Comparative Analysis of Minimally Invasive vs Conventional Caries Treatments Outcomes

Thesis Abstract

This study addresses the growing need to determine whether minimally invasive caries treatments yield outcomes comparable to or superior to conventional operative approaches in contemporary dental practice, with particular attention to progression-free survival, restoration longevity, patient-reported outcomes, and cost-effectiveness. The aim is to compare clinical, radiographic, and patient-centered outcomes of minimally invasive techniques (e.g., silver diamine fluoride, atraumatic restorative treatment, resin-based micro-invasive approaches) versus conventional drilling and filling strategies. Specific objectives include (i) to evaluate caries arrest rates and lesion progression over 24 months; (ii) to compare restorative survival and marginal integrity at 12 and 24 months; (iii) to assess patient-centered outcomes such as pain, anxiety, and satisfaction during and after treatment; (iv) to analyze cost-effectiveness from the healthcare payer and patient perspectives; and (v) to identify practitioner- and lesion-level modifiers (age, caries risk, lesion depth, and socio-economic status) associated with differential outcomes. A multicenter prospective cohort design will be employed, drawing a sample of 1,200 participants aged 6–65 years presenting with non-cavitated or cavitated lesions suitable for either minimally invasive or conventional treatments at five urban dental clinics. Allocation to treatment modality will follow real-world clinical decision pathways to preserve external validity, while propensity score matching will be used to balance covariates across groups, producing analytically comparable cohorts of approximately 600 participants each. Data collection will utilize standardized instruments clinical caries assessment using the International Caries Detection and Assessment System (ICDAS), radiographic analysis for lesion depth, standardized restoration longevity checks, and validated patient-reported outcome measures (PROMs) including the Child Fear Survey Schedule-Dental Subscale (CFSS-DS) or the Modified Dental Anxiety Scale (MDAS) for adults, and the Oral Health Impact Profile (OHIP-14) for quality-of-life. Economic data will be captured via time-driven activity-based costing (TDABC) to estimate direct and indirect costs. Data analyses will comprise descriptive statistics to summarize baseline characteristics, Kaplan–Meier survival analysis for restoration longevity, and Cox proportional hazards models to identify time-to-event differences between groups. Regression analyses will examine continuous outcomes such as lesion progression rates and PROM scores, while generalized estimating equations (GEE) will account for clustering by clinic and patient-level repeated measures. Subgroup analyses will explore interactions between treatment modality and caries risk status, lesion depth, and socio-economic factors. A theoretical framework integrating the Health Belief Model and the Theory of Planned Behavior will be employed to interpret patient acceptance and adherence to preventive and restorative strategies, complemented by a cost-effectiveness analysis comparing incremental cost-effectiveness ratios (ICERs) and quality-adjusted life years (QALYs) where applicable. Expected findings anticipate that minimally invasive treatments will demonstrate comparable arrest and progression control to conventional methods for early-stage lesions, with superior patient comfort and lower immediate pain perception, while long-term restoration survival may depend on lesion characteristics and adherence to preventive regimens. It is hypothesized that minimally invasive approaches will be more cost-effective in populations with limited access to dental care, due to reduced chair time and fewer anesthesia requirements, though upfront material costs may be higher in certain contexts. The study aims to contribute to knowledge by delineating context-specific effectiveness of treatment modalities and by identifying modifiers that influence outcomes, thereby informing evidence-based clinical guidelines and resource allocation. The study’s significance lies in providing robust comparative evidence to support decision-making in diverse clinical settings, potentially reducing overtreatment while enhancing patient experience and overall oral health economics. Anticipated recommendations include integrating minimally invasive protocols as first-line options for suitable lesions, refining patient education and risk-based maintenance schedules, and adopting standardized outcome measures that facilitate cross-study comparability. Limitations include potential residual confounding due to non-randomized design and varying practitioner expertise across sites, which will be mitigated through rigorous propensity scoring, sensitivity analyses, and thorough documentation of operator experience.