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Secondary caries: what is it, and how it can be controlled, detected, and managed?

par Askar, Haitham;Krois, Joachim;Göstemeyer, Gerd;Bottenberg, Peter ;Zero, Domenick;Banerjee, Avijit;Schwendicke, Falk
Référence Clinical oral investigations, 24, 5, page (1869-1876)
Publication Publié, 2020-05-01

Article révisé par les pairs

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Résumé :

AbstractObjectives: To define secondary caries, assess how to control, detect and treat it. This review serves to inform a joint ORCA/EFCD consensus process.Methods: Systematic and non-systematic reviews were performed or consulted. Where applicable, Bayesian network meta-analysis was used to synthesize data. Risk of bias of included studies was assessed via the Cochrane Risk of Bias tool, or risk of bias had been assessed by included reviews themselves.Results: Secondary caries is characterized by the presence of a wall (interfacial) lesion, distinguishing it from caries adjacent to restorations, which are not necessarily associated with a restoration. For comparing different contemporary adhesive strategies and restorative materials, a systematic review of randomized trials (published 2005-2017) was performed. 51 studies (performed in controlled settings, largely small cohorts and over short or medium follow-up periods) were included, often yielding no secondary caries lesions at all regardless of the group. Network meta-analysis found great uncertainty. With some chance, 3-step etch-and-rinse and 1-step self-etch instead of 2-step etch-and-rinse- or self-etch adhesives lower the risk of secondary caries development. For restorative strategies, resin-modified glass ionomer yielded high chances of preventing secondary caries development, while the differences between various resin composites or conventional glass-ionomer cements were limited. Current detection methods for secondary caries are only sparsely validated and likely to be prone to over-detection. Using specific methods or combining them was suggested. Detected secondary caries can be approached using the “5R” protocols, which may increase the longevity of the restoration, but are limited by indication. Conclusions: There is sparse data towards the nature of secondary caries and how to control, detect and treat it.Clinical significance: Despite often claimed to be a major complication of restorations, there is surprisingly little data on secondary caries from clinical studies. Longer-term studies may be needed to identify differences in secondary caries risk between materials and to identify characteristic features of progressive lesions (in need of treatment).