Non-Invasive Methods and the Use of Infiltrating Resins for the Control of Caries Progression in Deciduous Teeth: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To evaluate the influence of non-invasive treatment associated with the use of infiltrating resin for managing caries lesions in primary teeth. Material and Methods: A systematic review was performed by selecting articles from 6 online databases, using a search algorithm and eligibility criteria for data extraction and data synthesis for the papers included. Clinical trials involving primary teeth with incipient caries lesions (1/2 of the enamel or 1/3 of the outer dentin) were included, presenting full text and answering the study's guiding question. This study used the RoB 2 tool for the risk of bias assessment and GRADE for certainty of evidence. Random effects meta-analyses were implemented, and lesion progression treatment effects were estimated through relative risk (RR) and associated 95% confidence intervals. Results: A total of 440 studies were found. After analyzing the inclusion criteria and removal of duplicates, eight studies were analyzed for quality evidence. Five of the eight studies included in this review contributed to the meta-analysis, all with some reflections regarding the risk of bias. Overall, the results of the meta-analysis showed that non-invasive treatment, when associated with the use of infiltrating resins, significantly reduced the risk of caries progression in relation to the treatment without this addition for follow-up periods ranging from 12 months to 2 years (RR 0.51 [0.40-0.65]). Conclusion: There is moderate certainty of evidence that the use of infiltrating resins associated with non-invasive treatments decreases the risk of caries progression in primary teeth with incipient caries lesions (1/2 of the enamel or 1/3 of the dentin outer) when combined with non-invasive control methods alone.

Efficacy and Safety of Oral Midazolam Sedation Compared with its Combination with Hydroxyzine Use in Pediatric Dentistry: A Systematic Review

ABSTRACT Objective: To assess the efficacy and safety of the use of midazolam as monotherapy, compared to the associated use of midazolam and hydroxyzine for minimum and moderate sedation of children in dental offices, using data obtained from clinical trials. Material and Methods: A systematic review protocol was developed and registered on PROSPERO (CR42020208633). An electronic search was carried out in Pubmed, Lilacs, Science Direct, Open Gray, Web of Science, and central Cochrane Library. No language restrictions were included. Clinical trials were carried out with children aged 0-12 years, using midazolam as monotherapy compared to the use of midazolam associated with hydroxyzine to verify the effectiveness and safety of oral sedation. The quality of the studies was individually assessed and grouped using the RoB 2 (Revised Cochrane risk-of-bias tool for randomized trials) and GRADE (Grading of Recommendations Assessment, Development and Evaluation) systems, respectively. Results: A total of 749 studies were found. After analyzing the inclusion and removal of duplicates, two studies were analyzed for the quality of evidence. Through this analysis, it was possible to verify the very low level of scientific evidence on the superiority of the efficacy and safety of the combined use of midazolam and hydroxyzine for oral sedation in children in dental offices. Conclusion: The conflicting results and limitations of the studies enabled to establish that there is insufficient evidence to support the use of these drugs combined. There is only evidence for the use of midazolam as monotherapy.