The success rates of a glass ionomer cement and a resin-based fissure sealant placed by fifth-year undergraduate dental students

Survival Analysis of Glass Ionomer Cement and Resin-Based Sealant Retention: A 10-Year Follow-Up Study

Background and Objective: Sealant application is a proven method to prevent occlusal caries; however, long-term studies on this topic are scarce. This study aimed to assess the survival rate and clinical effectiveness of glass ionomer cement (GIC) and resin-based sealants (RBSs) on second permanent molars over a long-term follow-up period. Materials and methods: Sixteen patients aged 11-13 years with all four completely erupted permanent second molars were enrolled in the study. All patients attended 1-year and 3-year follow-ups; however, one participant did not respond after 10 years and was excluded from the final analyses. The oral health status evaluation was based on WHO criteria. A total of 32 teeth received an RBS (Clinpro), and a further 32 teeth were sealed with GIC (Fuji IX). The sealant retention was determined according to the Kilpatrick criteria after 1 year, 3 years, and 10 years, respectively. Statistical analysis included a chi-square test, the Kaplan-Meier method, and the Cox proportional hazard model. Results: At baseline, seven boys and eight girls participated in the study, with a mean age of 12.3 ± 0.9 years. The 1-year follow-up results revealed that 90% of the RBSs and 43.3% of the GIC sealants were completely retained, and no caries lesions were recorded (p = 0.01). The 3-year follow-up results showed that 23.3% of the RBSs and 0% of the GIC sealants demonstrated complete retention (p = 0.034). Moreover, 10.0% of the occlusal surfaces in the RBS group and 13.3% of the occlusal surfaces in the GIC group were filled (p > 0.05). A total of 6.7% of the RBSs showed complete retention. One-third of the sealed teeth (30.0% of the teeth sealed with RBSs and 36.7% of teeth applied with GIC) were filled after 10 years. The Kaplan-Meier analysis demonstrated a higher survival rate in the RBS group when compared with the GIC over the entire follow-up period (p = 0.001). Conclusions: Although the survival rate of RBSs was higher than GIC sealants, their effectiveness in preventing fissure caries in permanent second molars did not differ significantly over a 10-year follow-up.

Clinical performance of sealants under different humidity control conditions: a split-mouth 1-year randomized trial

PURPOSE

Sealants are an effective method of prevention and treatment for early caries lesions. This study analyzed the 1-year clinical performance of resin-based and ionomeric sealants applied to permanent teeth under different humidity conditions.

METHODS

The investigation was a triple-blind randomized clinical trial (RCT) with a four arms split-mouth design, divided according to the sealant protocol: (1) Resin-based sealant applied with rubber dam isolation, (2) Resin-based sealant applied with cotton rolls isolation, (3) Ionomeric sealant applied with rubber dam isolation and (4) Ionomeric sealant applied with cotton rolls isolation. Fifty-eight patients started the study (232 teeth), and 47 (188 teeth) remained until the 1-year recall. The modified USPHS criteria were used in the analyzes to investigate surface texture, retention and the presence of secondary caries lesions around the sealants; in the following periods: baseline, after 3, 6, 9, and 12 months by two calibrated examiners. Data were analyzed by the Mann-Whitney and Friedman tests.

RESULTS

There was no difference between the types of sealants (p > 0.05). The type of humidity control influenced the superficial texture (p = 0.0012) and the retention of sealants (p = 0.0023). The sealant displacement was greater under cotton rolls isolation. Only one active caries lesion in enamel was found in the 9th month.

CONCLUSION

It may be concluded that sealants effectively prevented caries, even when they were partially or totally lost, regardless of the material. The rubber dam isolation with a rubber dam promoted lower surface roughness and improved the retention rates. International Clinical Trials Registry Platform: #1111-1215-2832 (07/26/2018).

Twelve-month clinical evaluation of retention of resin-based sealant on first permanent molars

INTRODUCTION

The majority of researchers agree that sealants need to be monitored and kept in good condition because even a small amount of sealant loss raises the possibility of developing caries lesions. The first year after application is when sealant loss is reported to be at its highest. This motivated us to monitor silanized patients who received resin-based sealant for a full year.

A concise review of dental sealants in caries management

This concise review provides an update of the use of dental sealants. Dental sealants protect a tooth from caries development by providing a physical barrier to microorganism colonisation and creating a favorable environment for patients to clean. Some sealants release fluoride ions to promote remineralization. Dental sealants can be applied on pits and fissures of primary and permanent teeth to prevent and arrest early enamel caries. They are effective in caries prevention. The preventive fraction of resin sealant is up to 61% after 5 years. Dental sealants can be classified as resin, glass ionomer and hybrid (compomer or giomer) according to the material. Recent studies from 2012 to 2022 showed resin sealant has a high retention rate of up to 80% after 2 years, whereas glass ionomer sealants is 44%. Chemical etching with 37% phosphoric acid is the standard of care, whereas laser or air-abrasion cannot does not increase the sealant retention rate. Moist control is critical and studies found the use of rubber dam and cotton rolls had similar success for sealant retention. The longevity of dental sealant is also associated with clinical operative factors, including approaches of moisture control, enamel pretreatment, selection of dental adhesive, and time of acid etching.

A novel application of a bioactive material as a pit and fissure sealant: in vitro pilot study evaluating the sealing ability and penetration

PURPOSE

To compare the sealing ability and penetration of a bioactive material used as pit and fissure sealant to those of glass ionomer sealant.

METHODS

This was an in vitro experimental study conducted on 20 permanent teeth. For Group I of ten teeth, ACTIVA BioACTIVE-Base/Liner was applied as a sealant on pits and fissures, and the remaining ten teeth of Group II were sealed using glass ionomer cement. After thermocycling, the apex of the teeth was sealed using composite resin and they were immersed in 1% methylene blue solution, buffered at pH 7 for 24 h. Longitudinal sections were obtained from each tooth for evaluating the sealing ability and penetration, using a binocular light microscope at 4 × magnification. The obtained data were subjected to analysis using the Chi-square test and independent t test.

RESULTS

The comparison of the sealing ability and sealant penetration, between the two groups, showed statistically no significant difference (p = 0.104 and p = 1.0, respectively).

CONCLUSION

Bioactive material as a pit and fissure sealant, performed on par with glass ionomer sealant in terms of tested properties like sealing ability and penetration.

Comparison of Clinical Efficacy of Glass Ionomer-based Sealant using ART Protocol and Resin-based Sealant on Primary Molars in Children

Aim

The present in vivo study aims to evaluate and compare the clinical efficacy and survival rate of resin-based composite sealant (Clinpro Sealant, 3M ESPE, Irvine, California, United States of America) with high viscosity glass ionomer (GI) (Equia Forte, GC India, Patancheru, Telangana, India) using atraumatic restorative treatment (ART) sealant protocol in primary molars.

Materials and methods

The design of the study was a clinical, prospective split-mouth study. A total of 100 contralateral primary molars were selected and divided into two groups. In group I, children received Equia Forte, and in group II, children received Clinpro Sealant. The follow-up examinations were performed in the 1st and 6th months. Simonsen's criteria were used to check for retention. International Caries Assessment and Detection System II (ICDAS II) criteria were used to check for dental caries. The data obtained were subjected to statistical analysis.

Results

At 6 months, there was no statistically significant difference between the groups with regard to retention and caries preventive effect.

Conclusions

High-viscosity GI sealants can be applied using the ART protocol and provide an alternative to resin-based sealants.

Clinical significance

There is a limited number of studies on the performance of ART sealants in primary molars. Thus, the clinical efficacy and survival rate of resin-based composite sealant (Clinpro Sealant, 3M ESPE, Irvine, California, United States of America) with high viscosity GI (Equia Forte, GC India, Patancheru, Telangana, India) using ART sealant protocol in primary molars were evaluated. The research concluded that high-viscosity GI sealants using ART protocol are effective sealants in primary molars.

How to cite this article

Kaverikana K, Vojjala B, Subramaniam P. Comparison of Clinical Efficacy of Glass Ionomer-based Sealant using ART Protocol and Resin-based Sealant on Primary Molars in Children. Int J Clin Pediatr Dent 2022;15(6):724-728.

Retention and caries-preventive effect of four different sealant materials: A 2-year prospective split-mouth study

AIM

The aim of this observational split-mouth study was to compare the retention and caries protective effect of four different sealant materials in children aged 6-13 years during a 2-year follow-up period.

DESIGN

Eighty children were included in this study, which was conducted in Blato (Korčula island), Croatia. Each participant received at least two different sealant materials on caries-free permanent molars in two different quadrants. Sealant materials (M1 - glass-ionomer cement; M2, M4 - resin-based filled sealants; M3 - resin-based unfilled sealant) were delivered in a random order.

RESULTS

The results of this study showed that M2 (30 teeth, 46.2%) and M4 (27 teeth, 46.6%) showed statistically significantly higher number of teeth with total retention after 2-year follow-up period, in comparison with M1 (10 teeth, 19.2%) or M3 (12 teeth, 20.7%) (p < .001). There was no statistically significant difference in caries occurrence between different groups in which the sealant material was totally retained.

CONCLUSIONS

According to the results of this study, filled resin-based sealant materials showed better retention during the 2-year follow-up period while both resin-based and glass-ionomer sealants demonstrated protection against dental caries if totally retained on the occlusal surface.

Caries-Preventive Effect and Retention of Glass-Ionomer and Resin-Based Sealants: A Randomized Clinical Comparative Evaluation

Background. Deep fissures are highly unprotected from the development of caries. Resin-based materials and glass-ionomer cements for sealing fissures are useful in caries control through physical barrier formation, which prohibits metabolic exchange between fissure microorganisms. Retention is one of the most critical properties of fissure sealants. This in vivo study is aimed at comparing and evaluating the clinical efficacy of resin and glass ionomer-based fissure sealants on first permanent molars with follow-ups at 6-, 12-, and 18-month intervals. Methods. A randomized split-mouth design clinical study was conducted after obtaining the ethical committee approval. A total of 50 patients, aged between 7 and 12 years, were randomized and enrolled in the study to perform a total of 200 sealant placements on all four caries-free and hypoplasia-free first permanent molars having deep fissures, which are susceptible to caries, were included in this study. The four permanent molars were divided into the following four groups: group A (control), B (Grandioseal, Voco, Germany), C (Smartseal & Loc, Detax Gmbh & Co, Germany), and D (Fuji triage capsule, GC, Belgium). The sealed molars were clinically evaluated at intervals of 6, 12, and 18 months to assess sealant retention, surface roughness, marginal coloration, and caries status through visual evaluation of the sealant by two evaluators. Results. Concerning retention, there were statistically significant differences between the sealants in terms of the survival of partial and fully retained sealants as well as in the survival of caries-free teeth. Two resin-based (Smartseal & Loc) and glass-ionomer cement (Fuji triage) sealants showed significantly similar performances in permanent molars for up to 18 months. In terms of retention, one of the resin-based (Grandioseal) sealants performed better as compared to the others and showed better caries prevention in deep fissures. Conclusion. It is concluded that both the sealants had comparable retention and caries-preventive effects in 7 to 12-year-old children and can be considered as suitable sealants for a period of at least 18 months in moderate caries risk patients.

Remineralizing Effects of Resin-Based Dental Sealants: A Systematic Review of In Vitro Studies

The incorporation of remineralizing additives into sealants has been considered as a feasible way to prevent caries by potential remineralization through ions release. Thus, this systematic review aimed to identify the remineralizing additives in resin-based sealants (RBS) and assess their performance. Search strategies were built to search four databases (PubMed, MEDLINE, Web of Science and Scopus). The last search was conducted in June 2020. The screening, data extraction and quality assessment were completed by two independent reviewers. From the 8052 screened studies, 275 full-text articles were assessed for eligibility. A total of 39 laboratory studies matched the inclusion criteria. The methodologies used to assess the remineralizing effect included microhardness tests, micro-computed tomography, polarized-light microscopy, ions analysis and pH measurements. Calcium phosphate (CaP), fluoride (F), boron nitride nanotubes (BNN), calcium silicate (CS) and hydroxyapatite (HAP) were incorporated into resin-based sealants in order to improve their remineralizing abilities. Out of the 39 studies, 32 studies focused on F as a remineralizing agent. Most of the studies confirmed the effectiveness of F and CaP on enamel remineralization. On the other hand, BNN and CS showed a small or insignificant effect on remineralization. However, most of the included studies focused on the short-term effects of these additives, as the peak of the ions release and concentration of these additives was seen during the first 24 h. Due to the lack of a standardized in vitro study protocol, a meta-analysis was not conducted. In conclusion, studies have confirmed the effectiveness of the incorporation of remineralizing agents into RBSs. However, the careful interpretation of these results is recommended due to the variations in the studies’ settings and assessments.

Pit and Fissure Sealant versus Fluoride Varnish for the Prevention of Dental Caries in School Children: A Systematic Review and Meta-Analysis

Children's dental health has become the main concern, due to the increase in caries prevalence amongst children. Pit and fissure sealant (PFS) and fluoride varnish (FV) are effective measures for preventing dental caries. However, the clinical efficacy of these interventions when compared to one another is uncertain. The aim of the present systematic review with meta-analysis was to compare pit and fissure sealants with fluoride varnish for caries prevention of first permanent molars among schoolchildren. This is a meta-Analysis, which involves randomized control trials that compare the effectiveness of PFS with FV within 24 months of follow-up. Five databases were searched from 1990 to 2019 to identify studies published in Arabic or English language. The risk ratio (RR) and 95% confidence intervals (CIs) were calculated using a random-effects model. A total number of 4 studies were included with overall of 1249 children in both groups. Three included trial reported caries increment of first permanent molars (FPM) with 24 months of follow-up, there was no statistical significance (RR: 0.65; 95% CI 0.31 to 1.35; P = 0.26 I2 = 89%). As regards DMFS increment, the analysis showed no statistical differences between FV and PFS in terms of lowering DMFS increment (MD: 0.09; 95% CI: -0.03 to 0.21). Findings of this meta-analysis proved there is no significant difference between PFS and FV in caries prevention efficacy of FPMs at 2 years' follow-up, emphasizing the use of FV since it is more affordable and easier to apply.

The antibacterial effect and physical performance of pit and fissure sealants based on an antibacterial core-shell nanocomposite

The application of pit and fissure sealants is a well-established method to prevent and treat early childhood caries. Resin-based sealants with antibacterial properties provide additional benefits for caries prevention in a cariogenic oral environment. The objective of this study was to evaluate the effect of an antibacterial core-shell AgBr/cationic polymer nanocomposite (AgBr/BHPVP) on the properties of a resin-based pit and fissure sealant. A commercialized pit and fissure sealant without fluoride, Concise (3M, ESPE, USA), was used as the parent material and negative control. Experimental antibacterial sealants were formulated by the addition of AgBr/BHPVP nanoparticles at mass fractions of 0.5, 1.0, and 1.5 wt% to the parent material. A fluoride-releasing sealant, Clinpro (3M, ESPE), was used as the positive control. Bacterial colony-forming unit (CFU) counts, metabolic activity tests, field emission-scanning electron microscopy (FE-SEM), and confocal laser scanning microscopy (CLSM) observations were used to evaluate the antibacterial properties of AgBr/BHPVP-modified sealants against Streptococcus mutans before and after five months of aging. The Vickers microhardness, degree of conversion, and microleakage level of the sealants were also investigated. According to the results of CFU counts and metabolic tests, sealants containing AgBr/BHPVP showed better contact-killing bactericidal activity against S. mutans than the two commercial sealants, irrespective of aging conditions (both P < 0.05). The AgBr/BHPVP-modified sealants also showed a significant inhibitory effect on the planktonic S. mutans around the cured sealant surfaces. In addition, the Vickers microhardness, degree of conversion, and microleakage level of the parent material were not damaged by modification with AgBr/BHPVP (P > 0.05). AgBr/BHPVP-modified pit and fissure sealant with a dual bactericidal mechanism is a promising option for the prevention of pit and fissure caries.

Clinical success rate of fissure sealants: one-year follow-up

Purpose:

The aim of this study is to evaluate clinical success rate of resin-based fissure sealants applied at Istanbul University, Department of Pediatric Dentistry after 1 year of application.

Materials and methods:

Children with at least one pair of caries-free permanent first molars with deep pits and fissures were included in the study. The ages of children ranged from 7-13 (mean age: 9.2±1.22). Resin-based fissure sealant was applied to the 322 fissures of the first permanent molars in 100 children. 12 months after the application, children were recalled for examination. Recall examinations were carried out by the same dentist. Fissure sealants were evaluated at 12th month by using Ryge criteria: Retention (R), precence of caries (PC), marginal adaptation (MA), marginal discoloration (MD) and cracking (C).

Results:

12 months after the application, all of the children were recalled and fissure sealants were examinated. Our findigs are: R: Alpha 95 (29.5%), Bravo: 143 (44.4%), Charlie: 84 (26%); PC: Alpha 274, Bravo 48 (14.9%); MD: Alpha 322; MA: Alpha 279, Bravo 43 (13.3%); C: Alpha 321, Bravo 1 (0.3%).

Conclusion:

The preventive effects of the sealant are only maintained as long as it remains completely intact and bonded in place. After applying fissure sealants, patients must be recalled and sealants must be checked to provide retention and marginal adaptation.

Performance of fissure sealants on fully erupted permanent molars with incipient carious lesions: A glass-ionomer-based versus a resin-based sealant

Background. The effectiveness of fissure sealants in caries prevention depends on their long-term retention and ability to stop caries progression. This randomized controlled clinical trial compared the retention rate and cariostatic properties of a contemporary glass-ionomer-based sealant (GIS) versus a resin-based sealant (RS) placed on fully erupted permanent molars in a split-mouth design. Methods. The sealants were placed on fully erupted permanent teeth (8‒12 years of age) in 45 children. The evaluation was conducted after one week and three and six months. Results. There was a statistically significant difference in the retention rate and caries transition between the two groups over a six-month clinical evaluation period. The resin-based sealant group showed a better retention rate than the GIS group (75.56% and 48.88%, respectively). The resin-based sealant was superior to GIS in preventing caries progression. Conclusion. Resin-based fissure sealant with fluoride releasing properties might be preferable in preventing caries progression of incipient non-cavitated carious lesions in fully-erupted teeth.

Meta-analysis of the longevity of commonly used pit and fissure sealant materials

OBJECTIVE

This systematic literature review and meta-analysis compared the clinical retention of primed or adhesively bonded sealants to that of conventional sealant materials.

METHODS

A search of the MEDLINE, EMBASE and CENTRAL databases identified 3707 abstracts published prior to 12/31/2017, of which 335 clinical publications were analysed in detail. A total of 67 studies included information about sealant retention after 24, 36, or 60 months of follow-up. A meta-analysis using a random effects model was conducted to calculate the pooled estimate of the retention rates for the five groups of sealants. Subgroup moderator analysis was performed to compare the pooled retention rate estimate (RRE) of primed sealants against those of the other groups.

RESULTS

Primed sealants had a 2-year pooled RRE of 43.2% (95% CI: 30.5-55.8), which was significantly inferior to those of auto-polymerizing (80.8%, 95% CI: 72.2-89) and light-polymerizing sealants (68.4%, 95% CI: 60.2-76.7). Fluoride-releasing and light-polymerizing sealants had the highest 3-year pooled RREs (86.4%, 95% CI: 73.4-99.3 and 83.1%, 95% CI: 75.6-90.7, respectively).

SIGNIFICANE

The results of this meta-analysis suggest that primed sealants cannot be fully recommended for clinical practice due to their moderate survival rates. Auto-polymerizing, light-polymerizing and fluoride-releasing sealants continue to be considered the reference standards for pit and fissure sealants. However, future generations and developments of primed sealant materials may change this position.

Clinical Evaluation of the Retention of Resin and Glass Ionomer Sealants Applied as a Part of School-Based Caries Prevention Program

BACKGROUND:

Using of sealant on pits and fissures is likely one of the most generally well-known strategies by the new cavity-prevention systems.

AIM:

The purpose of this research is to measure the retentiveness of sealants of resin-modified ionomer glass cement (GIC) and resin pits and fissures, on the first permanent molars of special patients as a part of caries prevention program in schools.

METHODS:

The sample was comprised by 60 molars. Resin-based sealants on one side and glass-ionomer sealant on the contralateral side of the mouth. The molars were examined in three and six months after application for retention with three standards: TR: Totally Retained; PR: Partially Retained; and CL: Completely Lost.

RESULTS:

by the end of the study 60% of resin sealant was present. While 55% of GIC were retentive after 6 months.

CONCLUSION:

Resin sealants are more retentive than glass ionomer sealants in school-based carries prevention program.

Conservative and endodontic treatment performed under general anesthesia: A discussion of protocols and outcomes

AIMS

This work discusses the procedures and outcomes of restorative and endodontic treatments performed under general anesthesia, with examples from the Unit of Special Care Dentistry at the University Hospital of Clermont-Ferrand.

METHODS AND RESULTS

The restorative and endodontic treatment techniques used in the Special Care Unit are described. These techniques are compared to existing reports in the literature of treatment procedures under general anesthesia. Little evidence was found in the literature regarding sealants or restorative protocols. A few studies described root canal treatment and pulpotomy protocols carried out under general anesthesia, and the results of these met academic outcome standards.

CONCLUSION

Patients with equal needs should have equal access, equal quality of treatment and equal treatment outcomes, regardless of whether a facilitatory procedure is used to achieve treatment. The provision of restorative treatment under general anesthesia is essential to avoid an excessive number of extractions in patients unable to receive treatment in the chair. Restorative care provided under general anesthesia should be standardized and evaluated in the same way as treatment performed under local anesthesia. In this way, the provision of conservative dental care under general anesthesia could be promoted and the maintenance of a functional dentition encouraged.

Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis

OBJECTIVE

The aim of the present study is to update the results of two previous meta-analyses, published in 2006 and 2012, on the survival percentages of atraumatic restorative treatment (ART) restorations and ART sealants. The current meta-analysis includes Chinese publications not investigated before.

MATERIALS AND METHODS

Until February 2017, six databases were interrogated (two English, one Portuguese, one Spanish and two Chinese). Using six exclusion criteria, a group of six independent reviewers selected 43 publications from a total of 1958 potentially relevant studies retrieved. Confidence intervals and/or standard errors were calculated and the heterogeneity variance of the survival rates was estimated.

RESULTS

The survival percentages and standard errors of single-surface and multiple-surface ART restorations in primary posterior teeth over the first 2 years were 94.3% (± 1.5) and 65.4% (± 3.9), respectively; for single-surface ART restorations in permanent posterior teeth over the first 3 years, they were 87.1% (± 3.2); and for multiple-surface ART restorations in permanent posterior teeth over the first 5 years, they were 77% (± 9.0). The mean annual dentine-carious-lesion-failure percentages in previously sealed pits and fissures using ART sealants in permanent posterior teeth over the first 3 and 5 years were 0.9 and 1.9%, respectively.

CONCLUSIONS

ART single-surface restorations presented high survival percentages in both primary and permanent posterior teeth, whilst ART multiple-surface restorations presented lower survival percentages. ART sealants presented a high-caries-preventive effect.

CLINICAL RELEVANCE

ART is an effective evidence-based option for treating and preventing carious lesions in primary and permanent posterior teeth.

Glass ionomer cements as fissure sealing materials: yes or no?: A systematic review and meta-analysis

BACKGROUND

The aim of this systematic review and meta-analysis was to evaluate the ability of glass ionomer cements (GICs) and resin-based sealants (RBSs) to prevent the occurrence of caries and their retention in standards-based clinical studies.

TYPES OF STUDIES REVIEWED

The authors conducted a literature search (from database inception through September 20, 2017) to identify studies for inclusion in this systematic review. The authors assessed the quality of the evidence with the modified Jadad scale and performed the meta-analysis by using a random-effects model.

RESULTS

The authors considered 20 studies on caries prevention and 28 studies on retention that met the inclusion criteria for the meta-analysis. The results of the meta-analysis for caries development showed no significant difference (odds ratio, 0.938; 95% confidence interval, 0.647 to 1.359; P = .734). However, the result for the retention rate showed the advantage of RBSs (odds ratio, 6.006; 95% confidence interval, 3.226 to 11.183; P = .000).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

There was no difference between the percentage of caries development with use of GICs as fissure sealing material compared with that for the conventional RBSs, but the retention rate of conventional RBSs was much higher than that of the GICs.

Pit and fissure sealants for preventing dental decay in permanent teeth

BACKGROUND

Dental sealants were introduced in the 1960s to help prevent dental caries, mainly in the pits and fissures of occlusal tooth surfaces. Sealants act to prevent bacteria growth that can lead to dental decay. Evidence suggests that fissure sealants are effective in preventing caries in children and adolescents compared to no sealants. Effectiveness may, however, be related to caries incidence level of the population. This is an update of a review published in 2004, 2008 and 2013.

OBJECTIVES

To compare the effects of different types of fissure sealants in preventing caries in occlusal surfaces of permanent teeth in children and adolescents.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched: Cochrane Oral Health's Trials Register (to 3 August 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 7), MEDLINE Ovid (1946 to 3 August 2016), and Embase Ovid (1980 to 3 August 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 3 August 2016. No restrictions were placed on language or date of publication.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing sealants with no sealant or a different type of sealant material for preventing caries of occlusal surfaces of premolar or molar teeth in children and adolescents aged up to 20 years. Studies required at least 12 months follow-up. We excluded studies that compared compomers to resins/composites.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We presented outcomes for caries or no caries on occlusal surfaces of permanent molar teeth as odds ratio (OR) or risk ratio (RR). We used mean difference (MD) for mean caries increment. All measures were presented with 95% confidence intervals (CI). We conducted meta-analyses using a random-effects model for comparisons where there were more than three trials; otherwise we used the fixed-effect model. We used GRADE methods to assess evidence quality.

MAIN RESULTS

We included 38 trials that involved a total of 7924 children; seven trials were new for this update (1693 participants). Fifteen trials evaluated the effects of resin-based sealant versus no sealant (3620 participants in 14 studies plus 575 tooth pairs in one study); three trials with evaluated glass ionomer sealant versus no sealant (905 participants); and 24 trials evaluated one type of sealant versus another (4146 participants). Children were aged from 5 to 16 years. Trials rarely reported background exposure to fluoride of trial participants or baseline caries prevalence. Resin-based sealant versus no sealant: second-, third- and fourth-generation resin-based sealants prevented caries in first permanent molars in children aged 5 to 10 years (at 24 months follow-up: OR 0.12, 95% CI 0.08 to 0.19, 7 trials (5 published in the 1970s; 2 in the 2010s), 1548 children randomised, 1322 children evaluated; moderate-quality evidence). If we were to assume that 16% of the control tooth surfaces were decayed during 24 months of follow-up (160 carious teeth per 1000), then applying a resin-based sealant would reduce the proportion of carious surfaces to 5.2% (95% CI 3.13% to 7.37%). Similarly, assuming that 40% of control tooth surfaces were decayed (400 carious teeth per 1000), then applying a resin-based sealant would reduce the proportion of carious surfaces to 6.25% (95% CI 3.84% to 9.63%). If 70% of control tooth surfaces were decayed, there would be 19% decayed surfaces in the sealant group (95% CI 12.3% to 27.2%). This caries-preventive effect was maintained at longer follow-up but evidence quality and quantity was reduced (e.g. at 48 to 54 months of follow-up: OR 0.21, 95% CI 0.16 to 0.28, 4 trials, 482 children evaluated; RR 0.24, 95% CI 0.12 to 0.45, 203 children evaluated). Although studies were generally well conducted, we assessed blinding of outcome assessment for caries at high risk of bias for all trials (blinding of outcome assessment is not possible in sealant studies because outcome assessors can see and identify sealant). Glass ionomer sealant versus no sealant: was evaluated by three studies. Results at 24 months were inconclusive (very low-quality evidence). One sealant versus another sealant: the relative effectiveness of different types of sealants is unknown (very low-quality evidence). We included 24 trials that directly compared two different sealant materials. Comparisons varied in terms of types of sealant assessed, outcome measures chosen and duration of follow-up. Adverse events: only four trials assessed adverse events. No adverse events were reported.

AUTHORS' CONCLUSIONS

Resin-based sealants applied on occlusal surfaces of permanent molars are effective for preventing caries in children and adolescents. Our review found moderate-quality evidence that resin-based sealants reduced caries by between 11% and 51% compared to no sealant, when measured at 24 months. Similar benefit was seen at timepoints up to 48 months; after longer follow-up, the quantity and quality of evidence was reduced. There was insufficient evidence to judge the effectiveness of glass ionomer sealant or the relative effectiveness of different types of sealants. Information on adverse effects was limited but none occurred where this was reported. Further research with long follow-up is needed.

Retention and caries-preventive effect of glass ionomer and resin-based sealants: An 18-month-randomized clinical trial

The objective of this study was to compare the retention and caries-preventive effect of glass ionomer (Fuji Triage) and resin-based (Clinpro) sealants among 6-9-year-old children. This split-mouth, randomized clinical trial covered 35 children/140 fully erupted permanent first molars. Evaluation was conducted by two independent examiners after 6, 12, and 18 months and the data were compared in relation to the children's caries risk and age groups. The Kaplan-Meier survival method and chi-square test were used for analysis. There were no statistically significant differences in the survival of partial and fully retained sealants or in the survival of caries-free pits and fissures between glass-ionomer and resin-based sealants. In terms of retention, both sealants performed better in the younger age group at the end of the study, and showed better caries prevention in moderate caries risk children. After 18 months, both sealants had comparable retention and caries-preventive effects in 6-9-year old children.

3-year survival rates of retained composite resin and ART sealants using two assessment criteria

The aim was to test the null-hypothesis that there is no difference in the cumulative survival rate of retained composite resin (CR) sealants and a high-viscosity glass-ionomer Atraumatic Restorative Treatment (ART) sealant in first permanent molars calculated according to the traditional and the modified retention assessment criteria over a period of 3 years. This cluster-randomized controlled clinical trial consisted of 123 schoolchildren, 6-7-years-old. At baseline, high-caries risk pits and fissures of fully erupted first permanent molars were treated with CR and ART sealants. Evaluations were performed after 0.5, 1, 2 and 3 years. Retention was scored for free-smooth surface and for each of three sections into which the occlusal surface had been divided. The modified criterion differed from the traditional in that it determined an occlusal sealant to be a failure when at least one section contained no visible sealant material. Data were analysed according to the PHREG model with frailty correction, Wald-test, ANOVA and t-test, using the Jackknife procedure. The cumulative survival rates for retained CR and ART sealants in free-smooth and occlusal surfaces for both criteria were not statistically significantly different over the 3 years. A higher percentage of retained CR sealants on occlusal surfaces was observed at longer evaluations. Cumulative survival rates were statistically significantly lower for the modified criterion in comparison to the traditional. The modified retention assessment criterion should be used in future sealant-retention studies.

Clinical comparison of Fuji VII and a resin sealant in children at high and low risk of caries

The purpose was to compare the retention and caries preventive effect of Fuji VII and a resin-based sealant in children at high risk (HR) and low risk (LR) of caries. Fifty-seven schoolchildren (150 teeth) with completely erupted bilateral permanent first molars were included. The study was a split-mouth, randomized trial. Sealant retention and caries were evaluated after 6 months, 1 year and 2 years. After 2 years, there was no statistically significant difference in the incidence of caries between Fuji VII and Concise in the HR and LR groups. With Concise, LR children were less likely to have dental caries than HR. With Fuji VII, there was no difference in caries incidence between LR and HR. Retention of Concise was superior to that of Fuji VII. Our results suggest that Fuji VII and Concise sealants had similar caries preventive effects in children at high and low risk of caries.

The modified Ottawa method to establish the update need of a systematic review: glass-ionomer versus resin sealants for caries prevention

Objective

To demonstrate the application of the modified Ottawa method by establishing the update need of a systematic review with focus on the caries preventive effect of GIC versus resin pit and fissure sealants; to answer the question as to whether the existing conclusions of this systematic review are still current; to establish whether a new update of this systematic review was needed.

Methods:

Application of the Modified Ottawa method. Application date: April/May 2012.

Results

Four signals aligned with the criteria of the modified Ottawa method were identified. The content of these signals suggest that higher precision of the current systematic review results might be achieved if an update of the current review were conducted at this point in time. However, these signals further indicate that such systematic review update, despite its higher precision, would only confirm the existing review conclusion that no statistically significant difference exists in the caries-preventive effect of GIC and resin-based fissure sealants.

Conclusion

In conclusion, this study demonstrated the modified Ottawa method as an effective tool in establishing the update need of the systematic review. In addition, it was established that the conclusions of the systematic review in relation to the caries preventive effect of GIC versus resin based fissure sealants are still current, and that no update of this systematic review was warranted at date of application.