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

Cochrane Database of Systematic Reviews

Intervenciones microinvasivas para el tratamiento de las caries dentales proximales en dientes permanentes y primarios

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DOI:

https://doi.org/10.1002/14651858.CD010431.pub2 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

05 noviembre 2015see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Salud oral

Copyright:

Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

Mojtaba Dorri

Correspondencia a: Department of Restorative Dentistry, Bristol Oral and Dental School, Bristol, UK

[email protected]

[email protected]
Stephen M Dunne

Primary Dental Care, Kings College London Dental Institute, London, UK
Tanya Walsh

School of Dentistry, The University of Manchester, Manchester, UK
Falk Schwendicke

Department of Operative and Preventive Dentistry, Charité ‐ Universitätsmedizin Berlin, Berlin, Germany

Contributions of authors

Mojtaba Dorri (MD): drafting of the protocol, designing a search strategy, screening search results, selecting studies, writing to authors of papers for additional information, assessing quality, extracting data, carrying out the analysis, interpreting the analysis, drafting the final review, updating the review.
Falk Schwendicke (FS) ‐ selecting studies, writing to authors of papers for additional information, assessing quality, extracting data, carrying out the analysis, interpreting the analysis, drafting the final review, updating the review.
Stephen Dunne (SD) ‐ drafting the protocol, drafting the final review, updating the review.
Tanya Walsh (TW) ‐ extracting data, carrying out the analysis, interpreting the analysis, drafting the final review, updating the review.

Sources of support

Internal sources

School of Dentistry, The University of Manchester, UK.

External sources

National Institute for Health Research (NIHR), UK.

This project was supported by the NIHR, via Cochrane Infrastructure funding to the Cochrane Oral Health Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.
Cochrane Oral Health Group Global Alliance, Other.

Through our Global Alliance (http://ohg.cochrane.org/partnerships‐alliances), the Cochrane Oral Health Group has received support from: British Association for the Study of Community Dentistry, UK; British Association of Oral Surgeons, UK; British Orthodontic Society, UK; British Society of Paediatric Dentistry, UK; British Society of Periodontology, UK; Canadian Dental Hygienists Association, Canada; Mayo Clinic, USA; National Center for Dental Hygiene Research & Practice, USA; New York University College of Dentistry, USA; and Royal College of Surgeons of Edinburgh, UK.

Declarations of interest

Mojtaba Dorri: none known
Stephen M Dunne: none known
Falk Schwendicke: FS is lecturing dentists for DMG, Hamburg, and has been counselling DMG on future projects not related to techniques evaluated by the present review.
Tanya Walsh: none known

Acknowledgements

Review authors would like to thank the Cochrane Oral Health Group and referees Professors Kim Ekstrand, Margherita Fontana, Afshid Anvarkhah and Dr Nicola Innes for their comments, support and assistance in conducting this review. We would also like to thank Professor Helen Worthington for her expertise regarding the data synthesis and Dr Wael Sabbah for his contribution in developing the protocol for this review.

Version history

Published

Title

Stage

Authors

Version

2015 Nov 05

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

Review

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

https://doi.org/10.1002/14651858.CD010431.pub2

2013 Mar 28

Proximal sealing for managing dental decay in primary and permanent teeth

Protocol

Mojtaba Dorri, Stephen M Dunne, Wael Sabbah, Bahar Kiani

https://doi.org/10.1002/14651858.CD010431

Differences between protocol and review

Title of the review ‐ changed from 'Proximal sealing for managing dental decay in primary and permanent teeth' to 'Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth'.
Description of interventions ‐ we renamed three groups of interventions from the protocol in the full review, from:
1. "Conventional restorative management" to "Conventional invasive treatment";
2. "Non‐operative management" to "Non‐invasive treatment";
3. "Proximal sealing ‐ a novel approach" to "Proximal sealing (micro‐invasive) treatments".
Electronic searches ‐ we intended to search Google Scholar (http://scholar.google.com/) in addition to the databases listed in Electronic searches; however, as this might have yielded a large number of results with only limited scientific relevance, we did not do so.
Measures of treatment effect ‐ for dichotomous outcomes we used the odds ratio for the measure of effect. This was necessary because of the inappropriate reporting of the included split‐mouth studies, and the method employed to re‐analyse the data for meta‐analysis.
Additional subgroup analysis ‐ post hoc we added dentition (deciduous or permanent) and caries risk (low to moderate, moderate, mostly high or high).

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adolescent; Adult; Child; Child, Preschool; Female; Humans; Male;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

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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Intervenciones microinvasivas para el tratamiento de las caries dentales proximales en dientes permanentes y primarios

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