Systematic review of noninvasive treatments to arrest dentin non-cavitated caries lesions

Table 1 Summary of studies included in the analysis

Author/yr	Study design	Sample characteristics	Analyzed variables and evaluation methods	Tested treatments	Follow up	Results/conclusions
Borges et al[3] (2010)	Randomized controlled clinical trial	Sixty permanent molars in 35 individuals (12–19.5 years old) with non-cavitated carious lesions radiographically located between the dentin-enamel junction and middle third of dentin	Caries progression and sealant loss; clinical and radiographic examinations	Experimental (n = 30): oral hygiene instruction and fissure sealing (Fluorshield, Dentsply); control (n = 30): oral hygiene instruction	4-mo intervals for 1 year; control group was followed for only 8 mo due to signals of caries progression	Eight teeth (four per group) were lost at 1-year follow up. Clinical and radiographic caries progression was significantly more frequent in control than in experimental teeth. Sealant loss occurred in three cases and resulted in caries progression. Pit and fissure sealant effectively arrested caries progression, suggesting that this intervention may replace traditional invasive treatment of non-cavitated dentinal caries
Borges et al[4] (2012)	Randomized controlled clinical trial	Sixty permanent molars in 35 individuals (12-19.5 years old) with non-cavitated carious lesions radiographically located between the dentin-enamel junction and middle third of dentin	Caries progression and sealant loss; clinical and radiographic examinations	Experimental (n = 30): oral hygiene instruction and fissure sealing (Fluorshield, Dentsply); control (n = 30): oral hygiene instruction	4-mo intervals for 1 year, then 12-mo intervals to 36 mo; control group was followed for only 8 mo due to signals of caries progression	Eight teeth (four per group) were lost at 1-year follow up; no tooth was lost subsequently. Clinical and radiographic caries progression was significantly more frequent in the control than in the experimental group. Three teeth lost sealant and showed caries progression at the 12-mo follow up. No sealant loss or caries progression was observed at 24 or 36 mo. Pit and fissure sealant effectively arrested carious lesions for a 36-mo period
Borges et al[5] (2012)	Randomized controlled split-mouth clinical trial	Sixty deciduous molars in 30 schoolchildren (5-9 years old) with non-cavitated carious lesions radiographically located between the dentin-enamel junction and middle third of dentin	Experimental group: caries progression and sealant loss; control group: secondary caries emergence and clinical failure of composite restorations	Experimental (n = 30): fissure sealing (Fluorshield, Dentsply); control (n = 30): composite restoration (Ice, SDI)	4-mo intervals for 1 year	No tooth was lost to follow up. The treatment modalities were similarly effective in managing non-cavitated occlusal carious lesions in dentin of primary molars. Three teeth showed partial sealant retention and caries progression after 1 year. The invasive approach can be replaced with non-drilling fissure sealing techniques for the management of these lesions
da Silveira et al[6] (2012)	Randomized controlled clinical trial	Fifty-one permanent molars in 38 individuals (± 12.78 years old) with non-cavitated carious lesions radiographically located between the dentin-enamel junction and middle third of dentin	Caries progression and sealant loss; clinical and radiographic examinations	Experimental (n = 27): oral hygiene instruction and sealing with self-curing glass ionomer cement (Vidrion-R, SS White)	4-mo intervals for 1 year; control group was followed for only 8 mo due to signals of caries progression	No tooth was lost to follow up. Clinical examination showed no significant difference between groups, but radiographic examination showed less caries progression in sealed teeth
Bakhshandeh et al[7] (2012)	Clinical trial	Five premolars and 67 molars in 52 individuals (± 28 years old) lesions in need of restoration. The maximum depth of the lesions, radiographically assessed, was limited to the middle third of the dentin	Experimental group: caries progression and sealant loss; control group: secondary caries emergence and clinical failure of composite restorations	Control (n = 24): oral hygiene instruction; experimental (n = 60): resin-based fissure sealing (Delton, Dentsply) Control (n = 12): composite restoration (Filtek Supreme XT, 3M ESPE)	6-12-mo intervals for 25-38 (mean, 33) mo	Eleven sealed teeth were lost to follow up; no restored tooth was lost. All restorations and sealants functioned well; seven sealants were repaired/replaced due to failure and three sealed lesions were restored due to caries progression. Sealants arrested most (44/49) lesions; expansion of criteria for therapeutic sealing of occlusal carious lesions in adults will improve dental health