Abstract
Objectives
For
an ORCA/EFCD consensus, this systematic review assessed the question
“How to intervene in the caries process in proximal caries in
adolescents and adults”.
Material and methods
Separating
between the management of initial and cavitated proximal caries
lesions, Medline via PubMed was searched regarding
non-operative/non-invasive, minimally/micro-invasive and restorative
treatment. First priority was systematic reviews or randomized
controlled trials (RCTs), otherwise cohort studies. After extraction of
data, the potential risk of bias was estimated depending on the study
type, and the emerging evidence for conclusions was graded.
Results
Regarding non-invasive/non-operative care (NOC), no systematic reviews or RCTs were found. In cohort studies (n = 12)
with a low level of evidence, NOC like biofilm management and fluoride
was associated with a low proportion and slow speed of progression of
initial proximal lesions. Minimally/micro-invasive (MI) treatments such
as proximal sealants or resin infiltration (four systematic
reviews/meta-analyses) were effective compared with a
non-invasive/placebo control at a moderate level of evidence. Data on
restorative treatment came with low evidence (5 systematic reviews, 13
RCTs); with the limitation of no direct comparative studies, sample
size-weighted mean annual failure rates of class II restorations varied
between 1.2 (bulk-fill composite) and 3.8% (ceramic). Based on one RCT,
class II composite restorations may show a higher risk of failure
compared with amalgam.
Conclusions
Proximal
caries lesions can be managed successfully with non-operative,
micro-invasive and restorative treatment according to lesion stage and
caries activity.
Clinical relevance
Proximal caries treatment options like non-operative, micro-invasive and restorative care should be considered individually.
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