Outcomes of the conventional and biological treatment approaches for the management of caries in the primary dentition

Background: In the last few years, conventional restorations including complete removal of carious tissue (CT) with or without pulp therapy for the treatment of carious lesions (CL) in primary teeth have been challenged and a more biological approach has been suggested. This approach involves the use of less invasive techniques which alter the environment of the CL isolating it from the cariogenic biofilm and substrate. Two of these treatment approaches that are becoming increasingly widely accepted and used in paediatric dentistry are the Hall Technique and indirect pulp capping (IPC). Aim: To investigate the outcome of the conventional versus the biological approaches for the treatment of deep CL in the primary teeth in children, delivered in a specialist paediatric dentistry training environment. Design: This was a retrospective cohort study of 246 children aged 4–9 years, treated with either approach, conventional and biological, in two UK specialist hospital settings. Data were extracted from clinical dental records and post-operative radiographs of patients treated during the period 2006–2012. The outcome of the treatment in this study was categorised into three main categories: clinical, radiographic, and final outcome. Clinical and final outcomes were further described as success, minor, and major failure. Results: In total, 836 primary teeth were included. In the conventional approach, 324 teeth had complete CT removal and 104 teeth had a pulpotomy. In the biological approach, 388 teeth had Hall Technique preformed metal crowns (PMC) placed and 20 teeth received indirect pulp capping. PMC were the restoration of choice for most of the cases where a pulpotomy had been carried out, and resin composite was most frequently used restorative material for the complete CT removal group. The majority of the primary teeth treated with either approach remained asymptomatic after a follow-up period of up to 77 months, 95.3% in the conventional and 95.8% in the biological. No significant association was found between the final outcome and the approach used for treatment, age of the patient, gender and number of carious surfaces or tooth type. Conclusion: Both the conventional and biological treatment approaches had similar final outcomes and were equally successful for management of CL in the primary dentition.