Selective Procedures in Restorative Dentistry: A Critical Review

Selective Procedures in Restorative Dentistry: A Critical Review

Introduction

In restorative dentistry, the doctrine of minimal intervention is increasingly being followed, with selective procedures becoming popular. These procedures aim to preserve as much of the natural tooth structure as possible, while addressing the patient’s concerns and restoring their oral function. However, not all clinical procedures in restorative dentistry are supported by good research that follows the guidelines of evidence-based dentistry (EBD). To address this knowledge gap, Nagarkar et al. conducted a critical review of current clinical methods for selected restorative procedures.

Evidence-Based Dentistry

EBD aims to create a dialogue between dental practitioners and dental research, to drive new research and promote the use of the best available evidence to inform clinical decision-making. According to the Centre for Evidence-Based Dentistry, evidence-based practice involves integrating the best available research evidence with clinical expertise and patient values. This approach can help clinicians make informed decisions about patient care, based on the most up-to-date and reliable evidence.

Materials and Methods

MEDLINE (National Library of Medicine) via the Ovid interface was used for all literature searches, published in English only. Medical subject headings were used and advanced limits were selected in the Clinical Queries section. Only randomized controlled clinical trials (RCTs), non-randomized controlled clinical trials (NRCTs), systematic reviews (SRs) of RCTs/NRCTs, and evidence-based practice guidelines were included. Furthermore, cost-effectiveness analyses were included due to their practical relevance to the decision-making process. Lastly, to provide comparative or background information, other study designs (in vitro, narrative reviews, case series, cohort studies, etc.) were mostly utilized.

Results

The review found mixed results regarding the included interventions. Some procedures had adequate evidence supporting them, while others were mostly based on beliefs. The procedures that had sufficient evidence-based support were:

1. Glass-ionomer restorations for deciduous teeth
2. Sealants for caries prevention
3. Resin-based composite restorations for primary teeth
4. Caries diagnosis using lasers
5. Preformed metal crowns for primary molars
6. Interproximal caries removal using hand instruments
7. Laser-assisted caries removal
8. Rubber dam isolation for caries removal