Early treatment of incipient carious lesions - A two-year clinical evaluation

Background. The purpose of this study was to quantify conservation of tooth structure and evaluate the efficacy of early treatment of questionable carious lesions in pits and fissures of posterior teeth, using air abrasion followed by placement of preventive resin restorations. Methods. Ninety-three patients with 223 questionably carious teeth, mainly with darkly stained pits and fissures, were recruited from general dentistry clinics. After baseline evaluation, each tooth was randomly assigned to either an early treatment or control group. The authors used air abrasion to investigate the pits and fissures of teeth were sealed and restored with a flowable resin-based composite. All teeth in both groups were examined at six-month intervals to clinically evaluate the quality of the restorations and the caries status of the control teeth. Results. After two years, two of the 113 restorations in the early treatment group required further treatment because of penetrating stain at a margin. In the control group, 14 teeth required treatment because of caries. The mean weight of the impression material-a surrogate measure of volume of removed tooth structure-in preparations that extended into dentin in the early treatment group was 0.0260 grams compared with 0.0281 g in the control group. There was no statistically significant difference between the impression weights (P = .390). Conclusion. After two years of a proposed five-year study, the authors concluded that conservation of tooth structure was not substantiated by early treatment. Clinical Implications. Treating questionable carious lesions early may not conserve tooth structure.