Minimally Invasive Therapies for the Management of Dental Caries-A Literature Review

Abstract

In recent years, due to a better understanding of the caries pathology and advances in dental materials, the utilization of non-invasive and minimally invasive techniques that delay/obviate the need for traditional restorations has started gaining momentum. This literature review focuses on some of these approaches, including fluoride varnish, silver diamine fluoride, resin sealants, resin infiltration, chemomechanical caries removal and atraumatic restorative treatment, in the context of their chemistries, indications for use, clinical efficacy, factors determining efficacy and limitations. Additionally, we discuss strategies currently being explored to enhance the antimicrobial properties of these treatment modalities to expand the scope of their application.

Keywords: caries management; cariology; dental restorative technique; fluoride; minimally invasive dentistry; resin infiltration; sealants.

Figure 1

Schematic representation of caries prevention by sealant application. (A) Deep pits and fissures on occlusal surfaces of posterior teeth act as retentive sites that facilitate bacterial colonization. (B) Sealant application forms a mechanical barrier on the tooth surface and renders it more amenable to cleansing, making it less susceptible to bacterial colonization and preventing dental caries.

Figure 2

Schematic representation of caries arrest by sealant application. Sealant application deprives the biofilm within the carious lesion of nutrient supply, resulting in a reduction in the number of viable bacteria within the lesion, leading to the formation of a less virulent and less diverse biofilm, slowing/arresting caries progression.

Figure 3

Chemical structures of Quaternary Ammonium Compounds (QACs). 2-methacryloxylethyl dodecyl methyl ammonium bromide (MAE-DB), 2-methacryloyloxyethyl trimethylammonium chloride (METAC), dimethylamino- hexadecyl methacrylate (DMAHDM), 1,3,5-triacryloyl hexahydro-1,3,5-triazine (TAT), methacryloxylethyl cetyl dimethyl ammonium chloride (DMAE-CB).

Figure 4

Chemical Structure of resin monomers. Bisphenol A-glycidyl methacrylate (BisGMA) and Triethylene glycol dimethacrylate (TEGDMA).

Figure 5

Schematic representation of caries-arresting effect of resin infiltration. (A) Demineralization of enamel due to acids, resulting in the formation of enamel porosities (B) Resin infiltrants penetrate the demineralized enamel lesions and occlude the inter-crystalline spaces after polymerization, resulting in the formation of a polymer framework that acts as a barrier for hydrogen ions, inhibiting further demineralization and arresting the progress of caries.

Figure 6

Chemical Structure of resin monomers. Bisphenol A ethoxylate dimethacrylate (BisEMA) and Urethane dimethacrylate (UDMA).

Figure 7

Chemical Structure of resin monomer. Hydroxyethyl methacrylate (HEMA).

Figure 8

Chemical Structure of quaternary ammonium monomer. Dimethylaminododecyl methacrylate (DMADDM), n = 11.