Abstract
This study aimed to evaluate the efficacy of non-invasive and micro-invasive treatments on the arrest of occlusal enamel carious lesions in erupting permanent molars. This two-arm randomized clinical trial included 27 subjects, aged 5-11 years, with 64 erupting permanent molars presenting active occlusal enamel carious lesions (as assessed by the International Caries Detection and Assessment System [ICDAS]; scores 1-3). The sample was randomly assigned into two treatment groups: 1) resin-modified glass ionomer cement sealant (Clinpro XT Varnish; 3M ESPE) and 2) 4-week topical fluoride varnish application (Duraphat; Colgate). All children and parents received oral hygiene and dietary instructions. Teeth were evaluated at baseline and 3, 6, 9, and 12 months regarding the eruption stage, biofilm accumulation, as well as severity and activity of the carious lesions. The Kaplan-Meier method was used to evaluate the survival estimates for inactivation of the carious lesions for both treatment groups. Multivariate Cox regression models with shared frailty were performed to identify factors associated with the outcome (p < 0.05). After 12 months, 22% and 3% of the lesions treated with topical fluoride varnish and sealant, respectively remained active. The adjusted model demonstrated that younger children had a higher probability of active enamel carious lesions arresting (hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.22-0.78; p=0.01). However, the probability of active enamel carious lesions arresting after sealant application was 8.85 times higher compared with fluoride varnish applications (p=0.01). Sealing is a more effective approach than fluoride varnish for arresting occlusal enamel carious lesions in erupting permanent molars.
Highlights
IntroductionDespite the decline in the prevalence and progression rate of caries in children and adolescents worldwide,[1] permanent molars continue to be the most frequently decayed teeth.[2] The eruption stage is a predictor of caries on permanent teeth.[3] The average period of eruption is approximately
Submitted: May 9, 2020 Accepted for publication: November 25, 2020 Last revision: January 8, 2021Despite the decline in the prevalence and progression rate of caries in children and adolescents worldwide,[1] permanent molars continue to be the most frequently decayed teeth.[2]
The likelihood of active enamel carious lesions to arrest after sealant application was 8.85 times higher than that of fluoride varnish applications (HR 8.85 95%confidence intervals (CIs) 1.57–49.78; p = 0.01)
Summary
Despite the decline in the prevalence and progression rate of caries in children and adolescents worldwide,[1] permanent molars continue to be the most frequently decayed teeth.[2] The eruption stage is a predictor of caries on permanent teeth.[3] The average period of eruption is approximately. 15–2 7 months for the primary and secondary permanent molars, respectively.[4] The difficult access to molars, presence of gingival tissue on the occlusal surface, and absence of full occlusion are contributing factors for biofilm accumulation and, subsequently, caries activity.[5] Most occlusal carious lesions tend to arrest/revert when permanent molars reach the occlusal plane; a significant proportion of these lesions remain active.[5] This situation highlights the need for early caries assessment of these molar surfaces to establish minimally invasive strategies for arresting active enamel carious lesions at the initial eruption stages
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