Title: 0572 - Sealing or Infiltration of Proximal Lesions: Systematic Review and Network Meta-analysis
Falk Schwendicke (Presenter)
Gerd Göstemeyer, Charite University
Seif Reda, Charite University
Joachim Krois, Charite University
Objectives: Micro-invasive (sealing, infiltration) treatment seems more efficacious for arresting early (non-cavitated) carious lesions than non-invasive treatment (NI). Uncertainty remains as to the comparative efficacy of sealing versus infiltration and the robustness of the underlying evidence. We aimed to systematically review and synthesize this evidence using pairwise and network-meta-analysis (NMA).
Methods: Three electronic databases (Medline, Embase, Cochrane Central) were searched independently by two reviewers, complemented by hand searches and cross-referencing. Randomized controlled trials comparing micro-invasive strategies against each other, against NI or placebo for managing early (non-cavitated) proximal carious lesions were included. Our primary outcome was lesion progression, assessed using digital subtraction radiography (DSR), pairwise reading or, lesion staging. Pairwise and Bayesian network meta-analyses employing random-effects models were used for synthesis.
Results: Thirteen studies (486 participants with 1748 treated lesions) from seven countries were included. Mean follow-up was 25 months (min/max 12/36 months). Four studies assessed lesions in primary teeth, nine studies in permanent teeth. Four studies included only high-risk patients, the remaining studies included moderate to high or mixed caries risk patients or did not state that. All studies were performed on children, adolescents or young adults. Based on seven studies, risk of lesion progression was significantly reduced after sealing compared with NI (OR; 95% CI: 0.29; 0.18-0.46). Based on seven studies, risk of lesion progression was significantly reduced after infiltration compared with NI (OR; 95% CI: 0.22; 0.15-0.33). One study compared infiltration versus sealing and found no significant difference (0.70; 0.34-1.47). Based on Bayesian NMA, infiltration was ranked first in 79% of the simulations (sealant 21%, NI 0%). The surface-under-the-cumulative-ranking (SUCRA) values were 0.90 for infiltration, 0.61 for sealing and 0.00 for NI. We did not detect significant inconsistency.
Conclusions: Infiltration is likely to be the most efficacious therapy for proximal carious lesions.
The submitter must disclose the names of the organizations with which any author have a relationship, the nature of the relationship, and the clinical or research area involved. The following is submitted: FS gives presentations for DMG, Hamburg, who market the caries infiltration kit. The Charité Universitätsmedizin have research contracts with DMG, Hamburg.