Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis

Abstract

The goal of nonrestorative or non- and microinvasive caries treatment (fluoride- and nonfluoride-based interventions) is to manage the caries disease process at a lesion level and minimize the loss of sound tooth structure. The purpose of this systematic review and network meta-analysis was to summarize the available evidence on nonrestorative treatments for the outcomes of 1) arrest or reversal of noncavitated and cavitated carious lesions on primary and permanent teeth and 2) adverse events. We included parallel and split-mouth randomized controlled trials where patients were followed for any length of time. Studies were identified with MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews. Pairs of reviewers independently conducted the selection of studies, data extraction, risk-of-bias assessments, and assessment of the certainty in the evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Data were synthesized with a random effects model and a frequentist approach. Forty-four trials (48 reports) were eligible, which included 7,378 participants and assessed the effect of 22 interventions in arresting or reversing noncavitated or cavitated carious lesions. Four network meta-analyses suggested that sealants + 5% sodium fluoride (NaF) varnish, resin infiltration + 5% NaF varnish, and 5,000-ppm F (1.1% NaF) toothpaste or gel were the most effective for arresting or reversing noncavitated occlusal, approximal, and noncavitated and cavitated root carious lesions on primary and/or permanent teeth, respectively (low- to moderate-certainty evidence). Study-level data indicated that 5% NaF varnish was the most effective for arresting or reversing noncavitated facial/lingual carious lesions (low certainty) and that 38% silver diamine fluoride solution applied biannually was the most effective for arresting advanced cavitated carious lesions on any coronal surface (moderate to high certainty). Preventing the onset of caries is the ultimate goal of a caries management plan. However, if the disease is present, there is a variety of effective interventions to treat carious lesions nonrestoratively.

Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective

“…Early detection of incipient caries is key to the prevention of cavitation. Besides the primary prevention approaches listed above, more frequent fluoride varnish applications, such as four times per year, and applying pit and fissure sealants to susceptible molars are effective non‐invasive measures to arrest caries progression . Glass ionomer cements used for dental sealants have several properties favourable for use in pre‐school children, such as fluoride release, chemical bonding to enamel and dentine, as well as reduced moisture sensitivity …”

Effect of self-assembling peptide P11-4 on orthodontic treatment-induced carious lesions

“…The WSL persist visually almost unchanged 12-14 . Other remineralisation agents, often based on calcium phosphate, have been investigated, but could not show clinically significant advantage over fluoride 10,11,[15][16][17] .As a consequence, new treatment approaches have been called for and biomimetic mineralisation seems to be one promising possibility [18][19][20][21][22] . However, the only clinically available products at present are based on the self-assembling peptide P 11 -4 (SAP P 11 -4) 21 .The mode of action for the treatment of initial caries with SAP P 11 -4 is as follows 23,24 .…”

“…As neither of the previous clinical trials investigated the effect of SAP P 11 -4 following orthodontic treatment, it can be assumed that the lesions investigated in those clinical trials were mostly inactive [25][26][27] .Recently, the caries activity status of a lesion has become a new focus in cariology 28 . Orthodontic WSL are of particular interest for clinical investigations of caries in this respect, as they are assumed to be active until debonding of the brackets, whereupon they become inactive 4,8 and good accessible for several measurement methods 16,29 .Therefore, the present split-mouth study investigated the effect of SAP P 11 -4 in addition to the conventional treatment of early carious lesions after debonding of orthodontic brackets. The primary endpoint was the impedance measurement [29][30][31] .…”

“…The WSL persist visually almost unchanged 12-14 . Other remineralisation agents, often based on calcium phosphate, have been investigated, but could not show clinically significant advantage over fluoride 10,11,[15][16][17] .…”

“…Recently, the caries activity status of a lesion has become a new focus in cariology 28 . Orthodontic WSL are of particular interest for clinical investigations of caries in this respect, as they are assumed to be active until debonding of the brackets, whereupon they become inactive 4,8 and good accessible for several measurement methods 16,29 .…”