Progression of Active Initial-proximal Lesions After Infiltration, Sealing or Flossing-instructions

Efficacy of three treatment strategies for initial-approximal caries lesions (A-Infiltration; B-Sealing; C-Flossing-instruction) on 40 young adults was assessed by means of a split-mouth design. Objective: To determine the progression of lesions detected as active at baseline, by radiographic examination after one year. Methods: 120 proximal lesions with radiographic extension around the enamel-dentin-junction (R-3) or in the dentine outer-third (R-4) were selected. Baseline standardized x-rays of all selected lesions were taken. Lesions were then visually assessed after using orthodontic spacers over 48h by one examiner (SM) using ICDAS visual criteria for severity. Activity of lesions was assessed with following parameters: Plaque-stagnation area (1-no; 3-yes); Visual appearance (1-brown-spot lesion; 3-white-spot lesion; 4-surface breakdown/shadow/cavitation); Tactile feeling (2-smooth; 4-rough); Papilla bleeding (0-no; 1-yes) [Ekstrand et al.: Oper Dent 2007;32(3):225-35]. A lesion was judged for activity when all parameters were examined and was considered active when the sum of points was 8 or more. Then lesions were randomly allocated to one of the three treatment strategies. After one year standardized radiographs were taken and a blind examiner (JG) analyzed lesion progression using pair-wise reading and subtraction radiography. Results: activity was assessed in 85/117 lesions followed-up after one year (72.6%); in 32 cases visual or tactile access of lesions was not achievable. Of these, 26/27 group A, 27/28 group B, and 25/27 group C lesions were assessed as active at baseline. The number of active lesions that progressed based on the paired radiograph reading was as follows: A-5, B-7, and C-13. By subtraction radiography, the numbers were 12, 19 and 19, respectively. X2 tests showed significant differences in lesion progression both with the pair-wise- (÷2=20.7; P<0.000) and subtraction-reading (÷2=43.6; P<0.000) methods among the three groups. Conclusion: Less active initial lesions progressed after one year, when infiltrated than when sealed or given flossing instructions.