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

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––– Sealants: Prevention of Caries ––– Citation: Pardi V, Pereira AC, Mialhe FL, Meneghim Mde C, Ambrosano GM. A 5-year evaluation of two glassionomer cements used as fissure sealants. Community Dent Oral Epidemiol 2003; 31(5):386–91. Population: Children 6–8 years of age with 4 permanent first molars, no previous filling or clinical evidence of caries, who had lived in Piracicaba (0.7 ppm fluoride [F]), São Paulo, Brazil, since the age of 2 years, selected from a dental assistance program at the University of Campinas in Piracicaba, São Paulo, Brazil • Age and sex: 6–8 years at start of study; at 5-year follow-up experimental group had 43% boys and 57% girls with mean age of 10 years and 11 months, and the control group had 56% boys and 44% girls with mean age of 11 years and 11 months • Location: Department of community dentistry, School of Dentistry, University of Campinas, Piracicaba, São Paulo, Brazil • Representative of healthy young children in a dental assistance program and resident continuously since 2 years of age in a community with stable fluoridation Intervention: 100 children with a total of 400 permanent first molars • Material A: resin-modified glass ionomer cement (RMGI, Vitremer 3M ESPE, St. Paul, Minn.) • Material B: conventional glass ionomer cement (Ketac-Bond 3M ESPE) Every child received both materials as sealants, according to standardized procedures whereby right-side molars were sealed with material A and left-side molars were sealed with material B. Control: 108 children with a total of 432 permanent first molars, who received no sealant and reinforcement of brushing technique Outcomes: Definitions of sealant retention: • Total retention (TR) = total retention of sealant on the occlusal surface • Partial retention type 1 (PR1) = presence of sealant in two-thirds of the pit extension, with small fractures and losses of material • Partial retention type 2 (PR2) = presence of sealant in one-third of the pit extension with fractures and losses of material • Total loss (TL) = absence of sealant on the occlusal surface of the teeth Caries incidence: • No visible caries and noncavitated lesions • Presence of microcavity (diameter ≤ 1.5 mm across fissure) and large cavities • Filled teeth Total retention rates at 3, 4 and 5 years of follow-up were 24.1%, 12.8% and 1.6%, respectively, for material A; 3.5%, 4.1% and 1.6%, respectively, for material B; difference was significant (p < 0.01) in all evaluations for TR, PR1, PR2 and TL. After 2, 3 and 5 years for carious + filled teeth (statistically higher in control than experimental groups): • Experimental group: 12.0%, 13.6% and 21.5% (2.0% were carious and 19.5% were filled), respectively • Control group: 23.7%, 31.2% and 34.2% (9.5% were carious and 24.7% were filled), respectively Authors’ Conclusion: Sealing pits and fissures with glass ionomer cements was effective in preventing caries. Critical Appraisal: • No blinding of examiners • No randomization • Unclear whether the groups were similar at baseline • Care outside study was not identified or controlled for • No control for possible confounders: number of brushing session, diet, etc. • Half-mouth model but no crossover, so the same material was always on right teeth, which get less oral health care Level of Evidence, Grade of Recommendation and Score on “Checklist to Assess Evidence of Efficacy of Therapy or Prevention”: Level II-1; grade A for sealing teeth; score 10/16 JCDA • www.cda-adc.ca/jcda • March 2008, Vol. 74, No. 2 • App_183xxiii
––– Azarpazhooh ––– Appendix 2 Efficacy of pit and fissure sealants for primary teeth: included studies Citation: Corona SA, Borsatto MC, Garcia L, Ramos RP, Palma-Dibb RG. Randomized, controlled trial comparing the retention of a flowable restorative system with a conventional sealant: one-year follow up. Int J Paediatr Dent 2005; 15(1):44–50. Population: 40 children with 160 sound, caries-free, fully erupted first or second primary molars and first permanent molars with deep and retentive pits and fissures • Age: 4 and 7 years • Sex: Not mentioned • Location: Public Health Service in Marília (São Paulo State, São Paulo, Brazil) • Representative of preschool children seeking routine dental care in the public sector Intervention: Split-mouth design For both primary and permanent dentition, half of the teeth on one side of the mouth (n = 40 in each group) were sealed with flowable restorative system (Bond 1 + Flow-It!) Control: For both primary and permanent dentitions, half the teeth on the contralateral side (n = 40 in each group) were sealed with conventional filled resin sealant (Fluroshield) Outcomes (6- and 12-month follow-up): Retention rate: • Total loss at 1-year follow-up: 0 for both materials, both dentitions • Higher retention rate for Flow-It! sealants at both 6-month and 1-year evaluations (significant difference for primary teeth, trend for permanent teeth Primary teeth, Flow-It! vs. Fluroshield: Total retention (significant difference): • At 6 months: 97.5% vs. 82.5% • At 12 months: 95% vs. 77.5% Partial retention (significant difference): • At 6 months: 2.5% vs. 17.5% • At 12 months: 5% vs. 22.5% Permanent teeth, Flow-It! vs. Fluroshield: Total retention (nonsignificant difference): • At 6 months: 100% for both materials • At 12 months: 100% vs. 95% Partial retention (significant difference): • At 6 months: 0 for both materials • At 12 months: 0 vs. 5% Statistically significant difference between baseline and other evaluation periods when the sealant results were combined. Authors’ Conclusion: Flowable restorative system yielded optimal retention for both primary and permanent molars. Its retention rate was significantly higher than that of the conventional pit-and-fissure sealant on primary teeth. Critical Appraisal: • Blinding of examiner unclear • Insufficient study duration • No result on caries-preventive effect of the materials Level of Evidence, Grade of Recommendation and Score on “Checklist to Assess Evidence of Efficacy of Therapy or Prevention”: Level I; grade A for sealing primary teeth with Bond 1 + Flow-It! and for preventing caries, grade A for retention rate of both materials when sealing permanent teeth; score 13/16 App_183xxiv JCDA • www.cda-adc.ca/jcda • March 2008, Vol. 74, No. 2 •
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