High quality reviews (Ahovuo-Saloranta  et al) have confirmed the effectiveness of fissure sealants to prevent caries in occlusal surfaces and there is increasing interest in the use of sealants on smooth surfaces.  The aim of the review was to assess the effectiveness of sealing non-cavitated proximal caries lesions in primary and permanent teeth.

Methods

Searches were conducted in PubMed, Scopus, ISI Web of Science, Cochrane Library, Lilacs, SIGLE (System of Information on Grey Literature in Europe) and clinicaltrials.gov. Randomised-controlled trials (RCTs), and controlled clinical trials (CCTs) with at least 12 months of follow-up that compared of sealing non-cavitated proximal caries lesions in in primary and permanent teeth with different material/ technique or placebo.

Study selection was conducted independently by two reviewers followed by risk of bias assessment and data abstraction

Results

• 10 studies (7 published articles and 0 ongoing studies with partial results) were included in the review.
• Follow up periods ranged from 12-60 months
• 6 studies were considered to have high risk of bias, and 4 a low risk of bias
• A meta-analysis including the 4 low risk studies found the odds of caries progression to be significantly lower in the infiltration group (OR = 0.22 [95%CI 0.09-0.57]; p = 0.002; I² = 29%)

Conclusions

The authors concluded

sealing non-cavitated proximal caries lesions, both in primary and permanent teeth, seems to be effective in controlling caries progression in the short and medium term. Further long-term randomized controlled trials should be approached to increase this evidence.

Commentary

Nine of the 10 included studies were of split mouth design. While split mouth studies have some advantages as the patient can serve as their own control there are important limitations and statistical considerations that need to be borne in mind (Lesaffre et al). The number of patients included in the meta-analysis is small which should be taken into consideration when assessing the overall result. In addition the majority of studies only reported outcomes at 12 months. As the authors note more higher quality RCTs of longer duration are needed before the effectiveness of this intervention can be confirmed.

Links

Ammari MM, Soviero VM, da Silva Fidalgo TK, Lenzi M, Ferreira DM, Mattos CT, de Souza IP, Maia LC. Is non-cavitated proximal lesion sealing an effective method for caries control in primary and permanent teeth? A systematic review and meta-analysis. J Dent. 2014 Jul 24. pii: S0300-5712(14)00220-6. doi: 10.1016/j.jdent.2014.07.015. [Epub ahead of print] Review. PubMed PMID: 25066832.

Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington HV. Sealants for preventing dental decay in the permanent teeth. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD001830. DOI: 10.1002/14651858.CD001830.pub4 –

Lesaffre E, Philstrom B, Needleman I, Worthington H. The design and analysis of split-mouth studies: what statisticians and clinicians should know. Stat Med. 2009 Dec 10;28(28):3470-82. doi: 10.1002/sim.3634. PubMed PMID: 19536744.