The sealant restoration: indications, success and clinical technique

Toothbrush-Dentifrice Abrasion of Dental Sealants: An In Vitro Study

Objective  This study sought to investigate the toothbrush-dentifrice abrasion of dental sealants.

Materials and Methods  Weight loss (∆W) and depth loss (∆D) were used as abrasion indicators. Sealant samples from nine products were soaked in dentifrice slurry and abraded by using a toothbrushing machine with a brushing force of 300 g. The mean percentages of ∆W and mean values of ∆D after 24,000 and 48,000 strokes of brushing were compared by using paired t -test. A comparison of these mean values among sealant products was performed by using one-way ANOVA and multiple comparison analysis (Scheffe's test).

Results  Abrasive wear was observed in all sealants. Teethmate F-1 (Kuraray Noritake, Tokyo, Japan)—a fluoride-releasing unfilled sealant—exhibited the maximum abrasive wear, with ∆W and ∆D values of 1.14% ± 0.37% and 12.84 ± 4.28 µm, respectively. Delton (Dentsply Sirona, Charlotte, North Carolina, United States), a light-cured unfilled sealant, showed the minimum abrasive wear, with ∆W and ∆D values of 0.41% ± 0.09% and 2.93 ± 1.23 µm, respectively. No statistical differences were observed among unfilled sealants except when compared with Teethmate F-1. Similarly, no differences were observed when comparing among filled sealants and flowable composite.

Conclusion  Abrasive wear occurred in all sealants after brushing with dentifrice. Almost all unfilled sealants showed less wear compared with both filled sealants and flowable composite. However, the low abrasive values of all sealants after brushing with dentifrice implied that there is no clinical significance to this finding.

Effectiveness of pit and fissure sealants bonded with different adhesive systems: a prospective randomized controlled trial

OBJECTIVES

To evaluate and compare the clinical retention of a resin-based fissure sealant placed with an intermediate layer of etch-and-rinse (ER) or self-etch (SE) adhesives.

MATERIALS AND METHODS

Two hundred twenty-eight sealants were placed in 57 children with previously unsealed, caries-free permanent first molars, employing a split-mouth design. The teeth were randomized into four groups (n = 57 teeth/groups) according to the adhesive system placed under the tested sealant (Delton FS+; Dentsply). Group 1 (control): no bonding agent (conventional acid-etch sealant); group 2: prior enamel etch + ER adhesive (XP Bond; Dentsply); group 3: SE adhesive (Clearfil SE Bond; Kuraray) without prior etching; and group 4: prior enamel etch + SE adhesive (Clearfil SE Bond). Clinical assessments were performed according to modified USPHS criteria at 1, 3, 6, 12, 18, and 24 months. The data were analyzed statistically using Fisher's Exact test, the Kaplan-Meier analysis, and the Log-rank test.

RESULTS

At 24 months, sealants bonded with XP Bond and Clearfil SE Bond with prior enamel etching showed similar retention rates (p > 0.05), and these rates were significantly better than the rates of the conventional sealant and Clearfil-SE groups (p < 0.05). There was no significant difference between the retention rates of the latter two groups (p > 0.05). The cumulative survival rates on palatal/buccal surfaces showed similar outcomes as with occlusal surfaces: XP Bond (94%), Clearfil SE Bond + acid-etch (94%), conventional sealant (52%), and Clearfil SE Bond only (37%).

CONCLUSIONS

Application of the tested ER adhesive and the SE adhesive with enamel etching significantly improved the clinical retention of Delton-FS over the 24-month period.

CLINICAL RELEVANCE

The use of a resin-based fissure sealant placed with ER or SE adhesive with prior acid-etching yielded better retention than the conventional sealant over the 24-month period.

Sealant retention is better assessed through colour photographs than through the replica and the visual examination methods

The aim of this study was to test the hypothesis that the colour photograph method has a higher level of validity for assessing sealant retention than the visual clinical examination and replica methods. Sealed molars were assessed by two evaluators. The scores for the three methods were compared against consensus scores derived through assessing retention from scanning electron microscopy images (reference standard). The presence/absence (survival) of retained sealants on occlusal surfaces was determined according to the traditional and modified categorizations of retention. Sensitivity, specificity, and Youden-index scores were calculated. Sealant retention assessment scores for visual clinical examinations and for colour photographs were compared with those of the reference standard on 95 surfaces, and sealant retention assessment scores for replicas were compared with those of the reference standard on 33 surfaces. The highest mean Youden-index score for the presence/absence of sealant material was observed for the colour photograph method, followed by that for the replica method; the visual clinical examination method scored lowest. The mean Youden-index score for the survival of retained sealants was highest for the colour photograph method for both the traditional (0.882) and the modified (0.768) categories of sealant retention, whilst the visual clinical examination method had the lowest Youden-index score for these categories (0.745 and 0.063, respectively). The colour photograph method had a higher validity than the replica and the visual examination methods for assessing sealant retention.

Prevention. Part 8: The use of pit and fissure sealants in preventing caries in the permanent dentition of children

This paper reviews evidence concerning the use of pit and fissure sealants in preventing caries in the permanent dentition of children. While the evidence with respect to some sealant types and application techniques is incomplete, systematic reviews have clearly demonstrated that sealants are an effective preventive technology when used in high risk children, and that with proper application techniques long-term retention rates can be achieved. However, careful selection of patients and teeth for sealant placement is required to ensure cost-effectiveness.