Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic...

Dental caries is one of the most common non-communicable diseases in humans. Various interventions are available for the management, of which microinvasive techniques such as infiltration, sealants, glass ionomers, are novel and convenient. The purpose of this systematic review and meta-analysis was to compare microinvasive techniques with noninvasive or invasive treatment modalities in terms of effectiveness in halting interproximal caries lesion progression radiographically assessed.

The review was registered on PROSPERO (CRD42024557636). Three electronic databases, PubMed, Google Scholar and Cochrane Oral Health Group Trial Register, were searched for the randomized controlled trials comparing any of the microinvasive techniques with either non- invasive or invasive treatments for non-cavitated proximal lesions both in primary and permanent teeth. The radiographic lesion progression was set as primary outcome. Rayyan and EndNote X9 were used for screening and full text review respectively. The risk of bias was assessed using Cochrane Risk of Bias tool. We performed analysis with the help of RevMan5.4 and calculated odds ratio and 95% confidence interval for evaluation of efficacy. The quality of evidence was assessed with the help of GRADEpro.

A total of 185 studies were recruited after initial search, of which 18 were recruited after screening. Finally, 13 studies were included, and all were split mouth randomized controlled trials comparing various microinvasive techniques with non-invasive techniques. Five of the included trials studied primary teeth in children ranging from 3 to 9 years and seven trials assessed permanent teeth in children and adults ranging from 11 to 45 years while one trial included children having lesions on both primary and permanent teeth. The risk of bias assessment showed that 2 of the included studies had unclear risk of bias whereas 11 were at low risk of bias. Tau², I², and Chi-Square tests (0.04, 10% and 7.50 respectively) showed minimum level of heterogeneity. The overall odds ratio (95% confidence interval) of 0.29 (95% CI 0.19-0.38) showed that microinvasive techniques were superior as compared to noninvasive techniques for the management of proximal lesions. The subgroup analysis was also performed for types of dentitions, various microinvasive interventions and levels of caries depth. All showed improved outcomes in case of microinvasive interventions as compared to noninvasive techniques. The publication bias was assessed using forest plot and there was no significant publication bias. The quality of evidence assessed by GRADEpro came out to be moderate.

This review concludes that microinvasive techniques are superior to noninvasive interventions for the treatment of non-cavitated proximal lesions in both primary and permanent dentition. However, cost effectiveness, feasibility, durability, and long-term effects of microinvasive techniques need to be explored further.