Despite fails in caries level in recent decades caries is still a significant problem for many children The aim of this study was to compare the effect of infiltration and fissure sealing with fluoride varnish applications.

Children aged 5-8 with at least three primary molars with initial lesions on three occlusal surfaces in each child were eligible. Caries was scored clinically using the ICDAS visual scoring system, and bitewing radiographs taken. Three lesions were randomly allocated to either – infiltration (ICON®) plus fluoride varnish (IF) – sealing ( Delton®) plus fluoride varnish (SF) or fluoride varnish (F). All three selected occlusal lesions received fluoride varnish at baseline and three times during the study period. Follow up radiographs were taken.

• 50 children (150 primary molars) were enrolled
• Fifty-six first primary molars and 94 second primary molars were included in the study
• 3 patients were lost to follow up
• Radiographic follow up varied from 8–24months (mean 22 months). Progression was seen in: –
  • 7 lesions (15%) in the IF group,
  • 9 lesions (19%) in the SF group, and
  • 17 lesions (36%) in the F group
• When comparing clinical ICDAS scores radiographic progression was seen in: –
  • 20 of 83 lesions with ICDAS code 2,
  • 11 of 51 lesions with ICDAS code 1 and
  • 2 of 5 of the lesions with ICDAS code 4

The authors concluded

the infiltration technique plus fluoride varnish showed a high and significant effect in arresting caries progression of the initial occlusal caries lesions in primary molar teeth, whereas sealing plus fluoride varnish has a superior effect to fluoride application alone.

Comment

This small study shows that both infiltration and sealants performed better that varnish alone in slowing cares progression at two year. The authors highlight that radiographic lesion depth at the baseline was not equally distributed among the groups in this study with the infiltrated and sealed lesions having deeper lesion depth than the lesions treated with fluoride varnish only.

DMG (Chemisch-Pharmazeutische Fabrik GmbH, Hamburg, Germany) the manufacturer of ICON sponsored the material used in this study.

Links

Bakhshandeh A, Ekstrand K. Infiltration and sealing versus fluoride treatment of occlusal caries lesions in primary molar teeth. 2-3 years results. Int J Paediatr Dent. 2014 Jan 26. doi: 10.1111/ipd.12096. [Epub ahead of print] PubMed PMID: 24460688.

ICDAS