Treating pit-and-fissure caries: a systematic review and network meta-analysis.

Area of Science:

• Dentistry
• Cariology
• Evidence-based dentistry

Background:

• Pit-and-fissure lesions are common dental caries.
• Treatment options range from noninvasive to minimally invasive approaches.
• Comparing the efficacy of these strategies is crucial for clinical decision-making.

Purpose of the Study:

• To systematically review and compare noninvasive, microinvasive, and minimally invasive treatments for pit-and-fissure lesions in permanent teeth.
• To evaluate the risk of requiring invasive treatments or retreatments for each strategy using network meta-analysis.

Main Methods:

• Systematic review and network meta-analysis of randomized and nonrandomized clinical trials.
• Inclusion of studies on shallow to moderately deep primary caries in pit-and-fissure surfaces.
• Comparison of treatment strategies against untreated lesions, calculating odds ratios and confidence intervals.

Main Results:

• Minimally invasive and microinvasive treatments significantly reduced the need for invasive retreatments compared to controls.
• Noninvasive treatments showed nonsignificant results for reducing invasive retreatments.
• Network meta-analysis ranked minimally invasive first, microinvasive second, and noninvasive third, though microinvasive had more total retreatments.

Conclusions:

• Minimally invasive and microinvasive strategies appear effective in reducing subsequent invasive treatments for pit-and-fissure lesions.
• Consideration of long-term sequelae, costs, and patient impact is essential for treatment decisions.
• Further high-quality research is needed to draw definitive conclusions due to low evidence certainty.