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Paper: Gibbison R and Crozier R. Are RMGIC restorations as effective with or without selective caries removal in primary molars?. Evid Based Dent 2021; 22: 132-133.

Gibbison and Crozier's commentary reviewing a two-year randomised control trial investigated whether Resin Modified Glass Ionomer Cement (RMGIC) restorations are as effective with or without selective caries removal in primary molars. The research concluded that sealing Grade 5 (International Caries Detection and Assessment System) occlusal caries with RMGIC, without any caries removal, can be as effective as selective caries removal in reducing caries progression, thus allowing retention of primary teeth for up to a two-year period. In practice, when faced with presentation of a symptom-free, cavitated, non-mobile deciduous molar with no more than one third root resorption, there are multiple case-specific factors to consider including patient compliance, cavity depth and time to exfoliation. If the latter is less than two years, this paper provides evidence to suggest sealing with RMGIC without caries removal, especially in children with heightened anxiety towards dental treatment.

When time to exfoliation exceeds two years, higher restoration survival rates are seen with selective caries removal compared to sealing with RMGIC, despite no evident caries progression in either. Therefore, if patient compliance allows, there is evidence to suggest the superiority of selective caries removal to increase restoration longevity. During treatment planning, it is imperative to consider all restorative options when presented with a cavitated primary molar. These could include both methods discussed in the research, or restoring with a different material, or preformed metal crown via the hall technique. All of which should be preceded by preventative advice and acclimatisation in the form of oral hygiene instruction, diet analysis and fluoride use, plus include regular clinical and radiographic follow-up for caries progression, in accordance with the patient's risk status.