Evidence map›Paper›PMID 31444695›Full record

ArticleClinical oral investigations2019

When to intervene in the caries process? An expert Delphi consensus statement.

Falk Schwendicke, Christian Splieth, Lorenzo Breschi, Avijit Banerjee, Margherita Fontana, Sebastian Paris, Michael F Burrow, Felicity Crombie, Lyndie Foster Page, Patricia Gatón-Hernández and 9 more

Registry-linked trialAbstract readConsensus Statement
PubMed Publisher
In one paragraph

Article in Clinical oral investigations, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06608563 (The Effect of an Adhesive System on the Retention and Caries Prevention for Fissure Sealants in Permanent Molars), which is not on this map. Cited by 98 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
98citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06608563 narecruitingnot on this mapstarted 2024, after this paper: background citation

The Effect of an Adhesive System on the Retention and Caries Prevention for Fissure Sealants in Permanent Molars: a 2-year Randomised Clinical Trial

TypeinterventionalSponsorUniversity of Dublin, Trinity CollegeRan2024 to 2027Enrolled100ConditionsDental Caries, Fissure SealantArmsFissure sealant without adhesive system (NO BOND), Fissure sealant with adhesive system (BOND)
3 · Its place in the literature

Who cites it

98 citing papers in PubMed, 9 syntheses or guidelines pooled it.

  1. Guideline
  2. Guideline
  3. Pooled it
  4. Interdisciplinary Delphi study by PROSEC North America: Recommendations on single indirect restorations made from ceramic and nonmetallic biomaterials for posterior teeth.Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [et al.] · 2025
    Pooled it
  5. Minimal intervention dentistry for managing carious lesions into dentine in primary teeth: an umbrella review.European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry · 2022
    Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Trial
  11. Trial
  12. Trial
  13. Trial
  14. Article
  15. Review
  16. Article
  17. Article
  18. Article
  19. Article
  20. Observational

38 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Falk SchwendickeDepartment of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany. falk.schwendicke@charite.de.
Christian SpliethPreventive & Pediatric Dentistry, University of Greifswald, Greifswald, Germany.
Lorenzo BreschiDepartment of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna-Alma Mater Studiorum, Bologna, Italy.
Avijit BanerjeeConservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's Health Partners, King's College London, London, UK.
Margherita FontanaDepartment of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.
Sebastian ParisDepartment of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
Michael F BurrowFaculty of Dentistry, University of Hong Kong, Pokfulam, Hong Kong, SAR, China.
Felicity CrombieMelbourne Dental School, University of Melbourne, Melbourne, Australia.
Lyndie Foster PageDepartment of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
Patricia Gatón-HernándezDepartment of Dentistry, University of Barcelona, Barcelona, Spain.
Rodrigo GiacamanCariology Unit, Department of Oral Rehabilitation, University of Talca, Talca, Chile.
Neeraj GugnaniDepartment of Pediatric and Preventive Dentistry, DAV (C) Dental College, Yamunanagar, Haryana, India.
Reinhard HickelDepartment of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany.
Rainer A JordanInstitute of German Dentists, Cologne, Germany.
Soraya LealDepartment of Dentistry, Faculty of Health Sciences, University of Brasília, Brasilia, Brazil.
Edward LoFaculty of Dentistry, University of Hong Kong, Pokfulam, Hong Kong, SAR, China.
Hervé TasseryFaculty of Dentistry, AMU University, Marseille, France.
William Murray ThomsonDepartment of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
David J MantonMelbourne Dental School, University of Melbourne, Melbourne, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions.

methodsNon-systematic literature synthesis, expert Delphi consensus process and expert panel conference.

resultsCarious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.

conclusionsComprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions. CLINICAL RELEVANCE: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.

Indexed as

ConsensusDelphi TechniqueDental CariesDental EnamelDentinEsthetics, DentalHumansConsensusDecision-makingDental cariesOperative dentistryRestorationsThresholds

Identifiers

PMID31444695

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.