1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA.
2 Department of Pediatric Dentistry, School of Dentistry, University of Washington, Seattle, WA, USA.
J Dent Res. 2019 Jan;98(1):14-26. doi: 10.1177/0022034518800014. Epub 2018 Oct 5.
The goal of nonrestorative or non- and microinvasive caries treatment (fluoride- and nonfluoride-based interventions) is to manage the caries disease process at a lesion level and minimize the loss of sound tooth structure. The purpose of this systematic review and network meta-analysis was to summarize the available evidence on nonrestorative treatments for the outcomes of 1) arrest or reversal of noncavitated and cavitated carious lesions on primary and permanent teeth and 2) adverse events. We included parallel and split-mouth randomized controlled trials where patients were followed for any length of time. Studies were identified with MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews. Pairs of reviewers independently conducted the selection of studies, data extraction, risk-of-bias assessments, and assessment of the certainty in the evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Data were synthesized with a random effects model and a frequentist approach. Forty-four trials (48 reports) were eligible, which included 7,378 participants and assessed the effect of 22 interventions in arresting or reversing noncavitated or cavitated carious lesions. Four network meta-analyses suggested that sealants + 5% sodium fluoride (NaF) varnish, resin infiltration + 5% NaF varnish, and 5,000-ppm F (1.1% NaF) toothpaste or gel were the most effective for arresting or reversing noncavitated occlusal, approximal, and noncavitated and cavitated root carious lesions on primary and/or permanent teeth, respectively (low- to moderate-certainty evidence). Study-level data indicated that 5% NaF varnish was the most effective for arresting or reversing noncavitated facial/lingual carious lesions (low certainty) and that 38% silver diamine fluoride solution applied biannually was the most effective for arresting advanced cavitated carious lesions on any coronal surface (moderate to high certainty). Preventing the onset of caries is the ultimate goal of a caries management plan. However, if the disease is present, there is a variety of effective interventions to treat carious lesions nonrestoratively.
非修复性或非微创性龋齿治疗（基于氟化物和非氟化物的干预措施）的目标是在病变水平上管理龋齿疾病过程，并最大限度地减少健康牙体结构的损失。本系统评价和网络荟萃分析的目的是总结非修复性治疗在以下两个方面的现有证据：1）原发性和永久性牙齿上非龋性和龋性病变的静止或逆转，2）不良事件。我们纳入了平行和分牙随机对照试验，患者在任何时间长度内都可以接受随访。研究通过 Ovid 下的 MEDLINE 和 Embase、Cochrane 中心、Cochrane 系统评价数据库进行检索。由两名评审员独立进行研究选择、数据提取、偏倚风险评估以及使用推荐评估、制定和评价（GRADE）方法评估证据的确定性。使用随机效应模型和频率论方法进行数据综合。44 项试验（48 份报告）符合条件，共纳入 7378 名参与者，评估了 22 种干预措施在静止或逆转非龋性或龋性病变方面的效果。四项网络荟萃分析表明，封闭剂+5%氟化钠（NaF）漆、树脂渗透+5%NaF 漆以及 5000ppm F（1.1%NaF）牙膏或凝胶在静止或逆转原发性和/或永久性牙齿上的非龋性窝沟、邻面和非龋性及龋性根面病变方面最有效（低到中等确定性证据）。基于研究的证据表明，5%NaF 漆在静止或逆转非龋性颊舌面病变方面最有效（低确定性），而每年两次应用 38%的氨银溶液在静止或逆转任何冠面的进展性龋性病变方面最有效（中到高度确定性）。预防龋齿的发生是龋齿管理计划的最终目标。然而，如果疾病存在，有多种有效的干预措施可以非修复性地治疗龋病。
