Comparison of Fissure Sealant Chair Time and Patients' Preference Using Three Different Isolation Techniques

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.

Evaluation of fissure sealant retention rates using Isolite in comparison with rubber dam and cotton roll isolation techniques: A randomized clinical trial

BACKGROUND

Clinical studies comparing retention rates of pit and fissure sealants placed under Isolite, rubber dam, and cotton roll combined have not been conducted until now.

AIM

To evaluate the retention rate of pit and fissure sealants (PFS) placed under three different isolation techniques (Isolite system [IS], rubber dam isolation [RDI], and cotton roll isolation [CRI]).

DESIGN

One hundred and forty-four teeth from 48 children aged 6-15 years attending paediatric dental clinics at King Saud University in Saudi Arabia were randomized to receive three PFS using three isolation techniques. The children that met the inclusion criteria were randomized by a simple block random allocation method. All PFS were placed by an operator and evaluated by a blinded evaluator. The evaluation scores were recorded at baseline and followed up over a period of 12-22 months.

RESULTS

The children's mean age was 8.58 ± 1.93 years. Seven patients were lost to follow-up. A total of 123 teeth were clinically evaluated; of these teeth, 22% had completely retained sealants, whereas approximately 66% had a partial loss of sealants, and approximately 12% had a complete loss of sealants. There were, however, no significant differences between the three isolation techniques on the retention rate of pit and fissure sealant.

CONCLUSION

The types of isolation had no impact on the retention rate of pit and fissure sealant.

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.