Minimally Invasive Management of Early Childhood Caries: Strategies in Conservative Dentistry for Long-Term Oral Health

Early Childhood Caries (ECC) remains a global public health crisis, severely impacting the quality of life and general health of millions of children. Traditional surgical management often involves extensive tooth preparation, general anesthesia, and high treatment costs, leading to a significant restorative cycle burden. This research investigates the efficacy and clinical outcomes of a structured, Minimally Invasive Dentistry (MID) protocol designed for the comprehensive management of ECC in the primary dentition, focusing on sustained lesion arrest and long-term tooth survival.

The study employed a prospective, randomized clinical trial (RCT) design involving 180 children (ages 3–6) diagnosed with D2–D3 (ICDAS 3–5) lesions. Participants were randomized into two groups: the MID Group (G1), receiving a combination of Silver Diamine Fluoride (SDF) arrestment for non-cavitated lesions and Selective Caries Removal (SCR) followed by restoration with a high-viscosity Glass Ionomer Cement (GIC) for cavitated lesions; and the Conventional Group (G2), receiving complete caries removal and composite resin restorations under local anesthesia.

The 24-month follow-up revealed that the MID protocol (G1) demonstrated a significantly higher lesion arrest rate (92% vs. 78%; p < 0.01) and a lower incidence of pulpal complications (3% vs. 15%; p < 0.005) compared to the conventional approach. Crucially, the mean restorative time was reduced by 45% in G1, and the need for sedation or general anesthesia was eliminated. The study’s most significant outcome is the finding that SCR followed by GIC restoration, combined with biannual SDF application to adjacent at-risk surfaces, resulted in a 95% survival rate for the restored primary molars, statistically non-inferior to the conventional group’s 98% survival rate.

This research concludes that a systematic, evidence-based MID approach, heavily reliant on the synergistic application of SDF and selective-carious-tissue removal with bioactive materials, provides a highly effective, time-efficient, and child-friendly alternative to traditional surgical management. This strategy significantly mitigates the restorative burden, preserves maximum tooth structure, and promotes long-term oral health.