Two-Year Split-Mouth Randomized Controlled Clinical Trial On The Progression of Proximal Carious Lesions On Primary Molars After Resin Infiltration

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PEDIATRIC DENTISTRY V 42 / NO 2 MAR / APR 20

RANDOMIZED CONTROL TRIAL

Two-Year Split-Mouth Randomized Controlled Clinical Trial on the Progression of Proximal


Carious Lesions on Primary Molars After Resin Infiltration
Caroline Simão Sarti, MSc, PhD1 • Mariana Boessio Vizzotto, MSc, PhD2 • Leonardo Villar Filgueiras, MSc3 • Clarissa Calil Bonifácio, MSc, PhD4 •
Jonas Almeida Rodrigues, MSc, PhD5

Abstract: Purpose: The purpose of this split-mouth, randomized, controlled clinical trial was to assess the progression of early proximal carious
lesions on primary molars after resin infiltration. Methods: Twenty-eight children presenting two primary molars with proximal carious lesions
detected radiographically (on the outer half of the enamel up to the outer one-third of dentin) were included. Baseline assessments consisted
of standard digital bitewing radiographs, Visual Plaque Index (VPI), Gingival Bleeding Index (GBI), and visual examination of caries. Proximal
lesions were randomly allocated into two groups: (1) resin infiltration (test) and (2) no infiltration (control). Reassessments were performed after
two years. Lesion progression was considered when the radiographic score increased. Results: A significant difference in lesion progression was
observed between test (54.1 percent) and control (79.2 percent) groups after two years (McNemar’s test, P=0.03). Logistic regression for matched
pairs showed that the test group had an 82 percent lower risk of caries progression  (odds ratio equals 0.18, 95%CI 0.29 to 0.31). Conclusions:
Infiltrating proximal lesions decreases radiographic caries progression in primary molars after a two-year follow-up period. (Pediatr Dent 2020;
42(2):110-5) Received August 6, 2019 | Last Revision January 27, 2020 | Accepted January 30, 2020
KEYWORDS: DENTAL CARIES, RESIN INFILTRATION, PRIMARY TEETH

The proximal surface is a susceptible site for the development application is effective in treating these lesions in primary teeth
of carious lesions due to its anatomy and the difficult access when compared to fluoride varnish only.7,8
for oral hygiene and salivary protection.1 Children that have a A systematic review that analyzed the effect of infiltrating
high caries experience present a higher caries progression rate lesions on proximal carious lesions in permanent and primary
on the proximal surfaces, mainly those located in the outer teeth observed that the application of resin infiltrant com-
half of the dentin. In addition, children with greater caries bined with oral hygiene measures is more effective in controlling
experience have a higher risk of developing new proximal lesion progression than oral hygiene measures alone. Only one
lesions on healthy surfaces.2 study included in this review involved children. The authors
To control the progression of carious lesions on proximal suggested that further long-term randomized controlled clinical
surfaces, microinvasive approaches have been used as a treat- trials are necessary to incase this evidence, particularly in pri-
ment option in noncavitated lesions, which involves the appli- mary molars.9
cation of sealant or infiltrant on the dental surface.3,4 A review Considering the need for randomized controlled clinical
reported that microinvasive treatment, regardless of the material trials in primary teeth, the purpose of this split-mouth study
used, was superior in controlling the progression of the prox- was to compare the radiographic progression of early prox-
imal lesions compared to treatment with fluorotherapy and imal carious lesions on primary molars after resin infiltration
flossing.5 (test) to no infiltration (control) after two years of follow-up.
The use of resin infiltration is considered a promising tech-
nique that can reduce tooth mineral loss in proximal lesions. Methods
In addition, resin infiltrant treatment requires less patient co- This split-mouth, randomized, controlled clinical trial was
operation than flossing.6 Clinical trials have demonstrated that approved by the Local Ethics Committee of Federal University
infiltrating proximal lesions combined with fluoride varnish of Rio Grande do Sul, Porto Alegre, Brazil. Written informed
consent was obtained from the parents or legal guardians of
all children who agreed to participate. This study was con-
1 Dr. Sarti is a pediatric dentist, 2Dr. Vizzotto is an assistant professor, 3Dr. Filgueiras ducted in full accordance with the World Medical Associ-
is a dentist, and 5Dr. Rodrigues is an associate professor, all in the Pediatric Dentistry ation Declaration of Helsinki.
Division, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Su, Brazil; Sample. The sample size was calculated based on the pro-
and 4Dr. Bonifácio is an assistant professor, Academisch Centrum Tandheelkunde portion of proximal caries progression observed in a previous
Amsterdam (ACTA), Amsterdam, The Netherlands.
Correspond with Dr. Rodrigues at jorodrigues@ufrgs.br
split-mouth study10 using SPSS Statistics 21 statistical software
(SPSS Inc., Chicago, Ill., USA) for two paired outcomes with
a one-to-one allocation ratio, assuming normality, for a two-
HOW TO CITE:
sided test. Assuming a proportion of 37 percent progression
Sarti CS, Vizzotto MB, Filgueiras LV, Bonifácio CC, Rodrigues JA. Two-
(control) and seven percent progression (test), with α equals
year split-mouth randomized controlled clinical trial on the pro- 0.05, based on a two-sided test and a power of 80 percent, a
gression of proximal carious lesions on primary molars after resin total of 22 pairs of lesions would be needed. Considering a
infiltration. Pediatr Dent 2020;42(2):110-5. dropout rate of 30 percent, it was determined that 28 children
should be recruited in the study. The study occurred between

110 INFILTRATION OF PROXIMAL CARIES LESIONS


PEDIATRIC DENTISTRY V 42 / NO 2 MAR / APR 20

2014 and 2016 in the Pediatric Dental Clinic at Federal surfaces due to caries. The median of the dmft index was cal-
University of Rio Grande do Sul, Porto Alegre, Rio Grande culated, and children were classified as moderate caries ex-
do Su, Brazil. perience (dmft of five or less) or high caries experience (dmft
Participants. For this study, 189 healthy three- to eight- greater than five). Tooth type (first or second molar), side
year-olds, with at least two pairs of adjacent primary molars (right or left), and arch (maxillary or mandibular) were also
with proximal contact, were considered eligible. Inclusion cri- recorded.
teria included the presence of least two radiographically de- Randomization and intervention. The unit of random-
tected contralateral carious lesions on proximal surfaces in ization was the proximal lesion in a primary tooth. Each child
their primary molars (on the outer half of the enamel up to the who participated in this study had two proximal lesions: one
outer one-third of dentin). Exclusion criteria included unco- randomly allocated in the test group and one in the control
operative behavior, primary molars that should exfoliate in less group. They were randomly allocated using permuted blocks
than two years (more than two-thirds root resorption), fluorosis, generated via SPSS software by a researcher independent of
and/or hypoplasia. Among 189 children, 28 lived in an area the study. If more than two lesions were eligible, two of them
with a fluoridated water supply, met the inclusion criteria, and were selected by chance.
had their signed informed consent. Lesions allocated in the test group were infiltrated once at
Baseline assessments. Clinical baseline data included two baseline using the ICON System (DMG, Hamburg, Germany),
bitewing radiographs and clinical evaluations performed by one according to the manufacturer’s instructions, by one experi-
experienced dentist. Standardized bitewing radiographs from enced pediatric dentist. These instructions called first for
the 28 selected children were obtained using an X-ray machine cleaning the proximal surface with floss; local anesthesia was
Odontomax 70/7p (Astex, São Paulo, São Paulo, Brazil) and provided, and a rubber dam was applied. A special dental wedge
an Emmenix Film Holder (Hager & Werken, Duisburg, North was then inserted in the proximal region for better access to
Rhine-Westphalia, Germany). The digital images were obtained the proximal area; at this time, the presence of enamel break-
using a phosphor plate size zero (20 × 30 mm active area) from down was registered. Next, 15 percent hydrochloric acid was
the VistaScan digital system (Dürr Dental, Beitigheim-Bissingen, applied to the lesion for 120 seconds. The surface was rinsed
Baden-Württemberg, Germany). Images were scanned imme- and dried for 30 seconds. The surface was dehydrated with 95
diately after acquisition and stored using a VistaScan  Perio percent ethanol and air-dried using a three-in-one air syringe
Plus scanner (Dürr Dental) and DBSWIN software (Dürr for 30  seconds. Then, ICON infiltrant resin (triethylene-
Dental). An independent and experienced radiologist scored glycol-dimethacrylate-based resin, camphoroquinone, and
the images according to the following criteria: E1 equals radio- additives) was applied for 180  seconds. The excess material
lucency confined to the outer half of the enamel; E2 equals was removed with dental floss. Light-curing was performed
radiolucency involving the inner half of the enamel; D1 equals for 40  seconds (using an LED light; Schuster, Santa Maria,
radiolucency in the outer third of the dentin; D2 equals radio- Rio Grande do Sul, Brazil), and ICON infiltrant resin was
lucency in the middle third of the dentin; and D3 equals applied again for 60 seconds and light-cured for 40 seconds.
radiolucency in the inner third of the dentin.10 Lesions allocated in the control group were not infiltrated.
The presence of visible plaque was evaluated using the All children received standard-of-care preventive measures,
Visible Plaque Index (VPI), scored as zero equals no visible as usual, in the Pediatric Dental Clinic at Federal University
plaque, or one equals visible plaque. Gingival bleeding was of Rio Grande do Sul. They consisted of individualized treat-
evaluated using the Gingival Bleeding Index (GBI), scored as ment for caries activity based on oral hygiene instructions
zero equals no bleeding after gentle probing or one equals (toothbrushing using fluoridated toothpaste and flossing in-
bleeding after gentle probing.11 Children’s visual examination structions) and dietary recommendations at the baseline.
of carious lesions was carried out after teeth cleaning. Dental Moreover, since the included children were in active caries
caries was recorded based on two indexes of evaluation of caries activity status, one week after lesions infiltration three sessions
extent/severity and activity: (1) International Caries Detec- of professional fluoride application (acidulated fluoride gel 1.23
tion and Assessment System (ICDAS)12 complemented by (2) percent) with a toothbrush were conducted over a seven-day
Nyvad Criteria.13 Lesions were classified in scores as follows: interval.14
one equals active enamel noncavitated lesion; two equals in- Outcome and follow-up. The main outcome was the
active enamel noncavitated lesion; 3a equals active enamel radiographic caries progression in the test and control groups.
breakdown (enamel small active cavity); 3i equals inactive Clinical parameters (dmft, VPI, GBI, caries experience, tooth
enamel breakdown (enamel small inactive cavity); four equals type, side, and arch) of the participants were collected.
shadow in the dentin; 5a equals active cavitated dentin lesion; Digital radiographs of both proximal surfaces (test and
and 5i equals inactive cavitated dentin lesion. control) were taken by the same blinded, calibrated, and experi-
Active lesions were white, opaque, and rough in the enced radiologist. A total of 56 radiographs from the six-month
enamel and yellowish and soft in the dentin, whereas inactive follow-up recalls were used for intraexaminer reproducibility
lesions were shiny and smooth in the enamel and dark and assessment, and an unweighted kappa value of 0.78 was ob-
hard in the dentin.13 The examiner was trained and calibrated tained. This examiner assessed all digital radiographs in a
for the criteria of a visual examination of carious lesions. The random order, regardless of the lesion group and period of
training session included the clinical examination of 15 pa- assessment (baseline or follow-up), using the same equipment
tients who did not participate in the study. and methods as described earlier. To evaluate clinical param-
Children’s caries experience was scored using the decayed, eters, one calibrated examiner performed all examinations at
missing, and filled primary teeth (dmft) index. The “d” compo- baseline, six months, one year, and two years (intraexaminer
nent was defined as caries in a cavitated stage (scores three agreement for dental caries equals 0.70).
and five). The “m” component was defined as extracted teeth Lesion progression was considered when the radiographic
due to caries, and the “f ” component was defined as restored score increased, regardless of the score that the lesion had

INFILTRATION OF PROXIMAL CARIES LESIONS 111


PEDIATRIC DENTISTRY V 42 / NO 2 MAR / APR 20

progressed to. If any carious lesion progressed to evident visual The clinical parameters (VPI, GBI, caries experience,
cavity at any of the follow-up evaluations, a restorative treat- tooth type, side, and arch) at baseline and follow-up period
ment was provided and the lesion was considered progressed are presented in Table 1. At two years, no significant decrease
in the study. was observed in the VPI compared to the baseline (P=0.68).
Statistical analysis. Analyses were performed considering Half of the children demonstrated a high caries experience at
the child (matched pairs). Radiographic lesion progression be- the baseline (50 percent). The GBI index presented a signifi-
tween the baseline and follow-up period was analyzed using cant decrease after two years.
McNemar’s test. Furthermore, the effect of the intervention Table 2 presents the radiographic progression of the in-
was calculated from the relative risk reduction (RRR) – efficacy. cluded lesions after a two-year follow-up period; a statistically
The differences between VPI and GBI at baseline and significant difference in caries progression was observed in the
follow-up were assessed by Wilcoxon t-test. The differences be- test group (54.1 percent) versus the control group (79.2 per-
tween caries experience at the baseline and follow-up were cent). After a two-year follow-up period, a radiographic pro-
assessed via McNemar’s test. The significance level in all tests gression of six enamel breakdown lesions in the test group up
was set at a P‑value of 0.05. Statistical analyses were conducted was observed. A risk ratio of 68.4 percent (95% CI equals
with SPSS Statistics 21 software. 42.6 to 79.5) and an efficacy (RRR) of 32 percent (95% CI
Conditional logistic regression (matched pairs) analysis was equals 9.8 to 57.3) were found for the infiltrant associated
used to estimate the odds ratio (95 percent confidence interval with acidulated phosphate fluoride gel.
[95% CI]) of proximal caries progression. The analyzed vari- Table 3 presents the logistic regression analysis for matched
ables at tooth level were tooth type (first or second molar), pairs to estimate the odds ratio of proximal caries progression
side (right or left), arch (upper or lower), treatment group (test after the two-year follow-up period, according to the follow-
or control), enamel cavity (presence or absence), VPI, and ing variables: tooth type (first or second molar); side (right
GBI. The significance level was set at five percent. For this or left); arch (maxillary or mandibular); treatment (control or
analysis and power of the sample, RStudio 1.1.442 software
(Boston, Mass., USA) was used.
Table 1. BASELINE AND FOLLOW-UP
Results CLINICAL PARAMETERS
At baseline, 28 children were evaluated: 15 girls (53.6 percent) Baseline±(SD) 2-year
and 13 boys (46.4 percent), with a mean age of 6 years-old follow-up±(SD)
(±1.23 standard deviation). After icon wedge placement, eight
lesions in the test group presented enamel breakdown at the VPI * 31.40±20.3 25.31±14.4
baseline but remained in the study. GBI * 12.74±15.8 5.82±3.6
Throughout the study, four children withdrew their partici-
pation (Figure). The dropout rate was 10.7 percent. For this Baseline (%) 2-year
reason, after two years, 24 patients were reassessed (total equals follow-up (%)
48 lesions: 24 test group lesions and 24 control group lesions).
High 13 (46.4) 12 (50.0)
Moderate 15 (53.6) 12 (50.0)
Tooth type
Assessed children for eligibility
First molar 26 (46.4) 19 (39.6)
2014/2016
(n=189) Second molar 30 (53.6) 29 (60.4)
Side
Excluded (n=56) Right 30 (53.6) 24 (50.0)
Enrollment â Not meeting inclusion criteria
(n=56) Left 26 (46.4) 24 (50.0)
Included 28 children
Randomized lesions
Arch
(n=56)
Maxillary 28 (50.0) 26 (54.1)
â â Mandibular 28 (50.0) 22 (45.9)
Allocation
Allocated to Test Group Allocated to Control Group
(n=28 lesions)
– Received topical application
(n=56)
– Received topical application
* Mean index±(SD). VPI=Visible Plaque Index; GBI=
Gingival Bleeding Index.
of fluoride, flossing, diet of fluoride, flossing, and diet
counselling and infiltrant counselling † Children (%).

2 years Follow Up
â â Table 2. RADIOGRAPHIC LESION PROGRESSION AFTER
Lost to follow up (4 children) Lost to follow up (4 children) TWO YEARS OF FOLLOW-UP
– Did not attend the recall (0) – Did not attend the recall (0)
– Exfoliated teeth (n=0) – Exfoliated teeth (n=0) Follow-up Arrestment Progression P-value *
n (%) n (%)
â â
Test (n=24) 11 (45.9) 13 (54.1)
Analysed Analysed Analysed
n = 24 teeth 24 children n = 24 teeth 2 years Control 4 (20.8) 20 (79.2) 0.03
(n=24)

Figure. CONSORT flowchart of the participants’ progress through the trial phases. * P-value obtained from McNemar’s test.

112 INFILTRATION OF PROXIMAL CARIES LESIONS


PEDIATRIC DENTISTRY V 42 / NO 2 MAR / APR 20

infiltrant); and presence of enamel cavity. A significant asso-


Table 3. ASSOCIATION BETWEEN PREDICTOR ciation was found only for the variable treatment.
VARIABLES AND CARIES PROGRESSION Table 4 shows the distribution of the test and control
AFTER TWO YEARS OF FOLLOW-UP lesions at the baseline and two-year follow-up as well as a per-
Variable Proximal caries progression centage of progression according to the radiographic scores
and group. Nine lesions in the test group and nine lesions in
Odds 95% confidence P-value* the control group had progression into the dentin (D2 or D3).
ratio interval All these cavities received restorations.
Tooth type
Discussion
First molar 1.00 In this split-mouth, randomized, controlled clinical trial, after
Second molar 0.36 0.07 – 1.72 0.20 two years of follow-up, 24 children contributed with two
Side
lesions each, randomly allocated: one to the test group and
another to the control group. Both groups had the same oral
Right 1.00 environment, making it easier to control many potential con-
Left 1.00 0.22 – 4.53 1.00 founding factors, such as the oral hygiene habits of patients.15
Arch Among 28 children included at baseline, four withdrew
their participation in the study before completing the two-
Maxillary 1.00
year follow-up. This dropout rate (10.7 percent) is lower than
Mandibular 2.40 0.36 – 15.55 0.36 those observed in similar studies.7,8
Group The first split-mouth design study published using resin
Control 1.00 infiltrant in high-caries risk children (decayed, missing, and
filled surfaces less than four) associated infiltration with fluoride
Test 0.18 0.29 – 0.31 0.04 †
varnish.7 After a one-year follow-up, it reported a radiographic
Enamel small cavity progression of 23 percent in the test group and 62 percent
Absence 1.00 in the control group.7 The authors concluded that resin infil-
Presence 2.50 0.35 – 17.40 0.57 tration associated with fluoride varnish was promising for
controlling proximal lesion progression. 7 At the two-year
* P-value obtained from Logistic regression for matched pairs. follow-up, a significant difference in the progression rate was
† Statistically significant. observed between the test group (54.1 percent) and the control
group (79.2 percent), resulting in
an efficacy of 32 percent and resin
Table 4. RADIOGRAPH ASSESSMENT OF CARIES PROGRESSION FROM THE BASELINE AND infiltrant associated with acidulated
AT TWO YEARS BETWEEN THE TEST AND CONTROL GROUPS* phosphate fluoride gel. A previous
study compared resin infiltrant
Test Group (n=24) Control Group (n=24) with only flossing on the lesion
progression in proximal caries in
Baseline 2 years Baseline 2 years primary teeth. Radiographic pro-
Lesions Threshold Lesions (%) Threshold Lesions Threshold Lesions (%) Threshold gression was observed in 11.9 per-
cent of the lesions in the test group
1 E1 0 E1 and in 33.3 percent of the lesions
0 E2 0 E2 in the control group after one year
1 (7.7) D1 2 (10.0) D1 of follow-up.4 The authors reported
4 E1 6 E1
efficacy of 64.3 percent for resin
1 (7.7) D2 2 (10.0) D2
infiltrant.
1 (7.7) D3 2 (10.0) D3 Lesions of the test group pre-
2 E1 0 E1 sented an 82 percent lower chance
0 E2 0 E2 of progression than the lesions
1 (7.7) D1 1 (5.0) D1 of the control group (odds ratio
3 E2 5 E2
equals 0.18, 95% CI 0.29 to
0 D2 2 (10.0) D2
0.31). Similar results were ob-
0 D3 2 (10.0) D3 served in a previous study that
0 E1 1 E1 compared sealing proximal lesions
2 E2 0 E2 and flossing instructions, where
3 D1 6 D1
efficacy of 25 percent was found
17 D1 13 D1 after 2.5 years.16 Another clinical
4 (30.7) D2 3 (15.0) D2 trial that evaluated the effective-
5 (38.4) D3 6 (3.0) D3 ness of resin infiltration with
fluoride varnish versus fluoride
* Caries progression from baseline to follow-up according to each radiographic threshold. E1=radiolucency confined to varnish alone in lesions extending
the outer half of the enamel; E2=radiolucency involving the inner half of the enamel; D1=radiolucency in the outer
third of the dentin; D2=radiolucency in the middle third of the dentin; and D3=radiolucency in the inner third of
only to the enamel reported a sig-
the dentin. Shadow cells show the number of lesions (percentage) that progressed according to each threshold per
10 nificant difference in radiograph
group. progression of 40 percent in the

INFILTRATION OF PROXIMAL CARIES LESIONS 113


PEDIATRIC DENTISTRY V 42 / NO 2 MAR / APR 20

test group and 72 percent in the control group before the Considering the temporary character of the primary teeth,
two-year follow-up.8 These results are comparable with those the primary outcome (radiograph progression of the lesions) is
found in the present study at two years, even though the not always relevant to the patients. It depends on the patient’s
authors of the present study included most lesions in the dentin age and caries risk. Progression to an evident visual cavity that
and had no application of fluoride varnish. needs to be restored is also significant. This should be con-
Lesion progression could be observed in both the test and sidered when a treatment has to be indicated.
control groups. This could be explained by the fact that most
lesions at the baseline (17 [70.8 percent] in the test group and Conclusions
13 [56.5 percent] in the control group) were at the D1 radio- Based on this study’s results, the following conclusions can
graphic stage and that dentin proximal lesions show faster be made:
radiographic progression than enamel lesions. 17 Furthermore, 1. The application of a resin infiltrant in proximal lesions
early enamel lesions are reported to be completely infiltrated decreases radiographic caries progression in primary
by resin while advanced enamel lesions present an incomplete molars.
and inhomogeneous infiltration when observed by optical 2. Even when children adhered to oral health instruc-
coherence tomography.18 Another likely reason for progression tions, caries progression was observed.
in the control group is the fact that acidulated phosphate 3. Infiltration of proximal carious lesions in primary
fluoride gel cannot effectively remineralize early enamel prox- molars is a practical and effective treatment for children.
imal carious lesions.19,20
Furthermore, the high caries progression of lesions in both References
groups may also be related to the fact that most of the children 1. França-Pinto CC, Cenci MS, Correa MB, et al. Association
(92.9 percent) in this study were from a low socioeconomic between black stains and dental caries in primary teeth:
level. According to Tickotsky et al. (2017),18 children at a low Findings from a Brazilian population-based birth cohort.
socioeconomic level present an accelerated radiographic pro- Caries Res 2012;46(2):170-6.
gression of proximal carious lesions in primary teeth. 2. Vanderas AP, Gizani S, Papagiannoulis L. Progression of
Previous studies that tested resin infiltrant did not report proximal caries in children with different caries indices:
the presence of enamel breakdown on the proximal surfaces. A 4-year radiographic study. Eur Arch Paediatr Dent
Since the inclusion criterion of most studies on the efficacy of 2006;7(3):148-52.
resin infiltrant is the presence of radiolucency up to the outer 3. Ammari MM, Soviero VM, da Silva Fidalgo TK, et al. Is
dentin, it can be expected that some lesions might have small non-cavitated proximal lesion sealing an effective method
cavities when included in the studies. 20 The present study’s for caries control in primary and permanent teeth? A
authors decided not to exclude lesions presenting an enamel systematic review and meta-analysis. J Dent 2014;42(10):
breakdown in the test groups to more closely match the daily 1217-27.
practice of dentists and also because children had already re- 4. Ammari MM, Jorge RC, Souza IPR, Soviero VM. Efficacy
ceived anesthesia, rubber dam, and icon wedge placement of resin infiltration of proximal caries in primary molars:
when enamel breakdown was observed. In general patient care, 1-year follow-up of a split-mouth randomized controlled
most clinicians do not separate proximal surfaces if no evident clinical trial. Clin Oral Investig 2018;22(3):1355-62.
and visible cavity is observed. The authors observed that 75 per- 5. Krois J, Göstemeyer G, Reda S, Schwendicke F. Sealing
cent of lesions with enamel breakdown at the baseline and those or infiltrating proximal carious lesions. J Dent 2018;74:
treated with resin infiltrant presented a radiographic progres- 15-22. Erratum in: J Dent 2018;76:137-8.
sion at the two-year follow-up. Therefore, the observation of 6. Esan A, Folayan MO, Egbetade GO, Oyedele TA. Effect
small cavities on proximal surfaces may indicate a higher risk of of a school-based oral health education programme on use
lesion progression, even if these lesions were infiltrated. of recommended oral self-care for reducing the risk of
Similar to other studies, the blinding of the operator or the caries by children in Nigeria. Int J Paediatr Dent 2015;25
child was not possible because the infiltration technique is dif- (4):282-90.
ferent from the noninvasive technique.4,8 Nonetheless, the exam- 7. Ekstrand KR, Bakhshandeh A, Martignon S. Treatment of
iner of the main outcome (radiographic caries progression) did proximal superficial caries lesions on primary molar teeth
not participate in the clinical phase and was blind concerning with resin infiltration and fluoride varnish versus fluoride
the test and control lesions, and to the period (baseline or follow- varnish only: Efficacy after 1 year. Caries Res 2010;44(1):
up). This was possible because the infiltrant does not have 41-6.
radiopacity; thus, it is not possible to detect it via radiography. 8. Bagher SM, Hegazi FM, Finkelman M, et al. Radiographic
An improvement of oral hygiene habits was observed at effectiveness of resin infiltration in arresting incipient
the two-year follow-up. The GBI had a mean decrease from proximal enamel lesions in primary molars. Pediatr Dent
12.74 percent to 5.82 percent (P=0.04). These results showed 2018;40(3):195-200.
adhesion to the oral hygiene instructions; however, this re- 9. Chatzimarkou S, Koletsi D, Kavvadia K. The effect of
duction was not enough to avoid caries progression on some resin infiltration on proximal caries lesions in primary and
proximal surfaces. Previous studies have reported difficulties permanent teeth: A systematic review and meta-analysis of
of children and/or guardians in plaque control and flossing clinical trials. J Dent 2018;77:8-17.
proximal surfaces.6,16 As a protocol, all children and parents re- 10. Paris S, Hopfenmuller W, Meyer-Lueckel H. Resin infil-
ceived dietary counseling and oral hygiene and flossing instruc- tration of caries lesions: An efficacy randomized trial. J
tions at the baseline. Besides that, we observed difficulty in Dent Res 2010;89(8):823-6.
the participants in maintaining sufficient oral hygiene. More 11. Ainamo J, Bay I. Problems and proposals for recording
effective ways to motivate children and parents to manage oral gingivitis and plaque. Int Dent J 1975;25(4):229-35.
hygiene are still needed.

114 INFILTRATION OF PROXIMAL CARIES LESIONS


PEDIATRIC DENTISTRY V 42 / NO 2 MAR / APR 20

12. Ismail AI, Sohn W, Tellez M, et al. The International 17. Tickotsky N, Petel R, Araki R, Moskovitz M. Caries pro-
Caries Detection and Assessment System (ICDAS): An gression rate in primary teeth: A retrospective study. J Clin
integrated system for measuring dental caries. Community Pediatr Dent 2017;41(5):358-61.
Dent Oral Epidemiol 2007;35(3):170-8. 18. Schneider H, Park KJ, Rueger C, Ziebolz D, Krause F,
13. Nyvad B, Machiulskiene V, Baelum V. Reliability of a new Haak R. Imaging resin infiltration into non-cavitated
caries diagnostic system differentiating between active and carious lesions by optical coherence tomography. J Dent
inactive caries lesions. Caries Res 1999;33(4):252-60. 2017;60:94-8.
14. Jardim JJ, Pagot MA, Maltz M. Artificial enamel dental 19. Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. Caries re-
caries treated with different topical fluoride regimes: An mineralisation and arresting effect in children by profes-
in situ study. J Dent 2008;36(6):396-401. sionally applied fluoride treatment: A systematic review.
15. Liang Y, Deng Z, Dai X, Tian J, Zhao W. Micro-invasive BMC Oral Health 2016;16:12.
interventions for managing non-cavitated proximal caries 20. Urquhart O, Tampi MP, Pilcher L, et al. Nonrestorative
of different depths: A systematic review and meta- treatments for caries: A systematic review and network
analysis. Clin Oral Investig 2018;22(8):2675-84. meta-analysis. J Dent Res 2018;98(1):14-26.
16. Martignon S, Tellez M, Santamaria RM, Gomez J, Ekstrand
KR. Sealing distal proximal caries lesions in first primary
molars: Efficacy after 2.5 years. Caries Res 2010;44(6):
562-70.

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