Infiltration and sealing for managing non-cavitated proximal lesions: a systematic review and meta-analysis

Abstract

Background Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels. Methods Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings. Results In total, 1033 citations were identified, and 17 RCTs (22 articles) were included. Infiltration and sealing reduced the odds of lesion progression (infiltration vs. non-invasive: OR = 0.21, 95% CI 0.15–0.30; sealing vs. placebo: OR = 0.27, 95% CI 0.18–0.42). For both the primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI 0.20–0.45; permanent dentition: OR = 0.20, 95% CI 0.14–0.28). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.20, 95% CI 0.14–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.17, 95% CI 0.10–0.29; and high risk: OR = 0.14, 95% CI 0.07–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), infiltration was superior (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.20, 95% CI 0.10–0.39; and high risk: OR = 0.14, 95% CI 0.05–0.37). Conclusion Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.

Dental Caries and Its Management

“…Te caries process can be controlled by mechanical plaque control, efective oral hygiene, fuoride and antimicrobial application, and avoiding sugar intake between meals [6,7]. Resin infltration of WSLs and sealing of noncavitated lesions as a treatment option have been supported by several studies [51,56,59]. Tis method represents the minimal invasive option.…”

“…As previously mentioned, sealing the noncavitated carious lesion has been shown to stop lesion progression in vivo and in vitro effectively [51,[56][57][58]. A proximal carious lesion can be sealed after separating the afected tooth to reach the lesion.…”

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

“…Meta-analysis assessing the effectiveness of resin infiltration in arresting the progress of non-cavitated proximal lesions have found them to be highly efficacious in permanent teeth when the lesions extend into the enamel and outer third of dentin [ 125 , 126 , 127 , 128 , 129 , 130 ]. For permanent teeth, the risk of caries progression was shown to be significantly lower in infiltrated lesions (4–14%) relative to control (42–48%) over three years [ 131 , 132 ] and Paris et al found the seven-year rate of progression to be 9% for infiltrated lesions vs 45% for control lesions [ 133 ].…”

“…For primary teeth, early meta-analysis found the data regarding RI efficacy inconclusive, due to the heterogeneity of study designs and settings [ 125 , 126 , 127 ]. A meta-analysis by Chen et al in 2021 concluded that although more clinical studies were needed, findings from current studies were encouraging and resin infiltration is efficacious in arresting decay progress in primary teeth for 12–24 months [ 130 ]. Based on these studies, the therapeutic effect of RI was found to range from 21% [ 134 , 135 ] to 38% [ 136 ].…”

Assessment of the Potential Ability to Penetrate into the Hard Tissues of the Root of an Experimental Preparation with the Characteristics of a Dental Infiltratant, Enriched with an Antimicrobial Component—Preliminary Study

“…As a result, the window for penetration of bacterial toxins into the hard tissues and the bacteria producing them is closed. The result is inhibition of the decalcification process and caries development [ 19 , 20 ]. An infiltrant is a substance based on polymeric resins, capable of penetrating tissues due to capillary forces.…”