Restorative Treatments for Caries Lesions

Publication Date: June 27, 2023
Last Updated: June 28, 2023

Carious Tissue Removal Approaches in Primary Teeth

To treat moderate caries lesions on vital primary teeth requiring a restoration, the guideline panel suggests the use of selective carious tissue removal, nonselective carious tissue removal, or no carious tissue removal (that is, sealing lesions with a preformed crown). (C, VL)
620
To treat advanced caries lesions on vital primary teeth requiring a restoration, the guideline panel suggests prioritizing the use of selective carious tissue removal or no carious tissue removal (that is, sealing with a preformed crown) over nonselective carious tissue removal or stepwise carious tissue removal. (C, VL)
620

Carious Tissue Removal Approaches in Permanent Teeth

To treat moderate caries lesions on vital permanent teeth requiring a restoration, the guideline panel suggests prioritizing the use of selective carious tissue removal over nonselective carious tissue removal. (C, VL)
620
To treat advanced caries lesions on vital permanent teeth requiring a restoration, the guideline panel suggests prioritizing the use of selective carious tissue removal over stepwise carious tissue removal or nonselective carious tissue removal. (C, VL)
620

Direct Restorative Materials for Primary Teeth

For moderate and advanced caries lesions on vital anterior primary teeth requiring a Class III (approximal) restoration, the guideline panel suggests the use of either nanocomposite or hybrid resin composite (RC). (C, VL)
620
For moderate and advanced caries lesions on vital anterior primary teeth requiring a Class V (cervical third of facial or lingual) restoration, the guideline panel suggests the use of either conventional GIC, hybrid RC, or resin-modified GIC. (C, VL)
620
For moderate and advanced caries lesions on vital posterior primary teeth requiring a Class I (pit and fissure) restoration, the guideline panel suggests prioritizing the use of resin-modified GIC, RCs, conventional GIC, or preformed crowns over compomer or dental amalgam. (C, VL)
620
For moderate and advanced caries lesions on vital posterior primary teeth requiring a Class II (approximal) restoration, the guideline panel suggests prioritizing the use of resin-modified GIC, RCs, or preformed crowns over compomer, conventional GIC, or dental amalgam. (C, VL)
620
For moderate and advanced caries lesions on vital posterior primary teeth requiring a Class V (cervical third of facial or lingual) restoration, the guideline panel suggests the use of either conventional GIC, hybrid RC, or resin-modified GIC. (C, VL)
620
Good practice statement: The US Food and Drug Administration recommends not using dental amalgam in “children, especially those younger than six years of age; people with pre-existing neurological disease; people with impaired kidney function; [and] people with known heightened sensitivity (allergy) to mercury or other components. (U, U)
620

Direct Restorative Materials for Permanent Teeth

For moderate and advanced caries lesions on vital anterior permanent teeth requiring a Class I (lingual pit and fissure) restoration, the guideline panel suggests the use of either conventional GIC, hybrid RC, or resin-modified GIC. (C, VL)
620
For moderate and advanced caries lesions on vital anterior permanent teeth requiring a Class III (approximal) restoration, the guideline panel suggests the use of either nanocomposite or hybrid RC. (C, VL)
620
For moderate and advanced caries lesions on vital anterior permanent teeth requiring a Class V (cervical third of facial or lingual) restoration, the guideline panel suggests the use of either conventional GIC, hybrid RC, or resin-modified GIC. (C, VL)
620
For moderate and advanced caries lesions on vital posterior permanent teeth requiring a Class I (pit and fissure) restoration, the guideline panel suggests prioritizing the use of conventional GIC, dental amalgam, RC, or resin-modified GIC over compomer. (C, VL)
620
For moderate and advanced caries lesions on vital posterior permanent teeth requiring a Class II (approximal) restoration, the guideline panel suggests prioritizing the use of dental amalgam, RC, or resin-modified GIC over conventional GIC. (C, VL)
620
For moderate and advanced caries lesions on vital posterior permanent teeth requiring a Class V (cervical third of facial or lingual) restoration, the guideline panel suggests the use of either conventional GIC, hybrid RC, or resin-modified GIC. (C, VL)
620
Good practice statement: The Food and Drug Administration recommends not using dental amalgam in “children, especially those younger than six years of age; people with pre-existing neurological disease; people with impaired kidney function; [and] people with known heightened sensitivity (allergy) to mercury or other components. (U, U)
620

Figures/Tables

Figure 1. Clinical pathway of carious tissue removal approaches for the treatment of vital, nonendodontically treated, primary teeth

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Figure 2. Clinical pathway of carious tissue removal approaches for the treatment of vital, nonendodontically treated, permanent teeth

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Figure 3. Clinical pathway of direct materials to restore vital, nonendodontically treated, primary teeth

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Figure 4. Clinical pathway of direct materials to restore vital, nonendodontically treated, permanent teeth

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Table 1. Definitions of carious tissue removal approaches and clinical presentation of caries lesion.

Link to External Table Unavailable

Table 4. US national average cost to the patient for direct restorative materials

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Recommendation Grading

Abbreviations

  • ADA: American Dental Association
  • ART: Atraumatic Restorative Treatment
  • CTR: Carious Tissue Removal
  • GIC: Glass Ionomer Cement
  • HT: Hall Technique
  • PMC: Preformed Metal Crown
  • RC: Resin Composite
  • RMGIC: Resin-modified Glass Ionomer Cement

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Restorative Treatments for Caries Lesions

Authoring Organizations

Publication Month/Year

June 27, 2023

Last Updated Month/Year

September 5, 2023

Document Type

Guideline

Country of Publication

US

Document Objectives

To restore moderate and advanced caries lesions on vital, nonendodontically treated primary and permanent teeth, the panel suggests the use of more conservative, single-visit CTR approaches and various direct restorative materials. The panel acknowledges the importance of considering additional factors, such as patient and caregiver preferences and treatment costs, when developing a treatment plan.

Inclusion Criteria

Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory

Intended Users

Dentist, nurse, nurse practitioner, physician, physician assistant

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D003731 - Dental Caries

Keywords

caries, dental caries, dentistry, cavities, direct restorative materials

Supplemental Methodology Resources

Systematic Review Document