University of Oulu

Duggal, M., Gizani, S., Albadri, S. et al. Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document. Eur Arch Paediatr Dent 23, 659–666 (2022).

Best clinical practice guidance for treating deep carious lesions in primary teeth : an EAPD policy document

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Author: Duggal, M.1; Gizani, S.2; Albadri, S.3;
Organizations: 1College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
2Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian, University of Athens, Athens, Greece
3School of Dentistry, Unit of Oral Health, University of Liverpool, Liverpool, UK
4Department of Paediatric Dentistry, Justus-Liebig University Gießen, Giessen, Germany
5Department of Pediatric Oral Health and Orthodontics, University Center of Dental Medicine, Basel, Switzerland
6Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
7Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
8Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
9Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK
10Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany
11Faculty of Dentistry, National University of Singapore, Singapore, Singapore
12Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
13Department of Paediatric Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen) Medical Centre for Dentistry, Schlangenzahl 14, 35392, Giessen, Germany
14Department of Paediatric Dentistry, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria
15Lygidakis Dental Clinic (Private Dental Practice), 2 Papadiamantopoulou str. & Vasilissis Sofias Ave, 11528, Athens, Greece
16Medical Centre for Dentistry, Department of Operative Dentistry and Endodontics, Phillips-University Marburg, University Medical Centre Giessen and Marburg (Campus Marburg), Georg-Voigt-Str. 3, 35039, Marburg, Germany
17Department of Paediatric Dentistry, Sheffield Teaching Hospitals, Sheffield, UK
18Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
19Dublin Dental University Hospital, Trinity College, Dublin, Ireland
20Specialized Dental Practice, Warsaw, Poland
21Department of Paediatric Dentistry, School of Oral Health Sciences, Ghent University, B-9000, Ghent, Belgium
22Department of Paediatric Dentistry, UCL Eastman Dental Institute, London, UK
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
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Language: English
Published: Springer Nature, 2022
Publish Date: 2023-06-28


Purpose: The European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth.

Methods: Three expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified.

Results: There is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates.

Conclusion: The management of deep carious lesions in primary teeth can be challenging and must consider the patient’s compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option.

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Series: European archives of paediatric dentistry
ISSN: 1818-6300
ISSN-E: 1996-9805
ISSN-L: 1818-6300
Volume: 23
Issue: 5
Pages: 659 - 666
DOI: 10.1007/s40368-022-00718-6
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: The research leading to these results received funding from EAPD, but no funding was received to assist with the preparation of this manuscript.
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