Retention of resin-based filled and unfilled pit and fissure sealants: A comparative clinical study

Microleakage Assessment of Different Preparation Techniques and Pit and Fissure Sealants in Permanent Molars

BACKGROUND

This study aimed to evaluate the predisposition of microleakage in permanent molar teeth following different preparation techniques for pits and fissure sealants.

METHODS

In this cross-sectional analytical study, a dye penetration method was employed to evaluate microleakage in dental restorations. A total of 104 extracted molars were randomly assigned into two groups and further subdivided into two subgroups based on a class of sealant (filled/unfilled resin) containing 26 teeth each. Teeth in one group were prepared by a conventional method using pumice and acid etching with 37% phosphoric acid, and teeth in the other group were prepared with a 1/4-round carbide bur in a low-speed handpiece and then acid etched. In each group, 26 teeth were sealed with a filled sealant, and 26 teeth with an unfilled sealant. The chi-square test was used for the comparison of microleakage between the groups.

RESULTS

Unfilled sealants prepared with bur preparation showed the lowest degree of microleakage. The greater number of teeth (17) showed no microleakage in the group of teeth prepared using the bur preparation technique. Furthermore, in dye penetration analysis, the subgroup of teeth that were filled with unfilled sealants showed a greater number of teeth (57.6%), with zero penetration, and the dye penetration scores were statistically significant among the groups with different preparation techniques (p=0.002).

CONCLUSION

Teeth whose pits and fissures were prepared through 1/4 carbide bur and filled with unfilled pits and fissure sealants show less microleakage than those prepared with the conventional method and filled with filled sealants. Therefore, the choice of surface preparation technique for pit and fissure sealants can influence the effectiveness of the sealant in preventing microleakage.

Mechanical and antibacterial properties of conventional pit and fissure sealants with addition of miswak fibers

The occlusal surface of a tooth is affected by the development of biofilm in pits and fissures as bacteria and food particles accumulate in its complex structure. In this study, miswak fibers containing cellulose and antimicrobial extract were incorporated in commercial pit and fissure sealants. The miswak powder was characterized by different analytical techniques. The powder was mixed in different ratios (0-5%) into a pit and fissure sealant to result in five sealants (Groups 0-5), and their mechanical properties i.e. flexural strength, compressive strength, and Vickers hardness were evaluated. The sealants were also evaluated against streptococcus mutans oral pathogenic bacteria. SEM analysis confirmed irregular shape and micron-size particles of miswak powder. The infrared spectral analysis and X-ray differential peaks showed characteristic peaks related to miswak fibers. The particle appearance increased in prepared pits and fissure sealants with higher loading of miswak powder in SEM analysis. The flexural strength, compressive strength, and Vickers hardness values were obtained in the range of 148-221 (±16.6: p-value < 0.001) MPa, 43.1-50.3 MPa (±1.7: p-value <0.001), and 15.2-21.26 VHN (±0.56: p-value <0.001) for control and prepared sealant specimens respectively. In the antibacterial study, the zone of inhibitions increased with increased content of miswak from 15.6 ± 0.45 mm (Group 1) to 20.3 ± 0.32 mm (Group 5). The MIC was calculated to be 0.039%. The prepared experimental sealant had acceptable mechanical and good antibacterial properties therefore it could be recommended as an efficient pit and fissure sealant.

Twelve-month clinical evaluation of retention of resin-based sealant on first permanent molars

INTRODUCTION

The majority of researchers agree that sealants need to be monitored and kept in good condition because even a small amount of sealant loss raises the possibility of developing caries lesions. The first year after application is when sealant loss is reported to be at its highest. This motivated us to monitor silanized patients who received resin-based sealant for a full year.

A concise review of dental sealants in caries management

This concise review provides an update of the use of dental sealants. Dental sealants protect a tooth from caries development by providing a physical barrier to microorganism colonisation and creating a favorable environment for patients to clean. Some sealants release fluoride ions to promote remineralization. Dental sealants can be applied on pits and fissures of primary and permanent teeth to prevent and arrest early enamel caries. They are effective in caries prevention. The preventive fraction of resin sealant is up to 61% after 5 years. Dental sealants can be classified as resin, glass ionomer and hybrid (compomer or giomer) according to the material. Recent studies from 2012 to 2022 showed resin sealant has a high retention rate of up to 80% after 2 years, whereas glass ionomer sealants is 44%. Chemical etching with 37% phosphoric acid is the standard of care, whereas laser or air-abrasion cannot does not increase the sealant retention rate. Moist control is critical and studies found the use of rubber dam and cotton rolls had similar success for sealant retention. The longevity of dental sealant is also associated with clinical operative factors, including approaches of moisture control, enamel pretreatment, selection of dental adhesive, and time of acid etching.

Effectiveness of applying proximal enamel caries with fluoride-releasing sealant and fluoride varnish on caries progression in permanent teeth: A 12-month split-mouth randomized clinical trial

BACKGROUND

Few studies report on managing initial proximal caries with sealants, and no reports focus on fluoride-releasing sealants.

AIM

To compare the effectiveness between applications of a fluoride-releasing sealant and fluoride varnish on proximal enamel caries to control caries progression in permanent teeth.

DESIGN

This was a split-mouth randomized controlled trial in forty-four 11- to 16-year-old children with radiographic caries in at least one contralateral pair of teeth with proximal enamel caries. The lesions were evaluated using DIAGNOdent and were also assessed visually after tooth separation. The lesions in each subject were randomly sealed with a fluoride-releasing sealant (Helioseal® F) or applied with fluoride varnish (Duraphat®). The fluoride varnish-treated lesion was reapplied at 3 and 6 months. Clinical examination, bitewing radiograph evaluation, and DIAGNOdent assessment were performed at 6 and 12 months. The caries progression outcome variables were regression, no change, and progression. The data were analyzed with the McNemar-Bowker test.

RESULTS

Radiographic examination and DIAGNOdent assessment demonstrated no significant differences in the percentages of regression, no change, or progression at the 12-month follow-up (p > .05).

CONCLUSION

Applications of a fluoride-releasing sealant and of fluoride varnish three times resulted in a nonsignificant difference in caries progression of initial proximal caries at the 12-month follow-up.

Comparative Evaluation of Penetrative and Adaptive Properties of Unfilled and Filled Resin-Based Sealants When Placed using Conventional acid Etching, Lasing, and Fissurotomy Bur Technique of Enamel Preparation: An in vitro Scanning Electron Microscope Study

Background

There is a confusion regarding selection of unfilled or filled sealant and method of enamel preparation before sealant application. This study was carried out to compare three techniques of enamel preparation using both unfilled and filled type of sealants.

Objective

The objective of the study is to assess the penetrative and adaptive ability of filled and unfilled sealants in three techniques of enamel fissure preparations.

Materials and Methods

Total 36 extracted teeth were divided into 3 groups, each containing 12 samples. The samples of Group A were prepared by conventional acid etching with 37% phosphoric acid, and the Group B was subjected to Er: YAG lasing, while in Group C, fissurotomy followed by acid etching was done. The sealant placement was carried out using split tooth design in all the samples. Assessment of penetration and adaptation was done under scanning electron microscope using the scoring criteria adopted by Kane B et al. and Dukic W et al.

Results

Group A and Group C showed better adaptation than Group B. Statistically, no significant difference was observed in the penetration property among three techniques. Similarly, the unfilled and filled sealant showed statistically nonsignificant results for the penetration and adaptation comparison.

Conclusion

Irrespective of the sealant material selected, the conventional method of acid etching alone or in conjunction with fissurotomy bur for better retentiveness seems to be an acceptable choice of treatment modality. The study will help the clinicians to choose the sealant material and technique of enamel preparation.

Amyloid-Mediated Remineralization in Pit and Fissure for Caries Preventive Therapy

The pits and fissures of teeth have high caries susceptibility, and sealing these areas is considered as an effective method to prevent caries. However, long-term caries prophylaxis cannot be maintained because of the negative effects derived from the technical sensitivity and disadvantages of sealing materials. Herein, a new strategy is proposed to occlude fossae by amyloid-mediated biomimetic remineralization. In contrast to conventional inward blocking from the outside of fossae, amyloid-mediated biomimetic mineralization delivers an amyloid-like protein nanofilm into the deepest zone of the fossae and induces the formation of remineralized enamel inside. Such assembly from lysozyme conjugated with poly (ethylene glycol) enriches the interface with strongly bonded ionsand directs in situ nucleation to achieve enamel epitaxial growth. Not only is the structure of the enamel-like crystalline hydroxyapatite layer but also its mechanical stability is similar to that of natural enamel. Furthermore, the layer shows good biocompatibility and antibacterial properties. On the basis of the findings, it is demonstrated that amyloid-like protein aggregation may provide an enamel remineralization strategy to modify the current clinically available methods of pit and fissure sealing and shows great promise in preventing caries.

Pleomorphic Adenoma with Extensive Squamous and Adipocytic Metaplasia Mimicking as Low Grade Mucoepidermoid Carcinoma on FNAC

Pleomorphic adenoma (PA) is the most common salivary gland tumor, accounting for 54-76% of all salivary gland neoplasms. Extensive squamous metaplasia in PA can be mistaken for malignancy, including low grade mucoepidermoid carcinoma and squamous cell carcinoma. Here, we present an unusual case of PA with extensive squamous metaplasia and keratin cyst formations in a minor salivary gland, and discuss its microscopic features, including the immunohistochemical characteristics, and differential diagnosis of this uncommon presentation.

Evaluation of Microleakage of Different Types of Pit and Fissure Sealants: An In Vitro Comparative Study

Aim

Compare and evaluate the microleakage of different types of pit and fissure sealants, 3M ESPE Clinpro, GC Fuji Triage Capsule, and 3M ESPE Filtek Z350 XT.

Materials and methods

A total of 54 freshly extracted maxillary and mandibular premolar teeth were used and randomly divided into three groups of 18 teeth each, and the following pit and fissure sealants were used: group I-Clinpro, group II-GC Fuji Triage Capsule, and group III-Filtek Z350 XT. Samples underwent thermocycling at 5° and 55°C with a dwell time of 10 seconds for 250 cycles. The apices of the teeth were sealed with impression compound, and two coats of fingernail polish were applied and immersed in 5% methylene blue dye for 24 hours and then sectioned. The sectioned specimens were then analyzed at 4× magnification under a stereomicroscope for dye penetration and were evaluated based on Williams and Winters' criteria.

Results

The data were collected for statistical analysis. Descriptive statistics included mean, standard deviation (SD), frequency, and percentage. Inferential statistics included the Chi-squared test and one-way analysis of variance (ANOVA), followed by the post hoc Tukey's test. The level of significance was set at 0.05 at a 95% confidence interval, and the results revealed that the mean difference of the sealants was GC Fuji Triage (2.1667), Clinpro (0.7778), and Filtek Z350 XT (0.1667).

Conclusion

Filtek Z350 XT exhibited the least microleakage when compared to Clinpro and GC Fuji Triage, with their mean difference statistically significant. Hence, Filtek Z350 XT can be a promising sealant and a restorative material.

How to cite this article

Prabahar T, Chowdhary N, Konkappa KN, et al. Evaluation of Microleakage of Different Types of Pit and Fissure Sealants: An In Vitro Comparative Study. Int J Clin Pediatr Dent 2022;15(5):535-540.

Assessment of influence of LED curing units used on microhardness of resin-modified glass ionomer sealants

Aim: Resin modified glass ionomer (RMGI) is class of material that can be used as sealant for preventing and arresting the progression of caries in pits and fissures. As these are hybrid materials, their properties can be affected by factors related to the polymerization process. Therefore, this study aimed to evaluate the influence of different generations of LED curing units (Elipar DeepCure-L and VALO Grand) on Knoop microhardness values (KHN) of RMGI sealants (Clinpro XT and Vitremer). Methods: Forty cylindrical specimens (6mm ø x 1 mm high) were prepared according to the manufacturer’s instructions and divided into four groups (n=10) according to the type of RMGI and LED used. The KHN of the top surface of each sample was calculated 7 days after light-curing. Data were submitted to two-way ANOVA (α = 0.05). Results: Vitremer had higher KHN values than Clinpro XT after using both LEDs (p<0.0001), but especially when light-cured with the use of VALO Grand (p<0.0001). Whereas the KHN value of Clinpro was not influenced by the LED device (p>0.05). Conclusions: Top surface microhardness values of RGMI sealants were affected by both material composition and generations of LED curing units used. Third generation LED curing units seemed to be more efficient for the polymerization of RMGI-based sealants.

Retention and caries-preventive effect of four different sealant materials: A 2-year prospective split-mouth study

AIM

The aim of this observational split-mouth study was to compare the retention and caries protective effect of four different sealant materials in children aged 6-13 years during a 2-year follow-up period.

DESIGN

Eighty children were included in this study, which was conducted in Blato (Korčula island), Croatia. Each participant received at least two different sealant materials on caries-free permanent molars in two different quadrants. Sealant materials (M1 - glass-ionomer cement; M2, M4 - resin-based filled sealants; M3 - resin-based unfilled sealant) were delivered in a random order.

RESULTS

The results of this study showed that M2 (30 teeth, 46.2%) and M4 (27 teeth, 46.6%) showed statistically significantly higher number of teeth with total retention after 2-year follow-up period, in comparison with M1 (10 teeth, 19.2%) or M3 (12 teeth, 20.7%) (p < .001). There was no statistically significant difference in caries occurrence between different groups in which the sealant material was totally retained.

CONCLUSIONS

According to the results of this study, filled resin-based sealant materials showed better retention during the 2-year follow-up period while both resin-based and glass-ionomer sealants demonstrated protection against dental caries if totally retained on the occlusal surface.

COMPARATIVE EVALUATION OF A FISSURE SEALANT AND A FLOWABLE COMPOSITE: A 36-MONTH SPLIT-MOUTH, RANDOMIZED CLINICAL STUDY

OBJECTIVES

The purpose of the present clinical evaluation was to investigate the effect of a fissure sealant and a flowable composite at fissures of permanent molars in terms of retention and caries-incidence rates over a 36-month period.

METHODS

Thirty-four patients, ages varied from 16 to 22 years, diagnosed with at least 2 non-cavitated pit-and-fissure caries in the first and second molars were involved in the study. A total of 220 sealants, were placed in 117 upper molars and 103 lower molars. Teeth were sealed with either a flowable resin composite (Tetric Evo Flow) or a sealant material (Helioseal F)(n=110). Each restoration was evaluated in terms of retention and caries incidence at 6, 12, 24 and 36 months according to their location as well. Data were analyzed using Mann-Whitney U, Friedman and 1-way ANOVA tests at p < 0.05.

RESULTS

Tetric Evo Flow showed total retention with 95.5%, 93.8%, 88.5% and 80.2% at 6, 12, 24 and 36-month follow-ups respectively, while Helioseal F had retention rates of 95.5%, 94.8%, 85.4% and 80.2% respectively. After 36-months, there were 6 subjects totally lost in Helioseal F group, whereas 7 of the Tetric Evo Flow sunjects were totally lost. Caries development was firstly detected at 12-month evaluation for both of the materials however, no significant differences were observed among materials in retention rates or caries incidence after 36-month follow-ups (p>0.05).

SIGNIFICANCE

Using the flowable composite found as effective as the fissure sealant after 36-months regarding retention and caries incidence rates.

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.

Pit and Fissure Sealant versus Fluoride Varnish for the Prevention of Dental Caries in School Children: A Systematic Review and Meta-Analysis

Children's dental health has become the main concern, due to the increase in caries prevalence amongst children. Pit and fissure sealant (PFS) and fluoride varnish (FV) are effective measures for preventing dental caries. However, the clinical efficacy of these interventions when compared to one another is uncertain. The aim of the present systematic review with meta-analysis was to compare pit and fissure sealants with fluoride varnish for caries prevention of first permanent molars among schoolchildren. This is a meta-Analysis, which involves randomized control trials that compare the effectiveness of PFS with FV within 24 months of follow-up. Five databases were searched from 1990 to 2019 to identify studies published in Arabic or English language. The risk ratio (RR) and 95% confidence intervals (CIs) were calculated using a random-effects model. A total number of 4 studies were included with overall of 1249 children in both groups. Three included trial reported caries increment of first permanent molars (FPM) with 24 months of follow-up, there was no statistical significance (RR: 0.65; 95% CI 0.31 to 1.35; P = 0.26 I2 = 89%). As regards DMFS increment, the analysis showed no statistical differences between FV and PFS in terms of lowering DMFS increment (MD: 0.09; 95% CI: -0.03 to 0.21). Findings of this meta-analysis proved there is no significant difference between PFS and FV in caries prevention efficacy of FPMs at 2 years' follow-up, emphasizing the use of FV since it is more affordable and easier to apply.

Toothbrush-Dentifrice Abrasion of Dental Sealants: An In Vitro Study

Objective  This study sought to investigate the toothbrush-dentifrice abrasion of dental sealants.

Materials and Methods  Weight loss (∆W) and depth loss (∆D) were used as abrasion indicators. Sealant samples from nine products were soaked in dentifrice slurry and abraded by using a toothbrushing machine with a brushing force of 300 g. The mean percentages of ∆W and mean values of ∆D after 24,000 and 48,000 strokes of brushing were compared by using paired t -test. A comparison of these mean values among sealant products was performed by using one-way ANOVA and multiple comparison analysis (Scheffe's test).

Results  Abrasive wear was observed in all sealants. Teethmate F-1 (Kuraray Noritake, Tokyo, Japan)—a fluoride-releasing unfilled sealant—exhibited the maximum abrasive wear, with ∆W and ∆D values of 1.14% ± 0.37% and 12.84 ± 4.28 µm, respectively. Delton (Dentsply Sirona, Charlotte, North Carolina, United States), a light-cured unfilled sealant, showed the minimum abrasive wear, with ∆W and ∆D values of 0.41% ± 0.09% and 2.93 ± 1.23 µm, respectively. No statistical differences were observed among unfilled sealants except when compared with Teethmate F-1. Similarly, no differences were observed when comparing among filled sealants and flowable composite.

Conclusion  Abrasive wear occurred in all sealants after brushing with dentifrice. Almost all unfilled sealants showed less wear compared with both filled sealants and flowable composite. However, the low abrasive values of all sealants after brushing with dentifrice implied that there is no clinical significance to this finding.

Retention of pit and fissure sealants versus flowable composites in permanent teeth: A systematic review

OBJECTIVE

To summarize the available clinical evidence on the relative effectiveness of retention of resin-based pit and fissure sealants (PFS) with that of flowable composites on occlusal surfaces of permanent teeth when evaluated in clinical trials.

SOURCES

Electronic searches were performed in PubMed and Cochrane Library for the identification of relevant studies, from their inception until February 2020 and an additional search was done with the reference lists of included articles.

STUDY SELECTION

The review protocol followed the PRISMA guidelines and was registered in PROSPERO (CRD42018112805). The risk of bias of the studies was independently appraised using the revised Cochrane Risk of Bias tool (RoB 2.0).

DATA

Ten articles were considered relevant for qualitative synthesis. The data extracted from two of the included articles showed statistically significant difference between the two materials based on their retention potential, of which one article favored superior retention of flowable composites and one article favored higher retention of PFS and the other eight studies showed no significant difference between the two materials.

CONCLUSION

The current review has shown evidence suggesting the effective retention of resin-based pit-and-fissure sealants and flowable composites when applied to prevent occlusal caries in permanent molars, however, this evidence is of low quality. Carefully designed long-term clinical trials are required to support the results of this review.

CLINICAL SIGNIFICANCE

This is an important topic that would be of significant interest in the field of preventive dentistry, where sealants are the primary recommended method to prevent caries. The clinical efficacy of sealants is directly linked to their potential to retain and this systematic review focuses on comparing the relative effectiveness of resin-based pit-and-fissure-sealants with flowable composites in permanent teeth.

Comparison and Evaluation of the Retention, Cariostatic Effect, and Discoloration of Conventional Clinpro 3M ESPE and Hydrophilic Ultraseal XT Hydro among 12-15-year-old Schoolchildren for a Period of 6 Months: A Single-blind Randomized Clinical Trial

Introduction

Pit and fissures are more prone to caries as compared to smooth surfaces. Sealing the pit and fissures with sealants is considered to be highly effective in the prevention of pit and fissure caries. Hydrophobic sealants are technique sensitive in nature. Ultraseal XT Hydro sealant is moisture tolerant which incorporates the benefits of both hydrophilic and hydrophobic sealants into one unique chemistry. Hence, the study was conducted to compare and evaluate the retention, cariostatic effect, and discoloration of conventional Clinpro™ 3M™ ESPE™ and hydrophilic Ultraseal XT Hydro sealants among 12–15-year-old schoolchildren for 6 months.

Materials and methods

It was a single-blinded, randomized split-mouth clinical trial. Schoolchildren aged 12–15 years were recruited in this clinical trial. Clinpro sealant and Ultraseal XT Hydro were placed in the right and left quadrant molars, respectively, and were assigned as group I and II. The sample size arrived was 60 teeth per group and at 30 patients based on the computer-generated random sequence. Sealant coverage between the two sealants was compared using Mann–Whitney test and Z test for proportions.

Results

After 6 months, it was seen that 10 teeth out of 44 (22.72%) with Clinpro had the sealant covering all the fissures compared to Ultraseal XT Hydro which was only 9%. Fifty-nine percent of retention rate was seen with Clinpro compared to Ultraseal XT Hydro sealant (27.27%). Caries incidence was higher in the case of group II. No difference was observed with regard to the discoloration of the sealants.

Conclusion

It was concluded that for a longer follow-up period conventional Clinpro™ 3M™ ESPE™ was better than Ultra XT Hydro seal in terms of retention and cariostatic effect.

How to cite this article

Mohapatra S, Prabakar J, Indiran MA, et al. Comparison and Evaluation of the Retention, Cariostatic Effect, and Discoloration of Conventional Clinpro 3M ESPE and Hydrophilic Ultraseal XT Hydro among 12–15-year-old Schoolchildren for a Period of 6 Months: A Single-blind Randomized Clinical Trial. Int J Clin Pediatr Dent 2020;13(6):688–693.

Effectiveness of Seven Types of Sealants: Retention after One Year

Aim

The aim of this study is to determine the retention rate and pattern of different pit and fissure sealants placed on the occlusal surface of newly erupted first permanent molars after 3, 6, 9, and 12 months.

Materials and methods

Seventy children were enrolled in this study. They divided into seven groups (m = 10) according to the type of the sealant. The four permanent first molars of each child were sealed. The sealant was applied according to the instructions from the manufacturer. A clinical evaluation was carried out at 3, 6, 9, and 12 months. The clinical observations were divided into three categories: total retention (TR), partial retention (PR), and total loss (TL).

Results

The resin-based sealant performed better than the glass ionomer-based sealant except for the Ketac Molar Easymix. At 3 months, there was no significant difference among all the tested groups (p > 0.05), while at 6, 9, and 12 months, there was a highly significant difference (p < 0.001). The glass carbomer sealant showed the least retention rate at all intervals.

Conclusion

With an exception of the Ketac Molar Easymix, resin-based sealers performed better than glass ionomer-based sealers.

Clinical significance

A proper application of pit and fissure sealant will decrease the chance for caries development in newly erupted teeth.

How to cite this article

Hassan AM, Mohammed SG. Effectiveness of Seven Types of Sealants: Retention after One Year. Int J Clin Pediatr Dent 2019;12(2):96-100.

Retention of pit and fissure sealant versus flowable composite: An in vivo one-year comparative evaluation

INTRODUCTION

Pits and fissures are extremely vulnerable to the development of caries. Resin-based materials for sealing pits and fissures (pit and fissure sealants and flowable composites) are helpful in caries control by physical barrier formation, which prevents metabolic exchange between fissure microorganisms and oral environment. Retention is one of the most important prerequisites for pit and fissure sealants. Debris and pellicle might not be removed by conventional prophylaxis and etching; therefore, air abrasion (AB) for fissure preparation has been advocated for sealant retention. This in vivo study was aimed to compare the retention of resin-based pit and fissure sealant to flowable resin composition occlusal pits and fissures of all first permanent molars with and without air-abrasion over a 12-month follow-up.

MATERIALS AND METHODS

A randomized controlled clinical trial was done after obtaining ethical committee approval and informed and written consent. Thirty children with the age of 6-9 years, with all four caries-free first permanent molars without any hypoplasia/fracture but with pits and fissures prone to caries were included in this study. The four first molars were divided into the following four groups: Group A (tooth 16; sealant + AB), B (tooth 46; composite + AB), C (tooth 36; sealant), and D (tooth 26; composite). Assessments were made at 3, 6, 9, and 12 months for partial or total loss of sealant and caries according to Modified Simonsen's Criteria.

RESULTS AND CONCLUSIONS

Flowable composite was relatively better retained than sealant at 12 months' follow-up although results were statistically insignificant. AB followed by acid etching brought superior retention than acid etching. Mandibular teeth have shown relatively superior retention. Future studies should aim at investigating better techniques and materials for sealing pit and fissures.

Improvement of Pit-and-Fissure Sealant Bonding to Enamel with Subpressure Treatment

This research evaluated the effects of subpressure on the shear bond strength (SBS) of 80 specimens with flat enamel surfaces and on AgNO₃ microleakage of 40 specimens with flat enamel surfaces and 40 specimens with 1 mm deep cavities before and after thermocycling. The enamel of 168 specimens was grounded to a flat surface. Two types of sealants (E and H) were selected. Sealants were applied to enamel surface (88 specimens, group F) either subjected or not to subpressure. The bonding interfaces were observed using scanning electron microscopy (SEM) and the SBS was examined using a universal testing machine before and after thermocycling. The failure mode was also analyzed. For the microleakage test, 80 specimens were grouped as group A (original enamel flat surface) and group B (a round cavity of 1 mm in depth) (40 per group). Sealants were applied to the teeth either subjected or not to subpressure. The specimens were submitted to a microleakage protocol with AgNO₃ and analyzed before and after thermocycling. Statistical analysis was performed for the data. The results showed that subpressure eliminated voids on the interface between the enamel and sealants and significantly enhanced specimens' SBS. Although thermocycling reduced SBS significantly, specimens under subpressure after thermocycling still showed higher SBS than specimens under nonsubpressure before thermocycling. The subpressure groups showed a lower microleakage level compared to nonsubpressure groups, though thermocycling caused deeper silver infiltration. In addition, different sealants showed no significant effect on the SBS and microleakage performance. Overall, subpressure application improves sealant bonding and retention rate and has potential to prevent secondary caries.

Comparative Evaluation of Retention, Cariostatic Effect and Discoloration of Conventional and Hydrophilic Sealants - A Single Blinded Randomized Split Mouth Clinical Trial

Introduction:

Pit and fissures are approximately eight times vulnerable than the smooth surface caries lesion. Sealants are effective in preventing, arresting, and progression of pit-and-fissure occlusal caries lesions. The failure of sealant resin-based retention is mainly attributed to the moisture contamination. To overcome this drawback, UltraSeal XT^® hydro, a moisture-friendly sealant, has been introduced.

Aim:

This study aimed to compare and evaluate the retention, cariostatic effect, and discoloration of conventional Clinpro™ 3M™ ESPE™ and hydrophilic UltraSeal XT^® sealants among 12 to 15-year-old schoolchildren for 3 months.

Materials and Methods:

A single-blinded, randomized, split-mouth clinical trial was conducted among thirty schoolchildren aged 12–15 years. Sealants used in the present study were Group I – Clinpro™ and Group II – UltraSeal XT^® hydro. Sealants were provided in the school by two operators based on the computer-generated random sequence and the study participants were evaluated after 3 months for sealant coverage, caries incidence, and discoloration using Color, Coverage and Caries sealant evaluation system. Sealant coverage between the two sealants was compared using Mann–Whitney U-test and Z-test for proportions.

Results:

A total of 47 teeth (78.3%) with UltraSeal XT^® Hydro had the sealant covering in all the fissures compared to Clinpro™ 3M™ ESPE™ which was 46.7% (28 teeth) and the difference was observed to be statistically significant.

Conclusion:

Hydrophilic UltraSeal XT^® Hydro yielded better sealant coverage (retention) compared to the conventional Clinpro™ 3M™ ESPE™. No difference was observed with regard to cariostatic effect and discoloration.

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.

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.

Evaluation of retention of pit and fissure sealants placed with and without air abrasion pretreatment in 6-8 year old children - An in vivo study

Background

The success of pit and fissure sealants is directly related to their retention. The purpose of this study was to assess and compare the retention of pit and fissure sealants placed using acid etch alone and a combination of air abrasion and acid etch techniques.

Material and Methods

50 subjects aged 6-8 years were included in the study. Primary second molars and permanent first molars were sealed in all four quadrants using split mouth design. The right maxillary and mandibular molars (Group A) were treated by acid etching alone while the left maxillary and mandibular molars (Group B) were pretreated with air abrasion followed by acid etching before application of pit and fissure sealant. Retention of sealants was checked using Simonsen’s criteria of sealant retention after three and six months of sealant application.

Results

There was no significant difference in retention of sealants in Group A and Group B (p<0.05) after three and six months follow up. The difference in sealant retention in primary and permanent molars was not significant (p>0.05). Maxillary molars showed superior retention compared to mandibular molars, which was statistically significant at both three and six months (p<0.05).

Conclusions

Combining air abrasion pretreatment with subsequent acid etching did not result in statistically significant difference in sealant retention compared to acid etching alone in both primary and permanent molars after 3 and 6 months follow up. An additional air abrasion pretreatment step can be avoided in pediatric patients when placing sealants and the procedure can be completed faster with better behavior management using acid etching alone.

Key words:Pit and fissure sealant, acid etching, air abrasion.

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.