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

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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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