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

Oral Health Dental caries2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

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

Current version only

Micro-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)

CD010431.PUB2 (current) · 13 questions

Outcome	Effect	Evidence	Status / GRADE
Participant and operator perception same question in other reviews	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) same question in other reviews	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) same question in other reviews	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 same question in other reviews	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) same question in other reviews	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) same question in other reviews	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 same question in other reviews	OR 1.00 [0.14, 7.23]	1 study	Ungraded
Costs (direct treatment costs; indirect costs / time off school or work) same question in other reviews	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 same question in other reviews	OR 0.13 [0.01, 2.52]	1 study	Ungraded
Adverse events 1 to 3 years same question in other reviews	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 same question in other reviews	OR 0.33 [0.18, 0.59]	2 studies	Ungraded
Caries (lesion) progression (radiographic) 12 to 36 months (radiographic follow-up) · Resin infiltration same question in other reviews	OR 0.19 [0.08, 0.46]	2 studies	Ungraded
Material deficiency (retention/adaptation loss; re-treatment) 3 years same question in other reviews	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)

CD010431.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Caries (lesion) progression (radiographic) up to 3 years same question in other reviews	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)

CD010431.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	No studies compared micro-invasive treatments with invasive treatment (fillings)	0 studies	No studies

Proximal sealing (micro-invasive treatment): sealants, resin infiltration, or polyurethane tape, placed by dentists or dental care professionals vs Non-operative (preventive) measures (e.g. dental floss, fluoride varnish) or no intervention

Population: Dentate children and adults, male or female, with proximal carious lesions extended to enamel or dentine (and not pulp), as detected by radiographs; only teeth with no existing filling at the site of lesion

CD010431 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR 6 months to 3 years (planned)	no estimate extracted	0 studies	No studies

Proximal sealing (one micro-invasive technique/material) vs Another proximal sealing technique/material

CD010431 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR 6 months to 3 years (planned)	no estimate extracted	0 studies	No studies

Proximal sealing (micro-invasive treatment) vs Conventional or conservative (invasive) restorations

CD010431 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR 6 months to 3 years (planned)	no estimate extracted	0 studies	No studies