Does selective caries removal in combination with antimicrobial photodynamic therapy affect the clinical performance of adhesive restorations of primary or permanent teeth? A systematic review with meta-analysis

Antimicrobial photodynamic therapy (aPDT) is an adjunct to a selective caries removal (SCR) technique for deep caries lesion treatment. The knowledge about chemical and structural changes affecting the remaining dentin surface after the use of this therapy is still unknown. Objective: to answer the following question: Does the SCR technique in combination with aPDT affect the clinical performance of adhesive restorations in deep carious lesions of primary or permanent teeth? Study design: a systematic review was conducted. Five databases, supplemented by trial registers, google scholar, manual search, personal communications, and grey literature were investigated. Randomized clinical trials were included. Two independent reviewers selected the studies, extracted qualitatively the data, and evaluated the risk of bias (using Cochrane Collabo-ration’s tooland Robot Reviewer program). The certainty of the evidence was accessed based on The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A meta-analysis of comparable data was performed with RevMan software 5.3. Results: A total of 39 articles and 3 studies were found. The final selection included 3 articles with a total of 82 participants. No studies were found on permanent teeth. The studies presented low risk of bias. Considering the treatment in the experimental (SCR + aPDT) or control groups (SCR), no difference on clinical performance of adhesive restorations in deep caries of primary teeth was observed after 6 months (p = 0.78; CI −0.01 (−0.09, 0.07)) or 12 months (p =0.75; CI −0.02 (−0.12, 0.08)). All outcomes presented moderate certainty of evidence mainly due to the small sample size that downgrade the GRADE scores. Conclusions: based on moderate certainty of the evidence, the clinical use of aPDT as an adjuvant of SCR has potential indication for treatment in deep caries of primary teeth. However, studies with more follow up and on permanent teeth are missing with the necessity for further research.

Dental caries; Dental cavity preparation; Photochemoterapy; Adhesive restoration

1. Leal SC. Minimal intervention dentistry in the management of the paediatric patient. British Dental Journal. 2014; 216: 623–627.

2. Schwendicke F, Dörfer CE, Paris S. Incomplete caries removal: a systematic review and meta-analysis. Journal of Dental Research. 2013; 92: 306–314.

3. Franzon R, Opdam NJ, Guimarães LF, Demarco FF, Casagrande L, Haas AN, et al. Randomized controlled clinical trial of the 24-months survival of composite resin restorations after one-step in-complete and complete excavation on primary teeth. Journal of Dentistry. 2015; 43: 1235–1241.

4. Bjorndal L, Kidd EA. The treatment of deep dentine caries lesions. Dental Update. 2005; 32: 402–413.

5. Franzon R, Guimarães LF, Magalhães CE, Haas AN, Araujo FB. Outcomes of one-step incomplete and complete excavation in primary teeth: a 24-month randomized controlled trial. Caries Research. 2014; 48: 376–383.

6. Ornellas PO, Antunes LS, Fontes KBFDC, Póvoa HCC, Küchler EC, Iorio NLP, et al. Effect of the antimicrobial photodynamic therapy on microorganism reduction in deep caries lesions: a systematic review and meta-analysis. Journal of Biomedical Optics. 2016; 21: 090901.

7. Ornellas PO, Iorio NLP, Fontes K, Antunes LS, Antunes LAA. Use of antimicrobial photodynamic therapy for treatment of deep caries in the primary dentition: a step-by-step technique report. General Dentistry. 2017; 65: e1–e4.

8. Steiner-Oliveira C, Longo PL, Aranha AC, Ramalho KM, Mayer MP, de Paula Eduardo C. Randomized in vivo evaluation of photodynamic antimicrobial chemotherapy on deciduous carious dentin. Journal of Biomedical Optics. 2015; 20: 108003.

9. Ornellas PO, Antunes LS, Motta PC, Mendonça C, Póvoa H, Fontes K, et al. Antimicrobial photodynamic therapy as an adjunct for clinical partial removal of deciduous carious tissue: a minimally invasive approach. Photochemistry and Photobiology. 2018; 94: 1240–1248.

10. Alves LVGL, Curylofo-Zotti FA, Borsatto MC, Salvador SLDS, Valério RA, Souza-Gabriel AE, et al. Influence of antimicrobial photodynamic therapy in carious lesion. Randomized split-mouth clinical trial in primary molars. Photodiagnosis and Photodynamic Therapy. 2019; 26: 124–130.

11. Bjørndal L, Reit C, Bruun G, Markvart M, Kjaeldgaard M, Näsman P, et al. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation and direct pulp capping vs. partial pulpotomy. European Journal of Oral Sciences. 2010; 118: 290–297.

12. Ferreira JM, Pinheiro SL, Sampaio FC, de Menezes VA. Caries removal in primary teeth—a systematic review. Quintessence International. 2012; 43: e9–15.

13. Lai G, Lara Capi C, Cocco F, Cagetti MG, Lingström P, Almhöjd U, et al. Comparison of carisolv system vs. traditional rotating instruments for caries removal in the primary dentition: a systematic review and meta-analysis. Acta Odontologica Scandinavica. 2015; 73: 569–580.

14. de Amorim RG, Frencken JE, Raggio DP, Chen X, Hu X, Leal SC. Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis. Clinical Oral Investigations. 2018; 22: 2703–2725.

15. Mulrow CD. Rationale for systematic reviews. British Medical Journal. 1994; 309: 597–599.

16. Al Deeb L, Bin-Shuwaish MS, Abrar E, Naseem M, Al-Hamdan RS, Maawadh AM, et al. Efficacy of chlorhexidine, Er Cr YSGG laser and photodynamic therapy on the adhesive bond integrity of caries affected dentin. An in-vitro study. Photodiagnosis and Photodynamic Therapy. 2020; 31: 101875.

17. Alrahlah A, Niaz MO, Abrar E, Vohra F, Rashid H. Treatment of caries affected dentin with different photosensitizers and its adhesive bond integrity to resin composite. Photodiagnosis and Photodynamic Therapy. 2020; 31: 101865.

18. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews. 2015; 4: 1.

19. Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The cochrane collaboration’s tool for assessing risk of bias in randomised trials. British Medical Journal. 2011; 343: d5928–d5928.

20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. British Medical Journal. 2021; 372: n71.

21. Yi J, Lu W, Xiao J, Li X, Li Y, Zhao Z. Effect of conventional combined orthodontic-surgical treatment on oral health-related quality of life: a systematic review and meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics. 2019; 156: 29–43.e5.

22. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology. 2011; 64: 383–394.

23. Faria LV, Antunes LS, Pio LRR, Dias JC, Pinheiro LHM, Reis CLB, et al. Evaluation of composite restorations in primary molars subjected to selective caries removal associated with antimicrobial photodynamic therapy: a randomized controlled trial. International Journal of Paediatric Dentistry. 2022; 32: 585–597.

24. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Research Synthesis Methods. 2010; 1: 97–111.

25. Song F, Eastwood AJ, Gilbody S, Duley L, Sutton AJ. Publication and related biases. Health Technology Assessment. 2000; 4: 1–115.