Scientific evidence for the management of dentin caries lesions in pediatric dentistry: A systematic review and network meta-analysis

RESEARCH ARTICLE Scientific evidence for the management of dentin caries lesions in pediatric dentistry: A systematic review and network meta-analysis Tamara Kerber Tedesco ID1,2,3*, Thais Gimenez1,2, Isabela Floriano1, Anelise Fernandes Montagner2, Lucila Basto Camargo3, Ana Flávia Bissoto Calvo2,3, Susana Morimoto2, Daniela Prócida Raggio1 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil, 2 Graduation Program, School of Dentistry, Ibirapuera University, Sao Paulo, Sao Paulo, Brazil, 3 School of Dentistry, Paulista University, Campinas, Sao Paulo, Brazil * Abstract OPEN ACCESS Citation: Tedesco TK, Gimenez T, Floriano I, Montagner AF, Camargo LB, Calvo AFB, et al. (2018) Scientific evidence for the management of dentin caries lesions in pediatric dentistry: A systematic review and network meta-analysis. PLoS ONE 13(11): e0206296. https://doi.org/ 10.1371/journal.pone.0206296 Editor: Spyridon N. Papageorgiou, University of Zurich, SWITZERLAND Received: January 25, 2018 Accepted: October 10, 2018 Published: November 21, 2018 Copyright: © 2018 Tedesco et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All data are available from the repository Mendeley. DOI: 10.17632/ zr7f72cgfb.1. Funding: Funding was provided by Fundação de Amparo à Pesquisa do Estado de São Paulo to TT and DR. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Background A systematic quantitative evaluation of the available evidence of the treatment for caries lesions in primary teeth that considers how different caries progressions lead to the need for distinct interventions might provide additional useful information for clinical evidence-based decision making. The aim of this systematic review and network meta-analysis was to verify the effect of the treatments on caries lesion arrestment (CLA) or the success rate (SR) of dentin caries lesion treatments in the primary teeth. Methods A search was conducted using the MEDLINE/PubMed, Web of Science and Scopus databases through December 2017. The primary search terms used in combination were primary teeth, caries lesion and restoration. The grey literature was also screened, as were the reference lists of eligible studies. A search of prospective studies with at least 12 months of follow up that compared different techniques was performed. The exclusion criteria were the absence of a comparison group; no evaluation of different restorative techniques; the evaluation of other outcomes unrelated to this review; and the recruitment of specific patient. The risk of bias was evaluated by the tools: the Cochrane Handbook for Systematic Reviews of Interventions and ROBINS-I. A network meta-analyses and meta-analyses were conducted considering CLA or SR as outcomes according to the surface involved and the depth of progression. Results Of the 1671 potentially eligible studies, 15 were included. For occlusal surfaces, only two studies presented data regarding the outer half of the dentin, with conventional restorative treatment (CRT) using composite resin showing superior results; five studies presented data regarding the depth of caries lesions, and CRT with compomer resulted in the best PLOS ONE | https://doi.org/10.1371/journal.pone.0206296 November 21, 2018 1 / 20 Managment of dentin caries lesion in primary teeth: Network meta-analyses results. Seven studies considered occlusoproximal surfaces, and the Hall technique showed the best SR among the evaluated treatments. Finally, two annual applications of silver diamine fluoride showed the best nonrestorative approach to arrest caries lesions on occlusal and smooth surfaces. Discussion/Conclusions The treatments for dentin caries lesions in primary teeth depend on the depth of progression and the surface involved. However, few of the included studies provided evidence to strongly recommend the best treatment option. Other Funding: FAPESP; Systematic review registration number—PROSPERO CRD42016037784. Introduction The current scenario in dentistry indicates a high prevalence of dental caries across different age groups and populations [1], despite several existing prevention programs and the global use of fluoride dentifrice [2]. Especially in pediatric dentistry, this result is of great concern because caries is the most important risk factor for developing new caries lesions [3]. Thus, children with an active caries lesion in their primary dentition can also present with caries lesions in their permanent dentition [4]. Despite the knowledge and scientific evidence regarding the prevention of dental caries [5,6], information regarding the effectiveness of different treatment methods proposed for active caries lesions remains lacking. Treatments with strong scientific support have not been identified. A need exists for systematic reviews that compare the several available management options and consider both caries lesion arrestment and treatment success as outcomes. Previous systematic reviews that evaluated the preferred treatment for dentin caries lesions in primary teeth have focused on comparing only two types of treatments or the same treatment with different restorative materials, considering only the type of surface involved (occlusal or occlusoproximal) [7–9] or even other outcomes such as the prevention of secondary caries lesion [10,11]. The gap in the evidence that considers lesions of different depths and the number of surfaces involved that affect treatment effectiveness makes recommending the best treatment for dentin caries lesions with different levels of progression challenging. Thus, a systematic quantitative evaluation of the available evidence on the treatment for caries lesions in primary teeth that considers how different caries progressions lead to the need for distinct interventions might provide more useful information for clinical evidence-based decision making. Therefore, this systematic review and network meta-analysis compared the performance of the available treatments for dentin caries lesions, regardless of nearness to pulp or pulp involvement in primary teeth, on caries lesion arrestment (CLA) or the success rate (SR) and considered the different progression depths and surfaces involved. Material and methods This systematic review and network meta-analysis was reported according to the PRISMA-NMA extension [12] (S1 Table) and was registered at the International Prospective PLOS ONE | https://doi.org/10.1371/journal.pone.0206296 November 21, 2018 (...truncated)