Sealing or infiltrating proximal carious lesions

Area of Science:

• Dental caries management
• Minimally invasive dentistry

Background:

• Early non-cavitated proximal carious lesions require effective management strategies.
• Micro-invasive treatments (sealing, infiltration) show promise but require robust evidence comparison.
• Uncertainty exists regarding the comparative efficacy of sealing versus infiltration.

Purpose of the Study:

• To systematically review and synthesize evidence on the efficacy of micro-invasive treatments for proximal caries.
• To compare sealing and infiltration techniques against each other and non-invasive methods.
• To assess the robustness of the evidence using network meta-analysis and trial sequential analysis.

Main Methods:

• Systematic search of Medline, Embase, and Cochrane Central databases, supplemented by hand searches.
• Inclusion of randomized controlled trials comparing micro-invasive strategies, non-invasive methods, or placebo.
• Primary outcome: radiographically assessed lesion progression; analysis via pairwise and Bayesian network meta-analysis (NMA) and trial sequential analysis (TSA).

Main Results:

• Thirteen studies (486 participants) with a mean follow-up of 25 months were analyzed.
• Firm evidence confirms superior efficacy of sealing/infiltration over non-invasive treatment (NI).
• Infiltration (SUCRA 0.90) was ranked highest, followed by sealing (SUCRA 0.60), and NI (SUCRA 0.00) in NMA; no significant difference between sealing and infiltration was found in one direct comparison.

Conclusions:

• Micro-invasive treatments, specifically sealing and infiltration, are more efficacious in arresting early proximal carious lesions than non-invasive approaches.
• Clinical decisions between sealing and infiltration should consider practical factors beyond comparative efficacy.
• The findings support the use of micro-invasive techniques for managing early-stage dental caries.