Restorative Treatment Decisions in Posterior Teeth: A Systematic Review

Purpose: To determine the stage of caries in posterior permanent teeth at which dentists decide to intervene invasively. Materials and Methods: A search of the literature from January 1980 to November 2015 available in MEDLINE-PubMed, EMBASE, and the Cochrane Library was conducted. The main search terms used were decision-making, restorative treatment, dental caries lesion, occlusal surface, and approximal surface. The inclusion criterion was studies including dentists only. Three reviewers independently screened titles and abstracts to determine the eligibility of studies. Subsequently, the full texts of the papers deemed eligible were perused and included in the data extraction process. Results: The review encompassed 11 studies and the methodological quality was considered moderate. Most dentists would restore lesions confined to enamel and reaching the outer half of the dentin, irrespective of the surface involved. With regard to the occlusal surface, the percentage of dentists who restored enamel lesions ranged from 4.6% to 17.8%. Regarding dentin lesions (outer half), 50.2%-70.2% of the dentists opted for invasive treatment. For the approximal surface, the choice for invasive treatment of enamel lesions ranged from 5%-88%. In dentin lesions, 4.4%-94% of dentists restored lesions in the outer half of the dentin. Conclusion: Despite the progress achieved in the understanding of the development and management of caries, dentists still recommend restorative treatment in its early stages. Keywords: dental caries, decision making, permanent dentition, restorative treatment