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Table 1 Non- and micro-invasive strategies for managing proximal lesions and the associated evidence base

From: How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement

Strategies Evidence strength
Non-invasive
Oral hygiene measures, mainly flossing and interdental brushes Weak. Randomized studies find these measures to remove plaque and prevent gingivitis, but not necessarily prevent or manage existing caries.
Fluoride (varnish, gel) application Weak. No studies available testing this approach only; most combined it with oral hygiene.
Combined oral hygiene and fluoride Weak. Both randomized studies and cohort studies available using combinations of oral hygiene and fluoride. However, fluoride application likely more relevant (see above). Proximal lesion arrest or slowing down lesion progression seems viable using this measure.
Dietary advice Weak. No specific data supporting this measure for managing proximal lesions. Biologic plausibility is, however, given.
Micro-invasive
Caries sealing (lesion is conditioned using phosphoric acid and then sealed using an adhesive or flowable composite, or glass ionomer cement; mechanism of “diffusion barrier” installation) Weak. Randomized trials support caries sealing (mainly using resins) in addition to non-invasive measures for early lesions, with the majority being arrested. Applicability in full dental arch unclear, though.
Caries infiltration (lesion is conditioned using hydrochloric acid, dried, and a low-viscosity resin allowed to penetrate into the lesion body. After light-curing, a “diffusion barrier” has been established) Moderate. Randomized trials support caries infiltration in addition to non-invasive measures, with nearly all lesions being arrested. Applicability given also in full dental arch. Currently only one infiltration system on the market.