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Title Micro-invasive Treatments Are More Effective in Halting the Progression of Proximal Incipient caries in Primary Dentition Than Traditional Non-invasive Methods
Clinical Question In children with primary teeth containing proximal carious lesions (P), does the utilization of micro-invasive dental treatments (I) lead to superior arresting of carious lesions (O) compared to traditional non-invasive caries prevention methods (C)?
Clinical Bottom Line Micro-invasive methods such as silver diamine fluoride or resin infiltration are more effective treatment options than fluoride varnish and oral hygiene advice at halting proximal carious lesions in primary teeth. Micro-invasive treatment is a conservative modality that is recommended as an alternative for managing non-cavitated lesions and initial dentinal lesions compared to invasive methods that unnecessarily remove sound tooth structure.
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) 26545080Dorri/2015365 participants 4-39 years in ageSystematic review of randomized trials
Key resultsThis study employed a split-mouth design, comprising 365 participants from seven countries. Male and females ranging 4-39 years in age. It encompassed six trials in permanent dentition and two in primary dentition, with varying caries risk levels and follow-up periods ranging from one to three years. Micro-invasive treatments by either sealing or resin infiltration significantly reduced the odds of lesion progression compared to non-invasive treatment (e.g., fluoride varnish) or oral hygiene advice (e.g., flossing) with an odds ratio (OR) of 0.24 (95% CI 0.14 to 0.41; 602 lesions; seven studies; I(2) = 32%). These findings indicate a substantial benefit of micro-invasive treatments in arresting non-cavitated enamel and initial dentinal lesions. However, it remains unclear which specific micro-invasive technique offers the greatest benefit, and whether the effects of micro-invasive treatment vary based on clinical or patient considerations. The quality of evidence for micro-invasive treatments was assessed as moderate, and further research is unlikely to substantially change these findings.
#2) 32271666Hammersmith/2020131 children with 185 proximal carious lesions in primary teethRetrospective Cohort
Key resultsThe study assessed the efficacy of Silver Diamine Fluoride (SDF) for proximal caries management, applied with woven floss to lesions diagnosed via bitewing radiographs. At the 12-month follow-up, 84.0% of lesions showed radiographic evidence of caries arrest, with no significant differences observed between tooth types or insurance status. The study demonstrated that SDF, when applied with fluoride varnish two to three times within a 12-month period, effectively arrested interproximal carious lesions in children, particularly when lesions were confined to the dentin-enamel junction. However, the study highlighted the need for future placebo-controlled research to further investigate SDF's clinical efficacy in managing interproximal caries in pediatric populations.
Evidence Search (((interproximal) AND (caries)) AND (primary teeth)) OR (micro-invasive) (teeth) (primary)
Comments on
The Evidence
The evidence presented in Dorri/2015 holds moderate validity; the search performed to find articles created a substantial sample size from eight trials with international representation. However, the high risk of bias in seven of the trials due to the lack of blinding and limited reporting of adverse events and outcomes slightly compromises the study's reliability. Hammersmith/2020 included an adequate sample size using previously reported methods to measure and determine the extent of caries. However, there are some limitations. The study could be biased because both the patients and the researchers knew which treatment was given (researchers were not blinded to the treatment). Additionally, they didn't compare the treatment to other options or have a group that didn't receive the treatment (no control), so we can't definitively say if this treatment is better than others.
Applicability The research suggests that using minimally invasive methods, including resin infiltration, can effectively halt the progression of interproximal cavities, especially in the early stages of tooth decay. These approaches demonstrate better effectiveness compared to traditional non-invasive treatments like fluoride varnish or oral hygiene advice. One approach, utilizing Silver Diamine Fluoride (SDF) along with woven flossing, showed promising results in arresting interproximal cavities in children with a low risk of cavities, irrespective of tooth type or insurance coverage. These findings highlight the potential of these minimally invasive techniques, including resin infiltration, in preventing and treating interproximal cavities.
Specialty/Discipline (Public Health) (Pediatric Dentistry) (Restorative Dentistry)
Keywords Minimally invasive methods, Resin infiltration, proximal caries, Tooth decay, Effectiveness, Non-invasive treatments, Silver Diamine Fluoride (SDF), Preventing caries
ID# 3550
Date of submission: 10/25/2023spacer
E-mail hardyc1@livemail.uthscsa.edu
Author Chase Hardy, DMD
Co-author(s) Lane Shafer, DMD
Co-author(s) e-mail shaferr@livemail.uthscsa.edu
Faculty mentor/Co-author Dr. Bennett Amaechi
Faculty mentor/Co-author e-mail Amaechi@uthscsa.edu
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