Table 5.

A summary of several studies on noninvasive, microinvasive, and minimally invasive carious lesion management.

Reference	Study type	Materials and methods	Conclusions
Abuchaim et al. [61]	In vivo	The study included 44 adolescents who had bitewing radiographs taken to diagnose caries. The sample included noncavitated lesions extending up to half the thickness of the dentin. After tooth separation, the proximal caries-lesion surfaces in the experimental group (n = 33) were sealed with an adhesive. The control group (n = 11) was given oral hygiene instructions, including dental floss. After one year, follow-up radiographs were taken and compared to baseline radiographs.	Approximately 22% of the sealed lesions showed reduction, 61% no change, and 16% progressed. The corresponding values for the control lesions were 27%, 36%, and 36%, respectively. Sealing proximal caries lesions was not shown to be superior to lesion monitoring over a year.
Kantovitz et al. [60]	A systematic review	The Cochrane Library, Embase, PubMed, and Web of Science (ISI) databases were searched for papers published between January 1970 and September 2008.	While fissure sealing acts as a diffusion barrier on the lesion's surface, infiltration creates a barrier within the lesion by replacing the mineral lost with a low-viscositylight-curing resin.
Borges et al. [62]	In vivo	Sixty teeth from patients with a high caries risk had noncavitated dentinal occlusal caries. Patients were randomly assigned to one of two groups, each with 30 teeth. Oral hygiene instructions and a fissure sealant were given to the experiment group. Only oral hygiene instructions were given to patients in the control group. Over a 36-month period, clinical and radiographic examinations were used to track caries progression and sealant loss.	At 36 months, the pit and fissure sealant used in this study was shown to be effective in stopping carious lesions.
Ammari et al. [59]	A systematic review and meta-analysis	A thorough search was carried out in the following systematic electronic databases until June 2013: PubMed, Cochrane Library, Scopus, IBI Web of Science, Lilacs, SIGLE, and ClinicalTrials.gov. The study included only controlled clinical trials and randomised controlled clinical trials that evaluated the effectiveness of sealing on noncavitated proximal caries with a minimum follow-up of 12 months.	The findings indicate that sealing noncavitated proximal caries effectively controls proximal caries in the short and medium term. More long-term randomised clinical trials are needed to strengthen this evidence.
de Assuncao et al. [62]	A systematic review	Through November 2013, the MEDLINE/PubMed, LILACS, SciELO, and Scopus databases were searched for relevant publications. Only clinical trials evaluating the ability of noninvasive methods to stop the progression of occlusal noncavitated dentin carious lesions were considered.	Occlusal fissure sealing with a resin-based sealant may be used to arrest the progression of noncavitated occlusal dentine caries. Additional clinical trials with longer follow-up times are needed to enhance scientific evidence.
Dorri et al. [11]	A systematic review	The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, EMBASE via OVID, LILACs via BIREME Virtual Health Library, Web of Science conference proceedings, ZETOC conference proceedings, proquest dissertations and theses, ClinicalTrials.gov, OpenGrey, and the World Health Organization (WHO) International Clinical Trials Registry Platform were all searched until December 31, 2014. The metaRegister of controlled trials was searched up to and including October 1, 2014. There were no language or date restrictions in the electronic database searches. The investigation sought to assess the efficacy of microinvasive treatments for managing proximal caries lesions in children and adults with primary and permanent dentition.	According to the available evidence, microinvasive treatment of proximal caries lesions stops noncavitated enamel and initial dentinal lesions (limited to the outer third of dentine, based on radiograph) and is significantly more effective than noninvasive professional treatment (e.g., fluoride varnish) or advice (e.g., to floss).
Anauate-Netto et al. [63]	In vivo	A controlled clinical trial included 23 volunteers with clinically and radiographically noncavitated occlusal caries and caries risk ranging from “low” to “very high.” A total of 86 teeth were randomly assigned to one of two experimental groups: Group one received a commercial pit-and-fissure sealant; while group two received Icon infiltrant (DMG). Over a three-year period, caries progression was monitored using clinical (laser fluorescence caries detection) and radiographic examinations at 12-month intervals. The marginal integrity of the sealing materials was also evaluated.	After three years of clinical evaluation, the infiltrant was effective in preventing caries progression in noncavitated pit-and-fissures, comparable to the conventional sealant. The infiltrant also showed better radiographic results in caries progression at the 3-year evaluation time.
Krois et al. [64]	Systematic review and meta-analysis	Hand searches and cross-referencing were used in addition to searching three electronic databases (MEDLINE, Embase, and Cochrane Central). Randomized controlled trials comparing microinvasive strategies, noninvasive treatment, or placebo for treating proximal carious lesions were included in the study. The primary outcome was the radiographic progression of the lesion. For synthesis, pairwise and Bayesian network meta-analysis, as well as TSA, were used.	Microinvasive (sealing or infiltration) approaches are likely to be more effective than noninvasive approaches for arresting early (noncavitated) proximal lesions.
Abdelaziz et al. [65]	In vivo study	Extracted human posterior teeth with noncavitated proximal carious lesions (ICDAS code 1-2) were cut vertically to obtain two symmetrical lesions. Group: Noninvasive proximal adhesive restoration (NIPAR)—half of the paired lesions' surfaces (n = 13) were abraded with metallic strips and etched with 37% H3PO4 for 120 seconds. Group 2: The infiltration concept technique (ICON)—the other half of the paired lesions' surfaces (n = 13) were etched with 15% HCl gel for 120 seconds. Group 1 samples were infiltrated with Scotchbond universal for 180 seconds. Group 2 samples were infiltrated with ICON infiltrant	Noninvasive proximal adhesive restoration allowed for better infiltration of noncavitated proximal carious lesions than ICON. Clinical significance: The combination of infiltration and sealing using noninvasive proximal adhesive restoration (NIPAR) offers a suitable noninvasive treatment option for noncavitated proximal lesions combining the advantages of sealing and infiltration.
Chen et al. [51]	Systematic review	Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials comparing the efficacy of infiltration/sealing versus noninvasive treatments in proximal lesions were included. The primary outcome was determined by radiographic readings.	Infiltration and sealing were more efficacious than noninvasive treatments for halting noncavitated proximal lesions.