Sealing Distal Proximal Caries Lesions in First Primary Molars: Efficacy after 2.5 Years

Abstract

Background: The prevalence of proximal caries in primary molar teeth is high in many countries. Aims: (1) To study by means of a split-mouth design the 1- and 2.5-year efficacy of sealing proximal lesions vs. flossing instructions (control) on primary molar teeth. (2) To assess children’s behaviour and pain perception during the procedure. Methods: Ninety-one 4- to 6-year-old children from Bogotá, Colombia participated. Participants had to have at least two proximal lesions scored according to the following radiographic classification system: radiolucency (1) in enamel outer half, (2) restricted to enamel-dentine junction, or (3) restricted to dentine outer third. Baseline, 1- and 2.5-year follow-up bitewing radiographs were taken. Test and control lesions were randomly selected. After temporary separation test lesions were sealed (adhesive). Parents/caregivers received a flossing leaflet for their children. Progression of the lesions was assessed by means of independent reading of conventional bitewing radiographs. Results: One-year (n = 73) test vs. control lesion progression was 27.4 vs. 50.7%, respectively (p < 0.01, McNemar’s test), and 2.5-year (n = 56) test vs. control lesion progression was 46.4 vs. 71.4%, respectively (p < 0.01). The dropouts did not differ from those who remained in the study regarding relevant caries baseline data. More than 88% of the participants presented positive to definitively positive behaviour and very low or low pain intensity at both first and second appointments. Conclusion: The sealing technique was superior to flossing instructions both after 1 and 2.5 years of follow-up and the majority of the participants had no anxiety or pain during the treatment.

Tridimensional surface roughness analysis after resin infiltration of (deproteinized) natural subsurface carious lesions

“…Hence, lesion progression and cavitation by strengthening the remaining enamel structures should be hampered [1,3]; recent clinical studies corroborated this concept with dental adhesives [4][5][6][7] and revealed that the resin infiltrant's capability to stop the progress of early carious lesions ranged from some 70 % with deciduous molars after 1 year [8] and with young permanent teeth after 3 years [9] up to approximately 90 % of the cases after 1 [10,11] and after 3 years [12], respectively. A clear advantage of this therapeutic regimen is that no sealant margins are produced on the tooth surface [1][2][3].…”

Non‐surgical management methods of noncavitated carious lesions

“…Four trials evaluated sealants, while two studies evaluated resin infiltration. Sample sizes for the trials ranged from 22 subjects to 91 and were conducted between 12 months and 3 years (loss to follow‐up ranged from 0% to 38%).…”

“…All the studies except two (33,34) reported overall significant differences between test and control groups at follow-up. In particular, Martignon et al (36) reported that the percent of caries progression among approximal surfaces that were sealed was lower than those assigned to a homebased flossing control after 12 months (test: 27%, control: 51%) and 2.5 years (test: 46%, control: 71%). A second study conducted by the same author in 2012 (37) that evaluated infiltration and sealants versus placebo found significant differences between infiltration versus placebo (lesion progression 32% versus 70%, respectively, Pvalue: 0.001) and sealants versus placebo (41% versus 70%, P-value: 0.029) but no statistical difference between sealants and infiltration after a 3year period.…”

Study of the effect of a filled fluoride releasing enamel sealant versus fluoride varnish on initially demineralized enamel

“…Therefore, a protective sealant that completely covers an existing lesion would only inhibit further demineralization and does not have any remineralization effect. In vivo studies using non-filled resins 11,13,14 showed regression of some of the lesions after sealant application. Non-filled resins are unable to resist mechanical abrasion or chemical attack 20 .…”

“…Specimens treated with fluoride varnish showed less lesion depth compared to those treated with enamel sealant. Martignon et al 13 in their split-mouth design study on primary molar teeth showed that sealing initial carious lesions effectively arrested carious lesions both after 1 year and 2.5 years of follow-up compared to the controls, comparing baseline radiographs to follow-up ones at 1 year and 2.5 years periods. Paris, Hopfenmuller and Meyer-Lueckel 14 found that 37% of the initially demineralized enamel lesions progressed in the control group, versus only 7% of the resin sealed enamel lesions after 18 months follow-up.…”