Methods: A detailed search strategy was developed for the identification of randomised controlled trials (RCTs) of at least 1 year in duration comparing approximal sealing with no sealant or conventional filling for prevention and/or management of non-cavitated dental caries in primary and permanent teeth in adults and children. The primary outcome was caries progression in the approximal surfaces of posterior teeth. The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Pubmed), OVID, EMBASE, SCOPUS, SCISEARCH, CAplus, INSPEC, NTIS, PASCAL, DARE, NHS EED and HTA were searched (to Februrary 2012). The identified records and the risk of bias of the included trials were examined by two researchers independently. Any disagreements were resolved by discussion.
Results: Six split-mouth RCTs included in the review investigated the efficacy of approximal sealing in managing non-cavitated approximal lesions. Two studies examining adhesive patch (vs. flossing and fluoride toothpaste alone) and resin sealant (vs. fluoride varnish) in permanent posterior teeth reported no significant difference after 3 and 2 years follow-up, respectively (p > 0.05). Two studies reported significant reduction in caries progression for resin sealants vs. flossing in primary (24% and 25% after 1 and 2.5 years follow-up, respectively, p<0.001) and permanent (41%, 1.5 years follow-up, p<0.001) posterior teeth. Two studies reported positive therapeutic effects for resin infiltration in primary (vs. fluoride varnish alone, 1 year follow-up, 38% (95%CI: 23 56%)) and permanent (vs. placebo, 1.5 years follow-up, 30%, p<0.05) posterior teeth.
Conclusion: Approximal sealing may be recommended for managing early dental decay in primary and permanent teeth.