Non-Cochrane · intervention · PM39780151
Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic review and meta-analysis.
Tasleem Robina, Alqahtani Saleh Ali, Abogazalah Naif, et al. · BMC oral health · 2025 · PubMed · doi:10.1186/s12903-024-05400-5
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
12
current version
GRADE rated
1
No studies
1
Included studies
17
linked below
No studies 1 · 8.3%Ungraded 10 · 83.3%Very low 0 · 0%Low 0 · 0%Moderate 1 · 8.3%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 (not pulp); primary caries lesions only, no existing filling at the lesion site | 13 RCTs; 623 subjects; ages 3-45; 5 trials primary teeth (3-9y), 7 trials permanent teeth (11-45y), 1 trial both dentitions |
| Intervention | Proximal microinvasive treatments: resin or glass ionomer cement (GIC) sealants, polyurethane tapes, or resin infiltration, placed by dentists or dental care professionals | Resin infiltration (10 trials); glass ionomer cement varnish (1 trial); resin-based sealant (2 trials) |
| Comparison | Non-invasive measures (dental floss, fluoride varnish, oral hygiene advice), invasive means (conventional restorations), placebo, or no intervention | Non-invasive comparators: sham/mock infiltration, oral hygiene instruction, dietary advice, fluoridated toothpaste, flossing, fluoride varnish, standard of care |
| Outcomes | Primary: radiographic progression of proximal carious lesions. Secondary: adverse events (gingival bleeding, gingival bleeding index, visible plaque index) | Radiographic caries progression assessed in all 13 trials; secondary outcomes (gingival bleeding/GBI/visible plaque index) in 3 trials |
| Study designs | Randomized controlled trials (parallel-group and split-mouth); unit of randomization = group, individual, tooth, lesion, or tooth/lesion pairs | All 13 included trials were split-mouth RCTs |
| Timing | Follow-up at least 6 months; publications January 2015 to May 2024 | Complete follow-up durations 1 to 7 years |
Search date: May 2024. Databases: PubMed; Google Scholar; Cochrane Oral Health Group Trials Register
Questions and results
Microinvasive techniques (resin infiltration, resin/GIC sealant, or glass ionomer varnish) vs Non-invasive measures (fluoride varnish/toothpaste, flossing, oral hygiene instruction, sham/standard of care)
Population: Children and adults with non-cavitated proximal (interproximal) caries lesions in primary and/or permanent teeth (ages 3-45)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events and periodontal/secondary outcomes (gingival bleeding, gingival bleeding index, visible plaque index) Baseline and follow-up Only three trials reported secondary/adverse outcomes; no adverse events were attributed to microinvasive treatment and periodontal findings were mixed and not pooled (ungraded). Source: Results (Secondary outcomes); Discussion; Table 1 (secondary outcome column) · same question in other reviews | Reported narratively by 3 trials (Arthur 2018, Sarti 2020, Jorge 2019). No adverse events were attributed to microinvasive treatment. Gingival bleeding index: no significant difference in Arthur 2018 and Jorge 2019 but… | 3 studies | Ungraded |
Radiographic progression of proximal caries lesions Final follow-up (1 to 7 years across trials) · Overall (all microinvasive vs non-invasive pooled) Microinvasive techniques probably reduce radiographic progression of non-cavitated proximal caries lesions compared with non-invasive measures (moderate certainty). Source: Table 2 (GRADE evidence profile); Fig. 4 (forest plot, overall diamond); Abstract; Results (Radiographic caries progression); Quality of… · same question in other reviews | OR 0.27 [0.19, 0.38] -21.2 [-24.4, -17.2] percentage points (fewer lesions progressing with microinvasive) | 13 studies · 623 participants | Moderate Downgraded: risk of bias |
Resin infiltration vs Non-invasive measures (fluoride varnish/toothpaste, flossing, oral hygiene instruction, sham/standard of care)
Population: Children and adults with non-cavitated proximal (interproximal) caries lesions in primary and/or permanent teeth (ages 3-45)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Radiographic progression of proximal caries lesions Final follow-up (1 to 7 years across trials) · Resin infiltration vs non-invasive (Fig. 5, subgroup 2.1.1) Pooling 10 trials, resin infiltration reduced radiographic proximal caries progression versus non-invasive measures (OR 0.23); this subgroup was not separately GRADE-rated. Source: Fig. 5 (forest plot, subgroup 2.1.1 infiltration vs control) · same question in other reviews | OR 0.23 [0.15, 0.35] | 10 studies · 459 participants | Ungraded |
Resin-based sealant (proximal sealing / fluoride-releasing resin sealant) vs Non-invasive measures (fluoride varnish; no intervention)
Population: Children and adults with non-cavitated proximal (interproximal) caries lesions in primary and/or permanent teeth (ages 3-45)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Radiographic progression of proximal caries lesions Final follow-up (1 to 3.5 years) · Sealant vs non-invasive (Fig. 5, subgroup 2.1.2) Pooling 2 trials, resin-based sealants reduced radiographic proximal caries progression versus non-invasive measures (OR 0.24; ungraded subgroup). Source: Fig. 5 (forest plot, subgroup 2.1.2 sealant vs control) · same question in other reviews | OR 0.24 [0.10, 0.55] | 2 studies · 111 participants | Ungraded |
Glass ionomer (modified glass ionomer varnish) vs Non-invasive measures (standard of care)
Population: Children with non-cavitated proximal caries lesions in primary teeth (ages 5-8)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Radiographic progression of proximal caries lesions 1 year · Glass ionomer vs non-invasive (Fig. 5, subgroup 2.1.3) In one trial, glass ionomer varnish showed no statistically significant difference versus non-invasive care in radiographic proximal caries progression (OR 0.58, CI includes 1; ungraded subgroup). Source: Fig. 5 (forest plot, subgroup 2.1.3 ionomer vs control) · same question in other reviews | OR 0.58 [0.28, 1.20] | 1 study · 53 participants | Ungraded |
Microinvasive techniques (mostly resin infiltration; incl. resin sealant) vs Non-invasive measures (fluoride varnish/toothpaste, flossing, oral hygiene instruction, sham/standard of care)
Population: Children and adults with non-cavitated proximal caries lesions in permanent teeth (ages 11-45)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Radiographic progression of proximal caries lesions Final follow-up (1 to 7 years across trials) · Permanent teeth (Fig. 6, subgroup 2.1.1) In permanent teeth (7 trials), microinvasive techniques reduced radiographic proximal caries progression versus non-invasive measures (OR 0.18; ungraded subgroup). Source: Fig. 6 (forest plot, subgroup 2.1.1 permanent teeth) · same question in other reviews | OR 0.18 [0.10, 0.32] | 7 studies · 296 participants | Ungraded |
Microinvasive techniques (resin infiltration or glass ionomer varnish) vs Non-invasive measures (fluoride varnish/toothpaste, flossing, oral hygiene instruction, sham/standard of care)
Population: Children with non-cavitated proximal caries lesions in primary teeth (ages 3-9)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Radiographic progression of proximal caries lesions Final follow-up (1 to 2 years across trials) · Primary teeth (Fig. 6, subgroup 2.1.2) In primary teeth (5 trials), microinvasive techniques reduced radiographic proximal caries progression versus non-invasive measures (OR 0.38; ungraded subgroup). Source: Fig. 6 (forest plot, subgroup 2.1.2 primary teeth) · same question in other reviews | OR 0.38 [0.25, 0.57] | 5 studies · 266 participants | Ungraded |
Microinvasive technique (proximal sealing) vs No intervention
Population: Children with lesions in both primary and permanent teeth (ages 8-10)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Radiographic progression of proximal caries lesions 3.5 years · Both permanent and primary (Fig. 6, subgroup 2.1.3) In one trial including both primary and permanent teeth, proximal sealing reduced radiographic caries progression versus no intervention (OR 0.16; ungraded subgroup). Source: Fig. 6 (forest plot, subgroup 2.1.3 both permanent and primary) · same question in other reviews | OR 0.16 [0.06, 0.44] | 1 study · 61 participants | Ungraded |
Microinvasive techniques (resin infiltration, sealant, glass ionomer) vs Invasive treatment (conventional restorations)
Population: Children and adults with non-cavitated proximal (interproximal) caries lesions in primary and/or permanent teeth (ages 3-45)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Radiographic progression of proximal caries lesions No eligible studies compared microinvasive techniques with invasive (restorative) treatment; this planned comparison had zero included studies. Source: Comparator eligibility (Methods); Discussion (none of the included studies compared microinvasive with invasive interventions) · same question in other reviews | no estimate extracted | 0 studies | No studies |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment failure (time-to-failure, 7 years) Resin infiltration 1.3% vs standard of care 7.8% (Paris 2020, Kaplan-Meier) | no estimate extracted | 1 study | Ungraded |
Radiographic progression of proximal caries lesions Caries depth: lesions extending beyond DEJ (favored microinvasive; narrative, no numeric estimate) | no estimate extracted | NR | Ungraded |
Radiographic progression of proximal caries lesions Caries depth: lesions up to DEJ (favored microinvasive; narrative, no numeric estimate) | no estimate extracted | NR | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | No | no |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | No | No | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: Yes | RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Critically Low | no |
Included primary studies 17
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Bagher 2018 matched by author and year (probable) | 1 other review | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Khan 2023 matched by author and year (probable) | 1 other review | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Meyer-Lueckel 2016 matched by author and year (probable) | 1 other review | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Arsalan 2020 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Arslan 2020 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Arthur 2018 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Basili 2017 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Cristian 2017 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Foster 2017 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Jorge 2019 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Mathilde 2018 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Meyer 2016 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Paris 2020 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Peters 2018 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Peters 2019 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Sarti 2020 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
| Treeratweerapong 2023 matched by author and year (probable) | this review only | Radiographic progression of proximal caries lesions | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).