Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth

Mojtaba Dorri; Stephen M Dunne; Tanya Walsh; Falk Schwendicke

doi:10.1002/14651858.CD010431.pub2

Intervensi mikro‐invasif untuk mengendali kerosakan proksimal gigi primer dan kekal.

Appendices

Appendix 1. MEDLINE (OVID) search strategy

1. "Pit and Fissure Sealants"/
2. (fissure$ adj6 seal$).mp.
3. ((approximal adj6 seal$) or (proximal adj6 seal$)).mp.
4. (dental adj3 sealant$).mp.
5. ((resin$ adj4 sealant$) or (resin$ adj4 infiltrat$)).mp.
6. (compomer$ adj4 sealant$).mp.
7. (composite$ adj4 sealant$).mp.
8. "polyurethane tape$".mp.
9. exp Glass Ionomer Cements/
10. exp Resins, Synthetic/
11. ("glass ionomer$" or glassionomer$).mp.
12. 9 or 10 or 11
13. sealant$.mp.
14. 12 and 13
15. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 14

The above subject search was linked to the Cochrane Highly Sensitive Search Strategy (CHSSS) for identifying randomized trials in MEDLINE: sensitivity maximising version (2008 revision) as referenced in Chapter 6.4.11.1 and detailed in box 6.4.c of The Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0 [updated March 2011] (Higgins 2011).

1. randomized controlled trial.pt.
2. controlled clinical trial.pt.
3. randomized.ab.
4. placebo.ab.
5. drug therapy.fs.
6. randomly.ab.
7. trial.ab.
8. groups.ab.
9. or/1‐8
10. exp animals/ not humans.sh.
11. 9 not 10

Appendix 2. The Cochrane Oral Health Group Trials Registry search strategy

#1 ((fissure and sealant):ti,ab) AND (INREGISTER)
#2 (((approximal adj6 seal*) or (proximal and seal*)):ti,ab) AND (INREGISTER)
#3 ((dental and sealant*):ti,ab) AND (INREGISTER)
#4 (((resin* and sealant*) or (resin* and infiltrat*)):ti,ab) AND (INREGISTER)
#5 ((compomer* and sealant*):ti,ab) AND (INREGISTER)
#6 ((composite* and sealant*):ti,ab) AND (INREGISTER)
#7 ("polyurethane tape*":ti,ab) AND (INREGISTER)
#8 ((("glass ionomer*" or glassionomer*) and sealant*):ti,ab) AND (INREGISTER)
#9 (#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8) AND (INREGISTER)

Appendix 3. The Cochrane Central Register of Controlled Trials (CENTRAL) search strategy

#1 [mh ^"Pit and Fissure Sealants"]
#2 (fissure* near/6 seal*)
#3 ((approximal near/6 seal*) or (proximal near/6 seal*))
#4 (dental near/3 sealant*)
#5 ((resin* near/4 sealant*) or (resin* near/4 infiltrat*))
#6 (compomer* near/4 sealant*)
#7 (composite* near/4 sealant*)
#8 "polyurethane tape*"
#9 [mh "Glass Ionomer Cements"]
#10 [mh "Synthetic resins"]
#11 ("glass ionomer*" or glassionomer*)
#12 #9 or #10 or #11
#13 sealant*
#14 #12 and #13
#15 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #14

Appendix 4. EMBASE (OVID) search strategy

1. "Fissure Sealant"/
2. (fissure$ adj6 seal$).mp.
3. ((approximal adj6 seal$) or (proximal adj6 seal$)).mp.
4. (dental adj3 sealant$).mp.
5. ((resin$ adj4 sealant$) or (resin$ adj4 infiltrat$)).mp.
6. (compomer$ adj4 sealant$).mp.
7. (composite$ adj4 sealant$).mp.
8. "polyurethane tape$".mp.
9. "Glass Ionomer"/
10. Resin/
11. ("glass ionomer$" or glassionomer$).mp.
12. 9 or 10 or 11
13. sealant$.mp.
14. 12 and 13
15. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 14

The above subject search was linked to the Cochrane Oral Health Group filter for identifying RCTs in EMBASE via OVID:

1. random$.ti,ab.
2. factorial$.ti,ab.
3. (crossover$ or cross over$ or cross‐over$).ti,ab.
4. placebo$.ti,ab.
5. (doubl$ adj blind$).ti,ab.
6. (singl$ adj blind$).ti,ab.
7. assign$.ti,ab.
8. allocat$.ti,ab.
9. volunteer$.ti,ab.
10. CROSSOVER PROCEDURE.sh.
11. DOUBLE‐BLIND PROCEDURE.sh.
12. RANDOMIZED CONTROLLED TRIAL.sh.
13. SINGLE BLIND PROCEDURE.sh.
14. or/1‐13
15. ANIMAL/ or NONHUMAN/ or ANIMAL EXPERIMENT/
16. HUMAN/
17. 16 and 15
18. 15 not 17
19. 14 not 18

Appendix 5. LILACS via Bireme Virtual Health Library search strategy

("Mh Pit and Fissure sealants" or sealant$ or selladore$ or selante$) [Words] and (approxima$ or proxima$)

Appendix 6. Web of Science Conference Proceedings search strategy

# 9 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8
# 8 TS=(("glass ionomer*" or glassionomer*) and sealant*)
# 7 TS="polyurethane tape*"
# 6 TS=(composite* and sealant*)
# 5 TS=(compomer* and sealant*)
# 4 TS=((resin* and sealant*) or (resin* and infiltrat*))
# 3 TS=(dental and sealant*)
# 2 TS=((approximal and seal*) or (proximal and seal*))
# 1 TS=(fissure* and seal*)

Appendix 7. Zetoc Conference Proceedings search strategy

approximal AND seal*
proximal AND seal*

Appendix 8. Proquest Dissertations and Theses search strategy

all(dental OR tooth OR teeth) AND all((approximate OR proximal)) AND all(seal*)

Appendix 9. Open Grey search strategy

proximal AND seal
proximal AND sealant
proximal AND sealing
approximal AND seal
approximal AND sealant
approximal AND sealing

Appendix 10. Trials Registry Search Strategies

The following search strategy was used for the metaRegister of Controlled Trials, the US National Institutes of Health Trials Register (ClinicalTrials.gov) and the WHO International Clinical Trials Registry Platform:

dental AND proximal AND seal
dental AND proximal AND sealant
dental AND proximal AND sealing
dental AND approximal AND seal
dental AND approximal AND sealant
dental AND approximal AND sealing

Figure 1

Study flow diagram

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Figure 4

Forest plot of comparison: 1 Proximal sealing versus control/placebo, outcome: 1.1 Caries progression follow‐up 12 to 36 months ‐ DSR>Pairwise>Scoring

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Figure 5

Forest plot of comparison: 1 Proximal sealing versus control/placebo, outcome: 1.2 Caries progression follow‐up 12 to 30 months ‐ Scoring

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Figure 6

Forest plot of comparison: 1 Proximal sealing versus control/placebo, outcome: 1.2 Pairwise

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Figure 7

Forest plot of comparison: 1 Proximal sealing versus control/placebo, outcome: 1.4 Caries progression follow‐up 12 to 18 months ‐ Digital Substraction Radiography.

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Analysis 1.1

Comparison 1 Proximal sealing versus control/placebo, Outcome 1 Caries progression follow‐up 12 to 36 months ‐ DSR>Pairwise>Scoring.

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Analysis 1.2

Comparison 1 Proximal sealing versus control/placebo, Outcome 2 Caries progression follow‐up 12 to 30 months ‐ Scoring.

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Analysis 1.3

Comparison 1 Proximal sealing versus control/placebo, Outcome 3 Caries progression follow‐up 18 to 36 months ‐ Pairwise.

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Analysis 1.4

Comparison 1 Proximal sealing versus control/placebo, Outcome 4 Caries progression follow‐up 12 to 18 months ‐ Digital Substraction Radiography.

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Summary of findings for the main comparison. Micro‐invasive versus non‐invasive treatments for managing dental decay in primary and permanent teeth

Micro‐invasive versus non‐invasive treatments for managing dental decay in primary and permanent teeth
Patient or population: people with dental decay on proximal surfaces of primary and permanent teeth Settings: secondary care setting Intervention: different micro‐invasive methods (e.g. resin infiltration, resin sealant, sealant patch and glass ionomer) Comparison: non‐invasive treatments (e.g. fluoride varnish, advice to floss) Radiographic follow‐up period: 6 months to 3 years
Outcomes	*Anticipated absolute effects^ (95% CI)**		Odds Ratio (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with control	Risk with Sealing
Caries progression measured by DSR > pairwise > visual scoring (12 months to 36 months follow‐up)	Study population		OR 0.24 (0.14 to 0.41)	602 (7 RCTs)	⊕⊕⊕⊝ Moderate^a,b,c	The quality of evidence for caries progression measured by scoring (12 to 30 months), including 468 participants (5 RCTs), OR 0.27 (95% CI 0.17 to 0.44), was moderate^a,b,c. The quality of evidence for caries progression measured by pairwise (18 to 36 months), including 330 participants (4 RCTs), OR 0.31 (95% CI 0.18 to 0.53), was moderate^a,b,c. The quality of evidence for caries progression measured by digital substraction radiography (12 months to 18 months), including 270 participants (3 RCTs), OR 0.18 (95% CI 0.06 to 0.50), was moderate^a,b,c.
	547 per 1000	284 per 1000 (230 to 361)
	Moderate
	649 per 1000	337 per 1000 (272 to 428)
Change in decayed, missing and filled (DMF/dmf) figures at surface, tooth and whole mouth level.	—	—	—	—	—	No studies reported on caries measured as change in decayed, missing and filled (DMF/dmf) figures at surface, tooth or whole mouth level
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; OR: odds ratio.
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
^aOne or more studies lacked sufficient blinding of participants, personnel or both. Downgraded one level. ^bLow number of events. Downgraded one level. ^cOR < 0.5. Upgraded one level.

Summary of findings for the main comparison. Micro‐invasive versus non‐invasive treatments for managing dental decay in primary and permanent teeth

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Comparison 1. Proximal sealing versus control/placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caries progression follow‐up 12 to 36 months ‐ DSR>Pairwise>Scoring Show forest plot	7	602	Odds Ratio (Random, 95% CI)	0.24 [0.14, 0.41]

1.1 Resin sealant versus control	3	330	Odds Ratio (Random, 95% CI)	0.26 [0.13, 0.53]
1.2 Resin infiltration versus control/placebo	2	130	Odds Ratio (Random, 95% CI)	0.15 [0.06, 0.39]
1.3 Glass ionomer sealant versus control	1	82	Odds Ratio (Random, 95% CI)	0.13 [0.01, 2.51]
1.4 Sealant patch versus control	1	60	Odds Ratio (Random, 95% CI)	1.0 [0.14, 7.22]
2 Caries progression follow‐up 12 to 30 months ‐ Scoring Show forest plot	5	468	Odds Ratio (Random, 95% CI)	0.27 [0.17, 0.44]

2.1 Resin sealant versus control	2	256	Odds Ratio (Random, 95% CI)	0.33 [0.18, 0.59]
2.2 Resin infiltration versus control/placebo	2	130	Odds Ratio (Random, 95% CI)	0.19 [0.08, 0.46]
2.3 Glass ionomer sealant versus control	1	82	Odds Ratio (Random, 95% CI)	0.13 [0.01, 2.52]
3 Caries progression follow‐up 18 to 36 months ‐ Pairwise Show forest plot	4	330	Odds Ratio (Random, 95% CI)	0.31 [0.18, 0.53]

3.1 Resin sealant versus control	2	218	Odds Ratio (Random, 95% CI)	0.31 [0.18, 0.54]
3.2 Resin infiltration versus placebo	1	52	Odds Ratio (Random, 95% CI)	0.08 [0.01, 0.63]
3.3 Sealant patch versus control	1	60	Odds Ratio (Random, 95% CI)	1.0 [0.14, 7.23]
4 Caries progression follow‐up 12 to 18 months ‐ Digital Substraction Radiography Show forest plot	3	270	Odds Ratio (Random, 95% CI)	0.18 [0.06, 0.50]

4.1 Resin sealant versus control	2	218	Odds Ratio (Random, 95% CI)	0.23 [0.07, 0.70]
4.2 Resin infiltration versus placebo	1	52	Odds Ratio (Random, 95% CI)	0.05 [0.01, 0.45]

Comparison 1. Proximal sealing versus control/placebo

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The Cochrane Library

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Intervensi mikro‐invasif untuk mengendali kerosakan proksimal gigi primer dan kekal.

Appendices

Appendix 1. MEDLINE (OVID) search strategy

Appendix 2. The Cochrane Oral Health Group Trials Registry search strategy

Appendix 3. The Cochrane Central Register of Controlled Trials (CENTRAL) search strategy

Appendix 4. EMBASE (OVID) search strategy

Appendix 5. LILACS via Bireme Virtual Health Library search strategy

Appendix 6. Web of Science Conference Proceedings search strategy

Appendix 7. Zetoc Conference Proceedings search strategy