Evaluation of pit-and-fissure sealants placed with four different bonding protocols: a randomized clinical trial

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.

Comparison of the Effect of Different Bonding Agents on the Microleakage of Two Hydrophilic Pit and Fissure Sealants: An Ex Vivo Study

Aim

To compare the impact of fifth- and seventh-generation bonding agents on the microleakage between Embrace WetBond sealants and Ionoseal.

Materials and methods

Forty extracted human premolar teeth were used for the study and grouped according to different sealants and bonding agents-group I: Embrace WetBond sealant with fifth-generation bonding agent; group II: Embrace WetBond sealant with seventh-generation bonding agent; group III: Ionoseal with fifth-generation bonding agent; group IV: Ionoseal with seventh-generation bonding agent. For microleakage evaluation, all the teeth were subjected to invasive sealant placement using the respective sealant materials in combination with bonding agents as specified. The treated teeth were stored at 37°C for 24 hours and then thermocycled for 100 cycles at temperatures of 5°C and 55°C with a dwell time of 30 seconds. In order to assess microleakage, the samples were immersed in 0.2% methylene blue dye for 24 hours, then sectioned in buccolingual direction, and evaluated under stereomicroscope.

Results

The mean microleakage scores in group III were highest at 0.90 ± 0.57, while the least was in group IV at 0.30 ± 0.68, indicating that Ionoseal with seventh-generation bonding agent was the most effective. However, when the mean microleakage scores of the four groups were compared using Kruskal-Wallis test, it indicated that the differences were not statistically significant.

How to cite this article

V R, P P, A A, et al. Comparison of the Effect of Different Bonding Agents on the Microleakage of Two Hydrophilic Pit and Fissure Sealants: An Ex Vivo Study. Int J Clin Pediatr Dent 2024;17(3):270-273.

Retention in fissure resin-based sealants in schoolchildren: the etching step importance

DESIGN

Randomized controlled trial.

STUDY POPULATION

Forty-seven schoolchildren aged 9-10 years with fully sound/noncavitated erupted first permanent molars were included and randomly allocated in control and experimental groups in a split-mouth design.

CASES

47 schoolchildren (94 molars) fissure sealants applied using self-etch universal adhesive system.

CONTROLS

47 schoolchildren (94 molars) fissure sealants applied using conventional acid-etching technique.

OUTCOME MEASURE

Retention of sealants and secondary caries incidence (ICDAS).

DATA ANALYSIS

Chi-square test.

RESULTS

Conventional acid-etch sealants retention was superior to self-etch after 6 and 24 months (p < 0.001), but no differences were found in caries incidence after 6 and 24 months (p > 0.05).

CONCLUSIONS

Clinical retention of fissure sealants using conventional acid-etch technique is greater than self-etch.

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.

Clinical Evaluation of the Retention of Self-adhering Flowable Composite as Fissure Sealant in 6&ndash;9-year-old Children: A Randomized Controlled Trial

Aim

To evaluate the retention rate of self-adhering flowable composite as fissure sealant in comparison with the unfilled resin sealant on first permanent molars of 6–9-year-old children.

Materials and methods

A 2-arm, split-mouth randomized controlled trial included 100 children of age 6–9 years with completely erupted mandibular first permanent molars. A total of 200 teeth were randomly divided into two groups, group I: self-adhering flowable composite; group II: unfilled resin sealant. Sealants were placed on the mandibular first permanent molars and the children were recalled at 6, 12, and 18 months intervals to evaluate the retention rate. Chi-square test was used to analyze the data.

Results

Self-adhering flowable composite has shown a complete retention rate of 67%, 47%, and 46% at 6, 12, and 18-month intervals, respectively, whereas unfilled resin sealant has shown 41%, 8%, and 5% retention rate at 6, 12, and 18-month intervals, respectively. The difference in the complete sealant retention rates between the groups is found to be statistically highly significant at all the follow-up intervals (p = 0.0004, 0.0001, and 0.0001 at 6, 12, and 18-month intervals, respectively). In both groups, maximum sealant loss occurred between 6 and 12-month intervals. Retention rates were higher at 6 months intervals which were significantly reduced over 18 months intervals.

Conclusion

Self-adhering flowable composite has shown a higher retention rate compared to unfilled resin sealant at all the time intervals. The retention rate of both materials decreased with time. However, the loss of sealant was more with unfilled resin sealant.

Clinical significance

In pediatric dental practice, the elimination of a step in restorative dentistry protocol makes a big difference as time is a critical factor in obtaining children's cooperation. The use of self-adhering materials eliminates the step of bonding agent application, which simplifies the restorative protocol and makes the clinical practice effective. Therefore, these self-adhering flowable composite resin materials can be considered fissure sealants in routine clinical practice.

How to cite this article

Bhuvaneswari P, Vinay C, Uloopi KS, et al. Clinical Evaluation of the Retention of Self-adhering Flowable Composite as Fissure Sealant in 6–9-year-old Children: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(3):322-326.

Comparative Assessment of Retention and Caries Protective Effectiveness of a Hydrophilic and a Conventional Sealant-A Clinical Trial

Sealants are highly efficient and the most secure method for the prevention of caries lesions from pits and fissures in recently erupted permanent teeth. The aim of this study is to clinically assess and compare the retention and evolution of caries of a moisture-tolerant resin-based sealant with a conventional hydrophobic resin-based sealant. Material and method: We have included in the study 28 children with between 6 and 8 years old. For each child we sealed 4 permanent molars (a total of 112 teeth). The study group was divided into two subgroups: the Embrace Group—consisting of 56 first permanent molars that underwent dental sealing with moisture-tolerant resin-based fissure sealant (Embrace™ WetBond™ Pulpdent, Watertown, MA, USA) and the Helioseal Group—represented by the same number of 56 first permanent molars that were sealed with conventional hydrophobic resin-based sealant (Helioseal F™, Ivoclar Vivadent Schaan, Liechtenstein). The retention and the incidence of new carious lesions of each sealant were assessed clinically at 6, 12, 18, and 24 months. Results: The 12-month follow-up assessment showed perfect integrity in 50 molars (89.28%) sealed with moisture-tolerant resin-based material (Embrace Group), and in 51 molars (91.07%) with conventional resin-based sealant (Helioseal Group). At the 24-month recall, the retention was maintained in 44 molars (78.57%) in the Embrace Group and in 45 molars (80.35%) in the Helioseal Group, respectively. The follow-up assessments showed no statistically significant differences (p > 0.5) between the two materials regarding sealant retention. First evidence of new carious lesions was present at 12 months on two molars sealed with Embrace WetBond and on one molar sealed with Helioseal. At the 24-month evaluation, the prevalence of caries in the Embrace Group was 7.14% (four caries) and 3.56% (two caries) in the Helioseal Group. Moreover, there were no statistically significant differences (p > 0.05) between the two materials regarding new caries development at any of the follow-up assessments. Conclusions: Moisture-tolerant resin-based sealant was effective in terms of retention and caries prevention.

Shear Bond Strength and Microleakage of Pit and Fissure Sealants Placed after Saliva-Contaminated Etched Enamel

Saliva contamination of etched enamel before sealant application is the most common reason for failure of fissure sealants, thus affecting the effect of caries prevention. This study aimed to evaluate the shear bond strength (SBS) and microleakage of resin-based fissure sealant on saliva-contaminated etched enamel after rinsing, re-etching, and applying universal adhesive. Fifty human third molars were sectioned into 2 parts and embedded in acrylic resin to obtained 100 samples. The samples were randomly assigned to 5 groups: 1, etching; 2, etching + contamination; 3, etching + contamination + rinsing; 4, etching + contamination+ re-etching; 5, etching + contamination + universal adhesive. Each group was divided into 2 subgroups: 24 h storage and 5000× thermocycling. After measuring SBS, failure mode was analyzed. In an additional 15 teeth, microleakage was tested using dye penetration method. Three more teeth were used for scanning electron microscope (SEM) observation of the enamel surface morphology in each group. The adhesive group had significantly higher mean SBS after 24 h storage, while the re-etching group were better after 5000× thermocycling. The etching, etching+ contamination+ re-etching, and etching+ contamination+ universal adhesive groups showed the least microleakage. The SEM reveals considerable variations in the enamel surface appearance within groups. Re-etching or applying universal adhesive in saliva-contaminated etched enamel before sealant can achieve satisfactory results. Considering the less operative steps and the shorter chair time, applying universal adhesive is more recommended for a pediatric patient if saliva-contamination happened before sealant application.

Comparative evaluation of different adhesive strategies of a universal adhesive in class II bulk-fill restorations: A 48-month randomized controlled trial

OBJECTIVES

To compare the clinical performance of the universal adhesive used in etch-and-rinse (ER) and self-etch (SE) adhesive strategies for 48-month in class II bulk-fill restorations.

METHODS

A total of 84 class II bulk-fill resin composite (Tetric EvoCeram Bulk Fill) restorations were placed in 35 participants by one operator using the universal adhesive's (Adhese Universal VivaPen) etch-and-rinse or self-etch mode randomly. The restorations were evaluated by two calibrated examiners at baseline and after 6-, 12-, 24-, 36- and 48-month using modified USPHS criteria. The comparison of the two adhesive strategies for each evaluation criteria was performed with the chi-square test. The baseline scores were compared with those at the recalls using the Friedman and Cochran's Q-test (p < .05).

RESULTS

At 48-month, 74 restorations were evaluated in 30 participants (recall rate: 85.7%). Marginal discoloration was statistically more frequent in SE approach (p < .05), whereas no significant difference was observed between the two strategies in terms of marginal adaptation (p > .05). There were statistically significant differences between the baseline and 48-month recall in the SE group in terms of marginal adaptation and discoloration (p < .05). In ER group, significant differences were found between baseline and 48-month only for marginal adaptation (p < .05). None of the restorations showed post-operative sensitivity. Secondary caries was observed in one restoration from SE group.

CONCLUSIONS

The tested bulk-fill restorative exhibited better clinical performance only in terms of marginal discoloration when the universal adhesive was used with ER strategy.

CLINICAL RELEVANCE

Though ER approach of the tested universal adhesive appears to be advantageous in terms of marginal discoloration, both adhesive strategies had similar impact on the clinical success of bulk-fill resin restorations.

Using self-etch adhesive agents with pit and fissure sealants. In vitro analysis of shear bond strength, adhesive remnant index and enamel etching patterns

Purpose

The aim of this study was to evaluate in vitro, the shear bond strength (SBS) and adhesive remnant index (ARI) of pit and fissure sealants (PFS) after enamel conditioning with different new-generation self-etching (SE) agents; additionally, enamel etching patterns were assessed.

Methods

Healthy unerupted third molars surgically removed for therapeutic reasons (n = 25p/g), were randomly assigned to six groups. Conventional etching (CE) or SE was applied prior to pit and fissure sealants bonding. Enamel conditioned surfaces were evaluated by SEM at × 500, × 1000, and × 2000 magnification to determine etching patterns. Subsequently, 25 PFS blocks (3 × 2 × 1.5 mm) p/g were bonded to enamel surface.

Samples were stored in water at 37 °C for 24 h, previous to SBS and ARI test. One-way ANOVA and Tamhane statistic tests were used for SBS; while Mann–Whitney U and Kruskal–Wallis were employed for ARI (p ≤ 0.05).

Results

For SBS test, CE_PFS_3M and SE1_PFS_Shofu groups showed the lowest values (8.74 ± 4.02 and 8.75 ± 3.90, respectively). The highest scores were observed in SE_PFS_Kuraray group (13.46 ± 5.83). Significant differences in SBS and ARI assessments were found. All experimental groups showed type 1 etching pattern.

Conclusion

The etching pattern was less pronounced in self-etching groups, which showed an equal or superior in vitro performance compared to conventional etching agents. The clinical use of self-etching agents could be recommended before pit and fissure sealants application in new dental protocols. The best in vitro performance was observed when both applied materials, self-etching agent and pit and fissure sealant have 10-methacryloyloxydecyl dihydrogen phosphate in their chemical composition.

Guidelines for reporting randomized controlled trials in paediatric dentistry based on the CONSORT statement

BACKGROUND

The significance of randomized controlled trials (RCT) depends on how thoroughly the results were reported. Reporting of RCTs should be accurate and transparent and encompasses design, implementation, analysis, and results of the trial. The Consolidated Standards of Reporting Trials (CONSORT) statement and its extension were developed to guide the researchers to report clinical trials in a systematic manner. Despite this recommendation, the overall reporting quality of RCTs still remains suboptimal.

AIM

To describe the relevance and importance of CONSORT reporting guidelines and explain the items using examples derived from randomized trials published in Paediatric Dentistry.

METHODS

This is a narrative review that illustrates the importance of reporting items in the CONSORT guidelines from relevant sources. RCTs published in the International Journal of Paediatric Dentistry between 2017 and 2020 were identified from PubMed and Scopus databases and through handsearching. An explanation has been provided for each of the 37 items in the 2010 CONSORT checklist and 17 items in the CONSORT extension for reporting abstracts.

CONCLUSION

This explanation and elaboration document would enable investigators to report trials in Paediatric Dentistry with accuracy and transparency as well as for reviewers and editors in evaluating the suitability of RCTs for publication.

The effect of the Er: YAG laser on the clinical success of hydrophilic fissure sealant: a randomized clinical trial

Purpose:

The aim of this study was to assess the effect of the Er:YAG laser on the clinical success of a hydrophilic fissure sealant over 12 months.

Subject and methods:

This study was conducted on 132 permanent first molars from 44 (19 girls and 25 boys) patients aged 7-11 years. The teeth were divided into three groups. The first group (Group A-control) of teeth were etched with phosphoric acid, the second group of teeth (Group L) were etched with an Er:YAG laser, and the third group of teeth (Group A+L) were etched with both the Er:YAG laser and phosphoric acid. Clinical evaluations were performed at baseline and at 3-, 6-, 9- and 12-month follow-up visits. The data were analyzed with Pearson chi-square tests, Cochran Q tests and Kaplan-Meier analysis.

Results:

At the end of the 12 months, total retention rates were 72.7%, 59.1%, and 65.9% in the acid group, the laser group and the laser and acid group, respectively. Although there was no statistically significant difference between group retention rates (p>0.05), the lowest retention rate was found in the laser group at the end of the 12-month follow-up period. No new caries were observed in any group during the study period.

Conclusion:

Etching with the Er:YAG laser, phosphoric acid or a combination of both methods provided similar results for the clinical success of hydrophilic based fissure sealant.

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.

Reporting stAndards for research in PedIatric Dentistry (RAPID): A development protocol

Reporting guidelines can improve the quality of reports of research findings. Some specialities in health care however require guidance on areas that are not captured within the existing guidelines, and this is the case for Paediatric Dentistry where no such standards are available to guide the reporting of different types of study designs. The 'Reporting stAndards for research in PedIatric Dentistry' (RAPID) group aims to address this need by developing guidelines on reporting elements of research of particular relevance to Paediatric Dentistry. The development of RAPID guidelines will involve a five-phase process including a Delphi study, which is an explicit consensus development method designed and implemented in accordance with the Guidance on Conducting and REporting DElphi Studies. The guideline development process will be overseen by an Executive Group. Themes specific to areas in Paediatric Dentistry will be selected, and items to be included under each theme will be identified by members of the Executive Group reviewing at least five reports of experimental and analytical study types using existing reporting guidelines. For the Delphi study, the Executive Group will identify an international multidisciplinary RAPID Delphi Group (RDG) of approximately 60 participants including academics, Paediatric Dentists, parents, and other stakeholders. Each item will be evaluated by RDG on clarity using a dichotomous scale ('well phrased' or 'needs revision') and on suitability for inclusion in the Delphi study using a 9-point Likert scale (1 = 'definitely not include' to 9 = 'definitely include'). The items will then be included in an online Delphi study of up to four rounds, with participants invited from stakeholder groups across Paediatric Dentistry. Items scored 7 or above by at least 80% of respondents will be included in the checklist and further discussed in a face-to-face Delphi consensus meeting. Following this, the Executive Group will finalize the RAPID guidelines. The guidelines will be published in peer-reviewed scientific journals and disseminated at scientific meetings and conferences. All the outputs from this project will be made freely available on the RAPID website: www.rapid-statement.org.

Multi-Mode adhesives performance and success/retention rates in NCCLs restorations: randomised clinical trial one-year report

Aim: Compare clinical performance and success/retention rates of two multi-mode (MM) adhesives, applied in self-etch (SE) or etch-and-rinse (ER) modes, with SE-all-in-one adhesive (SE/SE with enamel etching) in NCCL restorations at one-year follow-up.

Material and methods: Prospective, double-blind RCT approved by the University Fernando Pessoa and the National-Clinical-Research-Ethics Committees (CEIC-20150305), ClinicalTrials.gov registered (NCT02698371), in 38 participants with 210 restorations (AdmiraFusion^®) randomly allocated to six groups (Adhesives_Adhesion mode), each with 35 restorations: G1-Control Futurabond^®DC_SE; G2-Control Futurabond^®DC_SE with enamel etching; G3-Futurabond^®U_ER; G4-Futurabond^®U_SE; G5-Adhese^®Universal_ER; G6-Adhese^®Universal_SE. Restorations evaluated at baseline and one-year by three calibrated examiners (ICC ≥0.952) using FDI criteria and statistical analysis with nonparametric tests (alpha = 0.05).

Results: At one-year recall 36 participants, 199 restorations were available for examination; five (2.5%) restorations (G1 n = 2; G2, G3, G4 n = 1) were lost due to retention (p > .05); G1 showed less satisfying marginal adaptation (p < .05) than G2 and MM adhesives groups, particularly G6. Overall success rates (p > .05) were: 93.9% (G1), 97.0% (G2; G3; G4) and 100.0% (G5; G6).

Conclusions: MM adhesives (Futurabond^®U and Adhese^®Universal) showed similar and acceptable performance/success rates but also better clinical outputs than the SE-all-in-one adhesive (Futurabond^®DC), particularly in SE mode. Success and retention rates were similar and not dependent on materials or adhesion modes.

Dental hypomineralization treatment: A systematic review

INTRODUCTION

Defects in the maturation stage of amelogenesis result in a normal volume of enamel but insufficient mineralization, called hypomineralization. Molar-incisor hypomineralization (MIH), amelogenesis imperfecta and dental fluorosis (DF) are examples of such defects.

OBJECTIVE

To evaluate the effectiveness of the treatments applied to the different forms of dental hypomineralization.

MATERIALS AND METHODS

PubMed, Scopus, Cochrane Library, Web of Science, and Embase were screened. The research was limited to studies published in English, Spanish, and Portuguese, until May 30, 2018. The research question was formulated following the Population, Intervention, Comparison, Outcome strategy. The quality of the methodology of each article was evaluated employing the Cochrane Handbook for Systematic Reviews.

RESULTS

From the initial research, 7895 references were obtained, of which 33 were included in the systematic review. The following treatments were reported: desensitizing and remineralizing products, resin infiltration, restorations, fissure sealants, tooth bleaching, enamel microabrasion and calcium, and vitamins supplements.

CONCLUSIONS

Although the results are suggestive, there is a clear need for a greater uniformity of the methodologies, thus allowing for the development of clinical guidelines. Nevertheless, it was possible to identify several effective treatments for teeth with MIH (arginine pastes or fluoride varnishes) and DF (tooth bleaching and/or enamel microabrasion).

CLINICAL SIGNIFICANCE

Because MIH, amelogenesis imperfecta, and DF are commonly seen in dental daily practice, it is extremely important to analyze the literature regarding its treatment.

Clinpro ™ XT Sealant Adhesion to the Occlusal Surface of Primary Molars: Longitudinal Evaluation

AbstractThe study aims to evaluate the bond strength of sealants on deciduous molars. Clinpro ™ XT, Vitremer ™, Fluroshield and Optibond FL materials were applied to the occlusal surface of 40 deciduous lower molars (n = 5). The teeth were prepared for the micro tensile test, obtaining a specimen in a stick format with a cross-sectional area of 0.8 mm2. After 24 hours and 6 months of restorative procedures, the specimens were traversed in universal test machine. The statistical analysis used the tooth as experimental unit, considering the adhesive and mixed fractures data, through Variance Analysis of repeated measures and Tukey tests (α = 0.05). There was a difference among the adhesion of the materials in 24 h, with higher union strength for Optibond FL (31.20 ± 1.36 MPa), significantly higher than that of Clinpro ™ XT (20.23 ± 1.16 MPa), Fluroshield (24.61 ± 2.76 MPa) and Vitremer™ (21.31 ± 2.32 MPa), which were similar. After 6 months of storage, the Clinpro ™ XT bond strength remained (22.18 ± 2.91 MPa), Optibond FL decreased (20.77 ± 1.53 MPa), but remained similar to that of Clinpro ™ XT in 6 months. The lowest adhesion values at 6 months were of Fluroshield (11.14 ± 1.98 Mpa) and Vitremer (5.29 ± 0.58 Mpa). It was concluded that the bond strength of the sealants to the occlusal surface of the deciduous molars was influenced by the material, with Clinpro ™ XT being the only material that maintained the bond strength values after 6 months.Keywords: Pit and Fissure Sealants. Tensile Strength. Tooth, Deciduous.ResumoO presente estudo teve como objetivo avaliar a adesão de selantes em molares decíduos. Os materiais Clinpro™ XT, VitremerTM, Fluroshield e Optibond FL foram aplicados na superfície oclusal de 40 molares inferiores decíduos (n=5). Os dentes foram preparados para o ensaio de microtração, com obtenção de corpo-de-prova em formato de palito com área de seção transversal de 0,8 mm2. Após 24 horas e 6 meses da realização dos procedimentos restauradores, os espécimes foram tracionados em máquina de ensaio universal. A análise estatística usou como unidade experimental o dente, considerando os dados de fraturas adesivas e mistas, pelos testes de Análise de Variância de medidas repetidas e Tukey (α=0,05). Houve diferença entre a adesão dos materiais em 24 h, com maior resistência de união para o Optibond FL (31,20 ±1,36 MPa), significativamente maior que a do Clinpro™ XT (20,23 ±1,16 MPa); Fluroshield (24,61 ±2,76 MPa) e VitremerTM (21,31 ±2,32 MPa) foram semelhantes. Decorridos 6 meses de armazenamento, a resistência de união do Clinpro™ XT se manteve (22,18 ±2,91 MPa) e a do Optibond FL diminuiu (20,77 ±1,53 MPa) mas se manteve semelhante à do Clinpro™ XT em 6 meses. Os menores valores de adesão em 6 meses foram do Fluroshield (11,14 ±1,98 Mpa) e do Vitremer (5,29 ±0,58 Mpa). Concluiu-se que a resistência de união dos selantes à superfície oclusal dos molares decíduos foi influenciada pelo material, sendo o Clinpro™ XT o único material que manteve os valores de resistência de união após 6 meses.Palavras-chave: Selantes de Fossas e Fissuras. Resistência à Tração. Dente decíduo.

Pit and Fissure Sealants-A Comprehensive Review

Even in the 21st century, dental caries is considered a global burden, severely upsetting the health and quality of life of those affected. Apart from the usage of fluoride and regular oral hygiene, one of the most important prophylactic approaches against the occurrence of caries is the sealing of pits and fissures. However, the rapid progress of new materials and applications for sealing pits and fissures also raises new questions about their correct application. Recent literature on pit and fissure sealing, caries prevention, as well as caries risk assessment for both children and adults was reviewed. This report provides a general overview of pit and fissure sealing, the materials used for sealing occlusal surfaces, as well as indications and possible side effects. The conclusions are that sealing pit and fissures of primary and permanent teeth is an effective method for preventing and arresting caries. However, regular checkups must be conducted to avoid advanced tooth decay attributable to leakages in the sealing.

Sealing effectiveness of fissure sealant bonded with universal adhesive systems on saliva-contaminated and noncontaminated enamel

Background

The effectiveness of sealants is dependent upon their adhesion to enamel surface. The aim of the study was to evaluate the sealing ability of a pit and fissure sealant used with a universal adhesive (etch-and-rinse vs. self-etch modes) when the site is contaminated with saliva. Adhesive properties were evaluated as microleakage and scanning electron microscopic (SEM) characteristics.

Material and Methods

A total of 72 mandibular third molars were randomly divided into 6 groups (n=12). Occlusal pits and fissures were sealed with an unfilled resin fissure sealant (FS) material with or without saliva contamination. The groups included: 1) phosphoric acid etching + FS (control), 2) phosphoric acid etching + Scotchbond Universal (etch-and-rinse) + FS, 3) phosphoric acid etching + saliva + Scotchbond Universal (etch-and-rinse) + FS, 4) Scotchbond Universal (self-etching) + FS,5) Scotchbond Universal (self-etching) + saliva + FS, and 6) Scotchbond Universal (self-etching) + saliva + Scotchbond Universal + FS. After thermocycling, the teeth were placed in 0.5% fuchsin, sectioned, and evaluated by digital microscopy. Two samples from each group were also observed by SEM. The data were analyzed with Kruskal-Wallis and Mann-Whitney tests for a significance of p<0.05.

Results

There were significant differences among groups. Groups 1,2 and 4 showed the least microleakage, with no significant differences among groups. Saliva contamination led to increased microleakage and gap formation in SEM images in groups 3, 5 and 6.

Conclusions

The fissure sealing ability of the universal adhesive in etch-and-rinse or self-etch modes was similar to that of conventional acid etching. Saliva contamination had a negative effect on sealant adhesion to pretreated enamel. Key words:Pit and fissure sealant, Universal adhesive, Saliva.

Clinical Follow-up of a Fissure Sealant Placed Using Different Adhesive Protocols: A 24-month Split-mouth Study

The purpose of this study was to evaluate the retention rates of a fissure sealant placed using different adhesive protocols over 24 months. Twenty-four subjects with no restorations or caries received fissure sealants (Clinpro Sealant, 3M ESPE) placed using different adhesive protocols. A total of 292 sealants were placed as follows by two previously calibrated dentists using a table of random numbers (n=73): group I, acid-etch/without adhesive; group II, with a self-etch adhesive (Adper Easy Bond, 3M ESPE); group III, with an etch-and-rinse adhesive (Adper Single Bond 2, 3M ESPE); group IV, with acid + self-etch adhesive (Adper Easy Bond). Two other calibrated examiners independently evaluated the sealants at baseline and at six-, 12-, 18-, and 24-month recalls. Each sealant was evaluated in terms of caries formation being present or absent and retention using the following criteria: 1 = total retention, 2 = partial loss, and 3 = total loss. Pearson's χ² test was used to evaluate differences in retention rates among the sealants for each evaluation period. At the end of 24 months, total retention rates were 57.5%, 27.4%, 84.9%, and 76.7% in the acid-etch, self-etch adhesive, etch-and-rinse adhesive, and acid + self-etch adhesive groups, respectively. Although there were no statistically significant differences between the retention rates among the adhesive protocols at 6 months ( p=0.684), significant differences were observed at the 12-, 18-, and 24-month evaluations. At 24 months, the lowest retention rates were observed in the self-etch group ( p<0.05). No caries development was observed in any of the groups. The retention rate of sealants placed using self-etch adhesive was poor compared with the other groups.

The Use of Pit and Fissure Sealants-A Literature Review

This paper reviews the literature and discusses the latest updates on the use of pit and fissure sealants. It demonstrates the effectiveness of pit and fissure sealants in preventing caries and the management of early carious lesions. It compares the use of different sealant materials and their indications. It describes the application technique for sealants. It also reviews the cost-effectiveness of sealants as a preventive strategy. From this review and after the discussion of recently published studies on pit and fissure sealants, it is evident that sealants are effective in caries prevention and in preventing the progression of incipient lesions. It is therefore recommended that pit and fissure sealant be applied to high-caries-risk children for optimum cost-effectiveness. It is a highly sensitive technique that needs optimum isolation, cleaning of the tooth surface, etching, and the application of a thin bonding layer for maximum benefit. Recall and repair, when needed, are important to maximize the effectiveness of such sealant use.

Resin infiltration of deproteinised natural occlusal subsurface lesions improves initial quality of fissure sealing

The aim of this ex vivo study was to evaluate the infiltration capability and rate of microleakage of a low-viscous resin infiltrant combined with a flowable composite resin (RI/CR) when used with deproteinised and etched occlusal subsurface lesions (International Caries Detection and Assessment System code 2). This combined treatment procedure was compared with the exclusive use of flowable composite resin (CR) for fissure sealing. Twenty premolars and 20 molars revealing non-cavitated occlusal carious lesions were randomly divided into two groups and were meticulously cleaned and deproteinised using NaOCl (2%). After etching with HCl (15%), 10 premolar and 10 molar lesions were infiltrated (Icon/DMG; rhodamine B isothiocyanate (RITC)-labelled) followed by fissure sealing (G-ænial Flo/GC; experimental group, RI/CR). In the control group (CR), the carious fissures were only sealed. Specimens were cut perpendicular to the occlusal surface and through the area of the highest demineralisation (DIAGNOdent pen, KaVo). Using confocal laser-scanning microscopy, the specimens were assessed with regard to the percentage of caries infiltration, marginal adaption and internal integrity. Within the CR group, the carious lesions were not infiltrated. Both premolar (57.9%±23.1%) and molar lesions (35.3%±22.1%) of the RI/CR group were uniformly infiltrated to a substantial extent, albeit with significant differences (P=0.034). Moreover, microleakage (n=1) and the occurrence of voids (n=2) were reduced in the RI/CR group compared with the CR group (5 and 17 specimens, respectively). The RI/CR approach increases the initial quality of fissure sealing and is recommended for the clinical control of occlusal caries.