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

Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic review and meta-analysis

BACKGROUND

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.

METHODOLOGY

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.

RESULTS

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.

CONCLUSION

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.

Resin infiltrant with antibacterial activity: effects of incorporation of DMAHDM monomer and NACP on physical and antimicrobial properties

OBJECTIVES

Considering the fact that resin infiltrants lack antibacterial activity, this study assessed the influence of the quaternary ammonium monomer dimethylaminohexadecyl methacrylate (DMAHDM) and amorphous calcium phosphate nanoparticles (NACP) on the physical and antibacterial properties of an experimental resin infiltrant (ERI).

METHODOLOGY

The following groups were established: ERI (75/25 wt.% TEGDMA/BISEMA), ERI + 2.5% DMAHDM (2.5DM), ERI + 5% DMAHDM (5DM), ERI + 2% NACP (NACP), ERI + 2.5% DMAHDM + 2% NACP (2.5DM_NACP), ERI + 5% DMAHDM + 2% NACP (5DM_NACP), and Icon® (IC), a commercial resin infiltrant. Degree of conversion (DC; n=4), sorption and solubility (SO/SOL; n=8), and contact angle (CA; n=10) tests were conducted. Biofilm biomass (BB; n=6) and bacterial metabolism (BM; n=8) were evaluated after Streptococcus mutans (UA159) cultivation for 48 h on material samples. Data were evaluated by one-way ANOVA and Tukey or Games-Howell post hoc tests (α=0.05).

RESULTS

IC exhibited the highest DC, with no difference from 2.5DM and 5DM. IC showed the lowest CA. IC had the lowest SO, followed by ERI, which had the lowest SOL, with no difference from IC. 5DM_NACP showed the lowest biofilm biomass, similar to 2.5DM and 5DM. Resin infiltrants containing DMAHDM showed reduced bacterial metabolism.

CONCLUSIONS

DMAHDM, with or without NACP, demonstrated significant antibacterial activity, while NACP impaired DC. Both DMAHDM and NACP increased the contact angle, sorption, and solubility of the resin infiltrant, which may affect the material's clinical performance.

Long-Term Outcomes of Conservative versus Surgical Management of Dental Caries

Introduction

The management of dental caries presents challenges for oral health professionals, with options including conservative and surgical interventions. However, debate persists regarding the long-term efficacy of these strategies.

Methods

This retrospective cohort research involved 500 subjects diagnosed with dental caries at the University Dental Clinic between January 1, 2018, and December 31, 2020. Data on demographics, dental history, treatments, and follow-up were collected from patient records. Subjects were categorized into conservative and surgical groups based on treatment received. Outcome measures included tooth survival, caries recurrence, and patient satisfaction.

Results

The research included 300 subjects, with 60% under conservative management and 40% under surgical management. Demographics were comparable between groups, and both groups showed similar outcomes in tooth survival, caries recurrence, and patient satisfaction. Statistical analysis revealed no significant differences in these outcomes between groups.

Conclusion

Conservative and surgical management approaches demonstrate comparable long-term outcomes in treating dental caries, emphasizing the importance of personalized treatment decisions. Further research with larger samples and prospective designs is needed to validate these findings and guide evidence-based practice in dental caries management.

Equivalence study of the resin-dentine interface of internal tunnel restorations when using an enamel infiltrant resin with ethanol-wet dentine bonding

This preregistered ex vivo investigation examined the dentinal hybrid layer formation of a resinous infiltrant (Icon), with reference to both thickness (HLT) and homogeneity when combined with modified tunnel preparation (occlusal cavity only) and internal/external caries infiltration. The adhesives Syntac and Scotchbond MP were used as controls (Groups 1 and 3) or in combination with Icon (Groups 2 and 4). A split-tooth design using healthy third molars from 20 donors resulted in 20 prepared dentine cavities per experimental group. The cavity surfaces (n = 80) were etched (37% H3PO4), rinsed, and air-dried. Rewetting with ethanol was followed by application of the respective primers. After labeling with fluorescent dyes, either Syntac Adhesive/Heliobond or Scotchbond MP Adhesive was used alone or supplemented with Icon. HLT, as evaluated by scanning electron microscopy, did not significantly differ (P > 0.05), and confocal laser scanning microscopy revealed homogeneously mixed/polymerized resin-dentine interdiffusion zones in all groups. Icon can be successfully integrated into an ethanol-wet dentine bonding strategy, and will result in compact and homogeneous hybrid layers of comparable thickness considered equivalent to the non-Icon controls, thus allowing for preservation of the tooth's marginal ridge and interdental space in the case of internal/external infiltration of proximal caries.

Resin Infiltration of Non-Cavitated Proximal Caries Lesions in Primary and Permanent Teeth: A Systematic Review and Scenario Analysis of Randomized Controlled Trials

The present study aimed to meta-analyze and evaluate the certainty of evidence for resin infiltration of proximal carious lesions in primary and permanent teeth. While resin infiltration has been shown efficacious for caries management, the certainty of evidence remains unclear. The protocol was registered with PROSPERO (CRD42018080895), and PRISMA guidelines have been followed. The databases PubMed, Embase, and Cochrane CENTRAL were systematically screened, complemented by hand searches and cross-referencing. Eleven relevant articles were identified and included, i.e., randomized controlled trials (RCTs) comparing the progression of resin infiltrated proximal caries lesions (combined with non-invasive measures) in primary or permanent teeth with non-invasive measures. Random-effects meta-analyses and trial sequential analyses (TSA) were performed for per-protocol (PP), intention-to-treat (ITT), and best/worst case (BC/WC) scenarios. Six included trials assessed lesions in permanent teeth and five trails assessed lesions in primary teeth. The trials had a high or unclear risk of bias. Risk of caries progression was significantly reduced for infiltrated lesions in the PP, ITT, and BC scenarios in both permanent teeth and primary teeth, but not in the WC scenario. According to the TSA, firm evidence was reached for all of the scenarios except the WC. In conclusion, there is firm evidence for resin infiltration arresting proximal caries lesions in permanent and primary teeth.

Dental Caries and Its Management

Objectives

In recent years, the management of dental caries has evolved significantly. Caries prevention, early detection, and a diagnosis based on risk indicators and risk factor assessments are the most current practical approaches. Furthermore, as proposed in minimally invasive dentistry, the new management approaches preserve healthy tissue and maintain pulp vitality. This article overviews the latest minimally invasive dental caries management and treatment options. The information will assist the reader in the early detection, diagnosis, and treatment of dental caries.

Materials and Methods

The PubMed (MEDLINE) search engine was used to gather the most relevant information on dental caries. The search was restricted to five years (May 30, 2018-May 29, 2022), and only English-language studies were accessed. A Boolean search of the PubMed data set was implemented to combine a range of keywords. The following filters were applied: abstract, free full text, full text, clinical trial, randomised control trial, systematic review, meta-analysis, and review. More studies were also obtained by manual searches from Google Scholar and textbooks on dental caries.

Results

By using this process, 683 articles and studies were obtained. The most relevant published studies were chosen and used in the current review. The selected articles are included in the references list. However, the search extended to cover the last five years as our understanding and management of dental caries have changed significantly.

Conclusions

Early detection and diagnosis of caries based on risk indicators and risk factor assessments are effective. Furthermore, minimally invasive restorative techniques are beneficial in managing dental caries and preserving healthy tissue and should be used whenever possible. This new information, knowledge, and materials should encourage professionals to implement this method. Having a strategy and system based on patient-centred care is critical, and our dental responsibilities must prioritise patient-centred care.

A concise review of dental sealants in caries management

This concise review provides an update of the use of dental sealants. Dental sealants protect a tooth from caries development by providing a physical barrier to microorganism colonisation and creating a favorable environment for patients to clean. Some sealants release fluoride ions to promote remineralization. Dental sealants can be applied on pits and fissures of primary and permanent teeth to prevent and arrest early enamel caries. They are effective in caries prevention. The preventive fraction of resin sealant is up to 61% after 5 years. Dental sealants can be classified as resin, glass ionomer and hybrid (compomer or giomer) according to the material. Recent studies from 2012 to 2022 showed resin sealant has a high retention rate of up to 80% after 2 years, whereas glass ionomer sealants is 44%. Chemical etching with 37% phosphoric acid is the standard of care, whereas laser or air-abrasion cannot does not increase the sealant retention rate. Moist control is critical and studies found the use of rubber dam and cotton rolls had similar success for sealant retention. The longevity of dental sealant is also associated with clinical operative factors, including approaches of moisture control, enamel pretreatment, selection of dental adhesive, and time of acid etching.

A 5-year clinical follow-up of the efficacy of proximal sealing in high caries risk children

OBJECTIVE

The aim of the present study was to evaluate, after 5 years, the efficacy of proximal microinvasive sealing of permanent teeth on the risk for caries lesion development.

METHODS

Children aged 8 to 10 y at baseline, at high caries risk, were studied. In the preventive (P) group the children had caries lesions on the distal surface of primary second molars (05d) but sound mesial surfaces of the approximating permanent first molars (6m). In the therapeutic (T) group the children had initial caries lesions on 6m that abutted lesions on 05d. Each child in the two groups had one 05d/6m pair. Using a split-mouth design, one 6m surface in each pair was randomly assigned to receive sealing while the other pair served as an unsealed control.

RESULTS

Of the 61 children at baseline 42 could be blindly examined clinically and radiographically both at baseline and after 5 years. In the P group, 8 of 28 (28.6%) sealed and 15 of 28 (53.6 %) unsealed sound 6m surfaces had developed caries lesions (p = 0.04). In the T group, the progression of the carious lesions on 6m was observed in 4 of 14 sealed (28.6%) and 8 of 14 (57.1%) unsealed caries control surfaces (p = 0.29). Pooling the data from the two groups, the difference between sealed and non-sealed surfaces was significant (p = 0.013).

CONCLUSION

Both preventive and therapeutic sealant to 6m adjacent to a lesion on 05d has effectiveness in caries reduction in high caries risk children CLINICAL SIGNIFICANCE: The beneficial effect of sealing is observed for at least 5 years after a single sealant treatment.

EFFECTIVENESS OF RESIN INFILTRATION IN CARIES INHIBITION AND AESTHETIC APPEARANCE IMPROVEMENT OF WHITE-SPOT LESIONS: AN UMBRELLA REVIEW

OBJECTIVES

Resin infiltration technique is a minimal interventive approach to manage white-spot lesions. The present umbrella review aimed to comprehensively appraise the previously published systematic reviews on the effectiveness of resin infiltration in arresting caries progression and improving the aesthetic appearance of white-spot lesions.

MATERIAL AND METHODS

Ten electronic databases were searched between January 1960 and May 2021. Only systematic reviews published in English on the use of resin infiltration in primary or permanent teeth were included. The degree of overlap across each review was calculated using the Corrected Covered Areas method and their evidence quality were assessed using A MeaSurement Tool to Assess systematic Reviews 2 assessment tool. Umbrella meta-analysis was carried out using a random-effects model.

RESULTS

Thirteen systematic reviews were chosen, but only eight were eligible for an umbrella meta-analysis. The overall Corrected Covered Areas value was very high (19.8%), whereas only three studies were classified as 'High Quality'. Qualitative synthesis suggested that resin infiltration demonstrated acceptable aesthetic results, whereas quantitative analysis showed favourable outcomes in minimizing the risk of caries progression (RR: 0.32; 95% CI: 0.29-0.36). White-spot lesions treated with resin infiltrant in permanent teeth demonstrated a lower risk of caries progression (P < .001) than primary teeth. Overall, low data heterogeneity was observed (I2: 0%-20%). However, quantitative umbrella analysis on the aesthetic outcome was unable to perform due to limited data.

CONCLUSION

Resin infiltration can be regarded as an effective treatment modality in minimizing the risk of caries progression and improving the aesthetic appearance of white-spot lesions. Future well-designed high-quality systematic reviews with long-term follow-up and more control of confounding variables are warranted.

Detecting Proximal Caries on Periapical Radiographs Using Convolutional Neural Networks with Different Training Strategies on Small Datasets

The present study aimed to evaluate the performance of convolutional neural networks (CNNs) that were trained with small datasets using different strategies in the detection of proximal caries at different levels of severity on periapical radiographs. Small datasets containing 800 periapical radiographs were randomly categorized into a training and validation dataset (n = 600) and a test dataset (n = 200). A pretrained Cifar-10Net CNN was used in the present study. Different training strategies were used to train the CNN model independently; these strategies were defined as image recognition (IR), edge extraction (EE), and image segmentation (IS). Different metrics, such as sensitivity and area under the receiver operating characteristic curve (AUC), for the trained CNN and human observers were analysed to evaluate the performance in detecting proximal caries. IR, EE, and IS recognition modes and human eyes achieved AUCs of 0.805, 0.860, 0.549, and 0.767, respectively, with the EE recognition mode having the highest values (p all < 0.05). The EE recognition mode was significantly more sensitive in detecting both enamel and dentin caries than human eyes (p all < 0.05). The CNN trained with the EE strategy, the best performer in the present study, showed potential utility in detecting proximal caries on periapical radiographs when using small datasets.

Transcriptome analysis reveals the prognostic and immune infiltration characteristics of glycolysis and hypoxia in head and neck squamous cell carcinoma

BACKGROUND

This study aims to construct a new prognostic gene signature in survival prediction and risk stratification for patients with Head and neck squamous cell carcinoma (HNSCC).

METHOD

The transcriptome profiling data and hallmark gene sets in the Molecular Signatures Database was used to explore the cancer hallmarks most relevant to the prognosis of HNSCC patients. Differential gene expression analysis, weighted gene co-expression network analysis, univariate COX regression analysis, random forest algorithm and multiple combinatorial screening were used to construct the prognostic gene signature. The predictive ability of gene signature was verified in the TCGA HNSCC cohort as the training set and the GEO HNSCC cohorts (GSE41613 and GSE42743) as the validation sets, respectively. Moreover, the correlations between risk scores and immune infiltration patterns, as well as risk scores and genomic changes were explored.

RESULTS

A total of 3391 differentially expressed genes in HNSCC were screened. Glycolysis and hypoxia were screened as the main risk factors for OS in HNSCC. Using univariate Cox analysis, 97 prognostic candidates were identified (P < 0.05). Top 10 important genes were then screened out by random forest. Using multiple combinatorial screening, a combination with less genes and more significant P value was used to construct the prognostic gene signature (RNF144A, STC1, P4HA1, FMNL3, ANO1, BASP1, MME, PLEKHG2 and DKK1). Kaplan-Meier analysis showed that patients with higher risk scores had worse overall survival (p < 0.001). The ROC curve showed that the risk score had a good predictive efficiency (AUC > 0.66). Subsequently, the predictive ability of the risk score was verified in the validation sets. Moreover, the two-factor survival analysis combining the cancer hallmarks and risk scores suggested that HNSCC patients with the high hypoxia or glycolysis & high risk-score showed the worst prognosis. Besides, a nomogram based on the nine-gene signature was established for clinical practice. Furthermore, the risk score was significantly related to tumor immune infiltration profiles and genome changes.

CONCLUSION

This nine-gene signature associated with glycolysis and hypoxia can not only be used for prognosis prediction and risk stratification, but also may be a potential therapeutic target for patients with HNSCC.

Minimally Invasive Therapies for the Management of Dental Caries—A Literature Review

In recent years, due to a better understanding of the caries pathology and advances in dental materials, the utilization of non-invasive and minimally invasive techniques that delay/obviate the need for traditional restorations has started gaining momentum. This literature review focuses on some of these approaches, including fluoride varnish, silver diamine fluoride, resin sealants, resin infiltration, chemomechanical caries removal and atraumatic restorative treatment, in the context of their chemistries, indications for use, clinical efficacy, factors determining efficacy and limitations. Additionally, we discuss strategies currently being explored to enhance the antimicrobial properties of these treatment modalities to expand the scope of their application.

Assessment of the Potential Ability to Penetrate into the Hard Tissues of the Root of an Experimental Preparation with the Characteristics of a Dental Infiltratant, Enriched with an Antimicrobial Component-Preliminary Study

Infiltration is a method of penetration with a low viscosity resin that penetrates deep into demineralised tooth tissue and fills the intergranular spaces, hence reducing porosity. Carious lesions initially located at the enamel–cement junction are usually found in elderly patients. Those spots are predisposed to bacterial adhesion originating both from biofilm and from gingival pocket bacteria. The aim of this study was to evaluate the penetration of an experimental preparation, which has the characteristics of a dental infiltrant, enriched with an antibacterial component, into the decalcified root cement tissues of extracted human teeth in elderly patients. An experimental preparation with the characteristics of a dental infiltrant was prepared, applied, and polymerised on the surface of extracted, previously decalcified human teeth. The control sample was Icon (DMG, Hamburg, Germany). The ability of the preparations to penetrate deep into the root cement was evaluated using scanning electron and light microscopy. The study showed that an experimental preparation could potentially be used for treatment of early carious lesions within the tooth root in elderly patients, among others, as it penetrates deep into demineralised tissues. More research is needed.

Proximal caries infiltration - Pragmatic RCT with 4 years of follow-up

OBJECTIVES

Efficacy of proximal caries infiltration to arrest lesion progression has been shown in university settings, but only once in a practice-based pragmatic design with a follow-up of 18 months. The aim of this randomized split-mouth placebo-controlled study was to follow-up this cohort for 3 years and those with high caries risk for 4 years.

METHODS

Originally, in 87 children and young adults pairs of 238 proximal caries lesions, radiographically extending into inner half of enamel (E2) or outer third of dentin (D1), were randomly allocated to two groups: infiltration (Icon; DMG) or mock (control) treatment by five dentists in four private practices. All subjects received risk-related instructions for diet, flossing and fluoridation. The primary outcome was radiographic lesion progression (pairwise comparison) evaluated by two evaluators independently being blinded to treatment allocation.

RESULTS

After 36 months [mean (SD): 1152 (166) days] 165 lesion pairs in 64 patients as well as after 48 months [mean (SD): 1496 (121) days] 71 lesion pairs in 20 high caries risk patients could be re-evaluated clinically as well as radiographically using individualized bitewing holders as at baseline. No adverse events could be observed. After 36 months, progression was recorded in 23/165 test (14%) and 64/165 control lesions (39%) [McNemar/Obuchowski test; p<0.001; relative risk reduction (CI95%): 64 (45-77%)]. After 48 months lesion progression was recorded in 13/71 test (18%) and 34/71 control lesions (48%) [p = 0.003; relative risk reduction (CI95%): 62 (34-78%)] of high caries risk patients.

CONCLUSIONS

It can be concluded that also in a practice-setting proximal caries infiltration is more efficacious in reducing lesion progression compared with individualized non-invasive measures alone over a period of four years.