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01-10-2019 | Caries | Discussion paper

When to intervene in the caries process? An expert Delphi consensus statement

Authors: Falk Schwendicke, Christian Splieth, Lorenzo Breschi, Avijit Banerjee, Margherita Fontana, Sebastian Paris, Michael F. Burrow, Felicity Crombie, Lyndie Foster Page, Patricia Gatón-Hernández, Rodrigo Giacaman, Neeraj Gugnani, Reinhard Hickel, Rainer A. Jordan, Soraya Leal, Edward Lo, Hervé Tassery, William Murray Thomson, David J. Manton

Published in: Clinical Oral Investigations | Issue 10/2019

Abstract

Objectives

To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions.

Methods

Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference.

Results

Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.

Conclusions

Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions.

Clinical relevance

Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.

Available only for authorised users

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Title: When to intervene in the caries process? An expert Delphi consensus statement
Authors: Falk Schwendicke
Christian Splieth
Lorenzo Breschi
Avijit Banerjee
Margherita Fontana
Sebastian Paris
Michael F. Burrow
Felicity Crombie
Lyndie Foster Page
Patricia Gatón-Hernández
Rodrigo Giacaman
Neeraj Gugnani
Reinhard Hickel
Rainer A. Jordan
Soraya Leal
Edward Lo
Hervé Tassery
William Murray Thomson
David J. Manton
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Keyword: Caries
Published in: Clinical Oral Investigations / Issue 10/2019
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-019-03058-w

At a glance: The STEP trials

Springer Medicine

When to intervene in the caries process? An expert Delphi consensus statement

Abstract

Objectives

Methods

Results

Conclusions

Clinical relevance

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Clinical relevance

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