher for SW than SE in permanent teeth (OR 2.25, 95% CI 1.33 to 3.82; 3 studies, 371 teeth; moderate-certainty evidence), but not primary teeth (OR 2.05, 95% CI 0.49 to 8.62; 2 studies, 126 teeth; very low-certainty evidence). For deep lesions, a network meta-analysis showed the probability of failure to be greatest for CR compared with SE, SW and HT.

Authors' conclusions: Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition. Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons.

Conflict of interest statement

FS: none.

TW: none. I am Statistical Editor with Cochrane Oral Health.

TL: none. I am an Editor with Cochrane Oral Health.

WA: none.

LB: none.

JEC: none. I am a Co‐ordinating Editor with Cochrane Oral Health.

MF: in the last 36 months, I have received grant support from the National Institutes for Health (NIH), the Delta Dental Foundation, DentaQUest, Colgate; have served as a grant reviewer for NIH; have consulted for 3M, DentaQuest; served as part of the National Scientific Advisory Committee for Delta Dental Foundation; and been a member of the Council for Scientific Affairs of the American Dental Association.

JGR: none.

GG: none.

CL: none.

AM: none.

DR: none.

MR: none.

RMS: none.

NPI: none.

Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Figures

1
1
Study flow diagram.
2
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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
1.1. Failure ‐ sealing vs  CR
5
5
2.1 Failure ‐ sealing vs SE
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6
3.1 Failure ‐ sealing vs no treatment
7
7
4.1 Failure ‐ CR vs HT
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8
5.1 Failure ‐ SE vs HT
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9
6.1 Failure ‐ CR vs NRCC
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10
7.1 Failure ‐ HT vs NRCC
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8.1 Failure ‐ CR vs SW
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9.1 Failure ‐ CR vs SE
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10.1 Failure ‐ SW vs SE
14
14
Network plot for different interventions for managing deep lesions. (a) Base‐case analysis, (b) sensitivity analysis excluding the single study using a modified Hall Technique (HT). Nodes (orange circles) and connections (grey lines) are used to display actual pairwise comparisons. The size of the node indicates the number of studies testing this strategy; thickness of the lines indicates the number of studies in which exact comparison was made. CR: complete removal; SE: selective removal; SW: stepwise removal.
15
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Network meta‐analysis relative effects of different interventions for treating deep lesions. (a) Base‐case analysis, (b) sensitivity analysis excluding the single study which used a modified Hall Technique (HT). Odds ratio and 95% credible intervals are shown. The odds of failure with each intervention in each row is compared against the ones in each column (e.g. in (a), CR had a 12.83 (1.05–252) times increased odds of failure compared with HT). CR: complete removal; SE: selective removal; SW: stepwise removal.
1.1. Analysis
1.1. Analysis
Comparison 1: Sealing versus conventional restoration (CR) (cavitated, permanent dentition), Outcome 1: Failure: sealing vs CR
2.1. Analysis
2.1. Analysis
Comparison 2: Sealing versus selective excavation (SE) (cavitated, primary dentition), Outcome 1: Failure: sealing vs SE
3.1. Analysis
3.1. Analysis
Comparison 3: Sealing versus no treatment (non‐cavitated, permanent), Outcome 1: Failure: sealing vs no treatment
4.1. Analysis
4.1. Analysis
Comparison 4: Conventional restoration (CR) versus Hall Technique (HT) (cavitated, primary), Outcome 1: Failure: CR vs HT
5.1. Analysis
5.1. Analysis
Comparison 5: Selective excavation (SE) versus Hall Technique (HT) (primary, cavitated; primary, deep), Outcome 1: Failure: SE vs HT
6.1. Analysis
6.1. Analysis
Comparison 6: Conventional restoration (CR) versus non‐restorative cavity control (NRCC) (cavitated, primary), Outcome 1: Failure: CR vs NRCC
7.1. Analysis
7.1. Analysis
Comparison 7: Hall Technique (HT) versus non‐restorative cavity control (NRCC) (cavitated, primary), Outcome 1: Failure: HT vs NRCC
8.1. Analysis
8.1. Analysis
Comparison 8: Conventional restoration (CR) versus stepwise (SW) (deep, primary; deep, permanent), Outcome 1: Failure: CR vs SW
9.1. Analysis
9.1. Analysis
Comparison 9: Conventional restoration (CR) versus selective excavation (SE) (deep, permanent; deep, primary; cavitated, primary), Outcome 1: Failure: CR vs SE
10.1. Analysis
10.1. Analysis
Comparison 10: Stepwise (SW) versus selective excavation (SE) (deep, primary; deep, permanent), Outcome 1: Failure: SW vs SE

References

References to studies included in this review Alves 2017 {published data only}

    1. Alves LS, Giongo FC, Mua B, Martins VB, Barbachan E Silva B, Qvist V, et al. A randomized clinical trial on the sealing of occlusal carious lesions: 3–4-year results. Brazilian Oral Research 2017;31:E44. [DOI: 10.1590/1807-3107BOR-2017.vol31.0044] [PMID: ]
Araujo 2020 {published data only}
    1. Araujo MP, Innes NP, Bonifacio CC, Hesse D, Olegario IC, Mendes FM, et al. Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal carious lesions in primary molars; 36-month follow-up of a randomised control trial in a school setting. BMC Oral Health 2020;20(1):318. [DOI: 10.21203/-31623/v2] [WEB: ]
    1. Hesse D, Araujo MP, Olegário IC, Innes N, Raggio DP, Bonifácio CC. Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal cavities in primary molars: study protocol for a randomized controlled trial. Trials 2016;17(169):1-13. [DOI: ]
Bjørndal  2017 {published data only}
    1. Bjørndal L, Fransson H, Bruun G, Markvart M, Kjældgaard M, Näsman P, et al. Randomized clinical trials on deep carious lesions: 5-year follow-up. Journal of Dental Research 2017;96(7):747-53. [DOI: 10.1177/0022034517702620] [PMID: ]
    1. Bjørndal L, Reit C, Bruun G, Markvart M, Kjaeldgaard M, Näsman P, et al. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. European Journal of Oral Sciences 2010;118(3):290-7. [DOI: 10.1111/j.1600-0722.2010.00731.x] [PMID: ]
Borges 2012a {published data only}
    1. Borges BC, De Souza Bezerra Araújo RF, Dantas RF, De Araújo Lucena A, De Assunção Pinheiro IV. Efficacy of a non-drilling approach to manage non-cavitated dentin occlusal caries in primary molars: a 12-month randomized controlled clinical trial. International Journal of Paediatric Dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children 2012;22(1):44-51. [DOI: 10.1111/j.1365-263X.2011.01156.x] [PMID: ]
Borges 2012b {published data only}
    1. Borges BC, Campos GB, da Silveira AD, Lima KC, Pinheiro IV. Efficacy of a pit and fissure sealant in arresting dentin non-cavitated caries: a 1-year follow-up, randomized, single-blind, controlled clinical trial. American Journal of Dentistry 2010;23(6):311-6. [PMID: ]
    1. Borges BC, Souza Borges J, Braz R, Montes MA, Assunção Pinheiro IV. Arrest of non-cavitated dentinal occlusal caries by sealing pits and fissures: a 36-month, randomised controlled clinical trial. International Dental Journal 2012;62(5):251-5. [DOI: 10.1111/j.1875-595X.2012.00117.x] [PMID: ]
Boyd 2021 {published data only}
    1. Boyd DH, Thomson WM, Leon de la Barra S, Fuge KN, den Heever R, Butler BM, et al. A primary care randomized controlled trial of Hall and conventional restorative techniques. JDR Clinical & Translational Research 2021;6(2):205-12. [DOI: ] [PMID: ]
Chompu‐inwai 2015 {published data only}
    1. Chompu-inwai P, Boonsongsawat K, Sastraruji T, Sophasri T, Mankaen S, Nondon S, et al. Three incomplete caries removal techniques compared over two years in primary molars with asymptomatic deep caries or reversible pulpitis. Pediatric Dentistry 2015;37(5):41-8. [PMID: ]
da Silveira 2012 {published data only}
    1. da Silveira AD, Borges BC, Almeida Varela H, Lima KC, Pinheiro IV. Progression of non-cavitated lesions in dentin through a nonsurgical approach: a preliminary 12-month clinical observation. European Journal of Dentistry 2012;6(1):34-42. [PMID: ]
Dias 2018 {published data only}
    1. Dias KR, Andrade CB, Wait TT, Chamon R, Ammari MM, Soviero VM, et al. Efficacy of sealing occlusal caries with a flowable composite in primary molars: a 2-year randomized controlled clinical trial. Journal of Dentistry 2018;74:49-55. [DOI: 10.1016/j.jdent.2018.05.014] [PMID: ]
Elhennawy 2021 {published data only}
    1. Elhennawy K, Finke C, Paris S, Reda R, Jost-Brinkmann PG, Schwendicke F. Selective vs stepwise removal of deep carious lesions in primary molars: 24 months follow-up from a randomized controlled trial. Clinical Oral Investigations 2021;25(2):645-52. [DOI: 10.1007/s00784-020-03536-6]
    1. Elhennawy K, Finke C, Paris S, Reda S, Jost-Brinkmann PG, Schwendicke F. Selective vs stepwise removal of deep carious lesions in primary molars: 12-months results of a randomized controlled pilot trial. Journal of Dentistry 2018;77:72-7. [DOI: 10.1016/j.jdent.2018.07.011] [PMID: ]
Foley 2004 {published data only}
    1. Foley J, Evans D, Blackwell A. Partial caries removal and cariostatic materials in carious primary molar teeth: a randomised controlled clinical trial. British Dental Journal 2004;197(11):697-701; discussion 689. [DOI: 10.1038/sj.bdj.4811865] [PMID: ]
Franzon 2014 {published data only}
    1. Franzon R, Guimarães LF, Magalhães CE, Haas AN, Araujo FB. Outcomes of one-step incomplete and complete excavation in primary teeth: a 24-month randomized controlled trial. Caries Research 2014;48(5):376-83. [DOI: 10.1159/000357628] [PMID: ]
    1. Franzon R, Opdam NJ, Guimarães LF, Demarco FF, Casagrande L, Haas AN, et al. Randomized controlled clinical trial of the 24-months survival of composite resin restorations after one-step incomplete and complete excavation on primary teeth. Journal of Dentistry 2015;43(10):1235-41. [DOI: 10.1016/j.jdent.2015.07.011] [PMID: ]
    1. Liberman J, Franzon R, Guimarães LF, Casagrande L, Haas AN, Araujo FB. Survival of composite restorations after selective or total caries removal in primary teeth and predictors of failures: a 36-months randomized controlled trial. Journal of Dentistry 2020;93:103268.
Hesse 2014 {published data only}
    1. Hesse D, Bonifácio CC, Mendes FM, Braga MM, Imparato JC, Raggio DP. Sealing versus partial caries removal in primary molars: a randomized clinical trial. BMC Oral Health 2014;14:58. [DOI: 10.1186/1472-6831-14-58] [PMID: ]
Innes 2011 {published data only}
    1. Innes N, Stewart M, Souster G, Evans D. The Hall Technique; retrospective case-note follow-up of 5-year RCT. British Dental Journal 2015;219(8):395-400. [DOI: 10.1038/sj.bdj.2015.816] [PMID: ]
    1. Innes NP, Evans DJ, Stirrups DR. Sealing caries in primary molars: Hall Technique RCT 5-year results. In: International Association of Dental Research (IADR); 2010 July 14-17; Barcelona, Spain. 2010.
    1. Innes NP, Evans DJ, Stirrups DR. Sealing caries in primary molars: randomized control trial, 5-year results. Journal of Dental Research 2011;90(12):1405-10. [DOI: 10.1177/0022034511422064] [PMID: ]
    1. Innes NP, Evans DJ, Stirrups DR. The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months. BMC Oral Health 2007;7:18.
    1. Schwendicke F, Krois J, Robertson M, Splieth C, Santamaria R, Innes N. Cost-effectiveness of the Hall Technique in a randomized trial. Journal of Dental Research 2019;98(1):61-7. [DOI: 10.1177/0022034518799742] [PMID: ]
Khokhar 2018 {published data only}
    1. Khokhar M, Tewari S. Outcomes of partial and complete caries excavation in permanent teeth: a 18 month clinical study. Contemporary Clinical Dentistry 2018;9(3):468-473. [DOI: 10.4103/ccd.ccd_344_18] [PMID: ]
Labib 2019 {published data only}
    1. Labib ME, Hassanein OE, Moussa M, Yassen A, Schwendicke F. Selective versus stepwise removal of deep carious lesions in permanent teeth: a randomised controlled trial from Egypt – an interim analysis. BMJ Open 2019;9(9):e030957. [DOI: 10.1136/bmjopen-2019-030957] [PMID: ]
Leksell 1996 {published data only}
    1. Leksell E, Ridell K, Cvek M, Mejàre I. Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth. Endodontics & Dental Traumatology 1996;12(4):192-6. [DOI: 10.1111/j.1600-9657.1996.tb00513.x] [PMID: ]
Lula 2009 {published data only}
    1. Lula EC, Monteiro-Neto V, Alves CM, Ribeiro CC. Microbiological analysis after complete or partial removal of carious dentin in primary teeth: a randomized clinical trial. Caries Research 2009;43(5):354-8. [DOI: 10.1159/000231572] [PMID: ]
Magnusson 1977 {published data only}
    1. Magnusson BO, Sundell SO. Stepwise excavation of deep carious lesions in primary molars. Journal of the International Association of Dentistry for Children 1977;8(2):36-40. [PMID: ]
Maltz 2018 {published data only}
    1. Jardim JJ, Mestrinho HD, Koppe B, Paula LM, Alves LS, Yamaguti PM, et al. Restorations after selective caries removal: 5-year randomized trial. Journal of Dentistry 2020;99:10341.
    1. Maltz M, Garcia R, Jardim JJ, Paula LM, Yamaguti PM, Moura MS, et al. Randomized trial of partial vs. stepwise caries removal: 3-year follow-up. Journal of Dental Research 2012;91(11):1026-31.
    1. Maltz M, Jardim JJ, Mestrinho HD, Yamaguti PM, Podestá K, Moura MS, et al. Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results. Caries Research 2013;47(2):103-9. [DOI: 10.1159/000344013] [PMID: ]
    1. Maltz M, Koppe B, Jardim JJ, Alves LS, Paula LM, Yamaguti PM, et al. Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial. Clinical Oral Investigations 2018;22(3):1337-43.
Mello 2018 {published data only}
    1. Mello B, Stafuzza CT, Vitor L, Rios D, Silva T, Machado M, et al. Evaluation of dentin-pulp complex response after conservative clinical procedures in primary teeth. International Journal of Clinical Pediatric Dentistry 2018;11(3):188-92. [DOI: 10.5005/jp-journals-10005-1509] [PMID: ]
Mertz‐Fairhurst 1998 {published data only}
    1. Mertz-Fairhurst EJ, Adair SM, Sams DR, Curtis JW Jr, Ergle JW, Hawkins KI, et al. Cariostatic and ultraconservative sealed restorations: nine-year results among children and adults. ASDC Journal of Dentistry for Children 1995;62(2):97-107. [PMID: ]
    1. Mertz-Fairhurst EJ, Call-Smith KM, Shuster GS, Williams JE, Davis QB, Smith CD, et al. Clinical performance of sealed composite restorations placed over caries compared with sealed and unsealed amalgam restorations. Journal of the American Dental Association (1939) 1987;115(5):689-94. [DOI: 10.14219/jada.archive.1987.0288] [PMID: ]
    1. Mertz-Fairhurst EJ, Curtis JW Jr, Ergle JW, Rueggeberg FA, Adair SM. Ultraconservative and cariostatic sealed restorations: results at year 10. Journal of the American Dental Association (1939) 1998;129(1):55-66. [DOI: 10.14219/jada.archive.1998.0022] [PMID: ]
    1. Mertz-Fairhurst EJ, Smith CD, Williams JE, Sherrer JD, Mackert JR Jr, Richards EE, et al. Cariostatic and ultraconservative sealed restorations: six-year results. Quintessence International 1992;23(12):827-38. [PMID: ]
    1. Mertz-Fairhurst EJ, Williams JE, Schuster GS, Smith CD, Pierce KL, Mackert JR Jr, et al. Ultraconservative sealed restorations: three-year results. Journal of Public Health Dentistry 1991;51(4):239-50. [DOI: 10.1111/j.1752-7325.1991.tb02222.x] [PMID: ]
Orhan 2010 {published data only}
    1. Orhan AI, Oz FT, Orhan K. Pulp exposure occurrence and outcomes after 1- or 2-visit indirect pulp therapy vs complete caries removal in primary and permanent molars. Pediatric Dentistry 2010;32(4):347-55. [PMID: ]
Phonghanyudh 2012 {published data only}
    1. Phonghanyudh A, Phantumvanit P, Songpaisan Y, Petersen PE. Clinical evaluation of three caries removal approaches in primary teeth: a randomised controlled trial. Community Dental Health 2012;29(2):173-8. [PMID: ]
Qvist 2017 {published data only}
    1. Qvist V, Borum MK, Møller KD, Andersen TR, Blanche P, Bakhshandeh A. Sealing occlusal dentin caries in permanent molars: 7-year results of a randomized controlled trial. JDR Clinical and Translational Research 2017;2(1):73-86. [DOI: 10.1177/2380084416680191] [PMID: ]
Ribeiro 1999 {published data only}
    1. Ribeiro CC, Baratieri LN, Perdigão J, Baratieri NM, Ritter AV. A clinical, radiographic, and scanning electron microscopic evaluation of adhesive restorations on carious dentin in primary teeth. Quintessence International 1999;30(9):591-9. [PMID: ]
Santamaria 2018 {published data only}
    1. NCT01797458. Randomised control trial on three different approaches to managing class 2 cavities in primary teeth. (first received 22 February 2013). [ IDENTIFIER: NCT01797458]
    1. Santamaría RM, Innes NP, Machiulskiene V, Schmoeckel J, Alkilzy M, Splieth CH. Alternative caries management options for primary molars: 2.5-year outcomes of a randomised clinical trial. Caries Research 2018;51(6):605-14. [DOI: 10.1159/000477855] [PMID: ]
    1. Santamaria RM, Innes NP, Machiulskiene V, Evans DJ, Alkilzy M, Splieth CH. Acceptability of different caries management methods for primary molars in a RCT. International Journal of Paediatric Dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children 2015;25(1):9-17. [DOI: 10.1111/ipd.12097] [PMID: ]
    1. Santamaria RM, Innes NP, Machiulskiene V, Evans DJ, Splieth CH. Caries management strategies for primary molars: 1-yr randomized control trial results. Journal of Dental Research 2014;93(11):1062-9. [DOI: 10.1177/0022034514550717] [PMID: ]
    1. Schwendicke F, Krois J, Splieth CH, Innes N, Robertson M, Schmoeckel J, et al. Cost-effectiveness of managing cavitated primary molar caries lesions: a randomized trial in Germany. Journal of Dentistry 2018;78:40-5. [DOI: 10.1016/j.jdent.2018.05.022] [PMID: ]
References to studies excluded from this review Ali 2018 {published data only}
    1. Ali AH, Koller G, Foschi F, Andiappan M, Bruce KD, Banerjee A, et al. Self-limiting versus conventional caries removal: a randomized clinical trial. Journal of Dental Research 2018;97(11):1207-13. [DOI: 10.1177/0022034518769255]
Alkilzy 2011 {published data only}
    1. Alkilzy M, Berndt C, Splieth CH. Sealing proximal surfaces with polyurethane tape: three-year evaluation. Clinical Oral Investigations 2011;15(6):879-84. [DOI: 10.1007/s00784-010-0457-z]
Alkilzy 2018 {published data only}
    1. Alkilzy M, Tarabaih A, Santamaria RM, Splieth CH. Self-assembling peptide P11-4 and fluoride for regenerating enamel. Journal of Dental Research 2018;97(2):148-54. [DOI: 10.1177/0022034517730531]
Allen 2005 {published data only}
    1. Allen KL, Salgado TL, Janal MN, Thompson VP. Removing carious dentin using a polymer instrument without anesthesia versus a carbide bur with anesthesia. Journal of the American Dental Association 2005;136(5):643-51. [DOI: 10.14219/jada.archive.2005.0237]
Ammari 2014 {published data only}
    1. Ammari MM, Moliterno LF, Hirata R Jr, Séllos MC, Soviero VM, Coutinho Filho WP. Efficacy of chemomechanical caries removal in reducing cariogenic microbiota: a randomized clinical trial. Brazilian Oral Research 2014;28:1-6. [DOI: 10.1590/1807-3107bor-2014.vol28.0031]
Anauate‐Netto 2017 {published data only}
    1. Anauate-Netto C, Neto LB, Amore R, DI Hipólito V, D'Alpino PH. Caries progression in non-cavitated fissures after infiltrant application: a 3-year follow-up of a randomized controlled clinical trial. Journal of Applied Oral Science 2017;25(4):442-54. [DOI: 10.1590/1678-7757-2016-0633]
Anusavice 1987 {published data only}
    1. Anusavice KJ, Kincheloe JE. Comparison of pain associated with mechanical and chemomechanical removal of caries. Journal of Dental Research 1987;66(11):1680-3. [DOI: 10.1177/00220345870660111501]
Arrow 2015 {published data only}
    1. Arrow P, Klobas E. Minimum intervention dentistry approach to managing early childhood caries: a randomized control trial. Community Dentistry and Oral Epidemiology 2015;3(6):511-20. [DOI: 10.1111/cdoe.12176] [PMID: ]
Aswathi 2017 {published data only}
    1. Aswathi KK, Rani SP, Athimuthu A, Prasanna P, Patil P, Deepali KJ. Comparison of efficacy of caries removal using polymer bur and chemomechanical caries removal agent: a clinical and microbiological assessment – an in vivo study. Journal of Indian Society Pedodontics and Preventive Dentistry 2017;35(1):6. [DOI: 10.4103/0970-4388.199232]
Azrak 2004 {published data only}
    1. Azrak B, Callaway A, Grundheber A, Stender E, Willershausen B. Comparison of the efficacy of chemomechanical caries removal (Carisolv‘) with that of conventional excavation in reducing the cariogenic flora. International Journal of Paediatric Dentistry 2004;14(3):182-91.
Bakhshandeh 2015 {published data only}
    1. Bakhshandeh A, Ekstrand K. Infiltration and sealing versus fluoride treatment of occlusal caries lesions in primary molar teeth. 2–3 years results. International Journal of Paediatric Dentistry 2015;25(1):43-50.
Balciuniene 2005 {published data only}
    1. Balciuniene I, Sabalaite R, Juskiene I. Chemomechanical caries removal for children. Stomatologija 2005;7(2):40-4.
Barata 2008 {published data only}
    1. Barata TJ, Bresciani E, Mattos MC, Lauris JR, Ericson D, Navarro MF. Comparison of two minimally invasive methods on the longevity of glass ionomer cement restorations: short-term results of a pilot study. Journal of Applied Oral Science 2008;16(2):155-60. [DOI: 10.1590/s1678-77572008000200014]
Bergmann 2005 {published data only}
    1. Bergmann J, Leitão J, Kultje C, Bergmann D, Clode MJ. Removing dentine caries in deciduous teeth with Carisolv: a randomised, controlled, prospective study with six-month follow-up, comparing chemomechanical treatment with drilling. Oral Health Preventive Dentistry 2005;3(2):105-11.
Bianchi 1989 {published data only}
    1. Bianchi S, Ciuffreda M, Poggio C, Piacentini C, Paroli R. The Caridex system for removal of dental caries. Clinical trial [Sistema Caridex per la rimozione della caries. Sperimentazione clinica]. Dental Cadmos 1989;57(12):46-52.
Bohari 2012 {published data only}
    1. Bohari MR, Chunawalla YK, Ahmed BM. Clinical evaluation of caries removal in primary teeth using conventional chemomechanical and laser technique: an in vivo study. Journal of Contemporary Dental Practice 2012;13(1):40-7. [DOI: 10.5005/jp-journals-10024-1093]
Braga 2009 {published data only}
    1. Braga MM, Mendes FM, De Benedetto MS, Imparato JC. Effect of silver diamine fluoride on incipient caries lesions in erupting permanent first molars: a pilot study. Journal of Dentistry for Children (Chicago, Ill.) 2009;76(1):28-33.
Bressani 2013 {published data only}
    1. Bressani AE, Mariath AA, Haas AN, Garcia-Godoy F, Araujo FB. Incomplete caries removal and indirect pulp capping in primary molars: a randomized controlled trial. American Journal of Dentistry 2013;26(4):196-200.
Calderari 1989 {published data only}
    1. Calderari G, Bruno E, Di Gianvittorio A, Gagliani M, Re S. Clinical investigation of the Caridex system [Sperimentazione clinica del Sistema Caridex]. Attualita Dentale 1989;5(26-27):6-16.
Cavel 1988 {published data only}
    1. Cavel WT, Kelsey WP 3rd, Barkmeier WW, Blankenau RJ. Clinical evaluation of chemomechanical removal of cervical caries. General Dentistry 1988;36(5):405-8.
Chomyszyn‐Gajewska 2006 {published data only}
    1. Chomyszyn-Gajewska M, Kwapinska H, Zarzecka J. Pain perception in children during caries removal with the Vector system: a pilot study. European Archives of Paediatric Dentistry 2006;7(1):38-41. [DOI: 10.1007/BF03320813 Full-text links]
de Almeida 2013 {published data only}
    1. Almeida SM, Franca FM, Florio FM, Ambrosano GM, Basting RT. Analysis of total microbiota in dentin after mechanical or papain-based chemomechanical caries removal. General Dentistry 2013;6(4):59-63.
Dülgergil 2005 {published data only}
    1. Dülgergil CT, Ercan E, Yildirim I. A combined application of ART-fluoride varnish for immigrant junior field-workers: 12-months follow-up field trial in rural Anatolia. Oral Health and Preventive Dentistry 2005;3(2):97-104.
Ekstrand 2010 {published data only}
    1. Ekstrand KR, Bakhshandeh A, Martignon S. Treatment of proximal superficial caries lesions on primary molar teeth with resin infiltration and fluoride varnish versus fluoride varnish only: efficacy after 1 year. Caries Research 2010;44(1):41-6. [DOI: 10.1159/000275573]
El‐Tekeya 2012 {published data only}
    1. El-Tekeya M, El-Habashy L, Mokhles N, El-Kimary E. Effectiveness of 2 chemomechanical caries removal methods on residual bacteria in dentin of primary teeth. Paediatric Dentistry 2012;34(4):325-30.
Flório 2001 {published data only}
    1. Flório FM, Pereira AC, Meneghim Mde C, Ramacciato JC. Evaluation of non-invasive treatment applied to occlusal surfaces. ASDC Journal of American Society of Dentistry for Children 2001;68(5-6):326-31.
Foley 2003 {published data only}
    1. Foley J, Blackwell A. In vivo cariostatic effect of black copper cement on carious dentine. Caries Research 2003;37(4):254-60. [DOI: 10.1159/000070867]
Fure 2000 {published data only}
    1. Fure S, Lingström P, Birkhed D. Evaluation of Carisolv™ for the chemo-mechanical removal of primary root caries in vivo. Caries Research 2000;34(3):275-80. [DOI: 10.1159/000016602]
Gibson 1980 {published data only}
    1. Gibson GB, Richardson AS. Sticky fissure management. 30-month report. Journal of Canadian Dental Association 1980;46(4):255-8.
Giza 2007 {published data only}
    1. Giza S. Comparative studies of carious defects filling using the classical method and dental drill, and using the Carisolv chemomechanical method and the YAG: Er CTL-1601 laser [Badanie Porównawcze Opracowywania Ubytków Próchnicowych Metodą Klasyczną Przy Użyciu Wiertarki Stomatologicznej, Metodą Chemo-Mechaniczną Preparatem Carisolv Oraz Laserem Yag:Er Ctl-1601]. Annales Academiae Medicae Stetinensis 2007;53(3):88-99.
Goyal 2015 {published data only}
    1. Goyal PA, Kumari R, Kannan VP, Madhu S. Efficacy and tolerance of papain gel with conventional drilling method: a clinico-microbiological study. Journal Clinical Paediatric Dentistry 2015;39(2):109-12. [DOI: 10.17796/jcpd.39.2.n25754863557k727]
Hamilton 2001 {published data only}
    1. Hamilton JC, Dennison JB, Stoffers KW, Gregory WA, Welch KB. Early treatment of incipient carious lesions: a two-year clinical evaluation. Journal of the American Dental Association 2002;133(12):1643-51. [DOI: 10.14219/jada.archive.2002.0114]
    1. Hamilton JC, Dennison JB, Stoffers KW, Welch KB. A clinical evaluation of air-abrasion treatment of questionable carious lesions: a 12-month report. Journal of the American Dental Association 2001;132(6):762-9. [DOI: 10.14219/jada.archive.2001.0273]
Handelman 1976 {published data only}
    1. Handelman SL, Leverett DH, Espeland M, Curzon J. Retention of sealants over carious and sound tooth surfaces. Community Dentistry Oral Epidemiology 1987;15(1):1-5. [DOI: 10.1111/j.1600-0528.1987.tb00470.x]
    1. Handelman SL, Leverett DH, Espeland MA, Curzon JA. Clinical radiographic evaluation of sealed carious and sound tooth surfaces. Journal of the American Dental Association 1986;113(5):751-4. [DOI: 10.14219/jada.archive.1986.0269]
    1. Handelman SL, Leverett DH, Solomon ES, Brenner CM. Use of adhesive sealants over occlusal carious lesions: radiographic evaluation. Community Dentistry Oral Epidemiology 1981;9(6):256-9. [DOI: 10.1111/j.1600-0528.1981.tb00341.x]
    1. Handelman SL, Washburn F, Wopperer P. Two-year report of sealant effect on bacteria in dental caries. Journal of the American Dental Association 1976;93(5):967-70. [DOI: 10.14219/jada.archive.1976.0007]
    1. Leverett DH, Handelman S, Brenner C, Iker H. Cost analysis of sealants: prevention and treatment of carious lesions. Journal of Dental Research 1983;80:225.
    1. Leverett DH, Handelman SL, Brenner CM, Iker HP. Cost-effectiveness of sealants as an alternative to conventional restorations. Journal of Dental Research 1978;57:360.
    1. Leverett DH, Handelman SL, Brenner CM, Iker HP. Use of sealants in the prevention and early treatment of carious lesions: cost analysis. Journal of the American Dental Association 1983;106(1):39-42. [DOI: 10.14219/jada.archive.1983.0024]
Hassan 2016 {published data only}
    1. Hassan AF, Yadav G, Tripathi AM, Mehrotra M, Saha S, Garg N. A comparative evaluation of the efficacy of different caries excavation techniques in reducing the cariogenic flora: an in vivo study. International Journal Clinical Paediatric Dentistry 2016;9(3):214. [DOI: 10.5005/jp-journals-10005-1366]
Heinrich 1988 {published data only}
    1. Heinrich R, Kneist S. Antimicrobial effect of calcium hydroxide [Antimikrobielle Wirkung von Kalziumhydroxid]. Stomatologie der DDR 1988;38(10):693-8. [PMID: ]
Hoefler 2016 {published data only}
    1. Hoefler V, Nagaoka H, Miller CS. Long-term survival and vitality outcomes of permanent teeth following deep caries treatment with step-wise and partial-caries-removal: a systematic review. Journal of Dentistry 2016;54:25-32. [DOI: 10.1016/j.jdent.2016.09.009]
Hosein 2008 {published data only}
    1. Hosein T, Hasan A. Efficacy of chemo-mechanical caries removal with Carisolv. Journal of College of Physicians and Surgeons Pakistan 2008;18(4):222-5.
Kakaboura 2003 {published data only}
    1. Kakaboura A, Masouras C, Staikou O, Vougiouklakis G. A comparative clinical study on the Carisolv caries removal method. Quintessence International 2003;34(4):269-71.
Kalf‐Scholte 2003 {published data only}
    1. Kalf-Scholte SM, Amerongen WE, Smith AJ, Haastrecht HJ. Atraumatic restorative treatment (ART): a three-year clinical study in Malawi – comparison of conventional amalgam and ART restorations. Journal Public Health Dentistry 2003;63(2):99-103. [DOI: 10.1111/j.1752-7325.2003.tb03482.x]
Kavvadia 2004 {published data only}
    1. Kavvadia K, Karagianni V, Polychronopoulou A, Papagiannouli L. Primary teeth caries removal using the Carisolv chemomechanical method: a clinical trial. Pediatric Dentistry 2004;26(1):23-8.
Kirzioglu 2007 {published data only}
    1. Kirzioglu Z, Gurbuz T, Yilmaz Y. Clinical evaluation of chemomechanical and mechanical caries removal: status of the restorations at 3, 6, 9 and 12 months. Clinical Oral Investigation 2007;11(1):69. [DOI: 10.1007/s00784-006-0072-1]
Kochhar 2011 {published data only}
    1. Kochhar GK, Srivastava N, Pandit IK, Gugnani N, Gupta M. An evaluation of different caries removal techniques in primary teeth: a comparative clinical study. Journal of Clinical Paediatric Dentistry 2011;36(1):5-9. [DOI: 10.17796/jcpd.36.1.u2421l4j68847215]
Kotb 2009 {published data only}
    1. Kotb RM, Abdella AA, El Kateb MA, Ahmed AM. Clinical evaluation of Papacarie in primary teeth. Journal of Clinical Paediatric Dentistry 2009;34(2):117-23. [DOI: 10.17796/jcpd.34.2.f312p36g18463716]
Lager 2003 {published data only}
    1. Lager A, Thornqvist E, Ericson D. Cultivatable bacteria in dentine after caries excavation using rose-bur or Carisolv. Caries Research 2003;37(3):206-11. [DOI: 10.1159/000070446]
Lakshmi 2018 {published data only}
    1. Lakshmi MS, Srilatha KT, Nandlal B, Deshmukh S. Clinical evaluation of preventive effect of fissure sealants on initial carious lesion of permanent mandibular molars pretreated with and without fluoride varnish by fluorescence camera. International Journal of Clinical Paediatric Dentistry 2018;11(2):89-93. [DOI: 10.5005/jp-journals-10005-1491]
Lozano‐Chourio 2006 {published data only}
    1. Lozano-Chourio MA, Zambrano O, González H, Quero M. Clinical randomized controlled trial of chemomechanical caries removal (Carisolv™). International Journal of Paediatric Dentistry 2006;16(3):161-7. [DOI: 10.1111/j.1365-263X.2006.00719.x]
    1. Lozano-Chourio MA, Zambrano O, Rivera L, Aguilera LA. Ultraconservative caries removal: microbiological evaluation, and identification with PCR. IADR General Session; 2009 Apr 1-4; Miami, FL 2009:682.
Maguire 2020 {published data only}
    1. Maguire A, Clarkson JE, Douglas GV, Ryan V, Homer T, Marshman Z, et al. Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: the FiCTION three-arm RCT. Health Technology Assessment 2020;24(1):1-174. [DOI: 10.3310/hta24010]
Malmström 2003 {published data only}
    1. Malmström HS, Chaves Y, Moss ME. Patient preference: conventional rotary handpieces or air abrasion for cavity preparation. Operative Dentistry 2003;28(6):667-71.
Maltz 2012 {published data only}
    1. Maltz M, Henz SL, Oliveira EF, Jardim JJ. Conventional caries removal and sealed caries in permanent teeth: a microbiological evaluation. Journal of Dentistry 2012;40(9):776-82. [DOI: 10.1016/j.jdent.2012.05.011]
Mandari 2001 {published data only}
    1. Mandari GJ, Frencken JE, van't Hof MA. Six-year success rates of occlusal amalgam and glass-ionomer restorations placed using three minimal intervention approaches. Caries Research 2001;37(4):246-53.
    1. Mandari GJ, Truin GJ, van't Hof MA, Frencken JE. Effectiveness of three minimal intervention approaches for managing dental caries: survival of restorations after 2 years. Caries Research 2001;35(2):90-4. [DOI: 10.1159/000047438]
Maragakis 2001 {published data only}
    1. Maragakis GM, Hahn P, Hellwig E. Clinical evaluation of chemomechanical caries removal in primary molars and its acceptance by patients. Caries Research 2001;35(3):205-10. [DOI: 10.1159/000047457]
Martignon 2012 {published data only}
    1. Martignon S, Ekstrand KR, Ellwood R. Efficacy of sealing proximal early active lesions: an 18-month clinical study evaluated by conventional and subtraction radiography. Caries Research 2006;40(5):382-8. [DOI: 10.1159/000094282]
    1. Martignon S, Ekstrand KR, Gomez J, Lara JS, Cortes A. Infiltrating/sealing proximal caries lesions: a 3-year randomized clinical trial. Journal of Dental Research 2012;91(3):288-92. [DOI: 10.1177/0022034511435328]
    1. Martignon S, Tellez M, Santamaría RM, Gomez J. Sealing distal proximal caries lesions in first primary molars: efficacy after 2.5 years. Caries Reseach 2010;44(6):562-70. [DOI: 10.1159/000321986]
Matsumoto 2013 {published data only}
    1. Matsumoto SF, Motta LJ, Alfaya TA, Guedes CC, Fernandes KP, Bussadori SK. Assessment of chemomechanical removal of carious lesions using Papacarie Duo™: randomized longitudinal clinical trial. Indian Journal of Dental Research 2013;24(4):488-92. [DOI: 10.4103/0970-9290.118393]
Moreira 2017 {published data only}
    1. Moreira KM, Kantovitz KR, Aguiar JP, Borges AF, Pascon FM, Puppin-Rontani RM. Impact of the intermediary layer on sealant retention: a randomized 24-month clinical trial. Clinical Oral Investigation 2017;21(5):1435-43. [DOI: 10.1007/s00784-016-1890-4]
Motta 2013 {published data only}
    1. Motta LJ, Bussadori SK, Campanelli AP, da Silva AL, Alfaya TA, Godoy CH, et al. Pain during removal of carious lesions in children: a randomized controlled clinical trial. International Journal of Dentistry 2013;2013:896381. [DOI: 10.1155/2013/896381]
    1. Motta LJ, Bussadori SK, Campanelli AP, Silva AL, Alfaya TA, Godoy CH, et al. Efficacy of Papacarie(®) in reduction of residual bacteria in deciduous teeth: a randomized, controlled clinical trial. Clinics (Sao Paulo). Clinics (Sao Paulo, Brazil) 2014;69(5):319-22. [DOI: 10.6061/clinics/2014(05)04]
    1. Motta LJ, Bussadori SK, Campanelli AP, Silva AL, Alfaya TA, Godoy CH, et al. Randomized controlled clinical trial of long-term chemo-mechanical caries removal using Papacarie™ gel. Journal Applied Oral Science 2014;22(4):307-13. [DOI: 10.1590/1678-775720130488]
Muñoz‐Sandoval  2019 {published data only}
    1. Muñoz-Sandoval C, Gambetta-Tessini K, Giacaman RA. Microcavitated (ICDAS 3) carious lesion arrest with resin or glass ionomer sealants in first permanent molars: a randomized controlled trial. Journal of Dentistry 2019;88:103163. [DOI: 10.1016/j.jdent.2019.07.001]
Nadanovsky 2001 {published data only}
    1. Nadanovsky P, Cohen Carneiro F, Souza de Mello F. Removal of caries using only hand instruments: a comparison of mechanical and chemo-mechanical methods. Caries Research 2001;35(5):384-9. [DOI: 10.1159/000047478]
Pandit 2007 {published data only}
    1. Pandit IK, Srivastava N, Gugnani N, Gupta M, Verma L. Various methods of caries removal in children: a comparative clinical study. Indian Society of Pedodontic and Preventive Dentistry 2007;25(2):93. [DOI: 10.4103/0970-4388.33456]
Peric 2009 {published data only}
    1. Peric T, Markovic D, Petrovic B. Clinical evaluation of a chemomechanical method for caries removal in children and adolescents. Acta Odontologica Scandinavica 2009;67(5):277-83. [DOI: 10.1080/00016350902976779]
Peters 2006 {published data only}
    1. Peters MC, Flamenbaum MH, Eboda NN, Feigal RJ, Inglehart MR. Chemomechanical caries removal in children: efficacy and efficiency. Journal of the American Dental Association 2006;137(12):1658-66. [DOI: 10.14219/jada.archive.2006.0111]
Rios Caro 2012 {published data only}
    1. Rios Caro T, Aguirre A, Saavedra JH, Alfaya T, Frana C, Fernandes K, et al. Effectiveness of carious removal with chemomechanical system versus traditional method. General Session of the International Association for Dental Research; 2012 Jun 20-23; Iguaçu Falls, Brazil.
Ruff 2018 {published data only}
    1. Ruff RR, Niederman R. Silver diamine fluoride versus therapeutic sealants for the arrest and prevention of dental caries in low-income minority children: study protocol for a cluster randomized controlled trial. Trials 2018;19(1):523. [DOI: 10.1186/s13063-018-2891-1]
Santamaria 2014 {published data only}
    1. Santamaria R, Innes N. Trial shows partial caries removal is an effective technique in primary molars. Evidence Based Dentistry 2014;15(3):81-2. [DOI: 10.1038/sj.ebd.6401044]
Sarmadi 2018 {published data only}
    1. Sarmadi R, Andersson EV, Lingström P, Gabre P. A randomized controlled trial comparing Er:YAG laser and rotary bur in the excavation of caries – patients' experiences and the quality of composite restoration. Open Dentistry Journal 2018;12:443-54. [DOI: 10.2174/1874210601812010443]
Straffon 1988a {published data only}
    1. Dennison JB, Straffon LH. Clinical evaluation comparing sealant and amalgam – 4 year report. Journal of Dental Research 1981;520:843.
    1. Straffon LH, Dennison JB. Clinical evaluation comparing sealant and amalgam after 7 years: final report. Journal of the American Dental Association 1988;117(6):751-5. [DOI: ] [PMID: ]
Straffon 1988b {published data only}
    1. Dennison JB, Straffon LH. Clinical evaluation comparing sealant and amalgam – 4 year report. Journal of Dental Research 1981;60:520.
    1. Straffon LH, Dennison JB. Clinical evaluation comparing sealant and amalgam after 7 years: final report. Journal of the American Dental Association 1988;117(6):751-5. [DOI: 10.14219/jada.archive.1988.0107]
Taifour 2003 {published data only}
    1. Taifour D, Frencken JE, Beiruti N, van't Hof MA, Truin GJ, Palenstein Helderman WH. Comparison between restorations in the permanent dentition produced by hand and rotary instrumentation – survival after 3 years. Community Dentistry and Oral Epidemiology 2003;31(2):122-8. [DOI: 10.1034/j.1600-0528.2003.00027.x]
    1. Taifour D, Frencken JE, Beiruti N, van't Hof MA, Truin GJ. Effectiveness of glass-ionomer (ART) and amalgam restorations in the deciduous dentition: results after 3 years. Caries Research 2002;36(6):437-44. [DOI: 10.1159/000066531]
Tavciovski 1966 {published data only}
    1. Tavciovski I, Cvetković N. Our results in the treatment of deep caries [Nasi rezultati vo lekuvanjeto na caries profunda]. God Zb Med Fak Skopje 1966;13:231-5.
Thompson 2015 {published data only}
    1. Thompson V, Craig RG, Curro FA, Green WS, Ship JA. Alternative Treatment of Deep Carious Lesions Based on Biological Evidences. (first received 9 September 2009). [CLINICALTRIALS IDENTIFICATION NUMBER: NCT00973089]
Valério 2016 {published data only}
    1. Valério RA, Borsatto MC, Serra MC, Polizeli SA, Nemezio MA, Galo R, et al. Caries removal in deciduous teeth using an Er:YAG laser: a randomized split-mouth clinical trial. Clinical Oral Investigations 2016;20(1):65-73. [DOI: 10.1007/s00784-015-1470-z]
    1. Valerio RA, Polizeli SA, Serra MC, Borsatto MC, Corona SA. Partial caries removal with Er: YAG laser. A pilot study. In: IADR/AADR/CADR General Session; 2013 Mar 20-23; Seattle, WA. Seattle (WA). Alexandria (VA): International Association for Dental Research, 2013.
Wang 2007 {published data only}
    1. Wang J, Wang HM. Effects of three caries removal methods on children's dental fear evaluated by physiological measure. Shanghai Kou Qiang Yi Xue 2007;16(2):149-52.
Welbury 1990 {published data only}
    1. Welbury RR, Walls AW, Murray JJ, McCabe JF. The management of occlusal caries in permanent molars. A 5-year clinical trial comparing a minimal composite with an amalgam restoration. British Dental Journal 1990;169(11):361-6. [DOI: 10.1038/sj.bdj.4807385]
Zakirulla 2012 {published data only}
    1. Zakirulla M, Uloopi KS, Subba Reddy VV. In vivo comparison of reduction in bacterial count after caries excavation with 3 different techniques. Journal of Dentistry for Children (Chicago, Ill.) 2012;78(1):31-5.
Zinck 1988 {published data only}
    1. Zinck JH, McInnes-Ledoux P, Capdeboscq C, Weinberg R. Chemomechanical caries removal—a clinical evaluation. Journal of Oral Rehabilitation 1988;15(1):23-33. [DOI: 10.1111/j.1365-2842.1988.tb00143.x]
References to ongoing studies Vicioni‐Marques 2018 {published data only}
    1. Vicioni-Marques F, Carvalho FK. Comparison of three restorative protocols in teeth with molar-incisor hipomineralization (MIH): a randomized controlled clinical study, University of Sao Paulo. (first received 30 November 2018). [ IDENTIFIER (NCT NUMBER): NCT03760497]
Additional references Bakhshandeh 2018
    1. Bakhshandeh A, Floriano I, Braga MM, Thorlacius KA, Ekstrand KR. Relationship between depth of approximal caries lesions and presence of bacteria in the dentine in primary and permanent posterior teeth: a radiographic examination with microbiological evaluation. Acta Odontologica Scandinavica 2018;76(7):509-14. [DOI: 10.1080/00016357.2018.1444201]
Bjørndal 1997
    1. Bjørndal L, Larsen T, Thylstrup A. A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Research 1997;31(6):411-7.
Bjørndal 2000
    1. Bjørndal L, Larsen T. Changes in the cultivable flora in deep carious lesions following a stepwise excavation procedure. Caries Research 2000;34(6):502-8.
Chaimani 2013
    1. Chaimani A, Higgins JP, Mavridis D, Spyridonos P, Salanti G. Graphical tools for network meta-analysis in STATA. PloS One 2013;8(10):e76654.
Deeks 2011
    1. Deeks JJ, Higgins JP, Altman DG. Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. .
Demant 2021
    1. Demant S, Dabelsteen S, Bjørndal LI. A macroscopic and histological analysis of radiographically well-defined deep and extremely deep carious lesions: carious lesion characteristics as indicators of the level of bacterial penetration and pulp response [A macroscopic and histological analysis of radiographically well-defined deep and extremely deep carious lesions: carious lesion characteristics as indicators of the level of bacterial penetration and pulp response]. International Endodontic Journal 2021;54(3):319-330. [DOI: 10.1111/iej.13424] [PMID: ]
Dias 2010
    1. Dias S, Welton NJ, Caldwell DM, Ades AE. Checking consistency in mixed treatment comparison meta-analysis. Statistics in Medicine 2010;29:932-44.
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315(7109):629-34.
ESE 2019
    1. Duncan HF, Galler KM, Tomson PL, Simon S, El-Karim I, Kundzina R, et al. European Society of Endodontology position statement: management of deep caries and the exposed pulp. International Endodontic Journal 2019;52(7):923-34.
GRADE 2013
    1. Schünemann H, Brożek J, Guyatt G, Oxman A, editor(s). Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach (updated October 2013). GRADE Working Group, 2013. Available from .
GRADEpro GDT [Computer program]
    1. McMaster University (developed by Evidence Prime) GRADEpro GDT. Version accessed 31 May 2018. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015. Available at .
Gruythuysen 2010
    1. Gruythuysen R. Non-restorative cavity treatment: managing rather than masking caries activity. Nederlands Tijdschrift voor Tandheelkunde 2010;117(3):173-80.
Hansen 2017
    1. Hansen NV, Nyvad B. Non-operative control of cavitated approximal caries lesions in primary molars: a prospective evaluation of cases. Journal of Oral Rehabilitation 2017;44(7):537-44. [DOI: 10.1111/joor.12508]
Higgins 2011a
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from .
Higgins 2011b
    1. Higgins JP, Green S. Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. .
Higgins 2011c
    1. Higgins JP, Green S. Chapter 7: Selecting studies and collecting data. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. .
Higgins 2013
    1. Higgins JP, Lasserson T, Chandler J, Tovey D, Churchill R. Standards for the conduct and reporting of new Cochrane intervention reviews, reporting of protocols and the planning, conduct and reporting of updates. (accessed 30 May 2018).
Houpt 1994
    1. Houpt M, Fuks A, Eidelman E . The preventive (composite resin/sealant) restoration: nine-year results. Quintessence International 1994;25:155-59.
Innes 2007
    1. Innes NP, Evans DJ, Stirrups DR. The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months. BMC Oral Health 2007;7 (18). [DOI: 10.1186/1472-6831-7-18]
Innes 2016
    1. Innes NP, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, et al. Managing carious lesions: consensus recommendations on terminology. Advances in Dental Research 2016;28(2):49-57.
Innes 2017
    1. Innes NP, Schwendicke F. Restorative thresholds for carious lesions: systematic review and meta-analysis. Journal of Dental Research 2017;96(5):501-8.
Kassebaum 2015
    1. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of untreated caries: a systematic review and metaregression. Journal of Dental Research 2015;94(5):650-8.
Lefebvre 2020
    1. Lefebvre C, Glanville J, Briscoe S, Littlewood A, Marshall C, Metzendorf M-I, et al. Technical Supplement to Chapter 4: Searching for and selecting studies. In: Higgins JP, Thomas J, Chandler J, Cumpston MS, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions, Version 6.1 (updated September 2020). Cochrane, 2020. Available from .
Listl 2015
    1. Listl S, Galloway J, Mossey PA, Marcenes W. Global economic impact of dental diseases. Journal of Dental Research 2015;94(10):1355-61.
Marcenes 2013
    1. Marcenes W, Kassebaum NJ, Bernabé E, Flaxman A, Naghavi M, Lopez A, et al. Global burden of oral conditions in 1990-2010: a systematic analysis. Journal of Dental Research 2013;92(7):592-7.
Marsh 2010
    1. Marsh PD. Microbiology of dental plaque biofilms and their role in oral health and caries. Dental Clinics of North America 2010;54(3):441-54.
McDonald 2011
    1. McDonald RE, Avery DR, Dean JA. Restorative dentistry. In: McDonald RE, Avery DR, Dean JA, eds. Dentistry for the Child and Adolescent. 9th edition. St Louis, Mo: CV MosbyInc, 2011:322-42.
Oong 2008
    1. Oong EM, Griffin SO, Kohn WG, Gooch BF, Caufield PW. The effect of dental sealants on bacteria levels in caries lesions: a review of the evidence. Journal of the American Dental Association 2008;139(3):271-8.
Owen 2019
    1. Owen RK, Bradbury N, Xin Y, Cooper N, Sutton A. MetaInsight: An interactive web-based tool for analyzing, interrogating, and visualizing network meta-analyses using R-shiny and netmeta. Research Synthesis Methods 2019;10:569-81.
Paddick 2005
    1. Paddick JS, Brailsford SR, Kidd EA, Beighton D. Phenotypic and genotypic selection of microbiota surviving under dental restorations. Applied Environmental Microbiology 2005;71(5):2467-72.
RevMan Web 2020 [Computer program]
    1. The Cochrane Collaboration Review Manager Web (RevMan Web). Version 3.2.1. The Cochrane Collaboration, 2020. Available at .
Ricketts 1995
    1. Ricketts DN, Kidd EA, Beighton D. Operative and microbiological validation of visual, radiographic and electronic diagnosis of occlusal caries in non-cavitated teeth judged to be in need of operative care. British Journal of Dentistry 1995;179(6):214-20.
Ricketts 2013
    1. Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No: CD003808. [DOI: 10.1002/14651858.CD003808.pub3]
Ricucci 2020
    1. Ricucci D, Siqueira JF Jr, Rôças IN, Lipski M, Shiban A, Tay FR. Pulp and dentine responses to selective caries excavation: a histological and histobacteriological human study. Journal of Dentistry 2020;100:103430.
Salanti 2011
    1. Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. Journal of Clinical Epidemiology 2011;64(2):163-71.
Schwendicke 2013
    1. Schwendicke F, Stolpe M, Meyer-Lueckel H, Paris S, Dörfer CE. Cost-effectiveness of one- and two-step incomplete and complete excavations. Journal of Dental Research 2013;92(10):880-7.
Schwendicke 2014
    1. Schwendicke F, Paris S, Stolpe M. Cost-effectiveness of caries excavations in different risk groups – a micro-simulation study. BMC Oral Health 2014;14:153.
Schwendicke 2015a
    1. Schwendicke F, Stolpe M, Innes N. Conventional treatment, Hall Technique or immediate pulpotomy for carious primary molars: a cost-effectiveness analysis. International Endodontic Journal 2015;49(9):817-26. [DOI: 10.1111/iej.12537]
Schwendicke 2015b
    1. Schwendicke F, Stolpe M, Meyer-Lueckel H, Paris S. Detecting and treating occlusal caries lesions: a cost-effectiveness analysis. Journal of Dental Research 2015;94(2):272-80.
Schwendicke 2016a
    1. Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, et al. Managing carious lesions: consensus recommendations on carious tissue removal. Advances in Dental Research 2016;28(2):58-67.
Schwendicke 2016b
    1. Schwendicke F, Diederich C, Paris S. Restoration gaps needed to exceed a threshold size to impede sealed lesion arrest in vitro. Journal of Dentistry 2016;48:77-80.
Schwendicke 2016c
    1. Schwendicke F, Göstemeyer G. Understanding dentists' management of deep carious lesions in permanent teeth: a systematic review and meta-analysis. Implementation Science 2016;11(1):142.
Schwendicke 2020
    1. Schwendicke F, Splieth CH, Bottenberg P, Breschi L, Campus G, Doméjean S, et al. How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement. Clinical Oral Investigations 2020;24(9):3315-21.
Takahashi 2011
    1. Takahashi N, Nyvad B. The role of bacteria in the caries process: ecological perspectives. Journal of Dental Research 2011;90(3):294-303.
Thompson 2005
    1. Thompson VP, Kaim JM. Nonsurgical treatment of incipient and hidden caries. Dental Clinics of North America 2005;49:905-21.
References to other published versions of this review Schwendicke 2018
    1. Schwendicke F, Walsh T, Fontana M, Bjørndal L, Clarkson JE, Lamont T, Levey C, Gostemeyer G, Santamaria RM, Ricketts D, Innes NPT. Interventions for treating cavitated or dentine carious lesions. Cochrane Database of Systematic Reviews 2018, Issue 6. Art. No: CD013039. [DOI: 10.1002/14651858.CD013039]

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