Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: An update of systematic review evidence

Comparative evaluation of retention and cariostatic effect of glass ionomer, hydrophobic & hydrophilic resin-based sealants: a systematic review and meta-analysis

OBJECTIVE

To compare the effectiveness of hydrophilic resin-based versus hydrophobic resin-based and glass-ionomer pit and fissure sealants.

METHODS

The review was registered with Joanna Briggs Institute and followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Google Scholar, Virtual Health Library, and Cochrane Central Register of Controlled Trials were searched from 2009-2019 using appropriate keywords. We included randomized controlled trials and randomized split-mouth trials conducted among 6-13-year-old children. The quality of included trials was assessed using modified Jadad criteria and risk of bias using guidelines specified by Cochrane. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) guidelines were used to assess the overall quality of studies. We used the random-effects model for meta-analysis. Relative risk (RR) and confidence intervals (CI) were calculated & heterogeneity was tested using I² statistic.

RESULTS

Six randomized clinical trials and five split-mouth trials met the inclusion criteria. The outlier augmenting the heterogeneity was omitted. Based on very-low to low-quality evidence, loss of hydrophilic resin-based sealants was less likely as compared to glass-ionomer fissure sealants (4 trials at 6 months; RR = 0.59; CI = 0.40-0.86), while it was similar or slightly lower than hydrophobic resin-based sealants (6 trials at 6 months; RR = 0.96; CI = 0.89-1.03); (6 trials at 12 months; RR = 0.79; CI = 0.70-0.89); (2 trials at 18 months; RR = 0.77; CI = 0.48-0.25).

CONCLUSION

This study revealed that retention of hydrophilic resin-based sealants is better than glass ionomer sealants but similar to hydrophobic resin-based sealants. However, higher-quality evidence is necessary to underpin the outcomes.

Caries Management in Special Care Dentistry

The objective of this article is to provide a summary of the current evidence-based recommendations for caries management in patients with special health care needs (SHCNs). Considerations regarding caries risk assessment and preventive measures are also discussed with the goal of helping clinicians to manage the caries disease process using a person-centered approach and risk-based interventions. Importantly, most of the evidence is still based on the general population, because the evidence for those with SHCNs is still limited.

Glass Ionomer Sealant versus Fluoride Varnish Application to Prevent Occlusal Caries in Primary Second Molars among Preschool Children: A Randomized Controlled Trial

Fissure sealant is a recommended preventive measure on permanent molars, but its efficacy on primary molars in preschool children is still in doubt. Sodium fluoride varnish (NaFV) enhances remineralization and is effective in preventing caries in smooth surfaces, but limited information is available regarding its use on occlusal surfaces of primary molars. The present study aimed to compare the efficacy of glass ionomer sealant (GIS) versus topical application of 5% NaFV in preventing and arresting occlusal caries in primary second molars among preschool children. One calibrated examiner examined children aged 3-4 years for visible plaque index (VPI), decayed-missing-filled primary surface (dmfs) index, and extent of carious lesions by the International Caries Detection and Assessment System (ICDAS). Subjects with 1 or more primary second molars that were sound or with incipient lesions (ICDAS 0-1), with distinct visual enamel changes (ICDAS 2), or with localized enamel breakdown (ICDAS 3) were recruited. The children were randomly assigned to either NaFV group - application of 5% NaFV at 3-monthly intervals or GIS group - 1 single placement of GIS. A parental questionnaire was used to collect information on the children's sociodemographic background and oral health-related habits. Two blinded examiners conducted clinical examinations after 6 and 12 months to evaluate the development of occlusal caries and the retention of GIS. Negative binomial regression using generalized estimating equations was employed to adjust for the clustering effect and evaluate the influence of selected variables on the development of occlusal caries into dentin at 12 months. A total of 323 children with 1,159 primary second molars received the respective preventive measures at baseline. At 12 months, 280 children with 989 molars were evaluated. Caries had developed or progressed into dentin in 7.8% and 8.0% of the molars in the NaFV and GIS groups, respectively, with no significant difference between the groups (p = 0.913). The overall retention rates of GIS were 24.6% and 13.5% at 6 and 12 months, respectively. Regression analyses showed only baseline caries experience, and an ICDAS code had a significant association with occlusal caries progression. Quarterly NaFV application and single GIS placement showed similar effectiveness in the prevention of occlusal caries development among preschool children.

Glass Ionomer Sealants Can Prevent Dental Caries but Cannot Prevent Posteruptive Breakdown on Molars Affected by Molar Incisor Hypomineralization: One-Year Results of a Randomized Clinical Trial

To evaluate the preventive effect of glass ionomer cement (GIC) against dental caries and posteruptive breakdown (PEB) on molars affected by molar incisor hypomineralization (MIH). In this randomized clinical trial, 77 children aged 5-9 years with at least 1 MIH-affected molar and without PEB or dentin caries lesions (n = 228) were included and randomly allocated to one of the following groups: (1) MIH-affected molars that remained unsealed and (2) MIH-affected molars that received GIC sealants. Dental caries and PEB were clinically evaluated after 6 and 12 months. Associations between dental caries and PEB with independent variables were evaluated using logistic regression analysis (p < 0.05). The MIH-affected molars allocated to the GIC sealant group were less likely to develop dental caries compared to those allocated to the unsealed group (OR = 0.23; 95% CI 0.06-0.95). Conversely, application of a GIC sealant was not associated with prevention of PEB (p = 0.313). Furthermore, MIH-affected molars presenting yellow-brown opacities were almost 5 times more likely to develop dental caries (p = 0.013) and PEB (p = 0.001) compared to those presenting white-creamy opacities. We can conclude that GIC sealants can prevent dental caries on MIH-affected molars; however, the same protective effect was not observed for PEB.

COMPLIANCE OF RANDOMIZED CLINICAL TRIALS ON DENTAL CARIES PREVENTION METHODS WITH THE CONSORT STATEMENT: A SYSTEMATIC REVIEW

OBJECTIVE

Reporting of randomized controlled trials (RCTs) in dentistry remains suboptimal. Considering the positive impact of the Consolidated Standards of Reporting Trials (CONSORT) guidelines on the quality of evidence in RCTs, the main objective of this systematic review was to determine whether RCTs on dental caries prevention conform to these guidelines. The secondary objective was to assess the association between CONSORT adherence and the year and impact factor of the journal in which the study was published.

METHODS

A systematic search was conducted in different databases using appropriate terms to retrieve RCTs that assessed the caries-preventive effect of at least 2 of the following materials-fluoride varnish, resin-based fissure sealants, and ionomer-based fissure sealants-on the occlusal surfaces of permanent molars. Since the first CONSORT statement was published in 1996, a time frame from 1997 to 2020 was established for the identification of studies. Selected articles were assessed according to their adherence to the CONSORT statement, risk of bias (Cochrane risk of bias tool, RoB 2.0), and journal impact factor based on the InCites Journal Citation Reports. The year of publication and other relevant data were also recorded. SPSS (SPSS Statistics 25.0, IBM©) was used to perform the linear correlation analyses to determine the relationship between the article CONSORT score (previously determined) and the year of publication and journal impact factor. A significance level of 5% was established for all analyses.

RESULTS

Of 3196 references retrieved, 30 articles were selected and evaluated. Using RoB 2.0, 8 studies were classified as having a high risk of bias, 16 as having some concerns about the risk of bias assessment, and 6 as having a low risk of bias. Concerning CONSORT adherence, 77% of the studies adequately reported the intervention domain, since the methodology for the application of fluoride varnish or sealant materials was thoroughly described. However, the participants' setting and location, random sequence generation, randomization, and the flowchart description of the losses/exclusions domains were poorly reported. Meanwhile, the allocation concealment process was not reported in 83% of the articles. Correlation analyses indicated a positive relationship between CONSORT adherence and the year of publication, as well as the journal impact factor.

CONCLUSION

When assessing clinical trials on the prevention of occlusal caries, most RCTs examined followed the CONSORT statement. However, some methodological domains remain poorly reported, demonstrating the need to improve CONSORT compliance in these RCTs.

Dawn of a New Age Fissure Sealant? A Study Evaluating the Clinical Performance of Embrace WetBond and ART Sealants: Results from a Randomized Controlled Clinical Trial

OBJECTIVES

 The main purpose of this article is to evaluate the clinical performance of atraumatic restorative treatment (ART) sealant versus Embrace WetBond sealant in terms of retention and fissure caries prevention among a section of school children in the southern Indian state of Karnataka (ClinicalTrials.gov NCT02716558).

MATERIALS AND METHODS

 After obtaining consent from the parents and screening the children against the inclusion cum exclusion criteria, 90 school children whose mandibular first molars were caries free and with a well-defined pit and fissure system were recruited for this spilt mouth trial. The respective molars were allocated either to the ART sealant or the embrace group after the randomization process. The sealants were applied according to the manufacturer's instructions and followed up at the end of 3rd, 6th, and 12th month, respectively. The outcome measures assessed were the retention and the caries preventive effects of the materials.

RESULTS

 At the end of the 6th month, about one-fourth of the sealants in either group remained totally intact, without evidence of caries. No significant differences were seen between the sealants either in terms of retention or caries preventive benefits at the end of 12 months.

STATISTICAL ANALYSIS

 The chi-squared test was used to check differences in proportions. The significance value was set at <0.05. Kappa test was performed to assess the intraexaminer reproducibility with respect to retention and caries status.

CONCLUSION

 The moisture-tolerant resin sealant could not replicate the physical properties usually associated with conventional resin sealants. The usage of ART sealants was deemed to be less cumbersome in an outreach setting as observed in this trial.

Tooth Decay Prevention: Knowledge and Practices Survey of Dental Students

OBJECTIVES

This study aimed to assess the level of knowledge, attitudes, and practices fissure sealants among undergraduate Saudi dental students.

METHODS

A modified questionnaire consisted of 24-items was distributed among 226 undergraduate dental students, males and females of different years at Al-Farabi Colleges, Riyadh, Saudi Arabia. Chi-square/Fisher's exact tests were used for descriptive statistical analyses.

RESULTS

The response rate was 100%. Most of the respondents were male (60.2) and (39.8%) were female. With regard to the level of study, 20.8% were in the fourth year, 43.8% in the fifth year, and 16.8% were in the sixth year. The respondents showed a sensible level of learning about sealants, with the majority (88%) believed that there is strong scientific evidence about fissure sealants effectiveness and around 90% showed a good understanding of sealant placement instructions. Furthermore, respondents demonstrated inadequate learning about sealants clinical practice.

CONCLUSION

Despite a high proportion of undergraduate dental students' showed sufficient knowledge about dental sealant, following guidelines and standardized procedures in clinical practice is lacking. The findings suggest an urgent need of dental colleges to additionally and/or update their curriculum regarding fissure sealants to reflect advance dental education that concentrates on evidence-based practice (EBP) in Pediatric Dentistry and Dental Public Health need for regular continuing education courses for the dental professional.

HOW TO CITE THIS ARTICLE

Al-Sabri FA, Ba-Salamah M, et al. Tooth Decay Prevention: Knowledge and Practices Survey of Dental Students. Int J Clin Pediatr Dent 2019;12(2):92-95.

In Vitro Microleakage Comparison of Flowable Nanocomposites and Conventional Materials Used in Pit and Fissure Sealant Therapy

Objectives:

Pit and fissure sealants are recognized as an effective preventive approach in pediatric dentistry. Composite resin is the most commonly used sealant material. Adding nanoparticles to composite resin could result in production of flowable composite with higher mechanical properties and better flowability than previous sealants. This study aimed to compare the microleakage of a flowable nanocomposite and materials conventionally used as pit and fissure sealants.

Materials and Methods:

A total of 185 extracted mandibular third molar teeth were selected and randomly divided into 5 groups (n=36): flowable nanocomposite, flowable composite, filled sealants, nano-filled sealants, and unfilled sealants. Five teeth were reserved for examination under a scanning electron microscope (SEM). The samples were thermocycled (5–55°C, 1-minute dwell time) for 1000 cycles and immersed in 0.2% fuchsine solution for 24 hours. Teeth were sectioned buccolingually. Microleakage was assessed qualitatively and quantitatively by means of dye penetration and SEM. Data were analyzed using chi-square, Kruskal-Wallis, and Bonferroni-corrected Mann-Whitney U tests.

Results: Qualitative microleakage assessment showed that flowable composite and nanofilled flowable composite had almost no microleakage (P<0.001). Regarding quantitative scores, the nanofilled flowable composite and unfilled fissure sealant showed the lowest and the highest rate of microleakage, respectively. No statistically significant difference was found between the two flowable composites (P=0.317). Filled resin-based sealant had significantly lower microleakage than unfilled resin-based sealant (P<0.001).

Conclusion:

Use of flowable and nanofilled flowable composites (but not unfilled resin-based fissure sealant) is recommended for sealing of pits and fissures of molars.

Knowledge Analysis of Pit and Fissure Sealants among the Dental Students of South India

AIM

This study aimed to assess the level of knowledge and attitudes for pit and fissure sealants among undergraduate Indian dental students.

MATERIALS AND METHODS

A modified questionnaire consisting of 24 items was distributed to 280 undergraduate dental students comprising males and females of different years at MNR Dental College, Sangareddy, India. Descriptive statistics and Chi-square/Fisher's exact tests were used for statistical analysis. The data were computationally tested using Statistical Package for the Social Sciences (SPSS) Version 20, IBM SPSS Statistics software for Windows, Armonk, NY, USA.

RESULTS

With the response rate at 100%, most of the respondents, i.e., 70.4%, were females and the remaining 29.6% were male. Regarding the level of study, 20.8% were in 3rd year, 43.8% in the 4th year, and 16.8% were in 5th year (internship). The respondents showed a reasonable level of knowledge about sealants, mostly being good with the theoretical concepts of the sealants. On the other hand, respondents showed insufficient knowledge about sealants in the clinical practice.

CONCLUSION

Although a high proportion of undergraduate dental students showed adequate knowledge about dental sealants, there is a lag in putting that knowledge into work during the clinical practice. These findings suggest an urgent need of dental schools to include and/or update their curriculum regarding fissure sealants to reflect modern dental education that concentrates on evidence-based practice in pediatric dentistry and improve the dental health among the future generations by reducing the incidence of caries.

Retention rates and caries-preventive effects of two different sealant materials: a randomised clinical trial

OBJECTIVES

The aim of this study was to compare the caries-preventive effect and the retention rates of sealants prepared with a new modified and a high-viscosity glass-ionomer cement (GIC) in recently erupted first permanent molars.  MATERIALS AND METHODS: Fifty-six children (224 teeth) were included in a split-mouth randomised clinical trial. All children had their four first permanent molars sealed with either Clinpro XT Varnish (CXT) or Fuji IX GP FAST (FJ). FJ sealants were placed according to the ART protocol. Retention rates and caries-preventive effect of both materials were assessed clinically after 24 months, and survival curves were created according to the Kaplan-Meier method. For sealant retention rates, analyses were performed according to both the traditional method and modified sealant retention categorisation.

RESULTS

FJ sealants were retained longer in comparison to CXT sealants (p < 0.05), regardless of the categorisation used. In relation to the caries-preventive effect, no statistically significant differences were observed between materials (p = 0.99). Sealants prepared with the high-viscosity GIC according to the ART protocol survived longer than those prepared with the modified GIC, but both materials were equally effective in preventing cavitated dentine lesions over 24 months.

CONCLUSION

We concluded that GIC-based sealants are effective in preventing dentine caries lesions.

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.

Treating High-Caries Risk Occlusal Surfaces in First Permanent Molars through Sealants and Supervised Toothbrushing: A 3-Year Cost-Effective Analysis

We conducted a 3-year cost-effectiveness analysis on the cavitated dentine carious lesion preventive capabilities of composite resin (CR) (reference group) and atraumatic restorative treatment (ART) high-viscosity glass-ionomer cement (HVGIC) sealants compared to supervised toothbrushing (STB) in high-risk first permanent molars. School children aged 6-7 years in 6 schools (2 per group) received CR and ART/HVGIC sealants or STB daily for 180 days each school year. Data were collected prospectively and cost estimates were made for sample data and a projection of 1,000 sealants/STB high-risk permanent molars. Although STB had the best outcome, its high implementation cost (95% of cost for supervisors visiting schools 180 days/school year) affected the results. ART/HVGIC was cost-effective compared to CR for the sample data (savings of USD 37 per cavitated dentine carious lesion prevented), while CR was cost-effective compared to ART/HVGIC for the projection (savings of USD 17 per cavitated dentine carious lesion prevented), and both were cost-saving compared to STB. Two STB scenarios were tested in sensitivity analyses with variations in caries incidence and number of supervision days; results showed STB had lower costs and higher savings per cavitated dentine carious lesion prevented than CR and ART/HVGIC. A major assumption is that both scenarios have the same high effectiveness rate experienced by STB under study conditions; however, they point to the value of further research on the benefits of adopting STB as a long-term venture in a general population of school children.

Economic evaluation of dental sealants: A systematic literature review

OBJECTIVES

To systematically review the literature on economic evaluations of dental sealants and examine the costs and effectiveness of caries prevention using sealants.

METHODS

Of 21 full-text articles examined, a total of 13 were included in this study. These studies are grouped by the type of intervention as follows: (i) sealants compared with no sealants; (ii) sealants compared with other forms of caries prevention; (iii) resin-based sealants compared with glass-ionomer sealants; (iv) different sealing strategies in primary teeth; (v) different sealing strategies in permanent teeth; and (vi) sealants based on school- or clinic-based setting of delivery. All currency is reported in constant 2010 US$.

RESULTS

Cost-effectiveness analyses differed due to varying study designs, assumptions, sealant delivery settings, outcomes, caries risk assessment and study durations. Findings varied on the cost-effectiveness of sealants compared with other caries-preventive strategies. Under the assumption of equal caries risk, always sealing primary molars appeared to be the most effective strategy, whereas risk-based sealing was the optimal strategy with differing caries risk. Studies that assessed sealing strategies in permanent teeth reported that risk-based sealing was more cost-effective than not sealing, but they differed on the cost-effectiveness of risk-based seal compared with non-risk-based seal. Sealants delivered in school settings had mixed results on costs but were as equally effective as sealants delivered in private practices.

CONCLUSIONS

The cost-effectiveness of sealants is dependent on the conditions of delivery. The list of cost-effectiveness ratios for each intervention can support policy makers to estimate expected returns on their investments in dental sealants.

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.

The logic behind the use of fissure sealant retention as a proxy outcome measure for dental caries prevention

Fissure sealant retention is traditionally considered as a proxy measure for caries prevention. This study investigated the logic behind this proposition, and its validity. A logical framework of the proposition was established. The mechanism of caries development was transferred into a Directed acyclic graph, and this was used to investigate the logical framework. The sensitivity and specificity of full sealant retention in the prediction of dental carious lesion development and the number of false positive/false negative prediction rates were computed. The sensitivity/specificity was statistically compared to that of random values. A contradiction in the logical framework was identified. The mean sensitivity/specificity was 37.9% (SD = 27.8%) and 67.6% (SD = 28.4%), respectively. When these values were compared against random values (30.5%, SD = 25.7% and 58.7%, SD = 31.6%), a non-significant sensitivity (P = 0.06) and a borderline higher specificity (P = 0.04) were observed. The overall false prediction rate was 33.7%, with 16.9% and 16.8% false negative and false positive predictions, respectively. The sensitivity/specificity was too low and the false prediction rate was too high to consider retention a valid proxy for caries prevention. The logic behind the investigated proposition is flawed, contradicted by the current empirical evidence, and thus invalid.

3-year survival rates of retained composite resin and ART sealants using two assessment criteria

The aim was to test the null-hypothesis that there is no difference in the cumulative survival rate of retained composite resin (CR) sealants and a high-viscosity glass-ionomer Atraumatic Restorative Treatment (ART) sealant in first permanent molars calculated according to the traditional and the modified retention assessment criteria over a period of 3 years. This cluster-randomized controlled clinical trial consisted of 123 schoolchildren, 6-7-years-old. At baseline, high-caries risk pits and fissures of fully erupted first permanent molars were treated with CR and ART sealants. Evaluations were performed after 0.5, 1, 2 and 3 years. Retention was scored for free-smooth surface and for each of three sections into which the occlusal surface had been divided. The modified criterion differed from the traditional in that it determined an occlusal sealant to be a failure when at least one section contained no visible sealant material. Data were analysed according to the PHREG model with frailty correction, Wald-test, ANOVA and t-test, using the Jackknife procedure. The cumulative survival rates for retained CR and ART sealants in free-smooth and occlusal surfaces for both criteria were not statistically significantly different over the 3 years. A higher percentage of retained CR sealants on occlusal surfaces was observed at longer evaluations. Cumulative survival rates were statistically significantly lower for the modified criterion in comparison to the traditional. The modified retention assessment criterion should be used in future sealant-retention studies.

Knowledge, Attitude and Practice among Dental Practitioners Pertaining to Preventive Measures in Paediatric Patients

INTRODUCTION

Prevention at primary level is of great value in Paediatric Dentistry. Since use of preventive measures can prevent future complications, dental professionals share an important responsibility toward early screening, prompt referral and treatment and this knowledge must transfer into the practice of dentistry.

AIM

To evaluate Knowledge, Attitude and Practice (KAP) among dental practitioners in Bhopal city (central part of India) pertaining to sealants, topical fluorides usage and orthodontic consideration in paediatric patients.

MATERIALS AND METHODS

A descriptive cross-sectional survey was conducted using a 20-item self-administered, closed ended, structured questionnaire. A total of 200 available private dental practitioners of Bhopal city made up the sampling frame of study.

RESULTS

Out of 200 practicing dentists, 147 participated with response rate of 73.5% in which 69.4% were males and 30.6% were females. A total of 83% dentists were less than 35 years of age, while 17% were equal to or more than 35 years of age. Qualification distribution revealed 67.3% dental graduate and 32.6% dental specialist. A highly significant difference in knowledge in relation to age was observed. The mean±SD were found for Knowledge as 8.46±1.82, Attitude as 2.65±0.780, and Practice as 1.66±1.57. Statistically significant correlations were found between attitude and practice (r=0.58, p<0.001).

CONCLUSION

Dentists in Bhopal city have vast knowledge towards preventive dentistry. The attitude is highly commendable but underutilized in practice, which needs to be improved.

Caries-Preventive Effect of High-Viscosity Glass Ionomer and Resin-Based Fissure Sealants on Permanent Teeth: A Systematic Review of Clinical Trials

BACKGROUND

Glass-ionomers are traditionally regarded to be inferior to resin as fissure sealants in protecting teeth from dental caries, due to their comparatively lower retention rate. Unlike low-viscosity glass-ionomers, high-viscosity glass-ionomer cements (HVGIC) are placed as sealants by pressing the material into pits and fissures with a petroleum-jelly-coated index finger. Hence, HVGIC sealants are assumed to penetrate pits and fissures deeper, resulting in a higher material retention rate, which may increase its caries-preventive effect.

METHODS

The aim of this review was to answer the question as to whether, in patients with fully erupted permanent molar teeth, HVGIC based fissure sealants are less effective to protect against dental carious lesions in occlusal pits and fissures than resin-based fissure sealants? A systematic literature search in eight databases was conducted. Heterogeneity of accepted trials and imprecision of the established evidence were assessed. Extracted sufficiently homogenous datasets were pooled by use of a random-effects meta-analysis. Internal trial validity was evaluated. The protocol of this systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO / Nr.: CRD42015016007).

RESULTS

Seven clinical trials were provisionally included for further review. Of these, one was excluded. Seven trial reports reporting on six trials were accepted. From these, 11 datasets were extracted and pooled in four meta-analyses. The results suggest no statistically significant differences after up to 48 months and borderline significant differences in favour of HVGIC sealants after 60 months (RR 0.29; 95% CI: 0.09-0.95; p = 0.04 / RD -0.07; 95% CI: -0.14, -0.01). The point estimates and upper confidence levels after 24, 36, 48 and 60 months of RR 1.36; RR 0.90; RR 0.62; RR 0.29 and 2.78; 1.67; 1.21; 0.95, respectively, further suggest a chronological trend in favour of HVGIC above resin-based sealants. The internal trial validity was judged to be low and the bias risk high for all trials. Imprecision of results was considered too high for clinical guidance.

CONCLUSION

It can be concluded that: (i) Inferiority claims against HVGIC in comparison to resin-based sealants as current gold-standard are not supported by the clinical evidence; (ii) The clinical evidence suggests similar caries-preventive efficacy of HVGIC and resin-based sealants after a period of 48 months in permanent molar teeth but remains challenged by high bias risk; (iii) Evidence concerning a possible superiority of HVGIC above resin-based sealants after 60 months is poor (even if the high bias risk is disregarded) due to imprecision and requires corroboration through future research.

Knowledge, value, opinion and practice about usage of pit and fissure sealant among dental professionals in Chennai, Tamil Nadu, India

AIM

A study was aimed to assess the knowledge, value, opinion, and practice regarding the use of dental sealants among private dental practitioners in Chennai, Tamil Nadu, India.

MATERIALS AND METHODS

A self-administrated questionnaire were distributed to 192 private dental practitioners in Chennai, Tamil Nadu, India by using simple random sampling. A convenience sampling technique was employed. The questionnaire consisted of 28 items, which included information about knowledge, value, opinion, and practice regarding dental sealants. The questionnaire was obtained from the study by San Martin et al. 2013 and Kailash Asawa et al. 2014. Frequency distribution was tabulated. For frequency distribution strongly, strongly agree, and agree were combined as "agree" and strongly disagree and disagree were combined as "disagree." There were no changes in "neutral."

RESULTS

Among the 196 study subjects 56.2% were males and 43.8% were females with their clinical experience of 52.1% for <5 years, 35.4% for 5-10 years, and 13.5% for >15 years. The mean scores for knowledge, value, opinion, and practice were 41.8 ± 3.7, 18.7 ± 2.8, 18.1 ± 1.4, and 12.9 ± 2.3, respectively.

CONCLUSION

The results suggest that dental practitioners had satisfactory knowledge about pit and fissure sealant and had neutral attitudes about sealants being effective. Dental practitioners adequately used the pit and fissure sealants but they did not follow the standardized procedures and specific guidelines.

Análise comparativa entre selante resinoso e selante ionomérico por microscópio eletrônico de varredura

<title>Resumo</title><sec><title>Introdução</title><p>O selamento de superfícies oclusais como procedimento efetivo na prevenção de cárie, desde o seu reconhecimento pela ADA em 1976, vem sendo utilizado como método preventivo, seguro e eficaz.</p></sec><sec><title>Objetivo</title><p>O presente estudo tem como objetivo a análise da capacidade vedante de produtos utilizados como selantes de cicatrículas e fissuras de dentes humanos, cujo quesito observado é a propriedade de penetração, visualizada em microscópio eletrônico de varredura (MEV).</p></sec><sec><title>Material e método</title><p>Realizaram-se selamentos de 40 pré-molares, sendo separados em dois grupos de 20 dentes cada um. Em um dos grupos, foi utilizado selante fotopolimerizável Fluroshield^® e, em outro, cimento ionomérico Vidrion R^®, mantendo-se dez dentes restantes como controle. Após executados esses procedimentos, os dentes foram cortados transversalmente por serra de precisão, passaram por etapas de fixação, além da limpeza de restos residuais, sendo então observados em MEV para avaliar o selamento e possíveis falhas ou fendas decorrentes.</p></sec><sec><title>Resultado</title><p>O selante resinoso fotopolimerizável apresentou maior penetração e vedamento em 71,5% das amostras, atingindo a região profunda do sulco, enquanto o cimento ionomérico, utilizado como selante, apresentou maior quantidade de falhas e fendas, e em nenhuma das amostras atingiu a região mais profunda do sulco.</p></sec><sec><title>Conclusão</title><p>O selante resinoso possui melhores propriedades nos quesitos analisados, tanto no selamento quanto na penetração.</p></sec>

Glass ionomer ART sealant and fluoride-releasing resin sealant in fissure caries prevention--results from a randomized clinical trial

Background

The relative performance of ART sealant and fluoride-releasing resin sealant in preventing fissure caries in permanent molars was compared in a randomized clinical trial conducted in southern China (ClinicalTrials.gov NCT01829334).

Methods

After obtaining ethical approval, healthy schoolchildren who had permanent first molars with occlusal fissures which were sound but deep or presented with only incipient caries were recruited for the study. Included molars were randomly allocated into one of four parallel study groups in units of left/right teeth per mouth. Two of the four groups adopted the methods of ART or fluoride-releasing resin sealant placement while the other two groups adopted the topical fluoride application methods. Fissure status of the molars in each group was evaluated every 6 months. Development of dentine caries and sealant retention over 24 months in the molars in the two sealant-using groups was compared in this report. Outcome on cost-effectiveness of all four groups over 36 months will be reported elsewhere.

Results

At baseline, a total of 280 children (383 molars) with mean age 7.8 years were involved for the two sealant groups. After 24 months, 261 children (357 molars) were followed. Proportions of molars with dentine caries were 7.3% and 3.9% in the ART sealant and fluoride-releasing resin sealant groups, respectively (chi-square test, p = 0.171). Life-table survival analysis showed that sealant retention (full and partial) rate over 24 months for the resin sealant (73%) was significantly higher than that (50%) for the ART sealant (p < 0.001). Molar survival (no development of dentine caries) rates in the ART sealant (93%) and fluoride-releasing resin sealant (96%) groups were not significantly different (p = 0.169). Multilevel logistic regression (GEE modeling) accounting for the effects of data clustering and confounding factors confirmed this finding.

Conclusions

Though the retention of fluoride-releasing resin sealant was better than that of the ART sealant, their effectiveness in preventing fissure caries in permanent molars did not differ significantly over 24 months. ART sealants could be a good alternative when and where resources for resin sealant placement are not readily available.

Dental Sealants: Knowledge, Value, Opinion, and Practice among Dental Professionals of Bathinda City, India

Objective. The purpose of the study was to assess the knowledge, value, opinion, and practice regarding use of dental sealants among private dental practitioners in Bathinda City, Punjab, India. Materials and Methods. A cross-sectional survey was conducted among all private dental practitioners in Bathinda City, Punjab. A self-administered structured questionnaire consisting of 28 items was used to assess their knowledge, value, opinion, and practice regarding dental sealants. One-way analysis of variance, independent sample t-test, and multivariate regression analysis were utilized for statistical analysis. Confidence level and level of significance were set at 95% and 5%, respectively. Results. The mean scores for knowledge, value, opinion, and practice were 41.8 ± 3.7, 18.7 ± 2.8, 18.1 ± 1.4, and 12.9 ± 2.3, respectively. Analysis revealed that qualification was statistically significant among all dependent variables (P ≤ 0.05); work experience was significantly associated with both knowledge and opinion means scores (P ≤ 0.05). Conclusion. The results suggest that dental practitioners had sufficient knowledge about dental sealants. They also acknowledge the importance of use of dental sealants. Practice of dental sealants in clinics was found adequate but they were not following the specific guidelines and standardized procedures.

The modified Ottawa method to establish the update need of a systematic review: glass-ionomer versus resin sealants for caries prevention

Objective

To demonstrate the application of the modified Ottawa method by establishing the update need of a systematic review with focus on the caries preventive effect of GIC versus resin pit and fissure sealants; to answer the question as to whether the existing conclusions of this systematic review are still current; to establish whether a new update of this systematic review was needed.

Methods:

Application of the Modified Ottawa method. Application date: April/May 2012.

Results

Four signals aligned with the criteria of the modified Ottawa method were identified. The content of these signals suggest that higher precision of the current systematic review results might be achieved if an update of the current review were conducted at this point in time. However, these signals further indicate that such systematic review update, despite its higher precision, would only confirm the existing review conclusion that no statistically significant difference exists in the caries-preventive effect of GIC and resin-based fissure sealants.

Conclusion

In conclusion, this study demonstrated the modified Ottawa method as an effective tool in establishing the update need of the systematic review. In addition, it was established that the conclusions of the systematic review in relation to the caries preventive effect of GIC versus resin based fissure sealants are still current, and that no update of this systematic review was warranted at date of application.

Validity of sealant retention as surrogate for caries prevention--a systematic review

INTRODUCTION/AIM

To appraise the clinical literature in determining whether loss of complete sealant retention as surrogate endpoint is directly associated with caries occurrence on sealed teeth as its clinical endpoint and to apply the appraised evidence in testing the null-hypothesis that the retention/caries ratio between different types of sealant materials (resin and glass-ionomer cement) is not statistically significant (= Prentice criterion for surrogate endpoint validity).

METHODS

Databases searched PubMed/Medline, Directory of Open Access Journals; IndMed, Scielo. Systematic reviews were checked for suitable trials. The search terms: "fiss* AND seal*" and "fissure AND sealant" were used. Article selection criteria were: clinical trial reporting on the retention and caries occurrence of resin and/or glass-ionomer cement (GIC) fissure sealed permanent molar teeth; minimum 24-month follow-up period; systematic review or meta-analysis. Datasets and information were extracted from accepted trials. The principle outcome measure was the ratio of Risk of loss of complete retention to the Risk of caries occurrence per sealant type (RCR). Risk of bias was assessed in trials and sensitivity analysis with regard to potential confounding factors conducted. The null-hypothesis was tested by graphical and statistical methods.

RESULTS

The risk of loss of complete retention of sealant materials was associated with the risk of caries occurrence for resin but not for GIC based sealants. The difference between RCR values of the two sealant types was statistically significant (p<0.05). The null-hypothesis was rejected.

CONCLUSIONS

The current clinical evidence suggests that complete retention of pit and fissure sealants may not be a valid surrogate endpoint for caries prevention as its clinical endpoint. Further research is required to corroborate the current results.

Retention loss of resin based fissure sealants - a valid predictor for clinical outcome?

PURPOSE

The null-hypothesis that retention loss of resin fissure sealants predicts caries manifestation no more accurately than random values was tested.

METHODS

Systematic reviews were checked and electronic databases searched for clinical trials. Trials reporting on the retention of resin sealants and caries occurrence in permanent molar teeth, with minimum 24-month follow-up period, were included. Extracted data: number of sealed teeth, number of teeth without completely retained sealants, number of sealed teeth with caries. The number of teeth with complete sealant retention and absence of carious lesions/cavities was calculated; the predictive outcomes: true/false positive; false/true negative were established. Random values were generated as control-data. Diagnostic Odds ratios (DOR) were computed and tested for statistical difference. Summary Receiver Operating Characteristic curves were plotted.

RESULTS

95 trials were found. Median DOR values were 1.21 and 0.28 for test- and control data, respectively. Wilcoxon test (z = 0.56; p = 0.58) and Sign test (z = 1.38; p = 0.17) results were statistically non-significant. The null-hypothesis was not rejected.

CONCLUSIONS

Predictions based on the retention loss of resin sealants, regarding caries manifestation, was no more accurate than random guesses. Sealant retention loss appears not to be a valid predictor for clinical outcome.

Dental sealant knowledge, opinion, values and practice of Spanish dentists

BACKGROUND

Multiple guidelines and systematic reviews recommend sealant use to reduce caries risk. Yet, multiple reports also indicate that sealants are significantly underutilized. This study examined the knowledge, opinions, values, and practice (KOVP) of dentists concerning sealant use in the southwest region of Andalusia, Spain. This is a prelude to the generation of a regional plan for improving children's oral health in Andalusia.

METHODS

The survey's target population was dentists working in western Andalusia, equally distributed in the provinces of Seville, Cadiz, and Huelva (N=2,047). A convenience sample of meeting participants and meeting participant email lists (N=400) were solicited from the annual course on Community and Pediatric Dentistry. This course is required for all public health sector dentists, and is open to all private sector dentists. Information on the dentist's KOVP of sealants was collected using four-part questionnaire with 31, 5-point Likert-scaled questions.

RESULTS

The survey population demographics included 190 men (48%) and 206 women (52%) with an average clinical experience of 10.6 (±8.4) years and 9.3 (±7.5) years, respectively. A significant sex difference was observed in the distribution of place of work (urban/suburb) (p=0.001), but no sex differences between working sector (public/private). The mean±SD values for each of the four KOVP sections for pit and fissure sealants were: knowledge=3.57±0.47; opinion=2.48±0.47; value=2.74±0.52; and practice=3.48±0.50. No sex differences were found in KOVP (all p>0.4). Independent of sex: knowledge statistically differed by years of experience and place of work; opinion statistically differed by years of experience and sector; and practice statistically differed by years of experience and sector. Less experienced dentists tended to have slightly higher scores (~0.25 on a Likert 1-5 scale). Statistically significant correlations were found between knowledge and practice (r=0.44, p=0.00) and between opinion and value (r=0.35, p=0.00).

CONCLUSIONS

The results suggest that, similar to other countries, Andalusian dentists know that sealants are effective, have neutral to positive attitudes toward sealants; though, based on epidemiological studies, underuse sealants. Therefore, methods other than classical behavior change (eg: financial or legal mechanisms) will be required to change practice patterns aimed at improving children's oral health.

Minimal intervention dentistry for managing dental caries - a review: report of a FDI task group

This publication describes the history of minimal intervention dentistry (MID) for managing dental caries and presents evidence for various carious lesion detection devices, for preventive measures, for restorative and non-restorative therapies as well as for repairing rather than replacing defective restorations. It is a follow-up to the FDI World Dental Federation publication on MID, of 2000. The dental profession currently is faced with an enormous task of how to manage the high burden of consequences of the caries process amongst the world population. If it is to manage carious lesion development and its progression, it should move away from the 'surgical' care approach and fully embrace the MID approach. The chance for MID to be successful is thought to be increased tremendously if dental caries is not considered an infectious but instead a behavioural disease with a bacterial component. Controlling the two main carious lesion development related behaviours, i.e. intake and frequency of fermentable sugars, to not more than five times daily and removing/disturbing dental plaque from all tooth surfaces using an effective fluoridated toothpaste twice daily, are the ingredients for reducing the burden of dental caries in many communities in the world. FDI's policy of reducing the need for restorative therapy by placing an even greater emphasis on caries prevention than is currently done, is therefore, worth pursuing.

Twenty-five-year atraumatic restorative treatment (ART) approach: a comprehensive overview

Background

The atraumatic restorative treatment (ART) approach was born 25 years ago in Tanzania. It has evolved into an essential caries management concept for improving quality and access to oral care globally.

Results

Meta-analyses and systematic reviews have indicated that the high effectiveness of ART sealants using high-viscosity glass ionomers in carious lesion development prevention is not different from that of resin fissure sealants. ART using high-viscosity glass ionomer can safely be used to restore single-surface cavities both in primary and in permanent posterior teeth, but its quality in restoring multiple surfaces in primary posterior teeth cavities needs to be improved. Insufficient information is available regarding the quality of ART restorations in multiple surfaces in permanent anterior and posterior teeth. There appears to be no difference in the survival of single-surface high-viscosity glass-ionomer ART restorations and amalgam restorations.

Discussion

The use of ART results in smaller cavities and in high acceptance of preventive and restorative care by children. Because local anaesthesia is seldom needed and only hand instruments are used, ART is considered to be a promising approach for treating children suffering from early childhood caries. ART has been implemented in the public oral health services of a number of countries, and clearly, proper implementation requires the availability of sufficient stocks of good high-viscosity glass ionomers and sets of ART instruments right from the start. Textbooks including chapters on ART are available, and the concept is being included in graduate courses at dental schools in a number of countries. Recent development and testing of e-learning modules for distance learning has increasingly facilitated the distribution of ART information amongst professionals, thus enabling more people to benefit from ART. However, this development and further research require adequate funding, which is not always easily obtainable. The next major challenge is the continuation of care to the frail elderly, in which ART may play a part.

Conclusion

ART, as part of the Basic Package of Oral Care, is an important cornerstone for the development of global oral health and alleviating inequality in oral care.

Research gaps identified during systematic reviews of clinical trials: glass-ionomer cements

BACKGROUND

To report the results of an audit concerning research gaps in clinical trials that were accepted for appraisal in authored and published systematic reviews regarding the application of glass-ionomer cements (GIC) in dental practice

METHODS

Information concerning research gaps in trial precision was extracted, following a framework that included classification of the research gap reasons: 'imprecision of information (results)', 'biased information', 'inconsistency or unknown consistency' and 'not the right information', as well as research gap characterization using PICOS elements: population (P), intervention (I), comparison (C), outcomes (O) and setting (S). Internal trial validity assessment was based on the understanding that successful control for systematic error cannot be assured on the basis of inclusion of adequate methods alone, but also requires empirical evidence about whether such attempt was successful.

RESULTS

A comprehensive and interconnected coverage of GIC-related clinical topics was established. The most common reasons found for gaps in trial precision were lack of sufficient trials and lack of sufficient large sample size. Only a few research gaps were ascribed to 'Lack of information' caused by focus on mainly surrogate trial outcomes. According to the chosen assessment criteria, a lack of adequate randomisation, allocation concealment and blinding/masking in trials covering all reviewed GIC topics was noted (selection- and detection/performance bias risk). Trial results appear to be less affected by loss-to-follow-up (attrition bias risk).

CONCLUSION

This audit represents an adjunct of the systematic review articles it has covered. Its results do not change the systematic review's conclusions but highlight existing research gaps concerning the precision and internal validity of reviewed trials in detail. These gaps should be addressed in future GIC-related clinical research.

Caries-preventive effect of sealants produced with altered glass-ionomer materials, after 2 years

OBJECTIVES

The aim of the present study was to investigate the caries-preventive effect of sealants produced with a high-viscosity glass-ionomer with an elevated powder-liquid ratio (ART), of having energy added to this glass-ionomer, and that of glass-carbomer, in comparison to that of resin composite sealants.

METHODS

The randomized controlled trial covered 407 children, with a mean age of 8 years. At a school compound three dentists placed sealants in pits and fissures of high caries-risk children. Evaluation by two independent evaluators was conducted after 0.5, 1 and 2 years. The Kaplan-Meier survival method, ANOVA and t-test were used in analyzing the data.

RESULTS

1352 first permanent molars were sealed. 6.6% of children and 6.8% of sealants dropped out within 2 years. 27 re-exposed pits and fissures, 20 in occlusal and 7 in smooth surfaces, in 25 children, developed a dentin carious lesion. The cumulative survival of dentin carious lesion-free pits and fissures in the glass-carbomer sealant group was statistically significantly lower (97.4%) than those in the high-viscosity glass-ionomer with energy supplied (99%) and the resin-composite (98.9%) sealant groups. There was no statistically significant difference in the cumulative survival of dentin carious lesion-free pits and fissures, between the high-viscosity glass-ionomer with (99%) and without (98.3%) energy supplied sealant groups, after 2 years.

SIGNIFICANCE

The survival of dentin carious lesion-free pits and fissures was high in all sealant types. More dentin carious lesions were observed in the glass-carbomer sealant group.