Improved sealant retention with bonding agents: a clinical study of two-bottle and single-bottle systems

Comparative Evaluation of Sonic Vibration and Heat Preheating Techniques on the Retention and Efficacy of Flowable Composite Resin Sealants: A Quasi-experimental Study

INTRODUCTION

Pit and fissure sealants are crucial in reducing the incidence of dental caries, particularly in the pediatric population. Despite their effectiveness, achieving optimal retention remains a challenge because of the complexity of the tooth morphology. This study evaluated the impact of two viscosity-reducing methods (heat energy and sonic vibration) on flowability, adaptability, and long-term retention of flowable composite resin sealants.

MATERIALS AND METHODS

This quasi-experimental split-mouth study included 72 systemically healthy children aged 6-10 years. Teeth with shallow, wide fissures were allocated to the heat preheating group, whereas those with deep, narrow fissures were assigned to the sonic vibration group. The heat group utilized a composite resin heated to 50°C using an Endoking dental resin composite heater (Sigma Biomedicals, Telangana, India; power supply: DC 15 V, 2 A, 30 W), whereas the sonic group utilized a modified electric toothbrush (MI Xiaomi, MI electric toothbrush T100, Xiaomi Corp., Beijing, China) for sonic vibrations. The sealants were subjected to standardized etching, bonding, and photopolymerization protocols. Clinical evaluations were systematically performed at intervals of one, three, six, nine, and 12 months to evaluate the marginal integrity (MI), marginal discoloration (MD), and anatomical form (AF). Quantitative analysis was executed using the IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York), with the threshold for statistical significance set at p<0.05.

RESULTS

The investigation revealed 100% MI in both cohorts at one- and three-month intervals. At the six-month interval, the incidence of MI decreased in 69 (95.8%) cases in the sonic cohort and 61 (84.7%) in the heat cohort (p=0.024). Throughout the 12-month period, the sonic cohort consistently exhibited superior performance compared to the heat cohort in the preservation of MI and reduction in MD (p=0.020). While both cohorts demonstrated similar levels of AF of pit and fissure sealants at most time points, the sonic cohort displayed enhanced retention and a lower incidence of sealant loss.

CONCLUSION

Both the heat and sonic vibration methods effectively reduced the viscosity of sealants, improving their retention and adaptation. However, sonic vibrations demonstrated superior long-term performance, particularly for deep and narrow fissures.

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.

Evaluation of Embrace WetBond and Helioseal-F sealant retention with and without a Self-etch adhesive: A 12 month follow-up

BACKGROUND

Pit and fissures on the young permanent tooth are ideal in harbouring dental plaque and calculus. Hence it is important to provide a preventive agent to protect against dental caries. Aim: To evaluate the retention of two different pit and fissure sealants with and without a self-etch adhesive in the first permanent molars for a period of one year.

MATERIAL AND METHODS

280 molars were included among 70 healthy children. According to randomisation, the groups were divided into Group IA - Embrace without Adhse One F bonding agent and Group IB - Embrace with Adhse One F bonding agent, Group IIA - Helioseal F without Adhse One F bonding agent and Group IIB - Helioseal F with Adhse One F bonding agent. The sealants were assessed clinically at 3,6,9, and 12 months using the modified Colour, Coverage, Caries (CCC) sealant evaluation system.

RESULTS

At the end of 12 months, the retention rates of Group IB showed statistically significant results, followed by Group IIB, Group IA and Group IIA.

CONCLUSIONS

At twelve months follow-up Embrase WetBond and Helioseal-F were better retentive when used with a Adhese One F bonding agent which was statistically significant. Key words:Retention, Bonding agent, Embrace WetBond, Helioseal-F.

Using bonding agent prior to pits and fissure sealant application enhances the microtensile bond strength and the interface morphology

Background

A pits and fissures sealant is an effective method for preventing dental caries. Using a bonding agent before applying the sealant may increase its retention. This study aimed to compare the microtensile strength (µTBS) of a fissure sealant with and without a bonding agent and to characterize the enamel-sealant interface using confocal laser scanning microscopy (CLSM). The null hypothesis was that the use of a bonding agent before fissure sealant application would not change the microtensile strength or the enamel-sealant interface.

Materials and methods

Twenty caries-free premolars were used. Each tooth was divided into four parts. The first two parts were assigned to the bonded group, where a bonding system was used before sealant application. The remaining two parts were treated only with a fissure sealant (i.e., the nonbonded group). In each group, the µTBS was examined after 24 h (n = 20) and after a 3-month aging period (n = 20). Five other caries-free extracted premolars were used to assess the enamel-sealant interface using CLSM. Two-way analysis of variance (ANOVA) and Pearson chi-square statistical analysis tests were used to analyze the µTBS and the enamel-sealant interface, respectively.

Results

The mean µTBS for the bonded group was significantly higher (p = 0.001) in the immediate group (36.87 ± 14.95 MPa) and the aged group (31.08 ± 15.88 MPa) than in the respective nonbonded groups (19.77 ± 9.67 MPa and 19.52 ± 14.14 MPa). The µTBS was not significantly different in either group after aging (p = 0.46 [bonded group] and p = 0.98 [nonbonded group]). In addition, using a dental adhesive, before applying a fissure sealant resulted in a significantly higher (53%) resin penetration into the enamel with the continuous integrity of the resin.

Conclusion

The use of a bonding agent before the application of fissure sealant resulted in superior microtensile bond strength immediately and after aging. In addition, the enamel-sealant interface characteristics were improved.

Comparison of successful outcome of pit and fissure sealants bonded with etch-and-rinse adhesive and self-etch adhesive system

BACKGROUND

Dental caries is one of the most common diseases around the world. The newly erupted permanent posterior teeth are at great risk due to the complex occlusal morphology of pits and fissures, infraocclusion and incomplete maturation of enamel. Pit and fissure sealants are the treatment of choice in such conditions.

OBJECTIVES

To compare the successful outcome of pit and fissure sealants bonded with etch-and-rinse adhesive system and self-etch adhesive systems in newly erupted permanent first molars.

METHODS

This randomized clinical trial was conducted at the Fatimah Jinnah Dental Hospital from June 2017 to May 2019. Children aged between 6 to 9 years who fulfilled the inclusion criteria were recruited for this study after parents' consent. Patients were randomly divided into two groups by the lottery method. Thirty patients with 60 first molar teeth in Group A were treated with etch-and-rinse adhesive system, while the other thirty patients with 60 first molar teeth in Group B were treated with self-etch adhesive system. After adhesive placement, all children received the same fissure sealants in newly erupted maxillary and mandibular permanent first molar. Each group was clinically evaluated at 6 and 12 months follow-up visit. Modified United States Public Health Service (USPHS) criteria were used for direct clinical evaluation of successful outcomes such as sealant retention and marginal discoloration.

RESULTS

Successful outcome was statistically significant in Group B compared to Group A (60% vs. 30% p= 0.020) at 12 months follow-up. Stratification analysis was performed with respect to age in which a successful outcome was not significant (p= 0.43) between groups for 6 to 7 years of age, while it was significant (p= 0.012) between groups in 8 to 9 years of age children.

CONCLUSION

Self-etch adhesive system is better than etch-and-rinse adhesive system in terms of long-term sealant retention. In addition, the bonding procedure is simple with relatively short clinical application time therefore it would offer great benefit to clinicians in treating pediatric patients.

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

This randomized clinical trial aimed to evaluate the patient’s preference and chair time needed during pit and fissure sealant placement under three isolation techniques (Isolite system, rubber dam isolation, and cotton roll isolation). Participants, aged 6–15 years and requiring four sealants on the first or second permanent molars, attending the pediatric dental clinics at King Saud University in Saudi Arabia were enrolled according to the inclusion criteria. Each participant received sealants on three random first or second permanent molars using three isolation techniques. The time required for sealant placement was recorded for each technique. Following sealant placement, an interview-based questionnaire was administered to the participants to evaluate their preference regarding the isolation techniques. Forty-eight children (23 male and 25 female) with a mean age of 8.58 ± 1.93 years participated in this study. The mean chair times were 248.14, 255.89, and 243.29 s for the Isolite system, rubber dam isolation, and cotton roll isolation, respectively. Approximately 79% of participants considered cotton roll isolation to be the most comfortable, whereas approximately 71% were significantly less likely to use rubber dam isolation again. In conclusion, there were no significant differences in sealant placement time among the three isolation techniques. However, cotton roll isolation was the technique that was most preferred by the participants.

Laser Tooth Preparation for Pit and Fissure Sealing

Objectives: Various approaches are available for pit and fissure sealing, including: the use of sealants, with or without mechanical preparation; the use of etching, with or without bonding; and the use of lasers as an alternative to mechanical preparation. The objective of this study is to evaluate pit and fissure sealing by comparing the retention and microleakage of sealants, between mechanical and Er:Yag laser enamel preparation. Methods: Sixty extracted sound third molars are classified into six groups: A, bur mechanical preparation and sealant application; B, bur mechanical preparation, etching and sealant; C, bur mechanical preparation, etching, bonding and sealant; D, laser mechanical preparation and sealant; E, laser mechanical preparation, etching and sealant application; F, laser mechanical preparation, etching, bonding, and sealant. Statistical analysis methods include Fisher’s exact test, a general linear model for one-way analysis of variance (ANOVA) of multiple comparisons, and Bonferroni multiple comparison tests. Results: All the groups showed dye microleakage beneath the sealants. Less microleakage was observed for those that used bur rather than laser, 41 versus 44 specimens, respectively. The number of specimens without microleakage decreased as follows: group E (24), group A (18), groups B and F (17), group C (14), and group D (5). Retention was 100% in all groups except group D. Conclusion: Mechanical preparation increases retention of sealants, especially when etching material is used; additionally, bonding can help the retention. The best technique is mechanical preparation via laser and subsequent use of etching, without bonding prior to application of the dental sealant.

Effect of Precuring and Postcuring of Total-Etch and Self-Etch Bonding Agents on the Microleakage of Fissure Sealants

Objectives:

Considering the importance of timesaving in pediatric dentistry, if the efficacy is achieved along with shorter working time and less technical sensitivity, the behavior management of young patients can be anticipated. This study aimed to compare the effect of precuring and postcuring of total-etch and self-etch bonding agents on the microleakage of sealants.

Materials and Methods:

This study was conducted on forty impacted third molars, which were surgically extracted. The samples were divided into five groups: 1. Control (etching and sealant), 2. Precured fifth-generation bonding agent (Adper Single Bond 2) and fissure sealant, 3. Postcured fifth-generation bonding agent (Adper Single Bond 2) and fissure sealant, 4. Precured seventh-generation bonding agent (Single Bond Universal) and fissure sealant, and 5. Postcured seventh-generation bonding agent (Single Bond Universal) and fissure sealant. All specimens were thermocycled (×1000), immersed in 0.5% basic fuchsine solution for 24 hours, sectioned, digitally photographed, and measured using the LAS EZ program. The data were analyzed using Kruskal-Wallis and Dunn’s tests.

Results:

Leakage in the control group and the third group was significantly lower than that in other groups. In pairwise comparisons, a significant difference was found between the control group and the fifth group and between the third group and the fifth group.

Conclusion:

The conventional method of sealant placement showed superior results in comparison with the use of an intermediate layer of the bonding agent.

Meta-analysis of the longevity of commonly used pit and fissure sealant materials

OBJECTIVE

This systematic literature review and meta-analysis compared the clinical retention of primed or adhesively bonded sealants to that of conventional sealant materials.

METHODS

A search of the MEDLINE, EMBASE and CENTRAL databases identified 3707 abstracts published prior to 12/31/2017, of which 335 clinical publications were analysed in detail. A total of 67 studies included information about sealant retention after 24, 36, or 60 months of follow-up. A meta-analysis using a random effects model was conducted to calculate the pooled estimate of the retention rates for the five groups of sealants. Subgroup moderator analysis was performed to compare the pooled retention rate estimate (RRE) of primed sealants against those of the other groups.

RESULTS

Primed sealants had a 2-year pooled RRE of 43.2% (95% CI: 30.5-55.8), which was significantly inferior to those of auto-polymerizing (80.8%, 95% CI: 72.2-89) and light-polymerizing sealants (68.4%, 95% CI: 60.2-76.7). Fluoride-releasing and light-polymerizing sealants had the highest 3-year pooled RREs (86.4%, 95% CI: 73.4-99.3 and 83.1%, 95% CI: 75.6-90.7, respectively).

SIGNIFICANE

The results of this meta-analysis suggest that primed sealants cannot be fully recommended for clinical practice due to their moderate survival rates. Auto-polymerizing, light-polymerizing and fluoride-releasing sealants continue to be considered the reference standards for pit and fissure sealants. However, future generations and developments of primed sealant materials may change this position.

Evaluation of Three Esthetic Restorative Materials Used for Carious or Noncarious Cervical Lesion Restoration

Background: Cervical lesions appear on the cervical surface of the lingual or buccal side of the tooth and are classified into carious and non-carious lesions.

Aim: The present study evaluates the performance of three different types of aesthetic restorative materials, used for the restoration of carious or non-carious cervical lesions.

Materials and methods: The study comprised 195 cervical lesions in 45 patients. The restorations were carried out for non-carious cervical lesions in 34.62% of the cases, for primary carious lesions in 40.00% of the cases, and to replace a previous restoration in 25.38% of the cases. The restorations were evaluated at 2 weeks (the reference line), and then at 1 and 2 years after placement. The following have been assessed: restoration retention, color harmonization, surface texture, margin discoloration, anatomical contour, margin integrity, and the presence of secondary caries. The characteristics were registered in conformity with the modified USPHS criteria.

Results: At the one-year evaluation, we noticed the loss of 12 restorations, and after 2 years, the loss of 19 restorations. The results showed significant differences between restorative materials regarding color, margin adaptation, margin coloration, surface texture, as well as criteria regarding the anatomical contour (p <0.05).

Conclusions: The evaluation of the success of restorative material retention must consider the location of the cervical lesion. A successful treatment depends particularly on a full understanding of the factors that caused the lesions and on the method of their treatment.

The Efficacy of Different Sealant Modalities for Prevention of Pits and Fissures Caries: A Randomized Clinical Trial

Objectives

This clinical trial evaluates the efficacy of different pit and fissure sealant modalities as a caries prevention tool.

Materials and Methods

Forty-four children aged 6-8 years with completely erupted first permanent molars participated in sealant placement randomized clinical trial. Split-mouth technique used and each child received four treatment modalities (ICON, Seal It, GCP glass seal, ICON/Seal It combination). Caries progression and sealant retention monitored over a period of 24 months.

Results

Seal It and combination modalities had the highest efficacy in the prevention of pits and fissures caries, whereas the ICON had the lowest efficacy. Regarding retention, there were no significant differences among the four modalities during the 1, 3, and 6 months follow-up intervals. However, at 12, 18, and 24 months, the retention of Seal It and combination modalities were better than ICON and better than GCP, but the differences were not statistically significant. In addition, the retention of combination modality was better than Seal It, but the difference was not significant. At the end of the trial, the caries incidence was the highest in ICON group (20 lesions) followed by GCP group (13 lesions), Seal It group (3 lesions) and the lowest observed in combination group (2 lesions).

Conclusions

Both Seal It and combination modalities are highly effective in the prevention of pits and fissures caries, GCP has acceptable effect while the use of ICON alone was not effective. The Seal It and ICON combination improves their clinical efficacy in caries prevention.

Combined Effect of Enamel Deproteinization and Intermediate Bonding in the Retention of Pit and Fissure Sealants in Children: A Randomized Clinical Trial

OBJECTIVE

This manuscript shows if enamel deproteinization along with an intermediate layer of bonding enhances the retention of pit and fissure sealants..

STUDY DESIGN

Two hundred six mandibular first permanent molars were allocated to Group I (n=103) and Group II (n=103). Group I underwent deproteinization, acid etching, bonding agent application and pit & fissure sealant placement while Group II treated with acid etching followed by pit & fissure sealant application only. Clinical analysis of all the teeth in the two groups was performed at 1, 3, 6, 9 and 12 months respectively. Pearson's chi - square test was utilized to evaluate the success of both treatment procedures (p<0.05).

RESULTS

At 12 months follow up the differences between the groups pertaining to Marginal integrity, Marginal discoloration and Anatomical form were statistically significant suggesting enhanced retention in Group I.

CONCLUSIONS

Enamel deproteinization along with the use of intermediate bonding layer significantly enhances the retention of pit and fissure sealants in terms of enhanced marginal integrity, decreased marginal discoloration and preserving the anatomical form.

Clinical Follow-up of a Fissure Sealant Placed Using Different Adhesive Protocols: A 24-month Split-mouth Study

The purpose of this study was to evaluate the retention rates of a fissure sealant placed using different adhesive protocols over 24 months. Twenty-four subjects with no restorations or caries received fissure sealants (Clinpro Sealant, 3M ESPE) placed using different adhesive protocols. A total of 292 sealants were placed as follows by two previously calibrated dentists using a table of random numbers (n=73): group I, acid-etch/without adhesive; group II, with a self-etch adhesive (Adper Easy Bond, 3M ESPE); group III, with an etch-and-rinse adhesive (Adper Single Bond 2, 3M ESPE); group IV, with acid + self-etch adhesive (Adper Easy Bond). Two other calibrated examiners independently evaluated the sealants at baseline and at six-, 12-, 18-, and 24-month recalls. Each sealant was evaluated in terms of caries formation being present or absent and retention using the following criteria: 1 = total retention, 2 = partial loss, and 3 = total loss. Pearson's χ² test was used to evaluate differences in retention rates among the sealants for each evaluation period. At the end of 24 months, total retention rates were 57.5%, 27.4%, 84.9%, and 76.7% in the acid-etch, self-etch adhesive, etch-and-rinse adhesive, and acid + self-etch adhesive groups, respectively. Although there were no statistically significant differences between the retention rates among the adhesive protocols at 6 months ( p=0.684), significant differences were observed at the 12-, 18-, and 24-month evaluations. At 24 months, the lowest retention rates were observed in the self-etch group ( p<0.05). No caries development was observed in any of the groups. The retention rate of sealants placed using self-etch adhesive was poor compared with the other groups.

The Use of Pit and Fissure Sealants-A Literature Review

This paper reviews the literature and discusses the latest updates on the use of pit and fissure sealants. It demonstrates the effectiveness of pit and fissure sealants in preventing caries and the management of early carious lesions. It compares the use of different sealant materials and their indications. It describes the application technique for sealants. It also reviews the cost-effectiveness of sealants as a preventive strategy. From this review and after the discussion of recently published studies on pit and fissure sealants, it is evident that sealants are effective in caries prevention and in preventing the progression of incipient lesions. It is therefore recommended that pit and fissure sealant be applied to high-caries-risk children for optimum cost-effectiveness. It is a highly sensitive technique that needs optimum isolation, cleaning of the tooth surface, etching, and the application of a thin bonding layer for maximum benefit. Recall and repair, when needed, are important to maximize the effectiveness of such sealant use.

Evaluation of pit-and-fissure sealants placed with four different bonding protocols: a randomized clinical trial

BACKGROUND

Application of adhesive after acid etching may increase the retention of pit-and-fissure sealants and improve clinical effectiveness.

AIMS

To clinically evaluate the retention, marginal discoloration and caries incidence of pit-and-fissure sealants applied using four bonding protocols: conventional acid etching, etch-and-rinse adhesive, multimode universal adhesive and self-etch adhesive used after acid etching.

DESIGN

In this split-mouth design study, the four adhesive protocols were randomly assigned to the four erupted, non-carious first permanent molars and involved 52 patients between 6 and 10 years of age. The sealants were evaluated at 3-, 6- and 12-month intervals. Statistical analysis was carried out using Friedman test and Kruskal-Wallis test.

RESULTS

At 12 months, the retention rate was maximum in etch-and-rinse and universal adhesive groups (77.1%) followed by self-etch adhesive (58.3%) and conventional acid etching group (45.8%). Dental caries was observed only in one tooth, and marginal discoloration was found to be the highest in conventional group and least in etch-and-rinse group.

CONCLUSIONS

Use of adhesives during pit-and-fissure sealant application does not significantly enhance sealant retention nor decrease marginal discoloration. Etch-and-rinse adhesive is advantageous only at short term.

Retention and caries-preventive effect of glass ionomer and resin-based sealants: An 18-month-randomized clinical trial

The objective of this study was to compare the retention and caries-preventive effect of glass ionomer (Fuji Triage) and resin-based (Clinpro) sealants among 6-9-year-old children. This split-mouth, randomized clinical trial covered 35 children/140 fully erupted permanent first molars. Evaluation was conducted by two independent examiners after 6, 12, and 18 months and the data were compared in relation to the children's caries risk and age groups. The Kaplan-Meier survival method and chi-square test were used for analysis. There were no statistically significant differences in the survival of partial and fully retained sealants or in the survival of caries-free pits and fissures between glass-ionomer and resin-based sealants. In terms of retention, both sealants performed better in the younger age group at the end of the study, and showed better caries prevention in moderate caries risk children. After 18 months, both sealants had comparable retention and caries-preventive effects in 6-9-year old children.

Randomized Clinical Trial of a Self-Adhering Flowable Composite for Class I Restorations: 2-Year Results

Objectives. To compare the clinical performances of a self-adhering resin composite and a conventional flowable composite with a self-etch bonding system on permanent molars. The influence of using rubber dam versus cotton roll isolation was also investigated. Materials and Methods. Patients aged between 6 and 12 years and presenting at least two permanent molars in need of small class I restorations were selected. Thirty-four pairs of restorations were randomly placed by the same operator. Fifteen patients were treated under rubber dam and nineteen using cotton rolls isolation and saliva ejector. They were evaluated according to the modified USPHS criteria at baseline, 6 months, and 1 and 2 years by two independent evaluators. Results. All patients attended the two-year recall. For all measured variables, there was no significant difference between rubber dam and cotton after 2 years of restoration with Premise Flowable or Vertise Flow (p value > 0.05). The percentage of restorations scored alpha decreased significantly over time with Premise Flowable and Vertise Flow for marginal adaptation and surface texture as well as marginal discoloration while it did not vary significantly for color matching. After 2 years, Vertise Flow showed a similar behaviour to the Premise Flowable used with a self-adhesive resin system.

Clinical/Photographic/Scanning Electron Microscopy Analysis of Pit and Fissure Sealants After 22 Years: A Case Series

Pit and fissure sealant is a clinical technique adopted to prevent caries lesion development. Ionomeric and/or resin-based materials are commonly used for this purpose. This article presents a case series of sealed teeth with 22-year follow-up evaluated by clinical, photographic, and microscopic analysis. In 1992, sixteen patients (9-14 years of age) had at least three teeth sealed with one of the following materials: resin-modified glass ionomer cement (RMGIC, Vitrebond or Fuji II LC) or polyacid-modified resin composite (PMRC, VariGlass VLC), totaling 86 sealed permanent teeth. After 22 years, 10 patients were recalled, representing 41 teeth. The retention of sealants was assessed by three methods: clinical analysis by visual inspection; photography; and scanning electron microscope (SEM) images and classified as retained (pits and fissures filled by sealant material); partially retained (pits and fissures partially filled by sealant material); or totally lost (no material was found in pits and fissures). The SEM images provided a higher number of retained sealants when compared with the clinical and photographic evaluations. Also, no totally lost scores were found with SEM analysis, regardless of the sealing material. No caries lesions were found. A fully or partially retained sealant in pits and fissures was capable of preventing caries lesions after 22 years within the patient pool analyzed.

Effectiveness of pit and fissure sealants bonded with different adhesive systems: a prospective randomized controlled trial

OBJECTIVES

To evaluate and compare the clinical retention of a resin-based fissure sealant placed with an intermediate layer of etch-and-rinse (ER) or self-etch (SE) adhesives.

MATERIALS AND METHODS

Two hundred twenty-eight sealants were placed in 57 children with previously unsealed, caries-free permanent first molars, employing a split-mouth design. The teeth were randomized into four groups (n = 57 teeth/groups) according to the adhesive system placed under the tested sealant (Delton FS+; Dentsply). Group 1 (control): no bonding agent (conventional acid-etch sealant); group 2: prior enamel etch + ER adhesive (XP Bond; Dentsply); group 3: SE adhesive (Clearfil SE Bond; Kuraray) without prior etching; and group 4: prior enamel etch + SE adhesive (Clearfil SE Bond). Clinical assessments were performed according to modified USPHS criteria at 1, 3, 6, 12, 18, and 24 months. The data were analyzed statistically using Fisher's Exact test, the Kaplan-Meier analysis, and the Log-rank test.

RESULTS

At 24 months, sealants bonded with XP Bond and Clearfil SE Bond with prior enamel etching showed similar retention rates (p > 0.05), and these rates were significantly better than the rates of the conventional sealant and Clearfil-SE groups (p < 0.05). There was no significant difference between the retention rates of the latter two groups (p > 0.05). The cumulative survival rates on palatal/buccal surfaces showed similar outcomes as with occlusal surfaces: XP Bond (94%), Clearfil SE Bond + acid-etch (94%), conventional sealant (52%), and Clearfil SE Bond only (37%).

CONCLUSIONS

Application of the tested ER adhesive and the SE adhesive with enamel etching significantly improved the clinical retention of Delton-FS over the 24-month period.

CLINICAL RELEVANCE

The use of a resin-based fissure sealant placed with ER or SE adhesive with prior acid-etching yielded better retention than the conventional sealant over the 24-month period.

Impact of the intermediary layer on sealant retention: a randomized 24-month clinical trial

OBJECTIVES

The aims of this study were to assess long-term impact of tooth eruption stages (ES) on sealant retention on occlusal surfaces previously coated with intermediary bonding layer and to determine caries prevention.

MATERIALS AND METHODS

Sixty-five school children were selected (aged 6-10 years), with four non-carious permanent first molar in different ES (OP (operculum present), ME (marginal edge), CE (completely erupted)). Split-mouth and single-blind study design was used. The teeth (260) were randomly selected according to treatment (sealant/technique): F (Fluroshield), H (Helioseal Clear Chroma), SF (Single Bond + F), EH (Excite + H). Sealant retention, marginal integrity, discoloration, and caries prevention were assessed after 6, 12, 18, and 24 months by calibrated examiner (Spearman = 0.91) using visual inspection. Data were submitted to the Cox proportional hazard model (survival analysis) and Likelihood ratio χ ² test (correlation), p ≤ 0.05.

RESULTS

At baseline, ES was 20 % in OP, 54 % in ME, and 26 % in CE. There was no significant difference on sealant retention between the treatments (p = 0.2774). However, significant differences were found regarding the ES on sealant retention (p = 0.0041). The CE stage showed the highest retention survival rate during the 24 months. The overall sealant prevention average was found to be about 99.4 % and showed no difference between the groups.

CONCLUSIONS

Eruption stages affect sealant retention irregardless of the intermediate layer and type of sealant. However, there was caries prevention on tooth occlusal surfaces after 24 months, regardless of treatment.

CLINICAL RELEVANCE

Sealing is recommended to prevent occlusal caries of newly erupted teeth in high-caries-risk patients. However, its application is critical on moisture limited control surfaces independently of sealer material and technique.

Bond Strength of a Bisphenol-A-Free Fissure Sealant With and Without Adhesive Layer under Conditions of Saliva Contamination

Dental sealants are important for prevention of carious lesions, if they have good shear strength. The aim of this study was to evaluate the shear bond strength (SBS) of two sealants to saliva-contaminated and non-contaminated enamel with and without an intermediate adhesive layer underneath the sealant. Ninety flat enamel surfaces from human third molars were randomly assigned to 6 groups (n=15): F (control): Fluroshield(tm) sealant; EWB (control): Embrace(tm) WetBond(tm); SB/F: Single Bond adhesive system + F; SB/EWB, s-SB/F and s-SB/EWB. In the s-SB/F and s-SB/EWB groups, the acid-etched enamel was contaminated with 0.01 mL of fresh human saliva for 20 s. Sealant cylinders were bonded to enamel surface with and without an intermediate adhesive system layer. The shear tests were performed using a universal testing machine (0.5 mm/min). Data were analyzed statistically by Kruskal-Wallis and Mann-Whitney tests (α=0.05). F presented higher mean SBS than EWB in all experimental conditions. The lowest SBS mean was obtained for EWB on contaminated enamel (p<0.05). In conclusion, an adhesive system layer should be used prior to sealant placement, in both dry and saliva-contaminated enamel. F had the best performance in all experimental conditions. EWB sealant showed very low results, but an adhesive layer underneath the sealant increased its SBS even after salivary contamination.

Adhesive systems under fissure sealants: yes or no?: A systematic review and meta-analysis

BACKGROUND

The authors of this systematic review and meta-analysis had 2 aims: to evaluate fissure sealant retention with and without the use of an adhesive system and to compare fissure sealant retention using etch-and-rinse adhesive systems versus self-etching adhesive systems.

TYPES OF STUDIES REVIEWED

The authors conducted a literature search (all articles published through November 1, 2015) to identify studies for inclusion in this systematic review. They assessed the quality of the evidence provided using the modified Jadad scale and performed meta-analyses using a random-effects model.

RESULTS

The authors considered 12 studies that met the inclusion criteria for the systematic review. In addition, they used 5 of 9 studies related to the first part of the study and 3 of 4 studies related to the second part of the study that met the inclusion criteria for meta-analysis. In the analysis of the first part of the systematic review, the authors found that adhesive systems had a significant positive effect on fissure sealant (odds ratio, 3.294; 95% confidence interval, 1.292-8.401; P = .013). In the analysis of the second part of the systematic review, the authors found that etch-and-rinse adhesives were superior to self-etching adhesives in the fissure sealant procedure (odds ratio, 14.569; 95% confidence interval, 2.616-81.131; P = .002).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The use of adhesive systems beneath fissure sealants can increase the retention of fissure sealants. Also, when adhesive systems are used with fissure sealants, etch-and-rinse systems are preferable.

A randomised clinical trial on the use of intermediate bonding on the retention of fissure sealants in children

OBJECTIVE

To assess whether an adhesive bonding agent increases the retention of resin fissure sealants on first permanent molars (FPMs) and to determine any difference in sealant retention on occlusal, buccal, or palatal surfaces. The effect of the child's behaviour on the retention of the sealants was also assessed.

METHODS

One hundred and twelve children were recruited (age range 5-15 years). One operator placed sealants (Helioseal, Ivoclar Vivadent) on 390 FPMs using a split-mouth design. The study group, (n = 195), had an ethanol-based adhesive bond (ExciTEF, Ivoclar Vivadent) placed prior to sealant application, and no bond was used in the control group (n = 195). The sealants were reviewed after 12 months and analysed using Fisher's exact test.

RESULTS

The addition of a bonding agent significantly increased sealant retention (P = 0.0005). Retention of bonded sealants on occlusal surfaces was higher (98%) than non-bonded sealants (93%) (P = 0.08). Bonded sealants placed on buccal/palatal surfaces were retained (92%) more successfully than non-bonded sealants (82%) (P = 0.0005). The behaviour of the patient significantly affected the retention of fissure sealants (P = 0.0001).

CONCLUSIONS

The addition of an ethanol-based bonding agent significantly increased the retention of sealants at 12 months particularly on palatal fissures of maxillary first permanent molar teeth.

Enamel Surface with Pit and Fissure Sealant Containing 45S5 Bioactive Glass

Enamel demineralization adjacent to pit and fissure sealants leads to the formation of marginal caries, which can necessitate the replacement of existing sealants. Dental materials with bioactive glass, which releases ions that inhibit dental caries, have been studied. The purpose of this study was to evaluate the enamel surface adjacent to sealants containing 45S5 bioactive glass (BAG) under simulated microleakage between the material and the tooth in a cariogenic environment. Sealants containing 45S5BAG filler were prepared as follows: 0% 45S5BAG + 50.0% glass (BAG0 group), 12.5% 45S5BAG + 37.5% glass (BAG12.5 group), 25.0% 45S5BAG + 25.0% glass (BAG25.0 group), 37.5% 45S5BAG + 12.5% glass (BAG37.5 group), and 50.0% 45S5BAG + 0% glass (BAG50.0 group). A cured sealant disk was placed over a flat bovine enamel disk, separated by a 60-µm gap, and immersed in lactic acid solution (pH 4.0) at 37 °C for 15, 30, and 45 d. After the storage period, each enamel disk was separated from the cured sealant disk, and the enamel surface was examined with optical 3-dimensional surface profilometer, microhardness tester, and scanning electron microscopy. The results showed a significant increase in roughness and a decrease in microhardness of the enamel surface as the proportion of 45S5BAG decreased (P< 0.05). In the scanning electron microscopy images, enamel surfaces with BAG50.0 showed a smooth surface, similar to those in the control group with distilled water, even after prolonged acid storage. Additionally, an etched pattern was observed on the surface of the demineralized enamel with a decreasing proportion of 45S5BAG. Increasing the 45S5BAG filler contents of the sealants had a significant impact in preventing the demineralization of the enamel surface within microgaps between the material and the tooth when exposed to a cariogenic environment. Therefore, despite some marginal leakage, these novel sealants may be effective preventive dental materials for inhibiting secondary caries at the margins.

Microtensile Bond Strength of Embrace Wetbond Hydrophilic Sealant in Different Moisture Contamination: An In-Vitro Study

AIM

Contamination of etched enamel with saliva has been shown to result in sealant failure. Recently, a hydrophilic sealant has been introduced. In absence of documented literature, this in vitro study was undertaken to ascertain the efficacy of Embrace Wet Bond without reduction of microtensile bond strength in the different moisture contamination.

MATERIALS AND METHODS

A 5mm block of sealant were built over prepared occlusal surface of 40 non-carious therapeutically extracted third molars which were sectioned into 1mm thick stick and tested using Zwick micro tensile tester. Obtained data were subjected to descriptive analysis, one-way ANOVA and Scheffe's post-hoc tests.

RESULTS

Mean microtensile bond strength of Embrace sealant was not significantly lowered in different moisture contamination groups except Group 3 (air drying), which showed very highly significant (p<0.001) decrease in μTBS as compared to Group 1 (non-contaminated).

CONCLUSION

Mean μTBS of Embrace sealant remains largely unchanged even in presence of moisture. Owing to its hydrophilic property, this sealant can be a great help in cases where maintaining isolation is difficult.

A randomized control clinical trial of fissure sealant retention: Self etch adhesive versus total etch adhesive

Context:

There are limited studies on comparison of Total etch (TE) and Self etch (SE) adhesive for placement of sealants.

Aims:

The aim of the study was to compare the retention of fissure sealants placed using TE adhesive to those sealants placed using SE (seventh generation) adhesive.

Settings and Design:

The study was conducted in the dental section, Aga Khan University Hospital. This study was a randomized single blinded trial with a split mouth design.

Materials and Methods:

The study included 37 patients, 101 teeth were included in both study groups. The intervention arm was treated with SE Adhesive (Adper Easy One, 3M ESPE, US). Control arm received TE adhesive (Adper Single Bond 2, 3M ESPE, US) before sealant application. The patients were followed after 6 months for assessment of sealant retention.

Statistical analysis used:

Interexaminer agreement for outcome assessment was assessed by Kappa Statistics and outcome in intervention group was assessed by McNemar's test.

Results:

Ninety-one pairs of molar (90%) were reevaluated for sealant retention. Complete retention was 56% in TE arm and 28% in SE arm with an odds ratio (OR) of 3.7.

Conclusions:

Sealants applied with TE adhesives show higher rate of complete sealant retention than SE adhesive.

Self-etch bonding agent beneath sealant: Bond strength for laser-irradiated enamel

OBJECTIVES

This study evaluated the in vitro shear bond strength (SBS) of a resin-based pit-and-fissure sealant (Fluroshield [F], Dentsply/Caulk) associated with either an etch-and-rinse (Adper Single Bond 2 [SB], 3M/ESPE) or a two-step self-etch adhesive system (Adper SE Plus [SE], 3M/ESPE) on Er: YAG laser-irradiated enamel.

MATERIALS AND METHODS

Seventeen sound third molar crowns were embedded in acrylic resin, and the mesial-distal enamel surfaces were flattened. The enamel sites were irradiated with a 2.94-μm wavelength Er: YAG laser (120 mJ, 4 Hz, noncontact mode/17 mm, 20 s). The specimens were randomly assigned to three groups according to the bonding technique: I - 37% phosphoric acid etching + SB + F; II - SE + F and III - F applied to acid-etched enamel, without an intermediate layer of bonding agent. In all of the groups, a 3-mm diameter enamel-bonding site was demarcated and the sealant cylinders were bonded. After 24 hours in distilled water, the shear bond strength was tested at a crosshead speed of 0.5 mm/minute. The data were analyzed by one-way ANOVA and Tukey's test. The debonded specimens were examined with a stereomicroscope to assess the failure modes.

RESULTS

The mean SBS values in MPa were I = 6.39 (±1.44); II = 9.50 (±2.79); and III = 5.26 (±1.82). No statistically significant differences were observed between groups I and III; SE/F presented a significantly higher SBS than that of the other groups (P = 0.001). With regard to the failure mode, groups I (65%) and II (75%) presented adhesive failures, while group III showed 50% adhesive failure. Cohesive failure did not occur.

CONCLUSION

The application of the two-step self-etch bonding agent (Adper SE Plus) beneath the resin pit-and-fissure sealant placement resulted in a significantly higher bond strength for the Er:YAG laser-irradiated enamel.

Sealing versus partial caries removal in primary molars: a randomized clinical trial

BACKGROUND

The resin-based pit and fissure sealant is considered a successful tool in caries prevention, however there is a growing evidence of its use in controlling already established caries in posterior teeth. The aim of this clinical trial is to verify the efficacy of pit and fissure sealants in arresting dentinal caries lesions compared to partial excavation and restorative treatment in primary molar teeth.

METHODS

Thirty six patients with occlusal cavitated primary molar reaching outer half of dentin were selected. The patients were randomly allocated into two groups: sealant application (experimental group - n = 17) and restoration with composite resin (control group - n = 19). Clinical and radiograph evaluation were performed after 6, 12 and 18 months. The chi-square test was used to verify the distribution of characteristics variables of the sample among the groups. The survival rate of treatments was evaluated using Kaplan-Meier survival and log-rank test. Fisher's Exact and logistic regression tests were calculated in each evaluation period (α = 5%).

RESULTS

The control group showed significantly better clinical survival after 18 months (p = 0.0025). In both groups, no caries progression was registered on the radiographic evaluations.

CONCLUSIONS

Sealing had similar efficacy in the arrestment of caries progression of cavitated occlusal lesions compared to partial excavation of the lesions, even though the frequency of re-treatments was significantly higher in sealed lesions.

TRIAL REGISTRATION

Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-9kkv53.

A Comparative Evaluation of the Effect of Bonding Agent on the Tensile Bond Strength of Two Pit and Fissure Sealants Using Invasive and Non-invasive Techniques: An in-vitro Study

BACKGROUND

Newer technologies and the development of pit and fissure sealants have shifted the treatment philosophy from 'drill and fill' to that of 'seal and heal'.

AIMS

The purpose of this in-vitro study was to evaluate the effects of bonding agents on the tensile bond strengths of two pit and fissure sealants by using invasive and non-invasive techniques.

STUDY DESIGN AND METHODS

One hundred and twenty bicuspids were collected and teeth were divided into two groups: Group-I (Clinpro) and Group-II (Conseal f) with 60 teeth in each group. For evaluating tensile bond strengths, occlusal surfaces of all the teeth were flattened by reducing buccal and lingual cusps without disturbing fissures. Standardised polyvinyl tube was bonded to occlusal surfaces with respective materials. Sealants were applied, with or without bonding agents, in increments and they were light cured. Tensile bond strengths were determined by using Universal Testing Machine.

STATISTICAL ANALYSIS

Data were then statistically analysed by using Student t-test for comparison.

RESULTS

A statistically significant difference was found in tensile bond strength in invasive with bonding agent group than in non-invasive with bonding agent group.

CONCLUSION

This study revealed that invasive techniques increase the tensile bond strengths of sealants as compared to non- invasive techniques and that the use of a bonding agent as an intermediate layer between the tooth and fissure sealant is beneficial for increasing the bond strength.

Moisture-tolerant resin-based sealant: A boon

Background and Objectives:

Pit and fissure sealants are highly effective in preventing occlusal caries. The present study clinically evaluated and compared the retention and development of caries when sealed with moisture-tolerant resin-based sealant, conventional resin-based sealant with and without a bonding agent, and Glass Ionomer Cement Sealant in young permanent teeth.

Materials and Methods:

A total of 80 healthy cooperative children aged 6-9 years who were at high caries risk with all four newly erupted permanent first molars were included in the study. Teeth were divided into 4 groups using a full-factorial design, and each of the molars was sealed with the four different sealant material. Evaluation of sealant retention and development of caries was performed at 6 and 12 months using Modified Simonsen's criteria. The data obtained were tabulated and subjected to statistical analysis using Kruskal-Wallis Test and Mann-Whitney Test.

Result and Conclusion:

The result from the present study indicated that moisture-tolerant resin-based sealant could be successfully used as a pit and fissure sealant because its hydrophilic chemistry makes it less technique sensitive and simplifies the sealant application procedure.

A 48-month Clinical Evaluation of Fissure Sealants Placed With Different Adhesive Systems

Aim

To compare the retention rates of a nanofilled occlusal fissure sealant placed with the use of an etch-and-rinse or a self-etch adhesive over 48 months.

Materials and Methods

The authors enrolled 244 teeth, each with no restoration or sealant and no detectable caries, from 16 patients. The sealants were placed with Solobond M two-step etch-and-rinse adhesive or Futurabond NR one-step self-etch adhesive by four previously calibrated dentists using a table of random numbers. After completion of the adhesive application, a nanofilled sealant, Grandio Seal, was applied and light-cured. Two other calibrated examiners, who were unaware of which adhesive had been used, independently evaluated the sealants at baseline and at 12-, 24-, 36-, and 48-month recalls. Each sealant was evaluated in terms of caries formation being present or absent and retention using the following criteria: 1 = completely retained, 2 = partial loss, and 3 = total loss. The Pearson χ2 test was used to evaluate differences in retention rates among the sealants used with different adhesives for each evaluation period.

Results

The retention rates for sealants in the Solobond M group were significantly higher than those in the Futurabond NR group in all periods of evaluation (p&lt;0.05). No statistically significant difference between the retention rates for premolars and molars was found at each evaluation period (p&gt;0.05). There was no new caries formation throughout the 48-month recall period.

Conclusion

Fissure sealants placed with etch-and-rinse adhesive showed better retention rates than those placed with self-etch adhesive.

Self-adhesive restoratives as pit and fissure sealants: a comparative laboratory study

OBJECTIVES

To evaluate the properties of self-adhesive restorative materials used as sealants in comparison with sealants with hydrophobic or hydrophilic monomers.

METHODS

The self-adhesive materials tested were Fusio (FS) and Vertise-Flow (VF) and the sealants Embrace Wetbond (EM/hydrophilic) and Helioseal-F (HS/hydrophobic). The properties tested were: (a) degree of cure (%DC, n: 5, ATR-FTIR), (b) extent of oxygen inhibition (n: 5, transmission optical microscopy), (c) flow (n: 5, ASTM D-4242 method), (d) hardness (VH0.2kp/10s dry/1w in water), (e) adaptation, microleakage and fissure penetration (n: 10, 1% fuschin dye, reflection optical microscopy and ESEM). Statistical analysis was performed by one-way ANOVA plus Tukey test (a-d), Fisher's exact and Kruskal-Wallis plus Tukey tests (e) at a 95% confidence level.

RESULTS

VF showed the highest %DC(76.1) followed by HS(68.7) and EM(61.3), FS(59.2). HS demonstrated the highest extent of oxygen inhibition (23μm vs. 13-10μm of the rest). EM and HS exhibited the greatest flow, followed by FS and VM. The VHN(0.2kp/10s) ranking before and after 1week water exposure was FS≥VF>EM≥HS. Water storage increased VF and reduced HS values. The lowest adaptation and microleakage scores were found in HS. FS and VF after alumina sandblasting showed the worst adaptation and leakage scores, that were improved after acid-etching. Improved fissure penetration was found in HS, EM and FS, VF after acid-etching.

SIGNIFICANCE

Although the self-adhesive materials presented improved setting characteristics, their low flow affected fissure penetration capacity. When combined with enamel acid-etching, adaptation and microleakage scoring were substantially improved in comparison with enamel sandblasting. The sealant with the hydrophobic monomers demonstrated the best sealing characteristics.

A 12-month clinical evaluation of pit-and-fissure sealants placed with and without etch-and-rinse and self-etch adhesive systems in newly-erupted teeth

Objectives

The objective of this one-year clinical study was to investigate the effect of two adhesive systems (Adper Single Bond, a two-step etch-and-rinse and Clearfil SE Bond, a two-step self-etch system) on pit-and-fissure sealant retention in newly-erupted teeth. This study compared the success of the sealants in mesial and distopalatal grooves with and without these two adhesive systems.

Material and Methods

In a clinical trial, 35 children aged 6-8 years undergoing sealant placement were recruited. This one-year clinical study scored 70 mesial and 70 distopalatal sealants of newly-erupted permanent maxillary first molar, with a split-mouth design. All children received sealant alone in one permanent maxillary molar tooth. Children were randomized into two groups. One group received Self-Etch (SE) bond plus sealant and the other group received Single Bond plus sealant in another permanent maxillary molar tooth. Clinical evaluation at 3, 6 and 12 months was performed and the retention was studied in terms of the success and failure.

Results

The success rate of sealant in the distopalatal groove, using SEB at 3, 6 and 12 months was 93.3% (95% CI: 68.0, 99.8), 73.3% (95% CI: 44.9, 92.2) and 66.7% (95% CI: 38.4, 88.2), respectively. It was greater than that of the distopalatal groove in SB group with a success rate of 62.5% (95% CI: 35.4, 84.8), 31.3% (95% CI: 11.8, 58.7) and 31.3% (95% CI: 11.8, 58.7), at the three evaluation periods. The success rate of sealant in the mesial groove using SEB was 86.6% (95% CI: 59.5, 98.3), 53.3% (95% CI: 26.6, 78.7) and 53.3% (95% CI: 26.6, 78.7), while this was 100% (95% CI: 79.4, 100.0), 81.3% (95% CI: 54.4, 96.0) and 81.3% (95% CI: 54.4, 96.0) using SB, at 3, 6 and 12-month evaluation periods.

Conclusions

These results support the use of these two bonding agents in pit-and-fissure sealants under both isolated and contaminated conditions. Further, SE bond seemed to be less sensitive to moisture contamination.

Effectiveness of fissure sealant retention and caries prevention with and without primer and bond

OBJECTIVE

This study evaluated the effectiveness of sealant retention and caries prevention with and without primer and bond below the fissure sealant among Kuwaiti schoolchildren.

SUBJECTS AND METHODS

This clinical trial used fissure sealant that was applied to four sound first permanent molars on 78 children. All the teeth were cleaned with pumice and rubber cups, isolated with rubber dams, and etched for 20 s. In a split-mouth study design, for the test teeth (n = 156), primer and bond (3M Scotchbond Multi-Purpose Plus System primer and bond) were applied below the sealant, and for the control teeth (n = 156), only sealant (Delton Plus) was applied. The number of tooth surfaces included was 480. Due to loss to follow-up, only 60 children were evaluated at 5 years for sealant retention and caries. The evaluation criteria were: completely retained sealant, complete or partial sealant retention, and caries.

RESULTS

In teeth sealed with primer and bond, 47 (19.6%) tooth surfaces had completely retained sealant, 60 (9.2%) teeth had partially retained sealant, while in 51 (21.3%) caries was prevented and 120 (50%) tooth surfaces were carious or filled. In teeth sealed without primer and bond, 25% (60 tooth surfaces) had completely retained sealant, 6% (14 teeth surfaces) had partially retained sealant, 26% (54 teeth surfaces) showed caries prevention, and 49.6% (119 tooth surfaces) were carious or filled. There was no difference between teeth sealed with primer and bond (120 teeth) and teeth sealed without primer and bond (120 teeth) in completely retained sealant (p = 0.15), complete or partial sealant retention (p = 0.6), caries prevented (p = 0.37), and caries (p = 0.93).

CONCLUSION

Caries prevention was not enhanced in teeth sealed with primer and bond sealant compared with those sealed with sealant alone.

Assessment of two curing systems in a self-etching primer/adhesive sealant: A preliminary study for a clinical trial

AIM

This was to assess the clinical performance of two different polymerization regimens of a non-rinse conditioning self/etching adhesive/sealant system (Adper Prompt-L-Pop, 3M ESPE) placed in recently erupted first permanent molars in two paediatric dental practices.

METHODS

A total of 40 healthy 5 to 8 year old patients (20 from each practice) presenting at least two caries-free recently erupted first permanent molars participated in this preliminary test. A total of 128 molars were fissure sealed (FS) and cured with two different curing regimens. Group 1 (64 teeth) used Adper L-Pop + Clinpro as a one-step cure regimen. Group 2 (64 teeth) used Adper L-Pop + Clinpro with a two-step cure regimen using cotton-roll isolation. Sealants were evaluated 6 to 12 months after placement.

RESULTS

No differences were found in the ratings between the two polymerization regimens. In Group 1, 28 molars recorded FS fully retained rated A, 29 were rated B (partially missing) and 7 sealants were completely lost (C). In Group 2, 30 molars were rated A, another 30 scored B and 4 molars were totally lost (C).

CONCLUSION

The poor performance of both FS polymerization regimens of the non-rinse conditioning self/etching adhesive/sealant system (Adper Prompt-L-Pop, 3M ESPE) placed in recently erupted first permanent molars in the present test does not justify its use in young children.

Bond strength and morphology of resin materials applied to the occlusal surface of primary molars

BACKGROUND

Hydrophilic adhesives may be used as pit and fissure sealants (sealants), but there is concern about the ability of self-etching adhesives to bond sealants to enamel.

AIM

To study the bond strength (BS) and morphology of adhesive systems used as sealants.

DESIGN

OptiBond FL, OptiBond All-in-One, combined OptiBond All-in-One+OptiBond FL adhesive, and Fluroshield were applied to the occlusal surfaces of 16 primary molars (n = 4). Teeth were stored in distilled water (24 h at 37°C) and sectioned through the interface to obtain sticks (0.8 mm(2) ) tested under a tensile load (0.5 mm/min). Failure modes were observed. Data were analysed by ANOVA and Tukey's tests (α = 5%). The morphology of 12 primary molars was examined in terms of the etching pattern and resin reproduction.

RESULTS

Differences in the BS were found (P = 0.001), with OptiBond FL showing the highest (36.84 ± 5.7 MPa), Fluroshield (24.26 ± 2.13 MPa) and OptiBond All-in-One (17.12 ± 4.97 MPa) similar, and OptiBond All-in-One + OptiBond FL adhesive the lowest (9.8 ± 2.94 MPA). OptiBond FL showed the best results in terms of morphology.

CONCLUSION

Under the conditions of this study, OptiBond FL was the best material to be used for sealing.

Evaluation of microtensile bond strength of different fissure sealants to bovine enamel

BACKGROUND

The aim of this study was to evaluate the microtensile bond strength (μTBS) of a new fissure sealant and compare it with conventional sealants which are applied to enamel alone, and also with self-etch and etch-and-rinse adhesives.

METHODS

Enamel specimens were prepared and randomly distributed into three groups according to fissure sealant (Aegis, Helioseal F, Helioseal Clear). Each group was then subdivided according to adhesive system (Clearfil S3, Single Bond, no adhesive). A universal testing machine was used to measure μTBS, and data were analysed using one-way ANOVA and Tukey's tests.

RESULTS

μTBS values for all Aegis subgroups were significantly lower than for comparable Helioseal F and Helioseal Clear subgroups (p < 0.05). No differences were observed in μTBS of Helioseal F and Helioseal Clear (p > 0.05). In the Helioseal Clear group, μTBS values for Single Bond were significantly higher than for Clearfil S3 (p < 0.05). However, no significant differences were found between the μTBS values of the adhesive subgroups in the Aegis or Helioseal F groups (p > 0.05).

CONCLUSIONS

Sealant μTBS values may be affected by material content. The addition of an adhesive may improve μTBS values of sealant to enamel.

Effect of the application of a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste and adhesive systems on bond durability of a fissure sealant

This study aimed to evaluate the effect of the previous application of a casein phosphopeptide-amorphous calcium phosphate paste (MI Paste, MI) and adhesive systems on the bond durability of a fissure sealant. Ninety-eight enamel blocks were obtained from proximal surfaces of erupted third molars. Specimens were divided into 14 groups (n = 7) according to the previous application of MI (with and without) and the adhesive systems used (no adhesive system; hydrophobic resin of a three-step etch-and-rinse adhesive system; etch-and-rinse single-bottle adhesive system; all-in-one adhesive system; two-step self-etching adhesive system; additional phosphoric acid conditioning and all-in-one adhesive system; additional phosphoric acid conditioning and two-step self-etching adhesive system). A fissure sealant (Fluroshield) was applied and photoactivated for 20 s. Beams (~0.7 mm(2)) were prepared for the microtensile bond strength test, which was executed after 24 h or 6 months of water storage. Fractured specimens were analyzed by scanning electronic microscopy. Data were analyzed by two-way ANOVA with repeated measures/Tukey's test (P < 0.05). Groups that received MI application and adhesive systems presented higher means than those groups where MI was not applied. Higher frequency of cohesive failures was observed for groups with MI. Applying a CPP-ACP containing paste on enamel before adhesive systems was an effective method to increase bond durability of the sealant tested.

Advances in dental materials

The use of materials to rehabilitate tooth structures is constantly changing. Over the past decade, newer material processing techniques and technologies have significantly improved the dependability and predictability of dental material for clinicians. The greatest obstacle, however, is in choosing the right combination for continued success. Finding predictable approaches for successful restorative procedures has been the goal of clinical and material scientists. This article provides a broad perspective on the advances made in various classes of dental restorative materials in terms of their functionality with respect to pit and fissure sealants, glass ionomers, and dental composites.

Resin-modified glass-ionomer cements versus resin-based materials as fissure sealants: a meta-analysis of clinical trials

AIM

To appraise quantitatively current evidence regarding the caries-preventing effect of resin-modified glass-ionomer cement (RM-GIC) fissure sealants in comparison to that of resin-based fissure sealants.

STUDY DESIGN

Systematic review with meta-analysis.

METHODS

8 Anglophone databases and 2 Lusophone databases were searched until 15 April 2009, using a pre-determined search strategy. Clinical trials were considered for inclusion if their titles/abstracts were relevant to the topic, published in English, Portuguese or Spanish and had a two-arm longitudinal study design. The outcome measure of the caries-preventive effect was caries absence on sealed teeth. Two reviewers independently extracted data from the accepted articles in order to complete a 2x2 table for meta-analysis. The unit of interest was the tooth, and the number of caries-free teeth (n) at the end of each time interval (6, 12 and 24 months) was compared against the total number of evaluated teeth (N).

STATISTICS

Datasets were assessed for their clinical and methodological heterogeneity, following Cochrane guidelines, and only homogeneous datasets were combined for meta-analysis, using a random effects model (RevMan 4.2). Differences in the caries-preventive effect were computed on the basis of the combined Relative Risk (RR) with 95% confidence interval (CI).

RESULTS

Of the 212 articles identified, only 6 trials were included. From these, 19 separate datasets were extracted. For the pooled data, equivalent caries-preventive effects were observed at 6 months (RR= 0.98, 95% CI 0.95- 1.00; p = 0.08); 12 months (RR=1.00, 95% CI 0.96-1.04, p = 0.99) and 24 months (RR=1.01, 95% CI 0.84-1.21, p = 0.91). The 36-month data (not pooled) favoured resin-based sealants (RR 0.93, 95% CI 0.88-0.97, p = 0.002).

CONCLUSIONS

This meta-analysis found no conclusive evidence that either material was superior to the other in preventing dental caries.

UK National Clinical Guidelines in Paediatric Dentistry: Use of fissure sealants including management of the stained fissure in first permanent molars

International Journal of Paediatric Dentistry 2010 Summary.  The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated to all Consultants in Paediatric Dentistry in the UK, to the Council of the British Society of Paediatric Dentistry (BSPD), and to people of related specialties recognised to have expertise in the subject. The final version of the guideline is produced from a combination of this input and thorough review of the published literature. The intention is to encourage improvement in clinical practice and to stimulate research and clinical audit in areas where scientific evidence is inadequate. Evidence underlying recommendations is scored according to the SIGN classification and guidelines should be read in this context. For those wishing further detail, the process of guideline production in the UK is described in the International Journal of Paediatric Dentistry 1997; 7: 267-268. This guideline is an update on the previously published BSPD policy document on fissure sealants. (Nunn et al., Int J Paed Dent 2000; 10: 174-177).

Microleakage of three different sealants on sound and questionable occlusal surfaces of permanent molars: an in vitro study

AIM

This was to evaluate the microleakage of 3 different sealants, applied on sound and questionably carious occlusal surfaces with and without a bonding agent.

METHODS

A total of 120 human molars were selected, photographed with a digital video microscope, and assigned by 3 independent examiners, according to the criteria of ICDAS II, in 2 groups of 60 teeth each. Group A: teeth with deep, clear, sound occlusal surfaces (ICDAS II, code 0). Group B: teeth with questionable occlusal surfaces, having deep, stained pits and fissures with probable incipient, but non-cavitated carious lesions (ICDAS II, codes 1 and 2). Each group was divided into 2 subgroups of 30 teeth each (bonding or no bonding) and then into 3 subgroups of 10 teeth each according to the type of sealant used: one conventional (Conseal) and 2 fluoridated (Conseal F and Teethmate F). After the application of the bonding agent and the sealant to the appropriate teeth, all specimens were subjected to thermal cycling and immersed in a 10% methylene blue dye solution for 4 hours. Average and summed microleakage for each sample were estimated from dye penetration scores on 3 mesiodistal sections of the tooth across the sealed occlusal surface. Non-parametric Friedman's 2-way ANOVA by ranks and Conover-Inman pair wise comparisons were used for differences at the 0.05 level of significance.

RESULTS

According to Friedman's 2-way ANOVA by ranks analysis, although there were no significant differences between the different sealants (chi(2) = 0.048, df = 2, P = .976), there were significant differences between the sound and questionably carious occlusal surfaces (chi(2) = 24, df = 3, P = .000). Conover- Inman pair wise comparisons showed no differences between the groups using and not using bonding agents, on sound (SNB-SWB, P = .4561) or questionable occlusal surfaces (QNB-QWB, P = .0842).

CONCLUSIONS

Sealant microleakage on questionably carious occlusal surfaces was statistically significantly higher than that of sound occlusal surfaces. Using a bonding agent or fluoridated FS did not influence microleakage significantly, either on sound or on questionable fissured surfaces.

Bond strength of resin-resin interfaces contaminated with saliva and submitted to different surface treatments

The purpose of this study was to investigate the effect of different surface treatments on shear bond strength of saliva-contaminated resin-resin interfaces. Flat resin surfaces were fabricated. In the control group, no contamination or surface treatment was performed. The resin surfaces of the experimental groups were contaminated with saliva and air-dried, and then submitted to: (G1) rinsing with water and drying; (G2) application of an adhesive system; (G3) rinsing and drying, abrasion with finishing disks, etching and application of adhesive system; (G4) rinsing and drying, etching, application of silane and adhesive system. Resin cylinders were placed over the treated surfaces. The specimens were stored in water or ethanol. Shear bond strength tests were performed and the mode of failure was evaluated. Data were submitted to two-way ANOVA and Dunnett T3 test. Contamination of resin-resin interfaces with saliva significantly reduced shear strength, especially after prolonged storage (p<0.05). Similar values to the original bond strength were obtained after abrasion and application of adhesive (G3) or etching and application of silane and adhesive (G4). If contamination occurs, a surface treatment is required to guarantee an adequate interaction between the resin increments.