Dental caries remains a significant public health problem and preventing the progression of early non-cavitated proximal lesion is important for caries management. Intensive oral hygiene measures using floss and/or interdental brushes, dietary advice and the use of topical fluorides and remineralising agents have been used to treat these early lesions. Recently the technique of resin infiltration has been demonstrating promising results in a number of studies.
The aim of this review was to assess the effectiveness of resin infiltration for the clinical management of proximal caries lesions in primary and permanent teeth.
Methods
Searches were conducted in the Medline, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, ClinicalTrials.gov (www.clinicaltrials.gov) and the National Research Register (www.controlled-trials.com) databases with no language restrictions. Randomised controlled trials (RCTs) or controlled clinical trials in primary or permanent teeth involving resin infiltration were considered.
Two reviewers independently selected studies extracted data and assessed risk of bias using the Cochrane tool. Disagreements being resolved by a third reviewer. Overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Odds Ratios (ORs) and 95% confidence intervals (CI) were calculated for lesion progression and random effect meta-analysis conducted.
Results
- 9 RCTs (all split-mouth design) reported in 10 papers were included.
- 4 RCTs were conducted in primary teeth
- Risk of bias was high in 3 RCTs and unclear in 7 RCTs.
- 5 RCTs contributed to the meta-analysis
- At 18-24mths resin infiltration combined with non-invasive oral hygiene measures resulted in significantly lower odds for lesion progression as compared to pure non-invasive methods; OR = 0.14 (95%CI; 0.08 to 0.25) [ 3 studies].
- At 3 years lesion progression was less likely following lesion infiltration; OR = 0.15 (95% CI; 0.06 to 0.36) [ 4 studies].
Conclusions
The authors concluded: –
The use of resin infiltration for sealing of early interproximal lesions when combined with oral hygiene measures was promising and more effective than oral hygiene measures alone for follow- up periods of up to 3 years in permanent teeth (low to moderate quality evidence). However, no solid conclusions can be drawn with regard to primary teeth. Overall, additional future trials should be designed at the highest standards of conduct and reporting to test the comparative effectiveness of resin infiltrants and other means of active interventions. This will smooth out uncertainty regarding treatment effects and will promote clinical decision making based on optimal clinical practices.
Comments
We looked at another review of this area by Krois et al last month (Dental Elf – 10th Sep 2018 ) and we have also previously discussed a Cochrane review (Dental Elf – 9th Nov 2015) . The review by Krois et al is broader in that it includes all micro invasive caries management approaches and includes more RCTs that the current review. All 3 reviews provide evidence that resin infiltration is effective at reducing lesion progression. However most of the studies have been conducted in a university setting with the assessment of lesion progression being measured in all but one study by radiography and despite typically using more than one examiner training and calibration is an important issue as noted by the authors. A majority of the studies included in the meta-analysis were industry supported. While the evidence suggests that this is a promising approach for the management of non-cavitated lesions additional studies are needed.
Links
Primary Paper
Chatzimarkou S, Koletsi D, Kavvadia K. The effect of resin infiltration of proximal caries lesions in primary and permanent teeth. A systematic review and meta-analysis of clinical trials. J Dent. 2018 Oct;77:8-17. doi: 10.1016/j.jdent.2018.08.004. Epub 2018 Aug 6. Review. PubMed PMID: 30092238.
Other references
Dental Elf – 10th Sep 2018
Dental Elf – 9th Nov 2015
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