Micro-invasive interventions for managing non-cavitated proximal caries of different depths: a systematic review and meta-analysis

Abstract

Objectives: The aim of this study was to further evaluate the caries-arresting effectiveness of micro-invasive interventions for non-cavitated proximal caries and analyze their efficacy for caries lesions of different depths.

Materials and methods: Randomized clinical trials (RCTs) of micro-invasive interventions for non-cavitated proximal caries were included in this study. We searched the Cochrane Library, PubMed, Embase, and Web of Science on May 25, 2017, without restrictions. After duplicate study selection, data extraction, and risk of bias assessment, a meta-analysis of the odds ratios (OR) with 95% confidence intervals (95% CIs) and a publication bias analysis were conducted using Stata 12.0.

Results: After 2195 citations were screened, 8 citations of seven studies with follow-up periods from 12 to 36 months were included. The subgroup analysis showed that resin infiltration and resin sealant, but not glass ionomer cement (GIC), could reduce the caries progression rate (resin infiltration: OR = 0.15, 95% CI 0.09 to 0.24; resin sealant: OR = 0.33, 95% CI 0.19 to 0.58; GIC: OR = 0.13, 95% CI 0.01 to 2.65). Further analysis of their efficacies for caries lesions of different depths indicated that resin infiltration could arrest progression of enamel caries and caries around the enamel-dentin junction (EDJ) (enamel: OR = 0.05, 95% CI 0.01 to 0.35; EDJ: OR = 0.07, 95% CI 0.01 to 0.70). However, when the outer third of the dentin was involved, resin infiltration yielded significantly different results compared with the control group (OR = 0.42, 95% CI 0.16 to 1.10). Resin sealant seemed to be ineffective regardless of the caries depth (enamel: OR = 0.62, 95% CI 0.13 to 3.00; EDJ: OR = 0.44, 95% CI 0.09 to 2.15; dentin: OR = 0.43, 95% CI 0.07 to 2.63).

Conclusions: Resin infiltration is effective in arresting the progression of non-cavitated proximal caries involved in EDJ, while the therapeutic effects of resin sealant for different caries depths still needs to be further confirmed.

Clinical relevance: Based on existing evidence, dentists should carefully select appropriate micro-invasive interventions according to the different depths of non-cavitated proximal caries.

Keywords: Meta-analysis; Micro-invasive interventions; Non-cavitated proximal caries; Resin infiltration; Resin sealant; Systematic review.