Factors influencing restorative treatment decisions for proximal caries of primary and immature permanent teeth: a survey

Background: The aim of this study was to determine restoration thresholds and restorative treatment decisions of dentists in Türkiye for proximal caries of primary and immature permanent teeth, to investigate factors associated with these decisions. Methods: The study was based on the evaluation of a prepared electronic survey. Participants completed a questionnaire comprising three sections: demographic information, daily clinical practices, hypothetical clinical case scenarios. The case scenarios section utilized diagram based on the Espelid classification (Degrees 1–6, ranging from outer enamel to inner dentine) to assess treatment thresholds and preferences. The first scenario involved a distal carious lesion on the upper second premolar of 14-year-old patient, while the second depicted a mesial carious lesion on the lower second primary molar of 5-year-old patient. The preference for Degrees 1–3 lesions were evaluated as early intervention. Statistical analysis was performed to examine the relationship between treatment thresholds, participant characteristics and clinical practices. Results: Total of 345 respondents participated, including general dentists (47.8%), pediatric dentists (26.7%), restorative specialists (8.1%), fifth-year college students (17.4%). In the first scenario, Degree 3 was the most frequently selected threshold (38.9%), with 59.1% favoring early intervention and 20.2% choosing Degrees 1 and 2. The box-only preparation method was preferred by 65% of respondents. In the second scenario, Degree 3 remained the most selected threshold, with 55.6%supporting early intervention and 17.1% opting for enamel-level thresholds. Total of 62.3% preferred the box-only preparation method. Pediatric dentists exhibited higher rates of early intervention compared to others. Composite materials were predominantly chosen for permanent teeth, while compomer materials were preferred for primary teeth. Gender, years of experience, and institution type significantly influenced the choice of restorative treatment and preparation method. Conclusions: Based on the questionnaire study, it was concluded that dentists in Türkiye have high tendency to intervene early.

Dental caries; Dental materials; Deciduous tooth; Molar; Dental restoration

[1] Desai H, Stewart CA, Finer Y. Minimally invasive therapies for the management of dental caries—a literature review. Dentistry Journal. 2021; 9: 147.

[2] Ismail AI, Pitts NB, Tellez M; Authors of the International Caries C, Management S. The international caries classification and management system (ICCMS™) an example of a caries management pathway. BMC Oral Health. 2015; 15: S9.

[3] Dental Quality Alliance, American Dental Association. Guidance on caries risk assessment in children: a report of the expert panel for use by the dental quality alliance. 2018. Available at: https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/dqa/educational-resources/cra_report.pdf (Accessed: 18 May 2022).

[4] Kühnisch J, Ekstrand K, Pretty I, Twetman S, Van Loveren C, Gizani S, et al. Best clinical practice guidance for management of early caries lesions in children and young adults: an EAPD policy document. European Archives of Paediatric Dentistry. 2016; 17: 3–12.

[5] Laske M, Opdam NJM, Bronkhorst EM, Braspenning JCC, van der Sanden WJM, Huysmans MCDNJM, et al. Minimally invasive intervention for primary caries lesions: are dentists implementing this concept? Caries Research. 2019; 53: 204–216.

[6] Schwendicke F, Splieth C, Breschi L, Banerjee A, Fontana M, Paris S, et al. When to intervene in the caries process? An expert Delphi consensus statement. Clinical Oral Investigations. 2019; 23: 3691–3703.

[7] Ismail AI, Tellez M, Pitts NB, Ekstrand KR, Ricketts D, Longbottom C, et al. Caries management pathways preserve dental tissues and promote oral health. Community Dentistry and Oral Epidemiology. 2013; 41: e12–e40.

[8] Mjor IA, Holst D, Eriksen HM. Caries and restoration prevention. Journal of the American Dental Association. 2008; 139: 565–570; quiz 626.

[9] Splieth CH, Banerjee A, Bottenberg P, Breschi L, Campus G, Ekstrand KR, et al. How to intervene in the caries process in children: a joint ORCA and EFCD expert Delphi consensus statement. Caries Research. 2020; 54: 297–305.

[10] American Academy of Pediatric Dentistry. Guideline on caries-risk assessment and management for infants, children, and adolescents. Pediatric Dentistry. 2013; 35: E157–E164.

[11] Banerjee A, Frencken JE, Schwendicke F, Innes NPT. Contemporary operative caries management: consensus recommendations on minimally invasive caries removal. British Dental Journal. 2017; 223: 215–222.

[12] Lussi A, Buzalaf MAR. Caries excavation: evolution of treating cavitated carious lesions. In Schwendicke F, Frencken J, Innes N (eds.) Monographs in oral science (pp. 56–161). Karger Medical and Scientific Publishers: Basel. 2018.

[13] Schwendicke F, Frencken JE, Bjorndal L, Maltz M, Manton DJ, Ricketts D, et al. Managing carious lesions: consensus recommendations on carious tissue removal. Advances in Dental Research. 2016; 28: 58–67.

[14] Espelid I, Tveit AB, Haugejorden O, Riordan PJ. Variation in radiographic interpretation and restorative treatment decisions on approximal caries among dentists in Norway. Community Dentistry and Oral Epidemiology. 1985; 13: 26–29.

[15] Espelid I, Tveit AB, Mejàre I, Sundberg H, Hallonsten AL. Restorative treatment decisions on occlusal caries in Scandinavia. Acta Odontologica Scandinavica. 2001; 59: 21–27.

[16] Khalaf ME, Alomari QD, Ngo H, Doméjean S. Restorative treatment thresholds: factors influencing the treatment thresholds and modalities of general dentists in Kuwait. Medical Principles and Practice. 2014; 23: 357–362.

[17] Rechmann P, Doméjean S, Rechmann BM, Kinsel R, Featherstone JD. Approximal and occlusal carious lesions: restorative treatment decisions by California dentists. Journal of the American Dental Association. 2016; 147: 328–338.

[18] Ruiz B, Urzúa I, Cabello R, Rodríguez G, Espelid I. Validation of the Spanish version of the “questionnaire on the treatment of approximal and occlusal caries”. Clinical Oral Investigations. 2013; 17: 29–35.

[19] Innes NPT, Schwendicke F. Restorative thresholds for carious lesions: systematic review and meta-analysis. Journal of Dental Research. 2017; 96: 501–508.

[20] Keys T, Burrow M, Rajan S, Rompre P, Doméjean S, Muller-Bolla M, et al. Carious lesion management in children and adolescents by Australian dentists. Australian Dental Journal. 2019; 64: 282–292.

[21] Moreau A, Dumais S, Nguyen C, Rompré P, Vu D. Clinical management of interproximal and occlusal caries in children and adolescents by Canadian dentists: a survey. Journal of the Canadian Dental Association. 2022; 88: m3.

[22] Muller-Bolla M, Aïem E, Coulot C, Velly AM, Doméjean S. Restorative thresholds for primary and permanent molars in children: French dentist decisions. International Journal of Paediatric Dentistry. 2021; 31: 299–310.

[23] Pitts NB, Ismail AI, Martignon S, Ekstrand K, Douglas GV, Longbottom C. ICCMS™ guide for practitioners and educators. 2014. Available at: https://www.iccms-web.com/uploads/asset/59284654c0a6f822230100.pdf (Accessed: 20 May 2022).

[24] Martignon S, Pitts NB, Goffin G, Mazevet M, Douglas GVA, Newton JT, et al. CariesCare practice guide: consensus on evidence into practice. British Dental Journal. 2019; 227: 353–362.

[25] Mejàre I, Källestål C, Stenlund H. Incidence and progression of approximal caries from 11 to 22 years of age in Sweden: a prospective radiographic study. Caries Research. 1999; 33: 93–100.

[26] Mejàre I, Stenlund H, Julihn A, Larsson I, Permert L. Influence of approximal caries in primary molars on caries rate for the mesial surface of the first permanent molar in Swedish children from 6 to 12 years of age. Caries Research. 2001; 35: 178–185.

[27] Bervian J, Tovo MF, Feldens CA, Brusco LC, Rosa FMd. Evaluation of final-year dental students concerning therapeutic decision making for proximal caries. Brazilian Oral Research. 2009; 23: 54–60.

[28] Drachev SN, Galieva AS, Yushmanova TN, Polivanaya EA, Stangvaltaite-Mouhat L, Al-Mahdi R, et al. Restorative treatment decisions for carious lesions: do Russian dentists and dental students apply minimal intervention dentistry? BMC Oral Health. 2021; 21: 638.

[29] Orhan AI, Alkan A, Orhan K, Tezel A, Karaoglanoglu S, Oztas D. Dental caries and associated factors among Turkish children and adults: findings from the 3rd National Oral Health Survey. Community Dentistry and Oral Epidemiology. 2024; 52: 499–508.

[30] Mejàre I, Stenlund H, Zelezny-Holmlund C. Caries incidence and lesion progression from adolescence to young adulthood: a prospective 15-year cohort study in Sweden. Caries Research. 2004; 38: 130–141.

[31] Nizami MZI, Yeung C, Yin IX, Wong AWY, Chu CH, Yu OY. Tunnel restoration: a minimally invasive dentistry practice. Clinical, Cosmetic and Investigational Dentistry. 2022; 14: 207–216.

[32] Doméjean-Orliaguet S, Tubert-Jeannin S, Riordan PJ, Espelid I, Tvoit AB, Tveit AB. French dentists’ restorative treatment decisions. Oral Health & Preventive Dentistry. 2004; 2: 125–131.

[33] Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. Minimal intervention dentistry for managing dental caries—a review: report of a FDI task group. International Dental Journal. 2012; 62: 223–243.

[34] Ghasemi H, Murtomaa H, Torabzadeh H, Vehkalahti M. Restorative treatment threshold reported by Iranian dentists. Community Dental Health. 2008; 25: 185–190.

[35] Rabi T, Arandi NZ. Restorative treatment decisions regarding approximal and occlusal carious lesions among general dental practitioners in Palestine. Brazilian Journal of Oral Sciences. 2021; 20: e212755.

[36] Kopperud SE, Tveit AB, Opdam NJ, Espelid I. Occlusal caries management: preferences among dentists in Norway. Caries Research. 2016; 50: 40–47.

[37] Ghoneim A, Yu B, Lawrence H, Glogauer M, Shankardass K, Quiñonez C. What influences the clinical decision-making of dentists? A cross-sectional study. PLOS ONE. 2020; 15: e0233652.

[38] Berkovitz BK, Holland GR, Moxham BJ. Oral anatomy, histology and embryology. 5th edn. Elsevier Health Sciences: Amsterdam, The Netherlands. 2017.

[39] Bjørndal L, Reit C, Bruun G, Markvart M, Kjældgaard 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.

[40] Chatterjee K. Essentials of dental anatomy & oral histology. 2nd edn. Jaypee Brothers Medical Publishers Ltd: New Delhi. 2014.

[41] El-Mowafy OM, Lewis DW. Restorative decision making by Ontario dentists. Journal of Canadian Dental Association. 1994; 60: 305–310, 313.

[42] Chisini LA, Collares K, Cademartori MG, de Oliveira LJC, Conde MCM, Demarco FF, et al. Restorations in primary teeth: a systematic review on survival and reasons for failures. International Journal of Paediatric Dentistry. 2018; 28: 123–139.

[43] Dhar V, Hsu K, Coll J, Ginsberg E, Ball B, Chhibber S, et al. Evidence-based update of pediatric dental restorative procedures: dental materials. Journal of Clinical Pediatric Dentistry. 2015; 39: 303–310.

[44] Kakudate N, Sumida F, Matsumoto Y, Manabe K, Yokoyama Y, Gilbert GH, et al. Restorative treatment thresholds for proximal caries in dental PBRN. Journal of Dental Research. 2012; 91: 1202–1208.

[45] Suliman A, Abdo A, Elmasmari H. Restorative treatment decisions on approximal caries among practicing dentists in the college of dentistry clinics, Ajman University, United Arab Emirates. The Open Dentistry Journal. 2020; 14: 97–102.