Arrest of non-cavitated dentinal occlusal caries by sealing pits and fissures: a 36-month, randomised controlled clinical trial.

OBJECTIVE: This study aimed to evaluate the progression of sealed non-cavitated dentinal occlusal caries in a randomised controlled clinical trial. MATERIALS AND METHODS: Sixty teeth with non-cavitated dentinal occlusal caries were selected in patients with a high risk for caries. Patients were randomly divided into two groups so that each group included 30 teeth. Patients in the experiment group were given oral hygiene instructions and a fissure sealant. Patients in the control group were given oral hygiene instructions only. Caries progression and sealant loss were monitored over a period of 36 months by clinical and radiographic examinations. RESULTS: Clinical and radiographic progression of caries was significantly more frequent in the control group than in the experiment group. Three teeth lost their sealant and showed caries progression, but this was apparent only at the 12-month follow-up. At the 24- and 36-month recall appointments, neither sealant loss nor caries progression were observed. CONCLUSION: The pit and fissure sealant utilised in this study was shown to be effective in arresting carious lesions at 36 months.

In vivo assessment of secondary caries and dentin characteristics after traditional amalgam restorations.

OBJECTIVE: This study aimed to evaluate in vivo the occurrence of secondary caries and dentin characteristics in permanent molars after traditional amalgam restorations, by means of clinical visual examination, radiographs and laser-induced fluorescence (LF) (DIAGNOdent). METHODS: Thirty first permanent molars of 30 schoolchildren in the 7 to14 year-old age group were included. Caries was removed by hand. Thus, indirect pulp capping was performed with glass-ionomer cement (GIC), the cavity was varnished and amalgam filled. LF was measured before and after cavity preparation and after a 12-month observation period. Dentin color after cavity preparation and after the 12-month observation period was recorded. Recurrent caries was also investigated by visual clinical and radiographic examinations, in addition to dentin thickness between pulp and indirect GIC pulp capping. Data was analyzed by ANOVA for repeated measurements, paired "t" test and descriptive statistic. RESULTS: There were statistically significant differences (P<.05) among LF scores for dentin in all periods evaluated, with the lowest scores shown after 12 month of observation. There was no statistical difference between dentin color after cavity preparation and following 12 months of observation. Moreover, there was no recurrent caries attack at 12-month follow-up; dentin thickness between pulp and indirect GIC pulp capping was similar between baseline and final observation periods. It was concluded that the clinical restorative procedure using hand caries removal, indirect pulp capping with GIC, varnishing and amalgam filling the cavity did not provide secondary caries and increased dentin mineral content after 12 months.

Update on nonsurgical, ultraconservative approaches to treat effectively non-cavitated caries lesions in permanent teeth.

Dental caries on tooth surfaces is still a problem in many industrialized countries. For many years, dentistry was influenced by a mechanical approach characterized by the use of high-speed rotary cutting instruments, and dentists predominantly used surgical methods to address caries. This included radical removal of diseased portions of the tooth, along with material-driven geometric extensions to areas that were assumed to be caries-resistant. This concept of extension for prevention was introduced by G. V. Black and influenced dentists for more than 120 years. Recently, a new paradigm of operative conservatism, sometimes referred to as "minimally invasive dentistry," has gained popularity. This paradigm is designed to promote maximum preservation of healthy dental structures over a lifetime. The aim of this review is to discuss the efficacy of current nonsurgical treatments for non-cavitated caries lesions in permanent teeth. Based on results obtained from clinical trials, this review evaluates treatments such as consumption of CPP-ACP added gums, resin infiltration and fissure sealing. Although in a few cases an invasive approach is needed to arrest caries progression, the non-surgical approach generally provides potential benefits that include conserving structure by delaying intervention or minimizing the operative procedure. All current non-invasive methods are effective in treating non-cavitated caries lesions. The adoption of non-invasive approaches in the management of these lesions can preserve dental tissues, thus increasing tooth longevity.