ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Sealing or Resin Infiltration of Non-Cavitated Proximal Carious Lesions Is An Effective Treatment Option For Prevention
Clinical Question For an adult or child with non-cavitated carious lesions on the proximal surfaces, does placement of a sealant or infiltration as opposed to other dental interventions, offer an effective method in arresting their progression?
Clinical Bottom Line Preventative treatments such as sealants and resin infiltration techniques have been shown to be effective in slowing the progression of non-cavitated carious lesions involving the proximal surfaces. The micro-invasive nature of the procedure, it’s applicability in patients with limiting dental compliance, and use interim to more invasive options make sealants and resin infiltration a highly attractive and effective option for short to mid term treatment.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25066832Ammari/2014967 records of controlled clinical trials (CCT’s) and randomized controlled clinical trials (RCCT’s) narrowed down to focus on 10 studies.Meta-Analysis
Key resultsThis systematic review focused on the short term and long term efficacy of sealing and infiltrating non-cavitated proximal lesions. In 8 out of the 10 studies infiltration in conjunction with a one year follow up appointment, proved to be effective in treatment of non-cavitated proximal lesions. The p-value calculated (p=.002) was significant and it’s low value when compared to the placebo group. Overall, this proximal infiltration technique or sealing technique offered a marked reduction in carious progression.
#2) 25661012Doméjean/2015Total patient pool of (n=131)Systematic review of randomized trials
Key resultsThis systematic review was an evaluation of four randomized clinical trials in an attempt to study, in vivo, the effectiveness of resin infiltration (RI) in the treatment of non-cavitated proximal lesion. This review focused on 4 studies, using a 95% confidence interval, and pair-wise comparison. The relative risk of progression of the carious lesions after infiltration was determined for all four studies. A range of .11 to .8 was calculated and the results indicated a significant difference when comparing relative risks to that of patients not treated with resin infiltration. Combinations of infiltration alongside fluoride varnish produced little differences in relative risk as compared to patients whom received resin infiltration without fluoride varnish. This study came to the conclusion that calculation of relative risks could be used as a useful tool in determining treatment efficacy of resin infiltration. The relative risk of progression of proximal lesions was found to be low and thus indicator that treatment of non-cavitated proximal lesion in vivo with resin infiltration is an effective option.
#3) 22922306Meyer-Lueckel/2012N=22 (young adult patients) 15 patients with a pair of non-cavitated proximal lesion 7 patients with two pairs of non-cavitated proximal lesionRandomized Controlled Trial
Key resultsAfter screening, patients were randomized into groups which consisted of two-pairs or one paired, E2 and D1 carious lesions. The sample was then randomly divided into a placebo control and or infiltration groups. Assessment of carious at intervals of 18 and 36 months was determined. This was made through digital subtraction radiography (DSR) and the value obtained served as a primary endpoint. The secondary endpoint was determined by a pair-wise (PW) comparison. Analysis of the primary and secondary endpoints was performed using McNemar test and sensitivity testing carried out, which yielded p-values obtained for PW and DSR; .031 and .008 respectively. A 4%, relative risk, following infiltration techniques, was found to be contrasted to the 42% of caries progression seen in test group suggests that proximal infiltration of non-cavitated carious lesions is effective. In patients at 3 years when comparing the percentage differences in data between the 18 and 36 months, lesions further extended into the dentin showed higher incidence of progression. When comparing data obtain from both 18 and 36 month recalls, infiltrated carious lesions did not lower in Caries Detection and Assessment System scores, consistent with the idea of resin infiltration serving as interim. However, based on analysis of the data it was concluded that resin infiltration is effective at slowing the progression of proximal caries.
Evidence Search proximal[All Fields] AND "Dental Caries"[Mesh] OR infiltration[All Fields] AND cavitated[All Fields]
Comments on
The Evidence
Validity: The first systematic review offers a high level of evidence. An extensive search included 967 records of controlled clinical trials (CCT’s) and randomized controlled clinical trials (RCCT’s). The number of studies was ultimately reduced down to 10 records, of which four were chosen for meta-analysis. This review was thorough and unique in some aspects it included studies involving both primary and permanent dentition. Each study chosen was assessed for biases using Cochrane Collaboration common scheme for bias. All four studies chosen involvement blinding of both patient and provider. A forest plot was constructed following meta-analysis of the four trials. After which, validity of the results and “heterogeneity among studies” was evaluated using I2 index. The second article a systematic review assessed its quality of evidence based the methodology. The review was deemed by the author to be of high quality evidence “respect to randomization, split-mouth design and blinding.” However, the studies limited sample of articles and differences in study design between the articles four articles allowed for heterogeneity among the studies. Also, as mentioned by the authors, while the split-mouth design methodology does offers the ability to use a single patient as both placebo and test, use of fluoride varnish may spill over and inadvertently alter results. Perspective: Based on positive results from the two previously discussed systematic reviews and the randomized clinical trial, there was sufficient evidence and differences in relative risks between treatment groups to placebo to conclude that resin infiltration or sealing of non-cavitated proximal carious lesions is sound treatment approach in conjunction proper follow up. While analysis of the data points to resin infiltration being effective at 3 years, the need to address long-term efficacy, and applying the technique clinically limits the evidence somewhat.
Applicability Infiltration or sealing of proximal non-cavitated lesion is important in that it is a micro-invasive preventative treatment. Recent studies have shown it to be highly effective in slowing the progression of non-cavitated proximal caries which extend no further than the outer third of the dentin. There are factors to take into consideration, however, that may hinder its application. The technical sensitivity as well as the dental provider’s ability to properly identify a cavitated lesion are factors which may affect the delivery. The micro-invasive nature of the procedure, it’s applicability in patients with limiting dental compliance, and use interim to more invasive options make sealants and resin infiltration a highly attractive and effective option for short to mid term treatment.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords Non-cavitated, proximal lesions, resin infiltration, sealant
ID# 3073
Date of submission: 03/22/2016spacer
E-mail aboudn@livemail.uthscsa.edu
Author Nicholas Aboud
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Suman Challa, BDS, MS
Faculty mentor/Co-author e-mail challas@uthscsa.edu
Basic Science Rationale
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