Nonrestorative treatment of initial caries lesion in primary teeth: a systematic review and network meta-analysis

To identify the best available approach to avoid initial caries lesions progression in primary teeth. Search was performed in MEDLINE/Pubmed, Web of Science, Embase and CENTRAL databases until March 2021. Studies compared treatment options to avoid the initial caries lesion progression with at least 12 months of follow-up were included. Network meta-analyses were conducted considering the non-progression of caries lesions as an outcome. Potentially eligible studies were screened (n = 2820) and eleven were included. Six studies evaluated the use of fluoride varnish, resin infiltration, sealing, and toothbrushing/flossing on proximal initial caries lesions. When considering occlusal surfaces, only two studies evaluating the ozone gas, fluoride varnish, resin infiltration, and sealants were included. For buccal/lingual surfaces, three studies evaluating toothbrushing, CPP-ACP paste, fluoride varnish, and resin infiltration were included. For all types of surfaces, the resin infiltration showed the best probability to avoid the progression of initial caries lesions. The limited number of included studies, most with a high risk of bias and lack of hard outcomes, such as frank cavitation, makes it not feasible to recommend a specific management approach for initial caries lesion control in primary teeth with a high certainty of evidence. PROSPERO: #CRD42016037781

本研究旨在明确可用于阻止乳牙早期龋损进展的最优干预方案。检索时限截至2021年3月，检索数据库包括MEDLINE/Pubmed、Web of Science、Embase及CENTRAL。纳入标准为对比各类阻止早期龋损进展的干预方案且随访时长至少12个月的研究。以龋损未进展为结局指标开展了网络荟萃分析（network meta-analysis）。经初步筛选，共获得符合纳入潜力的研究2820项，最终纳入11项。其中6项研究针对邻面早期龋损，评估了氟保护漆（fluoride varnish）、树脂渗透（resin infiltration）、窝沟封闭（sealing）及刷牙/牙线清洁的干预效果；针对咬合面的研究仅纳入2项，分别评估了臭氧气体、氟保护漆、树脂渗透及窝沟封闭的干预效果；针对颊/舌面的研究共纳入3项，评估了刷牙、CPP-ACP糊剂（CPP-ACP paste）、氟保护漆及树脂渗透的干预效果。综合所有牙面类型的分析结果显示，树脂渗透阻止早期龋损进展的概率最高。但由于纳入研究数量有限，且多数研究存在较高偏倚风险，同时缺乏明显龋洞形成等硬结局指标，因此无法以高证据确定性推荐适用于乳牙早期龋损控制的特定干预方案。PROSPERO注册号：#CRD42016037781