Root caries: little evidence on best restorations

As the population ages there is an increase in the number of exposed surfaces of tooth roots. This is likely to lead to an increase in the prevalence of root caries. Restoration of the carious root surface is challenging and a range of restorative materials have been used, amalgam, glass ionomer cement (GIC), resin-modified glass ionomer cement (RMGIC), modified polyacid resins (compomers) or composite resins.

The aim of this review was to compare the clinical performance of restorative materials for the treatment of root caries in adult patients.

Methods

The PubMed, Embase, Cochrane Register of Controlled Trials (CENTRAL) and the OpenSIGLE databases were searched. All randomised controlled trials (RCTs) and non- randomised controlled trials (CCTs) that compared two or more restorative materials in the restoration of carious lesions on root surfaces were considered. Two reviews independently selected studies and extracted data. Trials were assessed using the Cochrane Collaboration’s Risk of bias tool.

Results

5 studies involving a total of 269 patients were included.
All studies were assessed as at high risk of performance and detection bias.
Owing to the level of heterogeneity a narrative summary was presented.

Conclusions

The authors concluded

There is insufficient evidence to recommend any specific material for routine use in the restoration of root carious lesions. There is a need for further research in this area as there are insufficient good quality randomised clinical trials currently available to guide practitioners. In particular, there is a need to evaluate restorative materials in a more generalised population, as many of the studies included in this systematic review were confined to post-radiation, xerostomic patients, which may be atypical of the older adult dental patient.

Commentary

As the authors note there is little evidence available on which to recommend a specific material choice for the restoration of root canal lesions. There also note that many of the patients were from residential or nursing home or those with varying levels of xerostomia following radiotherapy as a results they one represent limited sub-groups of those patients requiring treatment of root caries. This is clearly an area that would benefit from high quality trials in order to provide clear evidence-based recommendations for future treatment options. However, in view of the treatment challenges that root caries is likely to present prevention is increasingly important and we recently reported on a review (Dental Elf 19^th Nov 2014) on a range of potential agents.