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

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––– 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
––– Azarpazhooh ––– • Significant interaction between molar and sealant placement site (distal vs. mesial fossae) in the upper molars Authors’ Conclusion: Sealants placed on second molars, those placed on lower molars and those placed on the distal fissure sites have a higher failure rate. As individual tooth sites in the mouth are not independent, any statistical analysis should allow for these associations when sealant retention is assessed. Critical Appraisal: • Not a strong design to evaluate efficacy • No randomization • No blinding • Not clear if the groups were similar at baseline • No mention of control over private dental care Level of Evidence, Grade of Recommendation and Score on “Checklist to Assess Evidence of Efficacy of Therapy or Prevention”: Level II-1; grade D for sealing teeth (because of the high loss rate); score 10/16 App_183xxii JCDA • www.cda-adc.ca/jcda • March 2008, Vol. 74, No. 2 •
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