Cochrane · intervention · CD010431
Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth
Dorri, M, Dunne, SM, Walsh, T, et al. · Cochrane Database of Systematic Reviews · 2015 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
15
current version
GRADE rated
4
No studies
4
Included studies
8
as reported
No studies 4 · 26.7%Ungraded 7 · 46.7%Very low 0 · 0%Low 0 · 0%Moderate 4 · 26.7%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Dentate children and adults with proximal carious lesions extending into enamel or dentine (but not the pulp), as detected by radiographs; only teeth with no existing filling at the lesion site (primary caries lesions) | Eight split-mouth trials; 365 participants randomised (602 lesions analysed); participant age 4 to 39 years; enamel or enamel-dentine lesions (outer third of dentine); six studies permanent and two primary dentition; caries risk low to high; conducted in Brazil, Colombia, Denmark, Germany, Thailand, Greenland and Chile |
| Intervention | Proximal micro-invasive treatments using resin or glass ionomer cement (GIC) sealants, polyurethane tapes, or resin infiltration, placed by dentists or dental care professionals | Resin sealant (n=212 lesions); Resin infiltration (n=116 lesions); Glass ionomer sealant (n=41 lesions); Adhesive/polyurethane patch (n=50 lesions) |
| Comparison | Another micro-invasive treatment; non-invasive measures (e.g. dental floss, fluoride varnish, oral hygiene advice); invasive means (conventional restorations); placebo; or no intervention | Flossing advice (n=3 studies); Fluoride varnish (n=2 studies); Sham infiltration/placebo plus flossing (n=1 study); Fluoride gel plus fluoride toothpaste/dentifrice (n=1 study); No treatment, both arms floss plus fluoride toothpaste (n=1 study) |
| Outcomes | Progression of existing carious lesion into enamel or dentine (radiographic) over minimum six months; Change in decayed, missing and filled (DMF/dmf) figures at surface, tooth and whole mouth level; Material deficiency (retention loss / re-treatment); Participant and operator perception; Adverse events; Direct and indirect costs of treatment | Caries (lesion) progression (7 studies pooled, 602 lesions; graded Moderate); Material deficiency (1 study); Adverse events (4 studies, none reported) |
| Study designs | Randomised controlled trials with at least six months follow-up (parallel-group and split-mouth designs) | Randomised controlled trials, all split-mouth design (n=8) |
| Timing | At least six months follow-up (studies with longer follow-up also considered) | Radiographic follow-up 6 months to 3 years; clinical follow-up 6 to 12 months |
Search date: 2014-12-31. Databases: The Cochrane Oral Health Group Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; LILACS via Bireme Virtual Health Library; Web of Science Conference Proceedings; ZETOC Conference Proceedings; Proquest Dissertations and Theses;…
Questions and results
Show all 2 versionsMicro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive measures (e.g. fluoride varnish, flossing/oral hygiene advice), no treatment, or placebo
Population: Dentate children and adults with non-cavitated proximal caries lesions extending into enamel or dentine (not pulp) in primary or permanent teeth (trial ages 4 to 39 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant and operator perception | None of the studies reported on participant or operator perception | 0 studies | No studies |
Caries (lesion) progression measured by pairwise reading of radiographs 18 to 36 months (radiographic follow-up) | OR 0.31 [0.18, 0.53] | 4 studies | Moderate Downgraded: risk of bias, imprecision |
Caries (lesion) progression (radiographic; most sensitive measure per study, DSR > pairwise > visual scoring) 12 to 36 months (radiographic follow-up) | OR 0.24 [0.14, 0.41] 547 per 1000 (study population); 649 per 1000 (moderate-risk baseline) vs 284 per 1000 (study population); 337 per… | 7 studies · 365 participants | Moderate Downgraded: risk of bias, imprecision |
Change in decayed, missing and filled (DMF/dmf) figures at surface, tooth and whole mouth level | No studies reported on caries measured as change in decayed, missing and filled (DMF/dmf) figures at surface, tooth or whole mouth level | 0 studies | No studies |
Caries (lesion) progression measured by digital subtraction radiography (DSR) 12 to 18 months (radiographic follow-up) | OR 0.18 [0.06, 0.50] | 3 studies | Moderate Downgraded: risk of bias, imprecision |
Caries (lesion) progression measured by radiographic scoring 12 to 30 months (radiographic follow-up) | OR 0.27 [0.17, 0.44] | 5 studies | Moderate Downgraded: risk of bias, imprecision |
Caries (lesion) progression (radiographic) 12 to 36 months (radiographic follow-up) · Sealant patch | OR 1.00 [0.14, 7.23] | 1 study | Ungraded |
Costs (direct treatment costs; indirect costs / time off school or work) | None of the studies reported on costs for micro-invasive treatment or non-invasive control | 0 studies | No studies |
Caries (lesion) progression (radiographic) 12 to 36 months (radiographic follow-up) · Glass ionomer sealant | OR 0.13 [0.01, 2.52] | 1 study | Ungraded |
Adverse events 1 to 3 years | The four studies that measured adverse events reported no adverse events after micro-invasive treatment (no events in either arm) | 4 studies | Ungraded |
Caries (lesion) progression (radiographic) 12 to 36 months (radiographic follow-up) · Resin sealant | OR 0.33 [0.18, 0.59] | 2 studies | Ungraded |
Caries (lesion) progression (radiographic) 12 to 36 months (radiographic follow-up) · Resin infiltration | OR 0.19 [0.08, 0.46] | 2 studies | Ungraded |
Material deficiency (retention/adaptation loss; re-treatment) 3 years | One study (Alkilzy 2011, sealant patch) reported material deficiency: 10% total and 23% partial loss of proximal sealants after three years; 53% maintained perfect margins and none had open margins. No studies reported… | 1 study | Ungraded |
Resin sealant (one micro-invasive treatment) vs Resin infiltration (another micro-invasive treatment)
Population: Dentate children and adults with non-cavitated proximal caries lesions extending into enamel or dentine (not pulp) in primary or permanent teeth (trial ages 4 to 39 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries (lesion) progression (radiographic) up to 3 years | Only one study (Martignon 2012) directly compared resin sealant versus resin infiltration; the review could not determine which technique is more advantageous and reported no direct effect estimate for this comparison. | 1 study | Ungraded |
Micro-invasive treatment (proximal sealing or resin infiltration) vs Conventional invasive treatment (restoration / drill and fill)
Population: Dentate children and adults with non-cavitated proximal caries lesions extending into enamel or dentine (not pulp) in primary or permanent teeth (trial ages 4 to 39 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | No studies compared micro-invasive treatments with invasive treatment (fillings) | 0 studies | No studies |