Randomized controlled clinical trial of resin infiltration in primary molars: 2 years follow-up

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.

Durability of infiltrated resin application on white spot lesions after different challenges: An ex vivo study

STATEMENT OF PROBLEM

Infiltrated resin has been widely used as a minimally invasive approach to masking white spot lesions and reinforcing demineralized enamel. Recent evidence confirms its satisfactory effect in the short term, but studies focusing on its long-term performance are lacking.

PURPOSE

The purpose of this ex vivo study was to evaluate the durability of infiltrated resin on white spot lesions after pH cycling and long-term thermocycling, staining, and toothbrushing.

MATERIAL AND METHODS

Four axial surfaces of 25 extracted human molars were sectioned and fabricated as specimens. The enamel surface of each specimen was prepared in 3 areas: sound enamel, demineralized enamel (white spot lesions), and demineralized enamel treated by infiltrated resin. Then, 4 specimens of each molar were allocated to different challenges simulating a 10-year follow-up: pH cycling, thermocycling, staining, and toothbrushing. The surface roughness, microhardness, and CIELab color values were measured before and after different treatments. A scanning electron microscope (SEM) was used to observe representative specimens. Linear mixed models were used to evaluate the effect of different treatments on microhardness, roughness, and color differences (ΔE) (α=.05).

RESULTS

Resin infiltration reduced the surface roughness and increased the microhardness of demineralized lesions, (P<.001) but the values of sound enamel at baseline were not reached. The pH cycling led to the greatest roughness values (515.6 ±56.9 nm) on resin-infiltrated lesions, followed by thermocycling (450.7 ±64.7 nm), toothbrushing (291.2 ±43.5 nm), and staining (183.6 ±49.3 nm) (all P<.001). Only pH cycling significantly decreased the microhardness of resin-infiltrated lesions (81.6 ±14.8 HV 0.2) after progressive demineralization (P<.001). No clinically identified differences were found between resin-infiltrated white spot lesions and sound enamel (ΔE=3.4 ±2.0) at baseline. However, resin-infiltrated lesions demonstrated significantly greater discoloration after pH cycling (ΔE=8.0 ±4.5, P<.001), thermocycling (ΔE=5.4 ±2.0, P=.014), and staining treatments (ΔE=10.4 ±3.2, P<.001) than sound enamel.

CONCLUSIONS

Infiltrated resin application reduced surface roughness, improved microhardness, and masked white spot lesions immediately. However, it could not reestablish the characteristics of sound enamel completely and resist chemical and mechanical challenges over time.

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.

Nonrestorative Caries Treatment: A Systematic Review Update

Caries is the most prevalent chronic noncommunicable disease. Strategies to prevent its onset and early interventions to arrest the progression of early lesions have been emphasised throughout recent decades to avoid or delay the restorative spiral of the tooth. More individuals are retaining their natural teeth into old age, thereby necessitating ongoing restorative dentistry intervention for their maintenance. The aim of this systematic review was to update the state of the art regarding clinical studies reporting the effectiveness of different nonrestorative caries treatment options in the 5-year period from 2017 to 2022. Relevant articles were retrieved from 2 electronic databases, including randomised clinical trials (RCTs) published from January 2017 until April 2022, assessing effectiveness and secondary effects of at least one nonrestorative caries treatment option, carried out with adults and/or children with noncavitated or cavitated carious lesions on either primary or permanent teeth and diagnosed by radiographs or visual/tactile assessment. All 35 included articles presented the results of RCTs with a follow-up period ranging from 6 to 84 months. Most of these studies were considered high-quality articles with a low risk of bias. Sealants and fluoride gels and varnishes were mentioned in 12 studies as effective strategies to prevent the onset of caries lesions and to arrest them in the early stages. Resin infiltration reported high caries arresting rates in noncavitated proximal lesions in 10 publications. Silver diammine fluoride presented high caries-arresting rates in open dentin lesions, both in primary and permanent dentitions as well as in root caries lesions that were accessible for cleansing. New evidence has been published between 2017 and 2022 as the result of numerous clinical studies providing further evidence of the effectiveness of nonrestorative caries treatment options.

Evaluation of composite restorations in primary molars subjected to selective caries removal associated with antimicrobial photodynamic therapy: A randomized controlled trial

BACKGROUND

Antimicrobial photodynamic therapy (aPDT) has been used as an adjunct treatment of deep caries lesions; however, studies on the effects of aPDT on the longevity of restorations are still limited.

AIM

To evaluate the clinical performance of composite restorations in primary molars subjected to selective caries removal (SCR) associated with aPDT.

DESIGN

A randomized clinical trial was designed. Primary molars of patients (mean age 6.15 years) with deep caries lesions without signs and symptoms of pulpal involvement were selected. A total of 64 teeth were randomly divided into groups G1 (SCR, 32 teeth) and G2 (SCR + aPDT, 32 teeth) for treatment, restored with composite, and evaluated after a week (T₀ ), 6 months (T₁ ), and 12 months (T₂ ) according to the criteria of FDI. Groups were compared using the Rao-Scott chi-squared test and the logistic regression analysis for complex designs to account for multiple observations per subject (alpha = 0.05).

RESULTS

From all FDI criteria evaluated, the marginal adaptation for the SCR + aPDT group was significantly better in comparison with the SCR group at T0 and T2 in the logistic regression analysis (T0: OR = 0.151; 95% CI = 0.03-0.068, P = .015; and T2: OR = 0.201; 95% CI = 0.05-0.79, P = .022).

CONCLUSION

The marginal adaptation of primary molar resin restorations was positively affected by aPDT after 12 months of follow-up.

Nonrestorative treatment of initial caries lesion in primary teeth: a systematic review and network meta-analysis

OBJECTIVE

To identify the best available approach to avoid initial caries lesions progression in primary teeth.

MATERIALS AND METHODS

Search was performed in MEDLINE/Pubmed, Web of Science, Embase and CENTRAL databases until March 2021. Studies compared treatment options to avoid the initial caries lesion progression with at least 12 months of follow-up were included. Network meta-analyses were conducted considering the non-progression of caries lesions as an outcome.

RESULTS

Potentially eligible studies were screened (n = 2820) and eleven were included. Six studies evaluated the use of fluoride varnish, resin infiltration, sealing, and toothbrushing/flossing on proximal initial caries lesions. When considering occlusal surfaces, only two studies evaluating the ozone gas, fluoride varnish, resin infiltration, and sealants were included. For buccal/lingual surfaces, three studies evaluating toothbrushing, CPP-ACP paste, fluoride varnish, and resin infiltration were included. For all types of surfaces, the resin infiltration showed the best probability to avoid the progression of initial caries lesions.

CONCLUSION

The limited number of included studies, most with a high risk of bias and lack of hard outcomes, such as frank cavitation, makes it not feasible to recommend a specific management approach for initial caries lesion control in primary teeth with a high certainty of evidence. PROSPERO: #CRD42016037781.

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.

Management of dental caries lesions in Latin American and Caribbean countries

Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.

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

Background

Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels.

Methods

Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings.

Results

In total, 1033 citations were identified, and 17 RCTs (22 articles) were included. Infiltration and sealing reduced the odds of lesion progression (infiltration vs. non-invasive: OR = 0.21, 95% CI 0.15–0.30; sealing vs. placebo: OR = 0.27, 95% CI 0.18–0.42). For both the primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI 0.20–0.45; permanent dentition: OR = 0.20, 95% CI 0.14–0.28). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.20, 95% CI 0.14–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.17, 95% CI 0.10–0.29; and high risk: OR = 0.14, 95% CI 0.07–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), infiltration was superior (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.20, 95% CI 0.10–0.39; and high risk: OR = 0.14, 95% CI 0.05–0.37).

Conclusion

Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.

Monitoring the results of enamel demineralization treatment with the caries infiltration method (according to laser fluorescence value)

Relevance. In the actual dentistry a special place takes opportune diagnosis of early stages of dental caries and effective non-surgical treatment. In the recent times new approaches, technologies and methods for diagnosing focal demineralization of tooth enamel have been developed, among which the laser fluorescence method is widely used.

Purpose. To study the results of local enamel demineralization treatment with the caries infiltration method according to laser fluorescence value.

Materials and methods. The method of caries infiltration was applied in 99 permanent teeth with local enamel demineralization in 15 children aged 10-16 years. Laser fluorescence method was used for enamel demineralization assessment before and immediately after the treatment, after 6, 12 and 18 months. Three study groups were formed according to laser fluorescence value before the treatment: the first one – values 14-20 (initial enamel demineralization), the second one – values 21-29 (deep enamel demineralization), the third one – values ≥ 30 (enamel and dentine demineralization). Proportions (%), mean-values and standard errors (M±m) were calculated, significance (p) of differences was assessed according to Students’ criteria (t) at p < 0.05. 

Results. During 18 months after caries infiltration caries cavities forming were not revealed. The mean-values of laser fluorescence were in the first group before the treatment 17.38 ± 0.27, after the treatment 5.00±0.82, after 18 months – 4.82 ± 0.79; in the second group 25.42 ± 0.38, 15.25 ± 0.78 and 13.96 ± 0.75, in the third group 33.08 ± 0.69, 22.54 ± 1.39 and 20.77 ± 1.44 respectively. The differences between the values before and after the treatment were significant statistically (p < 0,001) in all groups. After 18 months the laser fluorescence values corresponding to healthy enamel were revealed in 94.1% cases in the first group, in 50.0% cases in the second group, and in 7.7% cases in the third group.

Conclusions. Local enamel demineralization treatment of permanent teeth in children with the caries infiltration method prevented caries cavity forming. Monitoring laser fluorescence values revealed that the results of the treatment with the caries infiltration method depended on the depth of dental hard tissue demineralization.