Pit and Fissure Sealants in the Prevention of Dental Caries in ...

––– Azarpazhooh –––
Citation: Hamilton JC, Dennison JB, Stoffers KW, Welch KB. A clinical evaluation of air-abrasion treatment of questionable
carious lesions. A 12-month report. J Am Dent Assoc 2001; 132(6):762–9.
Population: 93 dental patients in a projected 5-year randomized clinical trial, with a total of 223 teeth, each with a
questionable incipient pit-and-fissure carious lesion but no frank caries (softness at the base of a pit or fissure, decalcification
or cavitation) or evidence of radiographic caries
• Age: 12–36 years (mean 23 years at baseline)
• Sex: Not mentioned
• Location: General dentistry clinics at University of Michigan School of Dentistry
• Representative of dental school patients with lower socioeconomic status
Intervention: n = 113 teeth, air abrasion and restoration with a flowable resin-based composite
Control: n = 110 teeth, observation but no treatment until definition of caries was met
Outcomes: Recall every 6 months (no results provided for 6-month follow-up)
Test group (at baseline: n = 63 treated with sealant, n = 50 caries extending into dentin) at 12-month follow-up:
• 3 sealants (4%) with partial loss
• Retreatment of restoration: 2 teeth (4%)
Control group at 12-month follow-up (n = 86):
• Caries progression: 9 (11%, 95% confidence interval 4–18%) teeth were diagnosed with pit-and-fissure caries and
were treated with air abrasion and restored with flowable resin-based composite.
• No statistically significant difference between volume of treatment and control preparations (weight of treatment
preparation impression as a surrogate measure of volume: 0.027 g in test group vs. 0.020 g in control group;
p = 0.279)
• Control group had significantly fewer carious lesions diagnosed than were determined by operating on the treatment
group
Logistic regression (controlling for sex; age; fluoride history; tooth type; decayed, missing or filled surfaces; score on
the Löe and Silness Gingival Health Index; score on the Simplified Oral Hygiene Index; pit and fissure colour; explorer
retention of the pits and fissures):
Caries penetrating into dentin:
• Positively correlated with explorer retention (p = 0.006)
• Negatively correlated with age (p = 0.0313)
Authors’ Conclusion: The merit of treating questionable incipient pit-and-fissure carious lesions early with air abrasion
was not demonstrated after 12 months in this clinical study.
Critical Appraisal:
• Study duration was short (12-month report)
• Care outside study was not identified or controlled for
Level of Evidence, Grade of Recommendation and Score on “Checklist to Assess Evidence of Efficacy of Therapy or
Prevention”: Level I; grade E for treating questionable incipient pit-and-fissure carious lesions early with air abrasion;
score 10.5/16
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JCDA • www.cda-adc.ca/jcda • March 2008, Vol. 74, No. 2 •