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

––– Sealants: Prevention of Caries –––
Citation: Morgan MV, Adams GG, Campain AC, Wright FA. Assessing sealant retention using a Poisson frailty
model. Community Dent Health 2005; 22(4):237–45.
Population: School-based comprehensive preventive program
• Age (mean): 12.35 ± 0.64
• Sex: 48.6% male
• Location: 2 nonfluoridated regions of Victoria, Australia
• Representative of at-risk schoolchildren
Intervention: Annual application or reapplication of light-cured fissure sealants in 210 12-year-old subjects over
3 years:
• n = 1,544 sealants during the study period
• n = 1,038 (67.2%) first placements at baseline
• n = 506 (32.8%) repairs or reapplications, of which 206 (40.7%) at first-year follow-up and 300 (59.3%) at second-year
follow-up
Control: None
Outcomes: Sealant failure and caries experience for n = 1,038 first placements at baseline:
At first follow-up, n = 984 sealants available for review (54 sealants in 10 subjects were lost to follow-up):
• Intact: 582 (59.1%)
• Failed (partial or total loss): 402 (40.9%) (136 never replaced, 60 not replaced until the second year)
At second follow-up, n = 739 out of 788 sealants at risk (49 sealants in 22 subjects were lost to follow up):
• Intact: 449 (60.8%)
• Failed: 290 (39.2%) (replacement done)
At third follow-up: n = 735 out of 749 sealants at risk (4 sealants in 2 subjects were lost to follow-up):
• Failed: 128 (17.2%)
For total n = 1,544 sealant placements and replacements over 3 years:
• Loss to follow-up: 107 (6.9%)
• Failure: 820 (57.1%) at some stage in 3 years
At sites with no previous failure: 603 (73.4%)
At sites with 1 previous failure: 186 (22.7%)
At sites with 2 previous failures: 31 (3.8%)
Caries experience: 51 (6.2%) of all failures: 23 with active decay, 1 extracted, 27 restored
For subjects (baseline n = 210; third-year follow-up n = 176):
n = 166 (94.3%) with at least one sealant failure
Total of 820 sealant failures by the completion of the program, representing a sealant failure rate of 35%
Success rate at year 3: 575 intact sealants out of 1,038 sealed sites = 55.4%
Of 674 teeth that needed resealing, only 624 were resealed
Significant failure rate ratio (95% confidence interval) for factors associated with sealant failure:
• Baseline pit and fissure DMFS ≥ 4 vs. 0 = 1.27 (1.01–1.61)
• Year of placement 2 vs. 1 = 0.62 (0.44–0.87)
• Second vs. first molars = 1.32 (1.11–1.60)
• Lower vs. upper molars = 1.33 (1.14–1.57)
• Upper distal fossae vs. upper mesial fossae = 1.33 (1.21–1.47)
Adjustment for year of replacement and baseline pit and fissure DMFS:
• No significant interaction between molar and arch type when model was adjusted for
JCDA • www.cda-adc.ca/jcda • March 2008, Vol. 74, No. 2 • App_183xxi