Los sellantes de uso odontológico han tenido una demanda de información inusitada en las preferencias de la profesión odontológica. Eso es por lo demas, lo que ha sucedido en este sitio. Ello no es de extrañar, si se considera en el contexto de la Prevención y su obvia importancia en la Odontología.
Dr. Jorge Garat
Am J Dent. 2009 Apr;22(2):89-91.
Sealant adaptation and penetration into occlusal fissures.
Kane B, Karren J, Garcia-Godoy C, Garcia-Godoy F.
College of Dental Medicine, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, Florida 33328, USA.
PURPOSE: To evaluate the adaptation and penetration into occlusal fissures of two different types of fissure sealants. METHODS: Extracted third molars (n=10) with evident occlusal fissures were cleaned with a pumice/water slurry and randomly divided into two groups and sealed following the manufacturers’ directions as follows: Group 1–Embrace fissure sealant (Pulpdent). Surfaces were cleaned and dried, then etched for 15 seconds. Excess water was removed leaving the surface slightly moist. Sealant was applied from cusp to cusp without covering marginal ridges and light cured for 20 seconds using a halogen light at 500 mW/cm2. Group 2–ClinPro (3M Espe). Surfaces were cleaned and dried then etched for 15 seconds. The etched surface was rinsed and thoroughly dried. Dried surfaces appeared frosty white. Sealant was placed making sure not to go beyond etched area, and light cured for 20 seconds. Teeth were thermocycled (500x) and sectioned with an Isomet in a mesio-distal direction (4 slices per tooth). The sections were examined under the SEM. The marginal adaptation of the sealants was evaluated under the SEM using the following criteria: 1 = Smooth adaptation. Sealant flows with enamel. No ledges; 2 = Sealant is not well adapted. Ledge may be present. The penetration ability of the sealants was evaluated under the SEM using the following criteria: 1 = Sealant penetrated 1/3 the total length of the fissure; 2 = Sealant penetrated 1/2 the total length of the fissure; 3 = Sealant penetrated the total length of the fissure. The results were statistically analyzed using a t-test. RESULTS: Embrace showed consistently more intimate marginal adaptation than ClinPro in fissures of the same approximate width and depth (P < 0.05).
Monogr Oral Sci. 2009;21:174-87. Epub 2009 Jun 3.
Novel operative treatment options.
Dundee Dental Hospital and School, University of Dundee, Dundee, UK. d.n.j.ricketts@dundee.ac.uk
There are an increasing number of more novel options available for operative intervention. This chapter outlines a series of operative treatment options which are available to the modern clinician to select from once a decision has been made to treat a carious lesion operatively. A series of novel methods of caries removal have been described; including chemomechanical caries removal, air abrasion, sono-abrasion, polymer rotary burs and lasers. There are also novel approaches to ensure complete caries removal and novel approaches for the management of deep caries. A novel question increasingly asked by clinicians is: does all the caries need to be removed? Operative management options here include: therapeutic fissure sealants, ultraconservative caries removal, stepwise excavation and the Hall technique. In conclusion, there is now a growing wealth of evidence that questions the traditional methods of caries removal and restoring the tooth. In parallel, there is a growing movement exploring the merits of therapeutically sealing caries into the tooth. This philosophy is alien to many of today’s dentists and, until further randomized controlled trials are carried out in primary care, prudent caution must be exercised with this promising approach. Research is required into techniques which will allow monitoring of sealed caries to detect any rare, but insidious, failures. These novel techniques are an alternative way of managing the later stages of the caries process from a sounder biological basis and have marked potential benefits to patients from treatment, pain and outcome perspectives. Copyright 2009 S. Karger AG, Basel
Monogr Oral Sci. 2009;21:156-63. Epub 2009 Jun 3.
Novel preventive treatment options.
Longbottom C, Ekstrand K, Zero D, Kambara M.
Dental Health Services and Research Unit, University of Dundee, Dundee, UK. c.longbottom@cpse.dundee.ac.uk
A number of novel preventive treatment options which, as with traditional methods, can be differentiated into 3 categories of prevention (primary, secondary and tertiary), have been and are being currently investigated. Those reviewed are either commercially available or appear relatively close to that point. These include: approximal sealants; fluoride applications, including slow-release devices; measures to help remineralize demineralized tissue, including 3 different methods of delivering amorphous calcium phosphate; measures to help modify the biofilm to reduce the cariogenic challenge, including ozone therapy and probiotics; measures to increase enamel resistance to demineralization, including laser treatment of enamel, and a novel ‘hybrid’ technique for the treatment of primary molar caries which involves ‘overlapping’ of secondary and tertiary prevention–the Hall technique. Although many of these techniques show considerable promise and dentists should be aware of these developments and follow their progress, the evidence for each of these novel preventive treatment options is currently insufficient to make widespread recommendations. Changes in dental practice should be explored to see how oral health can be best supported through novel preventive systems. Further research is also required involving double-blind randomized controlled trials in order to bring further benefits of more effective caries control to patients. Implementation in practice should follow promptly as new techniques are shown to be clinically valuable for individual patients. Copyright 2009 S. Karger AG, Basel
J Am Dent Assoc. 2009 Sep;140(9):1125-36.
Retention of metal-ceramic crowns with contemporary dental cements.
Johnson GH, Lepe X, Zhang H, Wataha JC.
Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash. 98195-7456, USA. gjohnson@u.washington.edu
BACKGROUND: New types of crown and bridge cement are in use by practitioners, and independent studies are needed to assess their effectiveness. The authors conducted a study in three parts (study A, study B, and study C) and to determine how well these new cements retain metal-ceramic crowns. METHODS: The authors prepared teeth with a 20-degree taper and a 4-millimeter length. They cast high-noble metal-ceramic copings, then fitted and cemented them with a force of 196 newtons. The types of cements they used were zinc phosphate, resin-modified glass ionomer, conventional resin and self-adhesive modified resin. They thermally cycled the cemented copings, then removed them. They recorded the removal force and calculated the stress of dislodgment by using the surface area of each preparation. They used a single-factor analysis of variance to analyze the data (alpha = .05). RESULTS: The mean stresses necessary to remove crowns, in megapascals, were 8.0 for RelyX Luting (3M ESPE, St. Paul, Minn.), 7.3 for RelyX Unicem (3M ESPE), 5.7 for Panavia F (Kuraray America, New York) and 4.0 for Fuji Plus (GC America, Alsip, Ill.) in study A; 8.1 for RelyX Luting, 2.6 for RelyX Luting Plus (3M ESPE) and 2.8 for Fuji CEM (GC America) in study B; and 4.9 for Maxcem (Kerr, Orange, Calif.), 4.0 for BisCem (Bisco, Schaumburg, Ill.), 3.7 for RelyX Unicem Clicker (3M ESPE), 2.9 for iCEM (Heraeus Kulzer, Armonk, N.Y.) and 2.3 for Fleck’s Zinc Cement (Keystone Industries, Cherry Hill, N.J.) in study C. CONCLUSIONS: Powder-liquid versions of new cements were significantly more retentive than were paste-paste versions of the same cements. The mean value of crown removal stress for the new self-adhesive modified-resin cements varied appreciably among the four cements tested. All cements retained castings as well as or better than did zinc phosphate cement. CLINICAL IMPLICATIONS: Powder-liquid versions of cements, although less convenient to mix, may be a better clinical choice when crown retention is an issue. All cements tested will retain castings adequately on ideal preparations because the corresponding removal stresses are comparable with or higher than those associated with zinc phosphate. Powder-liquid resin-modified glass ionomer cement, selected self-adhesive modified-resin cements and conventional resin cements provide additional retention when desired.
Dent Mater J. 2009 Jul;28(4):446-53.
Effect of an internal coating technique on tensile bond strengths of resin cements to zirconia ceramics.
Kitayama S, Nikaido T, Maruoka R, Zhu L, Ikeda M, Watanabe A, M Foxton R, Miura H, Tagami J.
Cariology and Operative Dentistry, Department of Restorative Science, Graduate School, Tokyo Medical and Dental University.
This study was conducted to enhance the tensile bond strengths of resin cements to zirconia ceramics. Fifty-six zirconia ceramic specimens (Cercon Base) and twenty-eight silica-based ceramic specimens (GN-1, GN-1 Ceramic Block) were air-abraded using alumina. Thereafter, the zirconia ceramic specimens were divided into two subgroups of 28 each according to the surface pretreatment; no pretreatment (Zr); and the internal coating technique (INT). For INT, the surface of zirconia was coated by fusing silica-based ceramics (Cercon Ceram Kiss). Ceramic surfaces were conditioned with/without a silane coupling agent followed by bonding with one of two resin cements; Panavia F 2.0 (PF) and Superbond C&B (SB). After 24 hours storage in water, the tensile bond strengths were tested (n=7). For both PF and SB, silanization significantly improved the bond strength to GN-1 and INT (p<0.05). The INT coating followed by silanizaton demonstrated enhancement of bonding to zirconia ceramics.
Clin Oral Investig. 2009 Aug 25. [Epub ahead of print]
Immediate bonding effectiveness of contemporary composite cements to dentin.
Sarr M, Mine A, De Munck J, Cardoso MV, Kane AW, Vreven J, Van Meerbeek B, Van Landuyt KL.
Leuven BIOMAT Research Cluster, Department of Conservative Dentistry, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Catholic University of Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
The objective of this study was to compare the one-week bonding effectiveness of nine contemporary composite cements used to lute ceramic to dentin and to determine an appropriate processing method for pretesting failures. The microtensile bond strengths (microTBS) of different luting agents including five self-adhesive cements (Unicem, 3 M ESPE; Maxcem, Kerr; Monocem, Shofu; G-Cem, GC; and Multilink Sprint, Ivoclar-Vivadent), two self-etch cements (Panavia F2.0 and Clearfil Esthetic Cement, Kuraray), and two etch-and-rinse cements (Calibra, Dentsply, and Variolink II, Ivoclar-Vivadent) were measured using a standardized protocol. As control, a two-step self-etch adhesive combined with a restorative composite (Clearfil SE+Clearfil APX, Kuraray) were included as luting material. Depending on the processing of the pretesting failures, two groups of cements could be distinguished: (1) those with low bond strength and many pretesting failures and (2) those with relatively high bond strength and few pretesting failures. Nevertheless, the control luting procedure involving a self-etch adhesive combined with a restorative composite presented with a significantly higher microTBS. The microTBS was clearly product-dependent rather than being dependent on the actual adhesive approach. Fracture analysis indicated that failure usually occurred at the dentin-cement interface especially for the cements with low bond strength and many pretesting failures. Depending on the cement system, an adequate immediate ceramic-to-dentin bond strength can be obtained, even with self-adhesive cements that do not use a separate dental adhesive. Yet, the self-etch adhesive Clearfil SE combined with the restorative composite revealed a superior bonding performance and should therefore be preferred in clinical situations where the restoration transmits light sufficiently.
J Dent. 2009 Aug 20. [Epub ahead of print]
In vitro wear gap formation of self-adhesive resin cements: A CLSM evaluation.
Belli R, Pelka M, Petschelt A, Lohbauer U.
Department of Operative Dentistry, School of Dentistry, Federal University of Santa Catarina, Brazil; Dental Clinic 1 – Operative Dentistry and Periodontology, University of Erlangen-Nuremberg, Glueckstr. 11, D-91054 Erlangen, Germany.
OBJECTIVES: To evaluate the depth of wear gaps of new self-adhesive cements after toothbrush abrasion and ACTA wear test. METHODS: Luting spaces (325+/-25mum width, 2mm depth) were produced in Empress 2 ceramic blocks with a diamond saw to obtain flat substrate segments for toothbrush abrasion (n=24) and ACTA wear (n=27). After etching and silanization, the slits were filled with 8 self-adhesive cements, 2 conventional resin cements and 1 flowable composite, stored for 2 weeks in distilled water at 37 degrees C and planished to the cement level. Toothbrush abrasion was carried out in a toothbrush simulator (Willytec, Germany) for 20,000 cycles (load 1N) using an abrasive slurry based on a commercial toothpaste (Elmex, Gaba, Germany, RDA=77). The ACTA wear experiment was performed following the ACTA protocol in millet seed slurry for 400,000 cycles (Willytec). The gap replicas were measured for vertical wear loss under a confocal laser scanning microscope (CLSM). The data were analyzed using one-way ANOVA and a mod-LSD test at p<0.05. RESULTS: Toothbrush wear values were lower than the ones obtained for the ACTA wear test for all cements. In the toothbrush test Bifix SE, Clearfil SA, SmartCem 2, G-Cem and Maxcem Elite obtained the highest values together with Grandio Flow. Grandio Flow and AllCem showed to be the most resistant to the ACTA wear test, while SpeedCem the least resistant. No correlation was found between the two wear test experiments. CONCLUSION: Self-adhesive cements have good wear resistance to toothbrush abrasion but most of them wear more rapidly under higher loads in the ACTA test than conventional resin cements and flowable composites.
Oper Dent. 2009 Jul-Aug;34(4):472-80.
Effects of storage temperature on the shelf life of one-step and two-step self-etch adhesives.
Ma S, Nakajima KF, Nishiyama N.
Nihon University Graduate School of Dentistry at Matsudo, Department of Dental Biomaterials, Matsudo, Japan.
Recently, self-etch adhesive systems, the one-step (all-in-one) and two-step adhesive systems, have become widely utilized due to their simplified application procedures and low technique sensitivity. In the current study, in order to understand the effects on shelf life of the two types of self-etch adhesives, the effects from storage temperature and time period on the alteration stage of 10-methacryloxydecyl dihydrogen phosphate (MDP)-based, a one-step adhesive (all-in-one adhesive system) and an MDP-based self-etching primer (two-step adhesive system) were examined. Clearfil Tri-S Bond (TSB), an MDP-based one-step adhesive (all-in-one adhesive system), and Clearfil Mega Bond Primer (MBP), an MDP-based self-etching primer (two-step adhesive system), were used. Both TSB and MBP, received within two days after they were produced, were immediately stored at 8 degrees C, 20 degrees C or 40 degrees C for 1, 3, 7 and 14 weeks, respectively. At the end of each storage period, 13C NMR observations were performed by an EX-270 spectrometer. In addition, NMR observations of TSB and MBP were immediately performed within two days, after both were produced as a control. The effects from the storage temperature and time period on the alteration rate and stage of TSB and MBP were examined by determining the amount of hydrolyzed 2-hydroxyethyl methacrylate (HEMA) and MDP in both materials. Specimens bonded to dentin by using TSB or MBP in different alteration stages were prepared. The degradation stage effect of TSB or MBP on bond durability was examined by measuring the shear bond strength before and after thermocycling (20,000 times). With increases in storage temperature and time period, the relative intensities of the NMR peak “epsilon” assigned to both methylene carbons in the ethylene glycol (EG) and to the NMR peak “zeta” assigned to the terminal methylene carbon bonded to the hydroxy group in the 10-hydroxydecyl dihydrogen phosphate (HDP) produced by the hydrolysis of the ester portion in HEMA or MDP, respectively, increased. The alteration stages of TSB and MBP were strongly dependent on storage temperature and time period. When TSB or MBP, stored at 40 degrees C for 14 weeks, was applied to dentin, specific decreases in mean bond strength were observed in both adhesive systems. However, the application of thermocycling did not exhibit any specific decreases in the mean bond strength, even though the alteration stage of TSB and MBP progressed. From the results of the current study, storage temperature and time period significantly affect the alteration rate and stage of TSB and MBP. However, TSB and MBP exhibit expectant bond strength and bond durability when both are stored below 20 degrees C.
J Adhes Dent. 2009 Apr;11(2):91-4.
Sealing of proximal surfaces with polyurethane tape: a two-year clinical and radiographic feasibility study.
Alkilzy M, Berndt C, Meller C, Schidlowski M, Splieth C.
Department of Preventive and Pediatric Dentistry, University of Greifswald, Germany. alkilzy@hotmail.com
PURPOSE: Proximal carious lesions comprise a constant clinical problem. The aim of this investigation was to test the safety and clinical effect of a new treatment for proximal caries. MATERIALS AND METHODS: In 50 patients with two proximal initial lesions (D1-3 without cavitation, bitewing radiograph), orthodontic rubber rings were applied to gain access to the interproximal space. One of the lesions was sealed with a thin polyurethane-dimethacrylate foil using a bonding agent; the other lesion received oral home care with dental floss and fluoridated toothpaste, and was left as control. RESULTS: In clinical follow-ups after 6 and 12 months and radiographic evaluation after two years, clinical retention of proximal tape and the underlying sealant, marginal adaptation, discoloration, tooth vitality, proximal plaque, and gingivitis were checked. In addition, carious lesions were assessed clinically and radiographically. The sealants showed good retention, marginal adaptation, and color. After two years, vitality of all teeth was still positive and no relevant differences in plaque accumulation or gingival status were found between sealed and control teeth. Nine sealed lesions showed caries regression and 2 progression. In contrast, only 4 control lesions regressed and also 2 showed progression. The loss of tape had no significant influence on the lesion progression, indicating the effect of the underlying bond. All other sealants and control lesions were stable, indicating an arrest of the lesion. CONCLUSION: Sealing initial proximal lesions showed no clinical problems and mostly arrest of initial carious lesions on bitewing radiographs.
N Y State Dent J. 2009 Mar;75(2):49-51.
Enamel bond strength of self-etch sealant with and without prior acid etching.
Wadenya RO, Herrera M, Smith J, Mante F.
wadenya@dental.upenn.edu
Our study was undertaken to evaluate the bond strength (BS) of a self-etch sealant to enamel and to determine the effect of prior enamel conditioning with phosphoric acid. Lingual surfaces of permanent human molars were mounted in copper rings and assigned to five groups: Group 1, Clinpro (control); Group 2, Enamel Loc; Groups 3, 4, 5, Enamel Loc with prior phosphoric acid etching of enamel for 5, 10, 15 seconds, respectively. Sealants were applied and BS measured. Clinpro showed significantly higher BS than Enamel Loc. Prior enamel etching for 10 and 15 seconds improved BS of Enamel Loc.
Community Dent Health. 2009 Mar;26(1):32-7.
The prevalence of dental caries and fissure sealants in 12 year old children by disadvantaged status in Dublin (Ireland).
Sagheri D, McLoughlin J, Clarkson JJ.
Department of Public and Child Dental Health, Dublin Dental School and Hospital, Trinity College, Ireland. darius.sagheri@dental.tcd.ie
OBJECTIVE: The aim was to record dental caries levels and the presence of fissure sealants in 12-year-old schoolchildren whose domestic water supply had been fluoridated since birth in Dublin (Ireland). RESEARCH DESIGN: Cross-sectional study. Participants A representative, random sample of 12-year-old schoolchildren in north-west Dublin. OUTCOME MEASURES: Dental caries levels were recorded using WHO criteria and fissure sealant was recorded when sealant was detectable on a permanent molar tooth. Medical card ownership, as a surrogate for disadvantage, was recorded by use of a questionnaire. RESULTS: Three-hundred and thirty-two (332) children were examined. The mean DMFT was 0.80 (SD 1.24). Analysis (Mann-Whitney U test) based on stratification of the sample according to medical-card status revealed no statistically significant difference between DMFT median scores of children of medical-card holders (i.e., social disadvantage background) and non medical-card holders (p-value = 0.23). However, the data revealed a social gradient in the presence of at least one fissure sealant. Approximately 10% more children in the group of medical-card holders had no fissure sealants present. Fisher’s exact test was used to examine the association between the absence of fissure sealants and at least one fissure sealant between the two groups and was considered to be statistically significant (p-value = 0.04). CONCLUSION: This study demonstrated a social gradient in the presence of fissure sealants, but no such gradient in dental caries levels. This demonstrates the importance of population-based measures in the prevention of dental caries, such as water fluoridation, in reducing oral health inequalities.
J Indian Soc Pedod Prev Dent. 2008 Jun;26(2):59-63.
The effect of fissure morphology and eruption time on penetration and adaptation of pit and fissure sealants: An SEM study.
Department of Pedodontia, Government Dental College, Amritsar, India. navgredent@hotmail.com
This study was designed to examine the effect of fissure morphology on penetration and adaptation of fissure sealants and their relationship with the eruption time of tooth. MATERIALS AND METHODS: One hundred and fifty extracted molars and premolars were divided into two groups on the basis of their eruption time. The two groups were further divided into five subgroups on the basis of fissure morphology. An scanning electron microscopic analysis of penetration and adaptation of sealant was done. OBSERVATIONS AND RESULTS: V- and U-shaped fissures were found to have the maximum penetration. Penetration was very poor for I- and IK-types of fissures. No significant difference in penetration was found in relation to eruption time. Adaptation of sealant was not affected by any of the factors. CONCLUSION: Even the well-applied sealant does not necessarily provide complete obturation of pits and fissures, thus necessitating periodical clinical observation to determine the success or potential failure of the sealant treatment.
J Contemp Dent Pract. 2009 Mar 1;10(2):26-33.
Microleakage of an adhesive system used as a fissure sealant.
Bonifacio CC, Navarro RS, Sardenberg F, Imparato JC, de Carvalho RC, Raggio DP.
Faculty of Dentistry at the Universidade de São Paulo, São Paulo, Brazil. clarissacalil@usp.br
AIM: The aim of this study was to investigate the microleakage of pit and fissure sealants in primary teeth and to determine if multi-step methods should produce better results in terms of microleakage prevention. METHODS AND MATERIALS: A total of 40 intact primary molars were randomly assigned to one of four sealant groups: resin based sealant Ultraseal XT (US – Ultradent) (Group 1, n=10); adhesive system Scotchbond Multi Purpose Plus (SBMP – 3M/ESPE) used as a sealant (Group 2, n=10); primer (SBMP) and US (Group 3, n=10); and primer, bond (SBMP) and US (Group 4, n=10). After thermocycling (x700, 5-55 degrees C) all teeth surfaces were made impermeable with the exception of the occlusal surface. Samples were immersed in 50% silver nitrate for 8 hours, sectioned longitudinally with two cuts in the central fissure pit, and then immersed in photo development solution followed by 16 hours in fluorescent light. Pictures were obtained by light microscope (x40) and the degree of microleakage was evaluated by three blinded evaluators. The data were analyzed using the Kruskal Wallis test. RESULTS: Significant statistical differences (p<.05) were observed between Groups 1-3, Groups 2-3, Groups 2-4, and Groups 3-4. Group 3 showed higher microleakage scores. CONCLUSION: The adhesive system and the resin based sealant demonstrated similar microleakage properties, suggesting the possibility that adhesives can be used in a clinical setting. Additionally, the increase in the number of clinical steps required by common application of resin based sealant, including use of primer or primer and bond, did not lead to better results in preventing microleakage. CLINICAL SIGNIFICANCE: The adhesive system can be used as a sealant without increasing the microleakage. Thus, the use of the adhesive system before the application of the sealant is not necessary to reduce the microleakage, although further research is warranted to support this conclusion.
Angle Orthod. 2009 Mar;79(2):338-45.
Effectiveness of pit and fissure sealants in reducing white spot lesions during orthodontic treatment. A pilot study.
Benham AW, Campbell PM, Buschang PH.
OBJECTIVE: A pilot investigation was performed to test the null hypothesis that highly filled (58%) resin sealants do not prevent white spot lesions in patients undergoing active orthodontic treatment. MATERIALS AND METHODS: A split-mouth design was applied to 60 healthy patients, with the sealant randomly allocated to either the right or the left side of each jaw. The sealant was applied to the incisors and canines from the gingival surface of the bracket to the free gingival margin. The contralateral teeth had the same type of bracket with no sealant. Sealants were placed on the experimental teeth 2 weeks to 3 months after initial bonding and were removed after 15 to 18 months. Intraoral photographs, visual assessments, and DIAGNOdent (KaVo Dental Corporation, Lake Zurich, Ill) measurements were used to assess white spot lesions after sealant removal. RESULTS: Six lesions on the teeth with sealants were identified visually, compared with 22 lesions on the teeth without sealants. The teeth without sealants had 3.8 times the number of white spot lesions than were noted on the sealed teeth. These sealants showed no visible signs of discoloration. The DIAGNOdent measured statistically significant differences between sealed and unsealed teeth in the maxilla (P < .001) and in the mandible (P = .010). DIAGNOdent measurements also showed a difference between sealed and unsealed teeth after the 28 teeth with visible lesions were excluded. CONCLUSION: The hypothesis was rejected. Ultraseal XT Plus clear sealant (Ultradent Products, South Jordon, Utah) produced a significant reduction in enamel demineralization during fixed orthodontic treatment and should be considered for use by clinicians to minimize white spot lesions.
Coll Antropol. 2009 Mar;33(1):157-62.
The influence of Healozone on microleakage and fissure penetration of different sealing materials.
Dukić W, Dukić OL, Milardović S.
Department of Pediatric Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia. dukic@sfzg.hr
The preventive effect of sealing materials depends on ability to penetrate into the fissures, and microleakage absence, resulting with better clinical success. The aim of present study was to investigate the influence of ozone on microleakage and penetration of nanoparticle fissure sealing resin and flowable composite, and quantitative and qualitative analysis of microleakage. Forty extracted non carious third molars were randomly divided in 4 groups. Group A: KaVo Healozone and Grandio Seal; Group B: Kavo Healozone and X-Flow; Group C: Grandio Seal; Group D: X-Flow. The teeth were thermocycled, immersed in 5% methylene dye for 24 hours, and sectioned with precision saw. The total of 149 slices were analysed with stereomicroscope for microleakage and sealant penetration. According to qualitative scores, there is a significant difference between groups C and D, group C showing better results. According to quantitative scores, there are no statistical differences between the groups. The treatment of the enamel with KaVo HealOzone after etching does not affect either microleakage or penetration proportion of flowable composite or sealing resin. There is no statistically significant difference in a degree of penetration between different groups of sealing materials. Groups of materials with flowable composite in combination with an adhesive system show a good degree of penetration into the fissure and low microleakage meaning that they can be used as a fissure sealing materials.
Caries risk in formerly sealed teeth.
Griffin SO, Gray SK, Malvitz DM, Gooch BF.
Division of Oral Health, Centers for Disease Control and Prevention, Chamblee, GA 30341, USA. sig1@cdc.gov
BACKGROUND: The authors examined the risk of caries development in teeth with partially or fully lost sealant (formerly sealed [FS] teeth) relative to the risk in teeth that never have received sealants (never-sealed [NS] teeth). METHODS: The authors searched the population of studies used in
five reviews of sealant effectiveness as established in split-mouth design studies involving resin-based sealants with no reapplication of lost sealant. They required included studies to contain sufficient data to estimate the risk of caries in FS teeth relative to that in NS teeth (relative risk [RR] = % FS development caries% NS development caries) and its 95 percent confidence interval (CI). To estimate the mean RR by year since sealant placement, they used a weighted bivariate model and tested for heterogeneity using the quantity I(2). RESULTS: The weighted mean RR was 0.998 (95 percent CI, 0.817-1.220) one year after placement (four studies, 345 tooth pairs) and 0.936 (95 percent CI, 0.896-0.978) at four years (five studies, 1,423 tooth pairs). CONCLUSIONS: Teeth with fully or partially lost sealant were not at a higher risk of developing caries than were teeth that had never been sealed. CLINICAL IMPLICATIONS: Inability to provide a retention-check examination to all children participating in school sealant programs because of loss to follow-up should not disqualify a child from receiving sealants.
J Esthet Restor Dent. 2008;20(6):386-92; discussion 393-4.
Shear bond strength of a sealant to contaminated-enamel surface: influence of erbium : yttrium-aluminum-garnet laser pretreatment.
Lepri TP, Souza-Gabriel AE, Atoui JA, Palma-Dibb RG, Pécora JD, Milori Corona SA.
Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paolo (USP), São Paulo, Brazil.
BACKGROUND: Salivary contamination is one of the factors that can disturb the sealing process and interfere in the longevity of pit and fissure sealants. Erbium : yttrium-aluminum-garnet (Er : YAG) laser could influence the bond strength of enamel and increase the acid resistance. PURPOSE: To evaluate the influence of Er : YAG laser on the shear bond strength of a sealant to a salivary contaminated enamel surface. METHODS: Twenty-four third molars had the roots sectioned 2 mm coronal to the cementoenamel junction. The crowns were mesiodistally sectioned providing 48 halves that were embedded in polyester resin. Enamel was flattened and a 2-mm diameter bonding area was demarcated. Specimens were randomly assigned to two groups according to the superficial pretreatment-37% phosphoric acid (A) and Er : YAG laser (80 mJ/2 Hz) + phosphoric acid (L), which were subdivided into two groups (N = 12), without salivary contamination (C) and with salivary contamination (SC). To contaminate the specimens, 0.25 mL of human fresh saliva was applied for 20 seconds and then dried. Fluroshield sealant was applied in all specimens. After storage, shear bond strength of samples were tested in a universal testing machine. RESULTS: Means in MPa were: AC-14.61 (+/-2.52); ASC-6.66 (+/-2.34); LC-11.91 (+/-1.34); and LSC-2.22 (+/-0.66). Statistical analysis revealed that surfaces without salivary contamination and with acid treatment had the highest mean (p < 0.05). The group with salivary contamination treated by Er : YAG laser followed by phosphoric acid application presented the lowest bond values (p < 0.05). CONCLUSIONS: The phosphoric acid etching under dry condition yielded better bonding performance. Er : YAG laser was not able to increase the effectiveness of conventional acid etching of enamel in the bond of sealants in both dry and wet conditions. CLINICAL SIGNIFICANCE: Under the conditions of this study, the conventional etching protocol (phosphoric acid without salivary contamination) is still preferable to laser-conditioning enamel surface prior to sealant application.
Bond strength of a pit-and-fissure sealant associated to etch-and-rinse and self-etching adhesive systems to saliva-contaminated enamel: individual vs. simultaneous light curing.
Gomes-Silva JM, Torres CP, Contente MM, Oliveira MA, Palma-Dibb RG, Borsatto MC.
Department of Pediatric Clinic, Preventive and Community Dentistry, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
This study evaluated in vitro the shear bond strength (SBS) of a resin-based pit-and-fissure sealant [Fluroshield (F), Dentsply/Caulk] associated with either an etch-and-rinse [Adper Single Bond 2 (SB), 3M/ESPE] or a self-etching adhesive system [Clearfil S3 Bond (S3), Kuraray Co., Ltd.] to saliva-contaminated enamel, comparing two curing protocols: individual light curing of the adhesive system and the sealant or simultaneous curing of both materials. Mesial and distal enamel surfaces from 45 sound third molars were randomly assigned to 6 groups (n=15), according to the bonding technique: I – F was applied to 37% phosphoric acid etched enamel. The other groups were contaminated with fresh human saliva (0.01 mL; 10 s) after acid etching: II – SB and F were light cured separately; III – SB and F were light cured together; IV – S3 and F were light cured separately; V – S3 and F were light cured simultaneously; VI – F was applied to saliva-contaminated, acid-etched enamel without an intermediate bonding agent layer. SBS was tested to failure in a universal testing machine at 0.5 mm/min. Data were analyzed by one-way ANOVA and Fisher’s test (alpha=0.05).The debonded specimens were examined with a stereomicroscope to assess the failure modes. Three representative specimens from each group were observed under scanning electron microscopy for a qualitative analysis. Mean SBS in MPa were: I-12.28 (+/-4.29); II-8.57 (+/-3.19); III-7.97 (+/-2.16); IV-12.56 (+/-3.11); V-11.45 (+/-3.77); and VI-7.47 (+/-1.99). In conclusion, individual or simultaneous curing of the intermediate bonding agent layer and the resin sealant did not seem to affect bond strength to saliva-contaminated enamel. S3/F presented significantly higher SBS than the that of the groups treated with SB etch-and-rinse adhesive system and similar SBS to that of the control group, in which the sealant was applied under ideal dry, noncontaminated conditions.
Community Dent Health. 2008 Dec;25(4):216-20.
Loss of sealant retention and subsequent caries development.
Tianviwat S, Chongsuvivatwong V, Sirisakulveroj B.
Prince of Songkla University, Faculty of Dentistry, Department of Preventive Dentistry, Songkhla, Thailand. sukanya.ti@psu.ac.th
OBJECTIVES: To assess the transition process of sealant retention and to determine the effect of sealant loss on subsequent caries. RISK DESIGN: A follow-up study from the day sealants was applied by dental nurses, every six months over a period of 30 months. SETTING: Mobile dental clinics at primary schools in Songkhla, Thailand. PARTICIPANTS: 206 first grade primary school children, with 383 first permanent molars. OUTCOME MEASURES: Intermediate outcomes were: three categories of sealant retention: full retention, partial retention and missing sealant. The final outcome was whether occlusal caries was present or not. RESULTS: The percentages of occlusal surfaces of first permanent molars which were at risk (caries free) at time points 6, 12, 18, 24 and 30 months which became carious during the subsequent six months were 2.4, 8.00, 7.4, 5.4 and 6.1 respectively. Caries incidence was highest in the first year after sealing. Odds ratio of conversion from non-caries to caries between partial retention and missing sealant was 3.07 and between full retention and missing sealant, 0.27. CONCLUSION: Under high caries risk and low retention rate settings, partial retention posed a high risk of caries, suggesting an urgent need to improve sealant performance.
Am J Dent. 2008 Dec;21(6):383-7.
Preparation for invasive pit and fissure sealing: air-abrasion or bur?
Kramer N, García-Godoy F, Lohbauer U, Schneider K, Assmann I, Frankenberger R.
Department of Pediatric Dentistry, University Medical Center Carl Gustav Carus, Dresden, Germany.
PURPOSE: To evaluate the effect of different air-abrasion devices on substance loss on flattened enamel, preparation extent, and microleakage of invasive pit and fissure sealings. METHODS: 150 freshly extracted caries-free human third molars were used. 60 teeth (n = 10) were embedded, enamel surfaces were polished to #1200, and six air abrasion devices abraded specimens for 5 seconds. Substance loss was profilometrically recorded as maximum and mean width, and maximum and mean depth. From 90 intact teeth (n = 10), fissures were enlarged by air abrasion (Rondoflex 27 microm/50 microm, Airsonic Mini Sandblaster, CoJet Prep, PrepStart, Primus CPE), or treated with a diamond bur (De Craene), or using a metal bur (Fissurotomy Micro NTF), or with oscillating diamond tips (SONICSeal). Prepared fissures were etched and rinsed and sealed with a light-curing sealant (Helioseal). After four weeks water storage and subsequent 2,000 thermocycles (5 degrees C/55 degrees C), microleakage was assessed with 5% methylene blue for 3 minutes at 30G on cross cuts at x40 magnification. Furthermore the parameters upper fissure width, prepared and unprepared area, penetration depth of the sealer, and area of voids were recorded. RESULTS: For substance loss on flattened enamel, CoJet Prep and Mini Sandblaster revealed the widest abrasion areas, PrepStart produced the deepest craters (P < 0.05). Regarding preparation characteristics, rotary burs and PrepStart caused significantly less substance loss than the other devices (P < 0.05). Due to the etch&rinse approach, microleakage was generally minimal. Only after air abrasion with Rondoflex (50 microm) significantly less complete sealings were recorded (P < 0.05).
J Am Dent Assoc. 2009 Jan;140(1):38-46.
A comparison of the effects of toothbrushing and handpiece prophylaxis on retention of sealants.
Kolavic Gray S, Griffin SO, Malvitz DM, Gooch BF.
Public Health Division, Northrop Grumman, Atlanta, GA, USA.
BACKGROUND: Tooth surface cleaning before acid etching is considered to be an important step in the retention of resin-based pit-and-fissure sealants. METHODS: The authors reviewed and summarized instructions for cleaning tooth surfaces from five manufacturers of 10 unfilled resin-based sealants marketed in the United States. The authors also searched electronic databases for studies that directly compared the effects of different surface-cleaning methods on sealant retention and for systematic reviews of the effectiveness of sealants. They explored the association between surface-cleaning methods and sealant retention in the studies included in the systematic reviews. They calculated the summary weighted retention rates for studies that used either a handpiece or toothbrush prophylaxis. RESULTS: All of the sealant manufacturers’ instructions for use (IFU) recommended cleaning the tooth before acid etching. None of the IFU directly stated that a handpiece was required to perform the cleaning, but five IFU implied the use of handpiece prophylaxis. None of the IFU recommended surface-altering procedures in caries-free teeth. Direct evidence from two clinical trials showed no difference in complete sealant retention between surfaces cleaned mechanically with pumice or prophylaxis paste and those cleaned with air-water syringe or dry toothbrushing. Indirect evidence from 10 studies found that weighted summary retention by year after sealant placement in studies that used toothbrush prophylaxis was greater than or equivalent to values for studies that used handpiece prophylaxis. CONCLUSIONS: Levels of sealant retention after surface cleaning with toothbrush prophylaxis were at least as high as those associated with hand-piece prophylaxis. CLINICAL IMPLICATIONS: This finding may translate into lower resource costs for sealant placement.
Quintessence Int. 2008 Jul-Aug;39(7):593-602.
Efficacy of pit and fissure sealing: long-term clinical observations.
Department of Conservative Dentistry, Medical University of Warsaw, Warsaw, Poland. ejodkowska@amwaw.edu.pl
OBJECTIVE: To investigate long-term clinical effects of fissure sealing in permanent teeth with regard to sealant retention, reduction of occlusal caries, and effect on the increment of smooth surface caries. METHOD AND MATERIALS: The study included 360 children aged 7 to 8 years with caries-free permanent teeth. Children were divided into 4 groups, and fissure sealing was performed as follows: group 1 — 1 maxillary first molar and 1 mandibular first molar sealed; group 2 — all first molars sealed; group 3 — all molars and premolars sealed on eruption; group 4 — controls, no teeth sealed. Materials used for sealing were Nuva-Seal (Caulk), Concise Brand White Sealant System (3M ESPE), and Concise Enamel Bond System (3M ESPE). Control examinations were performed over 15 years, every 6 months for 2 years and then every 12 months. RESULTS: Complete sealant retention after 15 years was observed in 22.0% of cases, and partial retention in 35.0%. The degree of sealant retention affected the occurrence of occlusal caries in sealed teeth. Reduction in caries after 15 years was 36.0% when all first molars were sealed and 54.0% when all posterior teeth were sealed. Caries developed in 7.4% of teeth with complete sealant retention, in 15.0% of teeth with partial sealant retention, and in 31.0% of teeth with complete loss of sealant. CONCLUSIONS: The degree of sealant retention depends on the duration of observation and tooth type. The degree of caries reduction depends on the number of teeth sealed. Mean caries increment was lower in children with sealed teeth than in controls.
Fuji III vs. Fuji VII glass ionomer sealants–a clinical study.
Dept of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Narketpally, Andhra Pradesh, PIN – 508254, India. kamalakiran@gmail.com
Glass ionomer cements possess several properties that support their consideration in a wide variety of clinical applications including Pit and fissure sealants. The aim of this study was to compare and evaluate Fuji III and Fuji VII glass ionomer sealants in terms of retention, caries incidence and salivary fluoride release between two groups of children aged 6 and-8 years respectively. One hundred and ten first permanent molars were sealed and the clinical evaluation showed no incidence of caries. There was partial or complete retention of the sealant in 80% of the treated teeth in both groups at the one-year evaluation. Irrespective of the sealant used, the pattern of fluoride release remained consistent, with an initial high fluoride release followed by low prolonged leakage before returning to baseline value at the end of one year.
J Adhes Dent. 2008 Oct;10(5):379-84.
Quantitative microleakage evaluation of fissure sealants applied with or without a bonding agent: results after four-year water storage in vitro.
Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
PURPOSE: To evaluate the effect of long-term water storage on the microleakage of a fissure sealant applied with or without different bonding agents. MATERIALS AND METHODS: Extracted human third molars were randomly assigned into 8 groups (n = 24/each). The occlusal surfaces were sealed with a fluoride fissure sealant material (Helioseal F) after one of the following pretreatments: (1) phosphoric acid etching only; (2) phosphoric acid etching + Single Bond; (3) phosphoric acid etching + Prime & Bond NT; (4) Clearfil SE Bond; (5) FL Bond; (6) One Up Bond F; (7) Prompt L-Pop; (8) Mac Bond II. All specimens were thermocycled (1000X), after which half of them (n=96) were stored in distilled water for 48 h (group A), and the remaining half (n=96) for 48 months (group B). The specimens were immersed in 0.5% basic fuchsin solution, sectioned, and digitally photographed. Microleakage was evaluated quantitatively using an open-source image analysis toolkit (ImageJ), and the data were analyzed statistically. RESULTS: Four-year water storage significantly increased the amount of leakage in all test groups (p < 0.001). In both the absence and presence of water aging, the etch-and-rinse adhesives yielded the lowest microleakage scores (p < 0.001). In the 48-h group, the following ranking was achieved in terms microleakage values: phosphoric acid + Prime & Bond NT = phosphoric acid + Single Bond < Prompt L-Pop = phosphoric acid etching only < FL Bond < Clearfil SE Bond < Mac Bond II = One Up Bond F. In the 48-month group, the ranking changed as follows: phosphoric acid + Prime & Bond NT = phosphoric acid + Single Bond < Prompt L-Pop = FL Bond < Clearfil SE Bond = Mac Bond II = One Up Bond F < phosphoric acid etching only. CONCLUSION: Long-term water storage significantly increased the microleakage of Helioseal F applied alone and with a bonding agent. Regardless of the storage term, the use of etch-and-rinse adhesives resulted in significantly less microleakage compared to that achieved with self-etching adhesives or acid etching alone. The sealants placed without a prior bonding agent showed the greatest amount of leakage after four years.
J Indian Soc Pedod Prev Dent. 2008 Sep;26(3):114-20.
Retention of a resin-based sealant and a glass ionomer used as a fissure sealant: a comparative clinical study.
Subramaniam P, Konde S, Mandanna DK.
Department of Pedodontics and Preventive Dentistry, The Oxford Dental College, Hospital and Research Centre, Bommanahalli, Hosur Road, Bangalore-560068, Karnataka, India. drpriyapedo@yahoo.com
Sealing occlusal pits and fissures with resin-based sealants is a proven method of preventing occlusal caries. Retention of the sealant is very essential for its efficiency. This study evaluated the retention of glass ionomer used as a fissure sealant when compared to a self-cure resin-based sealant. One hundred and seven children between the ages of 6-9 years, with all four newly erupted permanent first molars were selected. Two permanent first molars on one side of the mouth were sealed with Delton, a resin-based sealant, and the contralateral two permanent first molars were sealed with Fuji VII glass ionomer cement. Evaluation of sealant retention was performed at regular intervals over 12 months, using Simonsen’s criteria. At the end of the study period, the retention of the resin sealant was seen to be superior to that of the glass ionomer sealant.
Int J Paediatr Dent. 2008 Sep;18(5):368-73. Epub 2008 Feb 20.
Heat-treated glass ionomer cement fissure sealants: retention after 1 year follow-up.
Skrinjaric K, Vranic DN, Glavina D, Skrinjaric I.
Department of Paediatric Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia. kristina.skrinjaric@zg.t-com.hr
OBJECTIVE: The aim of this study was to assess the retention rate of glass ionomer cement (GIC) fissure sealants heated during setting time. METHODS: One hundred and twelve teeth with well-delineated fissure morphology were sealed with composite resin and GIC. Composite resin (Helioseal F, Vivadent) was used in control group A (56 teeth). GIC (Fuji VII, GC) was applied using split-mouth design with conditioning in group B (26 teeth) and without surface conditioning in group C (30 teeth). GIC was heated with external heat source (Elipar Trilight, Espe) for 40 s during the setting time according to the manufacturer’s instructions. Fissure sealants were evaluated 1 year after clinical service. RESULTS: Retention rate in group A was 80.4% after 1 year of clinical service. Group B showed retention rate of 30.8%, and group C of 26.7%. Two new caries lesions were detected in groups B and C. Significant differences in retention between the composite group and GIC groups were obtained by Kruskal-Wallis and Mann-Whitney tests. CONCLUSION: It could be concluded that retention rate of GIC sealing treated with heat during setting time was significantly lower than retention of conventional composite resin. The heating procedure during setting of GIC sealants cannot be recommended as routine treatment in clinical practice.
Cochrane Database Syst Rev. 2008 Oct 8;(4):CD001830.
Update of:
Cochrane Database Syst Rev. 2004;(3):CD001830.
Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents.
Ahovuo-Saloranta A, Hiiri A, Nordblad A, Mäkelä M, Worthington HV.
Finnish Office for Health Technology Assessment / FinOHTA, National Research and Development Centre for Welfare & Health / STAKES, Finn-Medi 3, Biokatu 10, Tampere, Finland, 33520. anneli.ahovuo-saloranta@stakes.fi
BACKGROUND: Although pit and fissure sealants are effective in preventing caries, their efficacy may be related to the caries prevalence in the population. OBJECTIVES: The primary objective of this review was to evaluate the caries prevention of pit and fissure sealants in children and adolescents. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register, CENTRAL (The Cochrane Library 2007, Issue 3) and MEDLINE (to October 2007); EMBASE (to June 2007); SCISEARCH, CAplus, INSPEC, NTIS, PASCAL, DARE, NHS EED and HTA (to February 2008). There were no language or publication restrictions. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials of at least 12 months in duration comparing sealants with no sealant or sealants from different classes of materials for preventing occlusal caries in children and adolescents under 20 years. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results, extracted data and quality assessed trials. Risk ratios (RR) were calculated for differences between intervention and control groups and in split-mouth studies for differences of paired tooth surfaces being carious or not. The meta-analyses were conducted using a random-effects model. MAIN RESULTS: Sixteen studies were included in the review; 7 studies provided data for comparison of sealant versus control without sealant and 10 studies for comparison of sealant versus sealant. Five split-mouth studies and one parallel group study with 5 to 10 year old children found a significant difference in favour of second or third generation resin-based sealants on first permanent molars, compared to a control without sealant, with a pooled RR of 0.13 (95% confidence interval (CI) 0.09 to 0.20), 0.22 (95% CI 0.15 to 0.34), 0.30 (95% CI 0.22 to 0.40), and 0.40 (95% CI 0.31 to 0.51) at 12, 24, 36 and 48-54 months follow up, respectively. Further, one of those studies with 9 years of follow up found significantly more caries in the control group compared to resin sealant group; 27% of sealed surfaces were decayed compared to 77% of surfaces without sealant.The results of the studies comparing different sealant materials were conflicting. AUTHORS’ CONCLUSIONS: Sealing is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. The effectiveness of sealants is obvious at high caries risk but information on the benefits of sealing specific to different caries risks is lacking.
Caries Res. 2008;42(5):328-33. Epub 2008 Aug 14.
The influence of pit and fissure sealants on infrared fluorescence measurements.
Diniz MB, Rodrigues JA, Hug I, Cordeiro RC, Lussi A.
Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland. mibdiniz@hotmail.com
The aim of this in vitro study was to evaluate the influence of pit and fissure sealants on fluorescence readings using lasers. We selected 166 permanent molars and randomly divided them into 4 groups which were each treated with a different sealant (a commercially available clear sealant, 2 opaque sealants and an experimental nanofilled clear sealant). The teeth were independently measured twice by 2 experienced dentists using conventional laser fluorescence (LF) and a laser fluorescence pen device (LFpen), before and after sealing, and again after thermocycling to simulate the thermal stressing between the tooth and the dental materials. Friedman test showed no statistically significant changes using LF and LFpen for the commercial clear sealant group, although values tended to increase after sealing. However, the values increased significantly after thermocycling. There was a statistically significant decrease in fluorescence after application of opaque sealants. After application of the experimental nanofilled clear sealant, LF values increased only after thermocycling, whereas the LFpen values increased after sealing and after thermocycling as well. The intraclass correlation coefficient ranged from 0.87 to 0.96 for interexaminer and 0.82 to 0.94 for intraexaminer reproducibility. It was shown that pit and fissure sealants influence LF and LFpen readings, with the values increasing or decreasing according to the material used. In conclusion, both laser fluorescence devices could be useful as an adjunct to detect occlusal caries under unfilled clear sealants. Nevertheless, surfaces sealed with clear nanofilled material could be assessed using only the LF device. Copyright 2008 S. Karger AG, Basel.
Semmelweis Egyetem, Fogorvostudományi Kar, Budapest.
The aim of this review is to give an overview of 50 years experience of fissure sealing and draw conclusions about the applicability and effectiveness of the method. Another purpose is to provide a summary of the relevant scientific evidence that will assist clinicians with their decision-making process. A fissure sealant is a material that is placed in the pits and fissures of teeth in order to prevent the development and/or to arrest of initial caries progression. Sealants, by providing a physical barrier, inhibit microorganisms and food particles from collecting in pits and fissures. Sealants are highly effective in preventing dental caries in pits and fissures of teeth when applied by trained operators. Sealant should be placed on pits and fissures of children’s and adolescents’ permanent teeth when it is determined that the tooth or the patient is at risk of developing caries. Fissure sealing can be recommended as a caries preventive measure. Whilst there is a good evidence to support the inclusion of fissure sealants as part of a preventive programme from the dental team, a number of related issues need to be considered. In areas of high caries prevalence it has been shown that treatment costs can actually be reduced by sealing susceptible surfaces, usually the occlusal surfaces of first permanent molars. Fissure sealing was introduced and first investigated in the years 1960-1970. During the past decades, evidence-based approaches have developed concerning the effectiveness of this primary and secondary preventive measure. It is generally accepted that the effectiveness of sealants for caries prevention depends on long-term retention. Resin-based sealants are the first choice of material for dental sealants. Glass-ionomer cement may be used as an interim preventive agent. Whilst cost-effectiveness is an important consideration, from an ethical standpoint the protection of oral health should not be viewed purely in economic terms. The oral health care professional should monitor and reapply sealants as needed to maximize effectiveness.
Community Dent Health. 2008 Sep;25(3):191-2.
Fissure sealants on permanent first molars–consequences of a one-year delay.
Department of Community Dentistry, School of Dentistry, University of Limpopo, Medunsa campus, 0204, South Africa. Ratilal.Lalloo@gmail.com
OBJECTIVE: The objective of this study was to compare the dental caries status of the occlusal surfaces of permanent first molars of Grade 2 (7-8 years of age) children who kept, and those who missed their Grade 1 (6-7 years of age) dental public health clinic appointment. DESIGN: The data were obtained from the records of schoolchildren attending the clinic for a comprehensive dental public health programme, with emphasis on fissure sealing permanent first molars. The records were grouped into those who had attended the clinic the previous year and those who did not attend. RESULTS: The permanent first molars were significantly more likely to be carious in children who missed the Grade 1 appointment compared to those who kept the appointment. CONCLUSION: A one year delay in fissure sealing the occlusal surfaces of permanent first molars substantially increased the likelihood of dental caries on these teeth.
Folia Med (Plovdiv). 2008 Jul-Sep;50(3):66-70.
Application of sealants in dental practice in Bulgaria.
Kondeva VK, Kukleva MT, Petrova SG.
Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical University, Plovdiv, Bulgaria.
AIM: The aim of the present study was to investigate application of sealants in an epidemiologic cross-sectional study, and to conduct a survey of the opinions of dentists on the application of sealants in their practice. PATIENTS AND METHODS: The epidemiologic study included 960 children aged 7 to 14, selected at random from schools in Plovdiv and 630 dentists from Plovdiv and other regions in Bulgaria. Data were analysed using alternative and nonparametric analysis (chi square test); the level of significance was set at P < 0.05. RESULTS: The epidemiologic survey suggest that the use of sealants to prevent occlusal caries in childhood is not a usual practice, but rather an exception. Bulgarian dentists are familiar with the indications and means of applying prophylactic protection of teeth in childhood. CONCLUSIONS: The results of the epidemiologic study and the survey indicate clearly that additional motivation is needed to boost the use of this type of prophylaxis to prevent occlusal caries in childhood.
Eur J Paediatr Dent. 2008 Sep;9(3):125-31.
Marginal seal evaluation of different resin sealants used in pits and fissures. An in vitro study.
Montanari M, Pitzolu G, Felline C, Piana G.
Department of Oral Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
ATM: Oral health is important for everyone, but specially for children and people requiring special care owing to impaired manual ability. Primary prevention, with correct oral hygiene, proper diet, use of fluoride and pit and fissure sealants, can reduce caries risk thereby improving patients’ quality of life. The first aim of this paper was to assess the marginal microleakage of different pit and fissure sealants after immersion in a cariogenic solution. The second aim was to evaluate the ability of the materials to penetrate into the bottom of the fissure. METHODS: 32 posterior teeth were divided into four groups based on the type of sealant tested: Concise, Clinpro, Fissurit, Fissurit F. Samples were immersed and stored in a lactic acid solution (pH 4.4, 0.1 M) at 37 degrees C for different periods: 1 day; 3 days; 7 days; 10 days. Then each sample was stored in erythrosine solution for 24 hours at 37 degrees C. Each sample was sectioned in a mesio-distal direction and evaluated at the stereomicroscope and subsequently at SEM. RESULTS: SEM analysis showed that Clinpro and Concise obtained a good penetration inside the fissure and a good adaptation to the enamel wall, while Fissurit and Fissurit F showed gaps at the sealant-enamel interface and voids. CONCLUSION: Sealant application is an important means for caries prevention but, for a lasting effect, it must be associated with good oral hygiene and regular dental check-ups.
Caries Res. 2008;42(4):291-6. Epub 2008 Jul 29.
Modelling the bilateral symmetry of caries incidence.
Burnside G, Pine CM, Williamson PR.
WHO Collaborating Centre in Community Oral Health, School of Dental Sciences, University of Liverpool, Liverpool, UK. g.burnside@liv.ac.uk
BACKGROUND/AIMS: Past caries experience has been shown to be the best predictor of the development of caries in the future, and clinical observations suggest that caries develops symmetrically in similar teeth on each side of the mouth. This study investigates whether caries on a given surface can be used as a predictor of future caries on the corresponding surface on the other side of the mouth. METHODS: The data come from a 3-year trial examining the caries-preventive efficacy of chlorhexidine varnish on adolescents. A logistic multilevel model was fitted with 3 levels; participant, tooth and surface. The outcome variable was the development of caries into enamel or dentine, after 3 years. Covariates were tooth position, the caries status of the contralateral surface at baseline, the caries status of the corresponding surface in the opposing jaw at baseline, the caries status of adjacent teeth and the total number of decayed, missing, filled surfaces at baseline. RESULTS: The effect of caries at baseline on the contralateral surface was highly significant (odds ratio = 4.80, 95% CI = 4.38-5.38). The effect of caries at baseline on the corresponding surface in the opposing jaw was also significant, but smaller in magnitude (odds ratio = 1.66, 95% CI = 1.49-1.83). CONCLUSION: Multilevel modelling provides a clinically useful method of estimating the probability of a surface developing caries over a period of time, based on the caries status of the contralateral surface and the corresponding surface in the opposing jaw, while controlling for the natural clustering in tooth surface data. Copyright 2008 S. Karger AG, Basel.
Resin-modified glass ionomer cement and a resin-based material as occlusal sealants: a longitudinal clinical performance.
Oliveira FS, da Silva SM, Machado MA, Bijella MF, Lima JE, Abdo RC.
Department of Pediatric Dentistry, Dental School of Federal University of Uberlândia, Uberlândia, Brazil. fasoliv@yahoo.com.br
PURPOSE: The aim of this study was to compare retention, effectiveness in caries prevention and superficial characteristics in 2 different materials used as an occlusal sealant. METHODS: The sample consisted of 108 school children with a mean age of 7.5+/-1.25 years, in which 364 first permanent molars were divided into 6 groups: (1) group 1=Delton + rubber dam (used only for this group); (2) group 2=Delton + cotton rolls; (3) group 3=Prime & Bond 2.1 + Delton; (4) group 4=Vitremer with a 0.25:1 powder/liquid proportion; (5) group 5=Primer + Vitremer with a 0.25:1 powder/liquid proportion; and (6) group 6=Vitremer with a 1:1 powder/liquid proportion. RESULTS: After 12 months, the total retention rate for groups 6, 1, 2, 3, 4, and 5 was, respectively: 92%, 79%, 67%, 52%, 41% and 12%. For the 3 occlusal areas, retention was: 97%, 92%, 86%, 77%, 69%, and 36%. For the modified criterion, the proportion test showed a statistically significant difference (P<.05) between: groups 1 and 4; groups 6 and 2; and group 3, 4, and 5 with all others groups. Considering the total of 3 areas, there was a statistically significant difference (P<.05) between: groups 1 and 6 with groups 3 and 4; group 2 with group 4; and groups 6 and 5 with the others. CONCLUSION: The resin-modified glass ionomer cement may be a promising alternative as an occlusal sealant.
J Indian Soc Pedod Prev Dent. 2007 Oct-Dec;25(4):169-73.
Retention and penetration of a conventional resin-based sealant and a photochromatic flowable composite resin placed on occlusal pits and fissures.
Aguilar FG, Drubi-Filho B, Casemiro LA, Watanabe MG, Pires-de-Souza FC.
Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
This study compares the retention and penetration of a conventional resin-based sealant (Fluroshield) and a photochromatic flowable composite resin (Tetric Flow Chroma) placed on occlusal pits and fissures and submitted to thermal or chemical cycling regimens. Penetration assessment–ten premolars were sealed with each material, isolated (except for the sealed surface) and immersed in 0.2% Rhodamine B. The teeth were serially sectioned in a mesiodistal direction. The images of the sections were digitized and analyzed (ImageLab). The distance between the most superficial and the deepest points on the occlusal central groove was calculated to determine the groove’s total depth. The length of the central groove filled with the sealant was divided by its total depth to obtain the percentage of sealing of the occlusal groove. Retention assessment–30 premolars were sealed, their occlusal surfaces were photographed and the area occupied by the sealing materials was demarcated (ImageLab). The teeth were submitted to different treatments: thermocycled, stored in artificial saliva and immersed in acetic acid and saliva (10 cycles/day protocol for 30 days). New photographs were taken to assess the final area occupied by the materials. The difference between the final and initial area was calculated to obtain the material loss. The data was analyzed (two-way ANOVA and Tukey’s test P<0.05). Both materials presented similar penetration of the occlusal central groove. After thermal and chemical cycling, the materials did not differ with respect to retention, except for immersion in acetic acid. In this case, Tetric Flow Chroma presented greater retention than Fluoroshield.
J Indian Soc Pedod Prev Dent. 2007 Apr-Jun;25(2):86-7.
Comparative evaluation for microleakage between Fuji-VII glass ionomer cement and light-cured unfilled resin: a combined in vivo in vitro study.
Department of Pedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Constituent Institution of Manipal Academy of Higher Education, Mangalore, India. ashwinrao17@yahoo.co.in
Glass ionomer cement, besides being used as restorative material, can also be used as pit and fissure sealant. The use of glass ionomer cement as pit and fissure sealant has added benefit by its fluoride-releasing property that results in increased resistance of the fissures to demineralize. The capacity of a sealant to prevent microleakage into the fissure is important, since microleakage may initiate and support a carious lesion beneath the sealant. The study was carried out to compare marginal microleakage between Fuji-VII glass ionomer cement (G C Corporation, Tokyo, Japan) and the conventional light-cured unfilled resin as pit and fissure sealants (3M Concise, 3M Dental Products, St. Paul, USA). The dye used was 2% methylene blue (Qualigens Fine Chemicals, Mumbai, India). The teeth were sectioned and studied under the stereomicroscope. The result revealed that there was no difference in microleakage (P > 0.05) between the two materials.
J Adhes Dent. 2008 Feb;10(2):151-6.
SEM analysis of sealant penetration in posterior approximal enamel carious lesions in vivo.
Gomez S, Uribe S, Onetto JE, Emilson CG.
Department of Preventive Dentistry, Faculty of Dentistry, Valparaiso University, Valparaiso, Chile. santiago.gomez@uv.cl
PURPOSE: To study the microstructure of sealant penetration in the enamel of in vivo sealed approximal noncavitated incipient caries lesions with and without a preceding bonding step. MATERIALS AND METHODS: A total of 26 proximal noncavitated caries lesions were sealed in vivo, using a sealant in 13 premolars with orthodontic indication of extraction. Each tooth was randomly assigned to mesial or distal surface application of a sealant in the lesion area and in surrounding sound enamel, with or without a bonding system. Four groups were analyzed: a nonbonding group in the lesion area (NBL); a nonbonding group in sound enamel (NBS); a bonding group in the lesion area (BL) and a bonding group in sound enamel (BS). The premolars were extracted after two weeks. All sealed areas were cut and demineralized with 37% hydrochloric acid for 24 h. For each group, the resin tags were observed and measured by scanning electron microscopy. RESULTS: The lesion areas showed a very irregular resin network with twisted and curved tags in contrast to the sound enamel where a regular etching pattern was observed. The length of resin tags in microns for each group (mean +/-SD) was: NBG-L = 4.19 +/- 1.59; NBG-S = 5.49 +/- 2.49; BG-L = 4.57 +/- 1.99; and BG-S = 4.21 +/- 1.87. The differences between the groups were not statistically significant (p = 0.34). Conclusion: The use of a bonding system prior to the application of a pit and fissure sealant on both lesion and sound enamel areas does not increase the resin penetration length under non-contaminated conditions.
J Dent Child (Chic). 2008 Jan-Apr;75(1):24-8.
Influence of surface sealants on microleakage of composite resin restorations.
dos Santos PH, Pavan S, Assunção WG, Consani S, Correr-Sobrinho L, Sinhoreti MA.
Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University, Araçatuba, Brazil. paulosantos@foa.unesp.br
PURPOSE: The purpose of this study was to verify the influence of surface sealants and dentin adhesive systems on the microleakage of composite restorations. METHODS: Class V cavities were made on the buccal faces of 100 permanent third molars and restored with Z250. After 24 hours, they were submitted to polishing and finishing processes. The teeth were divided into groups according to the sealant agent: group 1–Single Bond; group 2–Opti Bond Solo Plus; group 3–Fortify; group 4–Fortify Plus; and group 5–control without sealant. The analysis of immediate microleakage was performed in 10 restorations from each group, soon after the sealing. The other 10 specimens from each group were submitted to tooth-brushing and thermal cycles. The teeth were isolated and immersed in 2% methylene blue solution, washed in tap water, and sectioned in the buccolingual direction. The percentage of marginal leakage was calculated using an image analysis program, and results were submitted to analysis of variance and Tukey’s test. RESULTS: All the sealed groups demonstrated lower microleakage values compared to the control group. Group 3, sealed with Fortify, presented the lowest mean microleakage values. CONCLUSION: The application of surface sealants effectively decreased the microleakage in composite resin restorations.
Oper Dent. 2008 May-Jun;33(3):258-64.
Increasing the longevity of restorations by minimal intervention: a two-year clinical trial.
Moncada G, Fernández E, Martín J, Arancibia C, Mjör IA, Gordan VV.
Operative Dentistry Department, University of Chile, Santiago, Chile.
This investigation assessed the effectiveness of alternative treatments for the replacement of amalgam and resin-based composite restorations. Sixty-six patients (age 18 to 80 years, mean = 26.6) with 271 (amalgam [n = 193] and resin-based composite [n = 78]) defective restorations were randomly assigned to one of five different treatment groups: A) Repair (n = 27); B) Sealing of margins (n = 48); C) Refurbishing (n = 73); D) Replacement (n = 42) and E) Untreated (n = 81). USPHS/Ryge criteria were used to determine the quality of the restorations. Two calibrated examiners (Cohen’s Kappa 0.74) assessed the restorations independently at the beginning of the study (baseline) and at two years after treatment using seven parameters from the USPHS/Ryge criteria (Marginal Adaptation, Anatomic Form, Roughness, Marginal Stain, Occlusal Contact, Secondary Caries and Luster). RESULTS: Two-hundred and fifty-six restorations (178 amalgam and 78 resin-based composite) were examined at the two-year recall exam. The sealing of marginal defects showed significant improvements in marginal adaptation (p < 0.05). Refurbishing of the defective restorations significantly improved anatomic form (p < 0.0001), luster (p < 0.016), marginal adaptation (p < 0.003) and roughness (p < 0.0001). The repair significantly improved anatomic form (p < 0.002) and marginal stain (p < 0.002). Replacement showed significant improvements for all parameters (p < 0.05). The Untreated group showed significant deterioration on marginal adaptation (p < 0.013). CONCLUSIONS: The two-year recall examination showed that sealant, repair and refurbishing treatments improved the clinical properties of defective amalgam and resin-based composite restorations by increasing the longevity of the restorations with minimal intervention.
Compend Contin Educ Dent. 2008 Apr;29(3):186-92.
Length of resin tags in pit-and-fissure sealants: all-in-one self-etching adhesive vs phosphoric acid etching.
dos Santos KT, Sundfeld RH, Garbin CA, de Alexandre RS, Sundefeld ML, Ceolim BN.
Department of Community Dentistry, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, Brazil.
PURPOSE: To investigate the penetration (tags) of adhesive materials into enamel etched with phosphoric acid or treated with a self-etching adhesive, before application of a pit-and-fissure sealant. MATERIALS AND METHODS: The sample comprised six study groups with six specimens each. Before pit-and-fissure sealing with the materials Clinpro SealantTM (Groups I and II), Vitro Seal ALPHA (Groups III and IV) and Fuji II LC (Groups V and VI), the teeth in Groups I, III, and V were etched with 35% phosphoric acid for 30 seconds. Teeth in Groups II, IV, and VI received application of the self-etching adhesive Adper Prompt L-Pop. The treated teeth were sectioned buccolingually, ground to 100-microm thickness, decalcified, and analyzed by conventional light microscopy at 400x magnification. RESULTS: The teeth etched with phosphoric acid exhibited significantly greater penetration than specimens treated with self-etching adhesive. CLINICAL SIGNIFICANCE: When compared with enamel treated with a self-etching adhesive, the penetration (tags) of adhesive materials into enamel was greater when applied on enamel etched with phosphoric acid.
Am J Dent. 2008 Feb;21(1):25-9.
Comparison of visual inspection, radiographic examination, laser fluorescence and their combinations on treatment decisions for occlusal surfaces.
Valera FB, Pessan JP, Valera RC, Mondelli J, Percinoto C.
Bauru Dental School, University of São Paulo, Brazil.
PURPOSE: To compare visual inspection (VI), radiographic examination (RX) and the laser fluorescence device DIAGNOdent (L), as well as their combinations in vitro regarding treatment decisions for occlusal surfaces. METHODS: 72 extracted human permanent teeth (molars and premolars) were used. Treatment decisions were recorded by three calibrated examiners, and the options available were fissure sealant and conservative restoration. For validation of treatment decisions, the teeth were sectioned and examined in a stereomicroscope. Thereafter, dental slices were scanned and the images were edited to facilitate classification of existing carious lesions. Intra and inter-examiner reproducibility for the determination of treatment plans were calculated using Cohen’s kappa test (95%-CI). Sensitivity, specificity, positive and negative predictive values, and the area under the ROC curve were also calculated. RESULTS: VI and L provided on average the greatest intra- and inter-examiner reproducibility, respectively. Although the combination of diagnostic methods may decrease both intra- and inter examiners reproducibility, combination of VI, L and RX resulted in the greatest sensitivity, being statistically superior to RX and L. There was more inter-examiner agreement for the option of restorative treatment, while the use of sealants as a treatment option yielded the lowest values. Negative predictive values were numerically inferior to positive predictive values, indicating that the examiners preferred not to restore a carious tooth than to proceed operatively in an intact tooth. The combination of the three methods studied showed the best results in determining treatment plans for occlusal surfaces, when compared to the other types of exams. On the other hand, radiographic examination and laser fluorescence were less efficient when used alone.
Acta Odontol Scand. 2008 Apr;66(2):65-72.
Comparison of the effectiveness of fissure sealants in Finland, Sweden, and Greece.
Leskinen K, Ekman A, Oulis C, Forsberg H, Vadiakas G, Larmas M.
Department of Pediatric Dentistry, Cariology and Endodontics, Institute of Dentistry, University of Oulu, Oulu University Hospital, Oulu, Finland. kaja.leskinen@oulu.fi
OBJECTIVE: To evaluate the effectiveness of sealant treatment in preventing dental restorations due to caries in a practice-based research network in Finland, Sweden, and Greece. MATERIAL AND METHODS: Times of tooth emergence, sealing treatment, and dental caries were compiled from the dental charts of 4735 subjects born in 1970-72 in Finland and in 1980-82 in Finland, Sweden, and Greece. Survival time between tooth emergence and placement of first restoration was measured and estimated using survival analysis methodology. RESULTS: At the end of follow-up (7-10+ years), 30-40% of sealed molars and 60-80% of non-sealed molars were restored. Early sealant placement compared to late sealing did not result in significantly higher survival of 1st molars. The strategy of sealing the 1st molars only in high caries risk subjects was as effective as sealing all the molars and premolars routinely without caries risk determination. CONCLUSIONS: The sealing of all molar fissures proved to be no more effective than sealing risk fissures of subjects. Early sealing did not result in any better outcome than late sealing. The effectiveness of sealant treatment in preventing dental restorations is dependent on the caries risk of individuals and caries prevalence of the country.
J Dent Res. 2008 May;87(5):495-8.
Can caries fissures be sealed as adequately as sound fissures?
Hevinga MA, Opdam NJ, Frencken JE, Bronkhorst EM, Truin GJ.
Department of Preventive and Restorative Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. m.hevinga@dent.umcn.nl
Sealing caries fissures is considered an appropriate treatment option for arresting the caries process. However, little information is available regarding the sealing of occlusal cavitated dentin lesions. The hypothesis tested in this in vitro study was that no difference in microleakage and sealant penetration depth exists between cavitated and sound sealed fissures when a resin is used. Eighty molars, each with an occlusal cavitated dentin lesion, were treated according to 5 experimental protocols and compared with a control group of sealed sound molars. In the experimental groups, fissure sealants were placed with and without an adhesive, and in various ways. All teeth were sectioned, and microleakage and sealant penetration into the fissure were evaluated. Sealed caries fissures showed significantly more microleakage and insufficient sealant penetration depth than sound fissures. Neither the use of an adhesive nor its intermediate curing influenced the microleakage score and the penetration ability of sealants.
Pediatr Dent. 2008 Jan-Feb;30(1):29-33.
Marginal microleakage of a sealant applied to permanent enamel: evaluation of 3 application protocols.
Asselin ME, Fortin D, Sitbon Y, Rompré PH.
Department of Pediatric Dentistry, College of Dentistry, University of Iowa, Iowa, USA. marie-eve-asselin@uiowa.edu
PURPOSE: The purpose of this in vitro study was to investigate and compare the microleakage-occurring after the placement of a light-curing sealant-to unground permanent enamel which had been previously conditioned using 3 different application protocols. METHODS: Sixty-three molars were randomly distributed in 3 different groups according to the application protocol of the sealant: (1) conditioning of the enamel with 38% phosphoric acid (group 1); (2) conditioning with phosphoric acid and single-bottle dentin bonding agent (group 2); or (3) conditioning with a self-etching adhesive (group 3). Samples were: (1) thermocycled; (2) stained; (3) sectioned; and (4) examined for marginal microleakage. RESULTS: No dye penetration was noted for 25%, 59%, and 40% of cases for groups 1, 2, and 3, respectively. CONCLUSIONS: Placement of a bonding agent layer prior to the sealant allows significantly less microleakage than the traditional conditioning of enamel with phosphoric acid alone. The self-etching adhesive used here seems to be an attractive alternative to the acid-etch and adhesive technique for sealant application in young children, since it would simplify the procedure. Clinical trials should be performed to assess the performance of these products before definitive conclusions can be formulated.
Pediatr Dent. 2008 Jan-Feb;30(1):25-8.
Effectiveness of primer and bond in sealant retention and caries prevention.
Mascarenhas AK, Nazar H, Al-Mutawaa S, Soparkar P.
Division of Dental Public Health, Boston University School of Dental Medicine, Boston, MA, USA. karinam@bu.edu
PURPOSE: The purpose of this clinical trial was to test the use of a primer and bonding agent to increase the retention of a fissuresealant in a group of Kuwaiti children. METHODS: In 78 6- to 9-year-old children who required sealants in all 4 permanent frst molars, sealants were placed in 2 teeth using a primer and bond (3M Scotch Bond) and in 2 teeth without primer and bond. Sealant retention was evaluated 1 and 2 years later. Sealant retention was scored as: (1) complete retention; (2) partial loss of sealant; and (3) complete loss of sealant Caries was scored for those teeth in which the sealant was partially or completely lost RESULTS: At the 2-year examination, in teeth sealed with primer and bond (a) 64% of the sealants were completely retained; (b) 23% were partially lost; and (c) 13% were completely lost. In teeth sealed without primer and bond: (a) 68% of the sealants were completely retained; (b) 20% were partially lost; and (c) 12% were completely lost There was no difference in sealant retention (P=.22) and caries (P=.56) in teeth sealed with and without bond. In multivariate analyses after controlling for age, gender, tooth surface, and arch, no differences in sealant retention and caries were seen. CONCLUSION: If a proper technique is used in sealant placement, primer and bond does not enhance sealant retention.
J Am Dent Assoc. 2008 Mar;139(3):281-9; quiz 358.
Exploring four-handed delivery and retention of resin-based sealants.
Griffin SO, Jones K, Gray SK, Malvitz DM, Gooch BF.
Division of Oral Health, Centers for Disease Control and Prevention, Chamblee, GA 30341, USA. sig1@cdc.gov
BACKGROUND: To date, no trials have been published that examine whether four-handed delivery of dental sealants increases their retention and effectiveness. In the absence of comparative studies, the authors used available data to explore the likelihood that four-handed delivery increased sealant retention. METHODS: The authors examined data regarding the retention of autopolymerized resin-based sealants from studies included in systematic reviews of sealant effectiveness. The explanatory variable of primary interest was the presence of a second operator. To examine the unique contribution of four-handed delivery to sealant retention, the authors used linear regression models. RESULTS: Eleven of the 36 studies from systematic reviews met explicit criteria and were included in this analysis. The high level of heterogeneity among studies suggested that multivariate analysis was the correct approach. According to the regression model, the presence of a second operator increased retention by 9 percentage points. CONCLUSIONS: For this group of studies, four-handed delivery of autopolymerized sealants was associated with increased sealant retention. CLINICAL IMPLICATIONS: Using four-handed delivery to place resin-based sealants may increase retention.
J Am Dent Assoc. 2008 Mar;139(3):271-8; quiz 357-8.
The effect of dental sealants on bacteria levels in caries lesions: a review of the evidence.
Oong EM, Griffin SO, Kohn WG, Gooch BF, Caufield PW.
Centers for Disease Control and Prevention/Division of Oral Health/Surveillance, Investigations, and Research Branch, Chamblee, GA, USA.
BACKGROUND: Concern about inadvertently sealing over caries often prevents dentists from providing dental sealants. The objective of the authors’ review was to examine the effects of sealants on bacteria levels within caries lesions under dental sealants. METHODS: The authors searched electronic databases for comparative studies examining bacteria levels in sealed permanent teeth. To measure the effect of sealants on bacteria levels, they used the log(10) reduction in mean total viable bacteria counts (VBC) between sealed and not-sealed caries and the percentage reduction in the proportion of samples with viable bacteria. RESULTS: Six studies–three randomized controlled trials, two controlled trials and one before-and-after study-were included in the analysis. Although studies varied considerably, there were no findings of significant increases in bacteria under sealants. Sealing caries was associated with a 100-fold reduction in mean total VBC (four studies, 138 samples). Sealants reduced the probability of viable bacteria by about 50.0 percent (four studies, 117 samples). CONCLUSIONS: The authors found that sealants reduced bacteria in carious lesions, but that in some studies, low levels of bacteria persisted. These findings do not support reported concerns about poorer outcomes associated with inadvertently sealing caries. CLINICAL IMPLICATIONS: Practitioners should not be reluctant to provide sealants-an intervention proven to be highly effective in preventing caries-because of concerns about inadvertently sealing over caries.
J Am Dent Assoc. 2008 Mar;139(3):257-68.
Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs.
Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch B, Ismail A, Kohn W, Siegal M, Simonsen R; American Dental Association Council on Scientific Affairs.
American Dental Association, Chicago, USA.
BACKGROUND: This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association Council on Scientific Affairs. The panel addressed the following clinical questions: Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus. glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants’ retention and effectiveness in caries prevention? TYPES OF STUDIES REVIEWED: Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews. At the panel’s request, the ADA Division of Science staff conducted additional searches for clinical studies related to specific topics. The Centers for Disease Control and Prevention also provided unpublished systematic reviews that since have been accepted for publication. RESULTS: The expert panel developed clinical recommendations for each clinical question. The panel concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions. CLINICAL IMPLICATIONS: These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences. The evidence indicates that sealants can be used effectively to prevent the initiation and progression of dental caries.
J Mater Sci Mater Med. 2007 Dec;18(12):2257-61. Epub 2007 Jun 12.
Effect of the composite surface sealant application moment on marginal sealing of compactable composite resin restoration.
Delfino CS, Duarte S Jr.
Department of Restorative Dentistry, University of São Paulo at São Paulo, Sao Paulo, SP, Brazil. casincler@hotmail.com
An analysis was carried out to observe whether the application or not of a composite surface sealant (CSS), as well the moment for CSS application were able to reduce marginal microleakage in compactable composite resin restoration. All the preparations were restored with a compactable composite resin. The restored teeth were randomly assessed. G1 (control group): finished and polished; G2: finished, polished, etched and cover with CSS; G3: immediately after the restoration done the CSS was applied, then finished and polished; G4: CSS applied immediately after the restoration was done, the finished and polished, etched, and covered with CSS. The specimens were isolated with nail polish, thermocycled, immersed in aqueous solution of silver nitrate, and followed in a photo developing solution. The microleakage scores obtained from the occlusal and cervical walls were analyzed with the Kruskall-Wallis nonparametric test. No microleakage was found at the enamel margins. Comparing the microleakage scores at dentin/cementum margins (p < 0.05) it was found that G3 (p = 0.0162) and G4 (p = 0.0187) were able to reduce microleakage when compared with group G2. However the results were not statistically different from the control group. The application of CSS was not able to completely eliminate marginal microleakage at the dentin/cementum margins.
Lasers Med Sci. 2008 Apr;23(2):133-9. Epub 2007 May 23.
Effects of composite fissure sealants on IR laser fluorescence measurements.
Krause F, Braun A, Frentzen M, Jepsen S.
Department of Operative Dentistry and Periodontology, University of Bonn, Bonn 53111, Germany. felix.krause@uni-bonn.de
The influence of composite fissure sealants on caries detection with IR laser fluorescence measurements should be assessed. Thirty-five extracted human teeth with 105 initial carious lesions were included. Six groups containing 15 lesions each were sealed with either a clear or a white version of three sealants. Group 7 was sealed with an experimental nanofilled material. Occlusal surfaces were irradiated by a diode laser (<1 mW, 655 nm). Fluorescence was measured before and after acid etching, directly and 1 week after application of the sealants. Values significantly increased after etching (p < 0.05). Compared to initial measurements, values decreased after sealing with the white materials (p < 0.05). There was no difference between values before and after sealing with the clear and the experimental materials (p > 0.05). All values were reproducible. The study indicates that it might be possible to monitor caries activity under clear or nanofilled fissure sealants by means of laser fluorescence.
Am J Orthod Dentofacial Orthop. 2008 Apr;133(4 Suppl):S88-94.
Inhibition of enamel demineralization by an enamel sealant, Pro Seal: an in-vitro study.
Buren JL, Staley RN, Wefel J, Qian F.
Department of Orthodontics, University of Iowa, Iowa City, USA. orthojenni@hotmail.com
INTRODUCTION: Enamel demineralization adjacent to fixed orthodontic appliances compromises both esthetics and oral health. The purpose of this in-vitro study was to evaluate the effectiveness of a new enamel sealant, Pro Seal (Reliance Orthodontic Products, Itasca, Ill), on inhibiting enamel demineralization. Two materials that have demonstrated success in white spot prevention and do not require patient compliance were used for comparison. METHODS: Thirty-two noncarious extracted molars were divided into 4 groups and received 1 of the following treatments: no treatment (control), fluoride varnish (Fluor Protector; Ivoclar Vivadent, Amherst, Mass), unfilled resin sealant (Delton; Dentsply Professional, York, Pa), and filled resin sealant (Pro Seal). The teeth were subjected to 15,000 simulated brush strokes followed by acidic challenge for 96 hours. They were examined macroscopically and sectioned for quantitative examination with polarized light microscopy. RESULTS: All surface treatments provided statistically significant (P <.05) reductions in lesion depth compared with controls. Pro Seal performed significantly better (P <.05) than the other products, decreasing lesion depth by 97% compared with the controls and completely inhibiting lesion formation in 3 specimens. CONCLUSIONS: Pro Seal shows promise as an effective method of preventing enamel demineralization without patient compliance.
Int J Public Health. 2007;52(6):393-401.
Association of caries experience in adolescents with different preventive measures.
Momeni A, Hartmann T, Born C, Heinzel-Gutenbrunner M, Pieper K.
Department of Pediatric and Community Dentistry, Philipps-University Marburg, Germany.
OBJECTIVES: To assess the preventive measures which were associated with the striking caries decline observed in Marburg (Germany) between 1982 and 2002 and to investigate the relationship between caries prevalence and the type of educational level. METHODS: 1,237 twelve-year-old children were examined in four different types of schools. D3MFT and the number of teeth with fissure sealants were registered. Information about preventive measures carried out in the past was collected by structured questionnaires. To compare the mean caries scores of various subgroups, Mann-Whitney U-tests and ANOVA were performed. Variables associated with caries were included in a binary logistic regression analysis. RESULTS: In 2002 the mean D3MFT score amounted to 0.78. In 80.7% of the pupils fissure sealants were observed, on average 3.5 teeth with sealants were recorded per child. There were significant differences between the mean D3MFT scores and the mean number of teeth with fissure sealants among the various school types. CONCLUSIONS: Use of fluoride supplements in the past, use of fluoridated table salt and fissure sealants were the factors in the binary logistic regression analysis which were significant in preventing caries.
J Dent. 2008 Feb;36(2):130-7. Epub 2008 Jan 7.
Analysis of surface roughness and microleakage of fissure sealants following organic debris removal with Carisolv.
Yamada Y, Hossain M, Shimizu Y, Kimura Y, Masuda Y, Nakamura Y, Matsumoto K.
Department of Clinical Cariology and Endodontology, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ohta-ku, Tokyo 145-8515, Japan. yoshi@senzoku.showa-u.ac.jp <yoshi@senzoku.showa-u.ac.jp>
OBJECTIVE: The objective of the present study was to improve fissure sealing by pre-treatment with Carisolv in order to remove organic debris. The surface morphology and roughness of fissure cavities and the degree of microleakage after Carisolv application were compared with those after bristle brush treatment in vitro. METHODS: Fifty extracted human teeth were used in this study. The teeth were randomly divided into two groups of 25 each. Artificial fissures were prepared in all teeth into which artificial organic debris was placed. The debris in 25 teeth of one group was removed using Carisolv applied for 30s and excavation was performed with a dental explorer until the gel was clear. The remaining 25 teeth were then cleaned using bristle brush with prophylaxis paste. Surface roughness was analyzed in five samples from each group by color laser three-dimensional (3D) microscopy and by scanning electron microscopic examination. The remaining samples were filled with sealant and subjected to a microleakage test under thermocycling. Statistical analysis was performed using the Mann-Whitney U-test; a value of p<0.05 was considered significant. RESULTS: Morphologically, most of the debris in the fissures was removed by Carisolv treatment, whereas some fissures were not cleaned by bristle brush. Carisolv-treatment with acid-etching resulted in removal of debris-like smear layer leaving enamel prisms open, and 3D laser microscopy demonstrated that the roughness values increased after acid-etching. However, microleakage test of both Carisolv and brush methods showed similar results. CONCLUSIONS: Carisolv-treated surfaces especially when subjected to acid-etching might facilitate good adaptation of sealant to enamel, because of an increase in surface roughness and favorable surface characteristics.
J Dent. 2008 Feb;36(2):104-16. Epub 2007 Dec 31.
The application of ozone in dentistry: a systematic review of literature.
Azarpazhooh A, Limeback H.
Department of Endodontics and Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, ON, M5G 1G6 Canada. amir.azarpazhooh@dentistry.utoronto.ca <amir.azarpazhooh@dentistry.utoronto.ca>
OBJECTIVES: (1) To systematically review the clinical application and remineralization potentials of ozone in dentistry; (2) To summarize the available in vitro applications of ozone in dentistry. SOURCES: Ovid MEDLINE, CINAHL, etc. (up to April 2007). STUDY SELECTION: In vitro or in vivo English language publications, original studies, and reviews were included. Conference papers, abstracts, and posters were excluded. RESULTS: In vitro: Good evidence of ozone biocompatibility with human oral epithelial cells, gingival fibroblast, and periodontal cells; Conflicting evidence of antimicrobial efficacy of ozone but some evidence that ozone is effective in removing the microorganisms from dental unit water lines, the oral cavity, and dentures; Conflicting evidence for the application of ozone in endodontics; Insufficient evidence for the application of ozone in oral surgery and implantology; Good evidence of the prophylactic application of ozone in restorative dentistry prior to etching and the placement of dental sealants and restorations. In vivo: Despite the promising in vitro evidence, the clinical application of ozone in dentistry (so far in management of dental and root caries) has not achieved a strong level of efficacy and cost-effectiveness. CONCLUSIONS: While laboratory studies suggest a promising potential of ozone in dentistry, this has not been fully realised in clinical studies to date. More well designed and conducted double-blind randomised clinical trials with adequate sample size, limited or no loss to follow up, and carefully standardised methods of measurement and analyses are needed to evaluate the possible use of ozone as a treatment modality in dentistry.
J Dent Res. 2008 Feb;87(2):169-74.
The effectiveness of sealants in managing caries lesions.
Griffin SO, Oong E, Kohn W, Vidakovic B, Gooch BF; CDC Dental Sealant Systematic Review Work Group, Bader J, Clarkson J, Fontana MR, Meyer DM, Rozier RG, Weintraub JA, Zero DT.
Centers for Disease Control and Prevention/Division of Oral Health/Surveillance, Investigations, and Research Branch, Chamblee, GA 30341, USA. sig1@cdc.gov
A barrier to providing sealants is concern about inadvertently sealing over caries. This meta-analysis examined the effectiveness of sealants in preventing caries progression. We searched electronic databases for comparative studies examining caries progression in sealed permanent teeth. We used a random-effects model to estimate percentage reduction in the probability of caries progression in sealed vs. unsealed carious teeth. Six studies, including 4 randomized-controlled trials (RCT) judged to be of fair quality, were included in the analysis (384 persons, 840 teeth, and 1090 surfaces). The median annual percentage of non-cavitated lesions progressing was 2.6% for sealed and 12.6% for unsealed carious teeth. The summary prevented fraction for RCT was 71.3% (95%CI: 52.8%-82.5, no heterogeneity) up to 5 years after placement. Despite variation among studies in design and conduct, sensitivity analysis found the effect to be consistent in size and direction. Sealing non-cavitated caries in permanent teeth is effective in reducing caries progression.
Int Dent J. 2006 Dec;56(6):345-51.
The atraumatic restorative treatment (ART) approach for managing dental caries: a meta-analysis.
van ‘t Hof MA, Frencken JE, van Palenstein Helderman WH, Holmgren CJ.
WHO Collaborating Centre for Oral Health Care Planning and Future Scenarios, Radboud University Medical Centre, College of Dental Sciences.
The number of publications reporting on the survival of ART sealants and ART restorations has increased considerably in recent years. A systematic investigation of their longevity is therefore warranted. Based on three exclusion criteria, a literature search in the electronic libraries Pubmed and Medline revealed 28 eligible publications for inclusion in a meta-analysis. High mean survival rates for single-surface ART restorations using high-viscosity glass-ionomer in primary dentitions over 3 years were found (95% after 1 year to 86% after 3 years). These rates were statistically significantly higher than for those of multiple-surface ART restorations in primary dentitions (p<0.0001). High mean survival rates for single-surface ART restorations using high-viscosity glass-ionomer in permanent dentitions over 6 years were found (97% after 1 year to 72% after 6 years). The mean annual failure rates for single-surface ART restorations using high-viscosity glass-ionomer in primary and permanent dentitions and for multiple-surface ART restorations in primary dentitions are 4.7%, 4.7% and 17%, respectively. The number of studies reporting on the retention and caries preventive effect of ART sealants was low. It is concluded that single-surface ART restorations using high-viscosity glass-ionomer in both primary and permanent dentitions show high survival rates. Medium-viscosity glass-ionomer should not be used for ART restorations.
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003067.
Pit and fissure sealants versus fluoride varnishes for preventing dental decay in children and adolescents.
Hiiri A, Ahovuo-Saloranta A, Nordblad A, Mäkelä M.
University of Oulu, PO Box 5281, 90014 University of Oulu, Oulu, Finland. anne.hiiri@apollonia.fi
BACKGROUND: The majority of the detected increment in dental caries is confined to pit and fissure surfaces of first molars. Application of pit and fissure sealants and topical fluorides are widely used procedures in the prevention of decay, and their effectiveness in caries prevention has been proved by systematic reviews. OBJECTIVES: The objective of this study was to compare the effectiveness of pit and fissure sealants with fluoride varnishes in the prevention of dental decay on occlusal surfaces. SEARCH STRATEGY: Electronic searching was performed on the following databases: the Cochrane Oral Health Group’s Trials Register (last update November 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4), MEDLINE (from 1966 to December 2005), EMBASE (from 1974 to November 2004), SIGLE (from 1976 to December 2004), SCISEARCH, CAplus, INSPEC, JICST-EPLUS, NTIS, PASCAL (last update December 2004), DARE, NHS EED and HTA (last update November 2005). Reference lists from articles that fulfilled the inclusion criteria in this review and from review articles based on the search of MEDLINE were searched for additional relevant articles. Conference abstracts published as books or journals and handsearched by the Cochrane Oral Health Group were also included. SELECTION CRITERIA: The inclusion criteria for study selection were: random or quasi-random allocation study design; sealants versus fluoride varnish or sealants and fluoride varnish combination versus fluoride varnish alone; included studies included caries documentation on occlusal surfaces of permanent molars and the subjects were under 20 years of age. Both parallel and split-mouth study designs were accepted. The primary outcome of interest was the increment in the numbers of carious occlusal surfaces of premolars and molars. A study was excluded if sealants and fluoride varnish were not compared with each other. DATA COLLECTION AND ANALYSIS: Two review authors carried out the baseline searches, selecting the papers on the basis of the title, keywords and abstract and making decisions about the eligibility and data extractions. The same review authors assessed the methodological quality of all included studies: for example, the allocation concealment, blinding, and completeness of follow up. Authors of the studies were contacted for additional information. Risk ratios (RR) as effect estimates were calculated for the differences in whether surfaces were carious or not in the treatment groups, along with the appropriate standard errors and 95% confidence intervals (CI). No data could be combined or meta-analyses undertaken due to the clinical and methodological diversity between study designs. MAIN RESULTS: Four studies were eligible for inclusion in the review. Three of the four studies compared the effectiveness of sealants with fluoride varnish application, and one study compared the effectiveness of sealants and fluoride varnish combination with fluoride varnish alone. Results of two studies revealed the effectiveness of pit and fissure sealants to be statistically significantly higher than an application of fluoride varnish every 6 months in preventing occlusal decays of first molars at 23 months (RR 0.74, 95% CI 0.58 to 0.95) and at 9 years follow up (RR 0.48, 95% CI 0.29 to 0.79). One of these studies was classed as at low risk of bias, one of moderate to high risk. One small study at moderate to high risk of bias failed to find a statistically significant difference between sealants and fluoride varnishes. One study of low risk of bias found a statistically significant difference in favour of the sealants and fluoride varnish combination compared with merely fluoride varnish at 24 months follow up with RR 0.36 (95% CI 0.21 to 0.61). The age of children in the included studies was 5 to 9 years. Allocation concealment was classified adequate in two of these four studies. AUTHORS’ CONCLUSIONS: There was some evidence of the superiority of pit and fissure sealants over fluoride varnish application in the prevention of occlusal decays. However, it remained unclear to what extent there is difference between the effectiveness of pit and fissure sealants and fluoride varnishes. Therefore, more high quality research is needed. No recommendations for the clinical practice could be given and the benefit of pit and fissure sealants and fluoride varnishes should be considered locally and individually.
J Calif Dent Assoc. 2006 Jul;34(7):540-6.
Evidence-based recommendations for the use of sealants.
Reeves A, Chiappelli F, Cajulis OS.
University of California Los Angeles School of Dentistry, 90095, USA.
In traditional research, the “level of significance” refers to the probability value used to reject the null hypothesis. In evidence-based research, a similar term, “the level of evidence” refers to the quality of the published report that is analyzed critically in the context of a systematic review. A systematic review, the principal research tool of evidence-based dentistry, is distinct from a classical narrative literature review in that it is focused to examine the strengths and weaknesses of the research methodology, design and data analysis of each report included in the review. A systematic review is very clearly defined, and sets out to find what evidence there is for prescribing a particular intervention for a given patient. Evidence-based recommendations are grounded on systematic reviews, and the evaluation of systematic reviews in a given domain of dentistry is critical for the successful implementation of evidence-based dental practice. In the context of sealants, the evidence indicates that the intervention is effective in preventing dental decay on the molars and premolars of susceptible children and adolescents (Level of evidence: II-1). The preventive effect for second-generation sealants ranges from 33 percent to 71 percent. The median preventive effect is higher when sealants are reapplied, compared to a single application, because sealant effectiveness decreases over time. The majority of studies have focused on molars, and fewer studies have examined the preventive effect of sealants on premolars. In this paper, the authors have developed evidence-based recommendations for the use of sealants by discussing the level of evidence and, when applicable, the number needed to treat (NNT) and the prevented fraction (PF), two fundamental criteria in evidence-based dental practice.
Community Dent Oral Epidemiol. 2006 Oct;34(5):321-36.
Retention of resin-based pit and fissure sealants: A systematic review.
Muller-Bolla M, Lupi-Pégurier L, Tardieu C, Velly AM, Antomarchi C.
Dental Public Health Department, LASIO, University of Nice Sophia Antipolis, France. muller@unice.fr
The aim of the present study was to perform a systematic review on the retention of resin-based sealants (RBSs) according to the material used and the clinical procedure. An electronic search in MEDLINE, EMBASE, Cochrane library and SCOPUS was completed by a hand search in conference proceedings. One hundred and twenty-four studies were identified, 31 of which were included. The retention rate of auto-polymerized and light-cured RBSs did not differ significantly. Light-cured RBSs had a significantly higher retention rate than fluoride-containing light-cured RBSs at 48 months (RR = 0.80, 95% CI: 0.72-0.89) and more. Concerning the clinical procedure, the scarcity of well-conducted studies made judgement difficult, except for the isolation stage. If using a rubber dam did not affect retention of auto-polymerized RBSs, it did for fluoride-containing light-cured RBSs (RR = 2.03, 95% CI: 1.51-2.73).
Cochrane Database Syst Rev. 2004;(3):CD001830.
Comment in:
Evid Based Dent. 2004;5(4):93-4.
Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents.
Ahovuo-Saloranta A, Hiiri A, Nordblad A, Worthington H, Mäkelä M.
University of Tampere, Lapintie 10 A 7, 33100 Tampere, Tampere, Finland. anneli.ahovuo-saloranta@uta.fi
BACKGROUND: Fissure sealants used on occlusal tooth surfaces were introduced in the 1960s for protecting pits and fissures from dental caries. Although sealants have demonstrated to be effective in preventing caries, their efficacy may be related to the background caries prevalence in the population. OBJECTIVES: The primary objective of this review was to evaluate the caries prevention of resin based pit and fissure sealants and glass ionomer cements or sealants in children and adolescents. SEARCH STRATEGY: We searched the Cochrane Oral Health Group’s Trials Register (last update December 2002), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2002), MEDLINE via OVID (1966 to December 2002), EMBASE (1974 to February 2002), SCISEARCH, SIGLE, CAplus, INSPEC, JICST-EPLUS, NTIS, PASCAL (February 2002) and DARE, NHS EED, HTA (March 2002). Reference lists from included articles and review articles were searched for additional relevant articles. All relevant studies in most languages were considered and translated. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials of at least 12 months in duration in which sealants were used for preventing caries in children and adolescents under 20 years of age were included. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars. DATA COLLECTION AND ANALYSIS: In the first phase, two reviewers independently examined whether a given study was likely to be relevant on the basis of the title, key words and abstract. In the second phase, four of the reviewers independently classified studies to be included in final analyses. Study authors were contacted for additional information. In the split-mouth studies relative risk ratios were calculated for the paired differences of tooth surfaces being carious or not. In studies comparing resin based sealant with no treatment, fixed effect meta-analyses were used to combine the estimates of relative risk ratios. In one parallel group study, the mean DFS data as continuous data, the effect estimate being the difference in mean DFS, was calculated from data of occlusal surfaces of teeth included in the test and control groups. MAIN RESULTS: Eight trials were included in this review of which seven trials were split-mouth studies and one a parallel group study. Six studies provided data for comparing sealant with no treatment and three studies for comparing glass ionomers with resin based sealants. The overall effectiveness of resin based sealants in preventing dental decay on first molars was high. Based on five split-mouth studies with 5 to 10 year old children there were significant differences in favour of the second-generation resin sealant compared with no treatment with pooled relative risk values of 0.14, 0.24, 0.30, 0.43 at 12, 24, 36 and 48 to 54 months respectively. The reductions in caries therefore ranged from 86% at 12 months to 57% at 48 to 54 months. The 24 month parallel group study comparing second-generation resin sealant with control in 12 to 13 year old children found also significantly more caries in the control group children with DFS = 0.65 (95% CI 0.47 to 0.83). Allocation concealment was classified adequate in three of these six studies. However the information on background levels of caries in the population was insufficient to conduct further analyses to estimate the effectiveness of resin based sealants related to baseline caries prevalence.Only one study provided data for the comparison between glass ionomer sealant and control. Based on this, there is not enough information to say whether ionomer sealants are effective, or not. The results of three studies comparing resin sealants with glass ionomer sealants were conflicting and the meta-analyses were not carried out. REVIEWERS’ CONCLUSIONS: Sealing with resin based sealants is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. However, we recommend that the caries prevalence level of both individuals and the population should be taken into account. In practice, the benefit of sealing should be considered locally and specified guidelines for clinicians should be used. The methodological quality of published studies concerning pit and fissure sealants was poorer than expected.
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