Efficacy of resin infiltrate in noncavitated proximal carious lesions: A systematic review and meta-analysis

Abstract

Objectives: Resin infiltration is a minimally invasive technique for treating noncavitated proximal caries. It slows/stops the carious lesion progression rate by creating a diffusion barrier inside the porous enamel lesion body. The aim was to evaluate the efficacy of resin infiltration on noncavitated proximal carious lesions in primary and permanent teeth. Materials and Methods: The records were obtained using electronic and other sources. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to ensure transparent reporting. Eligible studies were randomized controlled trials evaluating the efficacy of resin infiltration for noncavitated proximal carious lesions by comparing it with control/placebo. Each included study was assessed concerning the “risk of bias” using the Cochrane Collaboration's “risk-of-bias” assessment tool. High risk-of-bias studies were excluded from the meta-analyses due to selective reporting matters. The statistics were performed by RevMan software (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) utilizing the random effect model. The GRADE approach was implemented for assessing the quality of evidence. Results: From 106 studies identified, 17 were assessed for eligibility. After “risk-of-bias” assessment, two meta-analyses were conducted to eliminate the limitation of the significant heterogeneity between trials inspecting primary teeth ( n = 2) and permanent teeth ( n = 3). I 2 = 0% indicates the absence of statistical heterogeneity. The risk of carious lesions’ progression with resin infiltration was significantly lower in primary (risk ratio [RR]; 95% confidence interval [CI]: 0.48; 0.30–0.75, P = 0.001) and in permanent teeth (RR; 95% CI: 0.19; 0.11–0.33, P < 0.00001) compared to that of control/placebo. The GRADE approach revealed high quality of evidence. Conclusion: The available evidence conveys high confidence that proximal resin infiltration has superior efficacy in slowing/arresting the carious lesions’ progression rate in comparison to conventional management modalities.

Infiltration and sealing for managing non-cavitated proximal lesions: a systematic review and meta-analysis

“…The other reason was that most of the included studies were calculated with per-protocol analysis; however, some studies have argued that, in the split-mouth design, it is doubtful whether attrition will affect the overall risk of bias [ 13 , 27 ]. Thus to qualify the studies, when the drop-out rate was more than 25%, the missing data were regarded to have potential impacts on the results [ 13 , 31 ]. Finally, the lack of pre-registration of the this study would be of great risk since the same type of meta-analysis would be published repeatedly.…”

“…Researchers must answer signalling questions as follows: bias arising from the randomisation process, bias due to deviations from intended interventions, bias due to missing outcome data, bias measurement of the outcome, bias in selection of the reported result. In addition, drop-out rates less than 25% were regarded to have no substantial impacts of the failure based on previous studies [ 13 , 31 ]. Overall risk of bias judgement is shown: trials with at least 1 item regarded as high risk were identified as having a high risk of bias.…”

Infiltration and Sealing for Managing Non-Cavitated Proximal Lesions: A Systematic Review and Meta-Analysis

“…In terms of attrition bias, some studies have argued that in the split-mouth design, it is doubtful whether attrition would affect the overall risk of bias [23,26]. Thus, in this research, studies with drop-out rates less than 25% were regarded as having a low risk of bias [25,26].…”

“…The procedure of sealing involves the application of a resin sealant, polyurethane tape or adhesives after tooth separation [19][20][21][22][23]. Previous systematic reviews and meta-analyses have shown that micro-invasive treatments are more effective than non-invasive treatments [3,11,[24][25][26][27].…”

Recommended procedures for the management of early childhood caries lesions – a scoping review by the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE)

“…One cannot fail to mention, however, that for the resin infiltration, to our knowledge, just a single commercial product holds the patent so that this fact can restrict its use. When it was not available, professionals can use other approaches, such as fluoride toothpaste and dental floss, and/or fluoride varnish, although these conventional management are less effective, probably because they demand a high level of patient compliance [42]. The use of fluoride toothpaste has been recommended in a few documents [22,23,32], although it is easy to apply and is currently recommended as a prevention measure secondary to ECC.…”