Alternative caries management options for primary molars: 2.5-yr outcomes of a randomised clinical trial

Ruth M. Santamaria (Lead / Corresponding author), Nicola Innes, V. Machiulskiene, J. Schmoeckel, M. Alkilzy, Christian H. Splieth

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Abstract

Less invasive caries management techniques for treating cavitated carious primary teeth, which involve the concept of caries control by managing the activity of the biofilm are becoming common. This study aimed to compare the clinical efficacy (Minor/Major failures) and survival rates (Successful cases without any failures) of three carious lesion treatment approaches: The Hall Technique (HT), Non-Restorative Caries Treatment (NRCT), and Conventional Restorations (CR), for management of occluso-proximal caries lesions (ICDAS 3-5) in primary molars. Results at 2.5 years are presented. 169 children (3-8-year-olds) were enrolled in this secondary care-based, three-arm parallel-group, randomized controlled trial. Participants were allocated to: HT (n=52; sealing caries with stainless steel crowns without caries removal), NRCT (n=52; opening-up the cavity and applying fluoride varnish), CR (n=65; control arm, complete caries removal and compomer restoration). Statistical analyses: Non-parametric Kruskal-Wallis analysis of variance, Mann-Whitney U-test and Kaplan-Meier survival analyses. 142 participants (84.02%; HT=40/52; NRCT=44/52; CR=58/65) had follow-up data of one to 33 months (mean= 26). Overall, 25 (HT=2, NRCT=9, CR=14) of 142 participants (17.6%) presented with at least one Minor failure (reversible pulpitis, caries progression, or secondary caries; p=0.013, CI=0.012-0.018; Mann-Whitney U-test). Ten (HT=1, NRCT=4, CR=5) of 142 participants (7.04%) experienced at least one Major failure (irreversible pulpitis, abscess, unrestorable tooth; p=0.043, CI=0.034-0.045). Independent comparison between two samples found NRCT-CR - no statistically significant difference in failures (p>0.05) but for CR-HT (p=0.037, CI=0.030- 0.040) and NRCT-HT (p=0.011, CI=0.010-0.016; Kruskal-Wallis test) significant differences were observed. Cumulative survival rates were HT=92.5%, NRCT=70.5%, and CR=67.2% (p=0.012). NRCT and CR outcomes were comparable. HT performed better than NRCT and CR for all outcomes.
Original languageEnglish
JournalCaries Research
Volume51
Issue number6
Early online date20 Dec 2017
DOIs
Publication statusPublished - 20 Dec 2017

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Keywords

  • caries
  • primary teeth
  • Non-Restorative Caries Treatment
  • Hall TEchnique
  • multisurface cavities

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