Caries is one of the world’s commonest diseases and preventing the progression of non-cavitated proximal lesions is an important part of caries management. In recent years there has been increasing interest in non-invasive or micro-invasive techniques for the management of these non-cavitated proximal lesions.
The aim of this review was to assess the caries-arresting effectiveness of micro-invasive interventions for non-cavitated proximal caries and analyse their efficacy for caries lesions of different depths.
Methods
Searches were conducted in the Cochrane Library, PubMed, Embase, and Web of Science with no restrictions on language or date of publication. Randomised controlled trials (RCTs) of micro-invasive interventions for non-cavitated proximal caries were considered.
Two reviewers independently selected studies and extracted data with disputes being resolved by a third reviewer. Risk of bias was assessed using the Cochrane tool. A meta-analysis of the odds ratios (OR) with 95% confidence intervals (95% CIs) and a publication bias analysis were conducted
Results
- 7 studies involving a total of 303 patients were included.
- Interventions included GIC, resin sealant (adhesive or pit and fissure sealant) and resin infiltration.
- 2 studies were considered to be at low risk of bias, 1 at unclear risk and 4 at high risk.
- The combined results (7 studies) showed that micro-invasive interventions significantly reduced the possibility of caries progression compared with the control, OR = 0.20, (95% CI 0.14 to 0.29).
- Sub group analysis showed
- Resin infiltration (4 studies) OR = 0.15 (95%CI; 0.09 to 0.24), and
- Resin sealant (3 studies) OR = 0.33 (95%CI; 0.19 to 0.58),
- For caries lesions of different depths findings suggest
- Resin infiltration could arrest progression of enamel caries and caries around the enamel-dentine junction (EDJ):
- Enamel: OR = 0.05 (95%CI; 0.01 to 0.35) [ 2 studies]
- EDJ: OR = 0.07 (95% CI;0.01 to 0.70). [1 study]
- Resin infiltration could arrest progression of enamel caries and caries around the enamel-dentine junction (EDJ):
- When the outer third of the dentin was involved, resin infiltration yielded significantly different results compared with the control group, OR = 0.42, 95% CI; 0.16 to 1.10).
- Resin sealant seemed to be ineffective regardless of the caries depth
- Enamel: OR = 0.62 (95%CI; 0.13 to 3.00) [1 study]
- EDJ: OR = 0.44 (95% CI;0.09 to 2.15) [1 study]
- Dentine: OR = 0.43 (95% CI 0.07 to 2.63). [1 study]
Conclusions
The authors concluded: –
Resin infiltration is effective in arresting the progression of non-cavitated proximal caries involved in EDJ, while the therapeutic effects of resin sealant for different caries depths still needs to be further confirmed.
Comments
Last month we looked at another review by Chatzimarkou et al (Dental Elf – 29th Oct 2018) that covered this topic. The Chatzimarkou review included 9 studies compared with the 7 included in this review by Liang et al with only 4 of the studies being common to both reviews. When we commented on the Chatzimarkou review (Dental Elf – 29th Oct 2018) we highlighted two other reviews that also considered micro-invasive caries management approaches.
While the available reviews suggest that these micro-invasive approaches to the management of non-cavitated proximal lesions are a promising approach the majority of the studies included have been conducted in a university setting and are relatively small with few of them being at low risk of bias. The findings of the review should be carefully considered in particular as some of the sub-group analyses and several only include just one or two studies. Additional high quality well reported studies with larger sample sizes and of appropriate duration are needed to confirm how and when micro-invasive approaches should be employed.
Links
Primary Paper
Liang Y, Deng Z, Dai X, Tian J, Zhao W. Micro-invasive interventions for managing non-cavitated proximal caries of different depths: a systematic review and meta-analysis. Clin Oral Investig. 2018 Nov;22(8):2675-2684. doi:10.1007/s00784-018-2605-9. Epub 2018 Sep 20. Review. PubMed PMID: 30238416.
Other references
Dental Elf – 29th Oct 2018
Dental Elf – Resin Infiltration blogs
