Effectiveness of non-operative approaches in active enamel carious lesions: a retrospective longitudinal study

Abstract The aim of the study was to investigate the effectiveness of non-invasive and micro-invasive treatments in active enamel carious lesions in high-caries-risk children. Clinical records of children treated in a dental school setting were retrospectively screened for active enamel carious lesions treated non-invasively (topical fluoride applications, oral hygiene instruction, or dietary guidance) or micro-invasively (sealant). The control of active carious lesions was set as the main outcome established by the combination of inactivation and non-progression of the lesions based on Nyvad and ICDAS criteria, respectively. Individual and clinical factors associated with the outcome were analyzed by Poisson regression. The sample consisted of 105 high-caries-risk children with a mean age of 8.3 (± 2.4) years. From a total of 365 active enamel carious lesions, most lesions (84.1%) were active non-cavitated carious lesions (ICDAS scores 1 and 2) and only 15.9% presented localized enamel breakdown (ICDAS score 3). Of these, 72.6% were inactivated and 92.1% did not progress (mean time of 6.5 ± 4.1 months). The prevalence of controlled carious lesions was higher among children older than 6 years (PR:1.43; 95%CI:1.00–2.03; p = 0.04) and in those with better biofilm control (PR:0.99; 95%CI: 0.98–0.99; p = 0.03). Non-operative approaches are effective for controlling active enamel carious lesions. The majority of active enamel carious lesions became inactive and did not progress after treatment. Caries control was associated with older children and better biofilm control.摘要 本研究旨在探究非侵入性与微侵入性治疗手段对高龋风险儿童活动性釉质龋损的治疗有效性。本研究回顾性筛查了牙科学院接诊儿童的临床病历，筛选出接受非侵入性治疗（局部氟化物涂布、口腔卫生指导或饮食指导）或微侵入性治疗（封闭剂治疗）的活动性釉质龋损病例。本研究以病变灭活与病变无进展作为主要结局指标，分别依据Nyvad标准与国际龋病检测和评估系统(ICDAS, International Caries Detection and Assessment System)进行判定。采用泊松回归分析与该结局相关的个体及临床因素。本研究共纳入105名高龋风险儿童，平均年龄为8.3(±2.4)岁。共计纳入365处活动性釉质龋损，其中84.1%为活动性非龋洞型龋损(ICDAS评分1、2级)，仅15.9%存在局限性釉质崩解(ICDAS评分3级)。其中72.6%的龋损得以灭活，92.1%未发生进展，平均随访时长为6.5±4.1个月。研究显示，6岁以上儿童的龋损控制率更高（PR=1.43；95%置信区间CI：1.00–2.03；p=0.04），菌斑控制更佳的儿童龋损控制率也更高（PR=0.99；95%CI：0.98–0.99；p=0.03）。非手术治疗手段对控制活动性釉质龋损具有有效性。大部分活动性釉质龋损在接受治疗后可实现灭活且无进展。龋损控制与患儿年龄更大、菌斑控制更佳显著相关。