PMC Best Evidence Primary Molar — ORE Part 1 MCQ

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EasyPaediatric DentistryPMC Best Evidence Primary MolarORE Part 1

A 5-year-old child at high caries risk has an advanced occlusal carious lesion in the lower right first primary molar. A bitewing radiograph shows a clear band of sound dentine between the lesion and the pulp. Which restorative option has the best evidence for long-term longevity?

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Correct answer: A — Preformed metal crown

The correct answer is A. Preformed metal crowns (PMCs), including those placed conventionally or using the Hall Technique where appropriate, have the strongest comparative evidence for longevity in carious primary molars. A Cochrane review found a substantially lower long-term risk of major failure for crowns than for fillings. The radiographic sound-dentine band confirms that sealing caries with a Hall Technique PMC can be appropriate if that technique is selected. Composite, compomer and glass ionomer are acceptable direct restorative materials for selected occlusal lesions under SDCEP guidance, but they do not have the same evidence for long-term survival as PMCs. Amalgam is also a direct filling material and is not superior to a PMC for longevity. The question asks for best evidence of durability, rather than the routine first-line approach for every isolated occlusal lesion.

Reference: Innes NPT, Ricketts D, Chong LY, et al. Preformed crowns for decayed primary molar teeth. Cochrane Database of Systematic Reviews, 2015;12:CD005512. https://pubmed.ncbi.nlm.nih.gov/26718872/