06 February 2024

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Which restorative adhesive strategies to adopt in root caries

Lara Figini

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In the age group of 70 years and above there is a peak in dental caries mainly at the root level.

These root carious lesions present dentists with several challenges in terms of intervention due to difficulties in controlling contamination, in access (especially in proximal lesions) and in the adhesive substrate, which in many cases consists exclusively of dentin.

In recent decades, the development of adhesive systems has progressed, also providing for a reduction in work phases. Therefore, several adhesive strategies have potentially been established to offer simplifications and alternatives in root caries restoration.

Materials and methods

In a systematic review, published in the Journal of Dentistry, the authors attempted to establish a hierarchy of different adhesive and/or restorative approaches to restore cavitated root caries through the synthesis of the available evidence.

A systematic search was conducted via Medline/Web of Science/Embase/Cochrane Library/Scopus/grey literature for randomized controlled trials (RCTs) evaluating ≥2 restorative strategies (restorative/adhesive materials) for root carious lesions in adult patients. The risk of bias in the studies was also assessed (Cochrane_RoB-2) and the primary outcome was the survival rate of the restorations at different time follow-ups (6/12/24 months).

Meta-analyses were conducted using the stratified random effects model for the various follow-ups. All available combinations of adhesives (1-SE: one-step self-etch; 2-3ER: two/three-step etch and rinse) and restorative materials (conventional-CC composites and conventional and modified glass ionomer cements) were included. resin-GIC, RMGIC).

Results

547 studies were identified and nine were eligible for review. In total, 1263 root caries lesions were restored in 473 patients of the included clinical studies. The patients involved were healthy (n = 6 studies), residing in nursing homes (n = 1 study) or undergoing head and neck radiotherapy (n = 2 studies). There was statistically weak evidence in favor of one or the other material/material combination regarding survival rate. A trend towards a higher survival rate (24 months) was observed for 2-3ER/CC (24month OR 2.65; 95%CI = [1.45/4.84]) as well as for RMGIC (24month OR 2.05; 95%CI = [1.17/3.61]) compared to GIC. However, these results were not found to be statistically significant.

Conclusions

From the data of this review, which must be confirmed in other similar studies and reviews, it can be concluded that an evidence-based choice of restorative strategy for the management of radicular cavitated carious lesions is currently impossible.