Detection of pit and fissure sealant microleakage using quantitative light-induced fluorescence technology: an in vitro study

This in vitro study aimed to evaluate the feasibility of quantitative light-induced fluorescence (QLF) technology for detecting the presence and severity of microleakage of pit and fissure sealants. The areas of interest (AOIs) were 160 pits and fissures of 40 extracted permanent teeth. Fluorescent images were acquired using a QLF device, and the maximum fluorescence loss ΔFmax of each AOI was analyzed. After staining and cross-sectioning of the teeth, histological dye penetration was scored on a scale of 0 to 3. The relationship between ΔFmax and microleakage depth was analyzed, and the areas under the curve (AUCs) were calculated. The │ΔFmax│ increased as microleakage depth increased. The ΔFmax values of microleakage areas showed a strong significant correlation with the histological scores of dye penetration (r = - 0.72, P = 0.001). AUC analysis showed a high diagnostic accuracy for microleakage depth (AUC = 0.83-0.91). The highest AUC of 0.91 was found when differentiating the outer half microleakage of the sealant (histological score 0 vs. 1-3). QLF technology is effective in assessing the presence and severity of microleakage, suggesting its potential for noninvasive detection and monitoring of sealant microleakage in clinical settings.

Effect of sonic oscillation on penetration and marginal adaptation of filled-resin-based fissure sealants

OBJECTIVES

To evaluate the effect of sonic oscillation on penetration depth and marginal adaptation of resin-based fissure sealants.

METHOD AND MATERIALS

Thirty-six extracted human third molars were randomized into three groups: in the HF group, teeth were sealed with a filled-resin-based sealant (Helioseal F); in the Sonic-HF group, teeth were sealed with Helioseal F and subjected to sonic oscillation (Compothixo Device, 140 Hz vibration frequency and ± 150 µm amplitude) before curing; in the CO group, teeth were sealed with an unfilled-resin-based sealant (Clinpro). All teeth were thermocycled for 1,500 cycles at 5°C and 55°C, then sectioned buccolingually into four sections (mesial, two middle, and distal). Sections were evaluated under SEM for marginal adaptation and scored. For penetration depth, three independent measurements from each tooth were recorded under SEM, and data were subjected to statistical analysis.

RESULTS

The group subjected to sonic oscillation (Sonic HF) resulted in significantly superior penetration depth and marginal adaptation compared with the HF group, but with no significant difference compared with the CO group.

CONCLUSIONS

Sonic activation of resin-based sealant increased penetration depth into fissures and marginal adaptation to the enamel wall without decreasing filler load or compromising sealant mechanical properties.

Evaluation of the amount of residual monomer released from different flowable composite resins

Today, resin materials are used in the restoration of permanent and deciduous teeth or as fissure sealants. The materials can contain different types of monomers (Bis-GMA, UDMA, TEGDMA). These monomers can be released into the oral cavity after polymerization. Residual monomers released from resin-containing restorative materials after polymerization have been reported to have negative effects on mechanical properties. The aim of our study is to evaluate the amount of residual monomers released after polymerization of different flowable composite resin materials using two different modes of LED light source. Composite disc samples (8 mm diameter/2 mm depth) prepared for each material group were polymerized using two different modes of the LED light device (Standard mode and extra power mode). HPLC (High Performance Liquid Chromatography) device was used to measure the amount of residual monomer release at 1 h, 1 day, 3 days and 7 days periods. Pairwise comparison of the differences between the materials was performed by Post-hoc test. For each residual monomer, the Kruskal Wallis test was used to analyze the difference between the materials in standard mode and the difference between the materials in extra power mode. According to the results of the study; Grandio flow flowable composite showed the highest release of TEGDMA and Bis-GMA while SDR® Flow flowable composite showed the lowest release of TEGDMA, Bis-GMA and UDMA. For all materials, the extra power mode resulted in more residual monomer release. TEGDMA and Bis-GMA release was detected in all tested flowable composites at all time periods.

In vitro evaluation of wear resistance, microhardness and superficial roughness of different fissure sealants after aging

The aim of this study was to compare the aging effects on wear, surface roughness and microhardness of fissure sealants having varying contents. Four fissure sealant types were used in the study: Aegis (Bosworth, USA) (Group A), Beautisealant (Shofu, Japan) (Group B), Clinpro (3M, USA) (Group C), and Ultraseal XT/Hydro (Ultradent, USA) (Group U). Hundred disc-shaped specimens (5 mm diameter/3 mm width) were designed according to the manufacturer's instructions and assigned for microhardness/Vickers Hardness (VHN), surface roughness, and wear tests. Thermocycling (10,000 times/5-55 °C ± 2 °C/20 s) and chewing simulator (75,000 times/49 N) were applied as the aging procedures. Measurements were made before and after the aging procedures. The specimens were examined by Scanning Electrone Microscopy (SEM). Data was statistically analyzed through Kruskal Wallis, Wilcoxon and Welch tests. The highest and the lowest changes in mean microhardness values were obtained for Group U (9.88 ± 1.46) and Group A (4.40 ± 0.46), respectively; and a significant difference (p < 0.001) was found between the mean changes in microhardness numbers (U > B > C > A). The median roughness values had no significant difference; the surface roughness had the highest mean differences in Groups U and C (U = C > A > B). Significant difference was found between the mean changes in wear/weight values (p < 0.001); the highest and the lowest mean weight losses were recorded in Group U (0.0097 ± 0.0003 gr), and Group C (0.0041 ± 0.0006 gr), respectively (U > B > A > C). The highest physical changes were determined in Group U after the aging procedures. It is concluded that the aging procedures affect physical structures of all test materials with varying degrees, however Ultraseal XT/Hydro is the most affected. The individual treatment needs and material properties must be considered to select a fissure sealant material.

Evaluation of the effect of high-intensity light-curing device on micro-leakage of pits and fissure sealants

Reducing treatment time is one of the most important trends in modern dentistry. This study aimed to compare the micro-leakage around the resin sealants when using both high and conventional intensity light-curing systems. The study sample consisted of 30 extracted human maxillary premolar teeth that were divided into two equal groups according to the light-curing system used: Group 1, High-Intensity Light-Curing System and Group 2, Conventional Light-Curing System. Light-curing by Woodpecker I-LED device with two intensities (high and conventional) has been used. All teeth were subjected to 500 cycles of thermocycling. Then, a methylene blue dye microleakage test was performed, and the teeth were sectioned longitudinally and studied under a stereo microscope. The mean of micro-leakage in the high-intensity group (1.33 ± 1.29) was less than in the conventional intensity group (1.63 ± 1.29) without any statistically significant differences (p = 0.320). The high-intensity light-curing system mode may be a good and acceptable alternative to conventional intensity light-curing system mode in polymerization of pits and fissure sealants.

Wear behavior of different materials used for pit and fissure sealing

PURPOSE

To evaluate the wear of different materials used for pit and fissure sealing applied with non-invasive and invasive preparation techniques.

METHODS

A total of 170 molar teeth were divided into two main preparation groups (non-invasive and invasive), each consisting of eight subgroups after a control group was separated for wear standardization. Eight subgroups included: nano-filled flowable composite (Filtek Ultimate Flow), nanohybrid flowable composite (GrandioSo Flow), micro-hybrid flowable composite (Majesty Flow), resin-based unfilled fissure sealant (ClinPro Sealant), resin-based filled fissure sealant (Fissurit FX), resin-based highly filled fissure sealant (GrandioSeal), giomer-based fissure sealant (BeautiSealant), and glass-ionomer-based fissure sealant (Fuji Triage) (n= 10). The materials were applied according to the manufacturers' instructions. The initial data were obtained for wear analysis. The specimens were subjected to 2-year thermocycling and brushing simulations. Final data were obtained, and the wear characteristics were evaluated digitally. Data were statistically analyzed (P< 0.05).

RESULTS

There were no significant differences in wear between the non-invasive and invasive application groups (P< 0.05). In comparison of the materials, flowable composites presented the lowest wear (0.15 P± 0.13), and glass-ionomer-based fissure sealant presented the highest wear (0.66 P± 0.32).

CLINICAL SIGNIFICANCE

The present study reported that the invasive preparation technique, which slightly abrades the enamel surfaces, did not adversely affect the wear of the sealant materials. Although the application of flowable composites as fissure sealants with a bonding agent is time-consuming and costly, it yielded better results in terms of wear.

Factors that Affect the Shear Bond Strength of Pit and Fissure Sealants to Tooth Structure: A Systematic Review

INTRODUCTION

Pit and fissure sealants are effective in preventing caries disease, however, they may present flaws that damage the physical barrier leading to treatment failure.

OBJECTIVE

To answer the question ''Do pit and fissure sealants present good adhering to the dental structure when analyzed by their resistance to shear/microshear?".

METHODS

This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and was recorded in Open Science Framework. Embase, PubMed, SCOPUS, and Web of Science databases were used for the search strategy. The articles were selected according to the eligibility criteria. The risk of bias was performed with the adaptation of the quasi-experimental studies tool by Joanna Briggs Institute (JBI).

RESULTS

1245 studies were found in the databases when applying the search strategy, after removal of duplicates 881 were evaluated and 44 were selected. After applying the JBI tool, 30 studies presented low risk and 15 moderate risk of bias. Meta-analysis was not possible to performed due to the heterogeneity of the studies.

CONCLUSION

The adhesion is dependent on the application protocol, and among the protocols evaluated, conditioning with 37% phosphoric acid for 60 seconds and contamination of the substrate, as these can affect sealant adhesion.

Impact of the COVID-19 pandemic on oral health care use in the United States through December 2021

BACKGROUND

The purpose of this study was to assess the effects of the COVID-19 pandemic on oral health care provided from July 2020 through December 2021 using national claims data.

METHODS

Deidentified quarterly claims from 2017 through 2021 were analyzed (2017-2019 provided prepandemic data). Data were sorted into multiple treatment categories. Analyses compared prepandemic with postpandemic procedure volumes and were stratified according to age groups (0-5 years, 6-18 years, 19-64 years, ≥ 65 years).

RESULTS

For children aged 0 through 5 years, use of sealants and topical fluorides other than varnish were considerably lower in 2021, as were direct operative and palliative procedures from 2020 through 2021. Only use of silver diamine fluoride, prefabricated crowns, and oral surgery increased significantly (P < .05) in some quarters. For children aged 6 through 18 years, diagnostic, direct operative, periodontic, oral surgery, and palliative procedures were significantly lower in most of 2020 through 2021, and only prefabricated crowns and indirect operative procedures increased significantly in more than 3 quarters. For adults aged 19 through 64 years, diagnostic and preventive procedures were significantly lower in 3 quarters, and direct operative, gingival surgery, endodontic, and palliative procedures were significantly lower in most of 2020 through 2021. Only occlusal guards and scaling and root planing increased significantly in more than 3 quarters. For adults 65 years and older, direct operative, gingival and osseous surgery, and palliative procedures were significantly lower in more than 3 quarters; all other procedures increased significantly in more than 3 quarters.

CONCLUSIONS

The pandemic was associated with changes in the provision of oral health care that persisted for more than 1 year.

PRACTICAL IMPLICATIONS

Reductions in preventive procedure volumes across age groups younger than 65 years may have implications for longer-term effects of the pandemic.

Evaluation of the marginal integrity of various pit and fissure sealants

PURPOSE

To evaluate the marginal integrity of various pit and fissure sealants subjected to different application methods.

METHODS

A total of 253 non-carious human third molars extracted and randomly divided into two groups according to the preparation method employed: invasive or non-invasive. Eight fissure sealant materials were tested: nano-filled flowable composite (Filtek Ultimate Flow), nanohybrid flowable composite (GrandioSo Flow), micro-hybrid flowable composite (Majesty Flow), resin-based unfilled fissure sealant (ClinPro Sealant), resin-based filled fissure sealant (Fissurit FX), resin-based highly filled fissure sealant (GrandioSeal), giomer-based fissure sealant (BeautiSealant), and glass ionomer-based fissure sealant (Fuji Triage). Samples were subjected to two-year cyclic thermo-mechanical and brushing simulations. Two observers quantitatively evaluated the restoration margins and classified them as either "permanent restoration edge", or if a gap larger than 250 μm was evident, "gapping at the restoration edge". The extent of the gap was recorded as a percentage relative to the total length of the restoration edge.

RESULTS

The baseline marginal adaptation had no significant effect on the marginal adaptation (P > 0.05). However, the preparation method and type of fissure sealant material had a significant impact on the marginal adaptation (P < 0.05).

CONCLUSION

On the basis of quantitative analysis, the highest marginal integrity was observed for flowable composites, whereas the lowest was observed for glass ionomer-based fissure sealant.

Shear Bond Strength and Microleakage of Fissure Sealant to Contaminated and Non-Contaminated Enamel: A Systematic Review and Meta-Analysis of In Vitro Studies

Purpose: The purpose of this study was to review the in vitro literature on shear bond strength (SBS) and microleakage of pit and fissure sealant materials in contaminated (water, human, or artificial saliva) and non-contaminated conditions. Methods: PubMed®, Web of Science™, Scopus®, Embase™, and Cochrane Library databases were used as data sources. Of the 974 studies identified, 56 were considered eligible for full-text screening and 32 were selected for data extraction. Results: The meta-analysis demonstrated that contaminated conditions decreased the SBS of the sealants by 4.33 MPa. In the contaminated subgroup analysis, both unfilled (Clinpro™, 3M™) and filled (FluroShield®, Dentsply) resin-based sealants achieved a similar SBS (P=0.82). Regarding the outcome measurements, extensive methodological heterogeneity was found among the studies for SBS measurements (I 2 equals greater than or equal to 84 percent; P<0.001), whereas homogeneity was found for microleakage (I 2 equals 84 percent; P=0.85). When evaluating resin-based sealants, the level of microleakage in the contaminated and non- contaminated groups was not significantly different (P=0.1). Conclusion: Surface contamination decreases the bond strength between contaminated enamel and both unfilled and filled resin-based sealants, which affects the clinical effectiveness of sealants.

Do nanofillers provide better physicomechanical properties to resin-based pit and fissure sealants? A systematic review

The purpose of this study was to systematically review the impact of nanofillers on the physicomechanical properties of resin-based pit and fissure sealants (RBS). This review included in vitro studies with full-length English-language articles reporting on the physicomechanical properties of nanofilled RBS until February 2023. PubMed, Web of Sciences, Scopus, and LILACS databases were accessed for literature searches. The review was formulated based on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and used the Consolidated Standards of Reporting Trials (CONSORT) guidelines and risk of bias Cochrane tool for quality assessment. The search resulted in 539 papers, of which 22 were eligible to be included in the review. Inorganic, polymeric, core-shell, and composite nanomaterials were used to reinforce the studied RBS. The inherent nature of the nanomaterial used, its morphology, concentration, and volume used were the primary parameters that determined the nanomaterial's success as a filler in RBS. These parameters also influenced their interaction with the resin matrix, which influenced the final physicomechanical properties of RBS. The use of nanofillers that were non-agglomerated and well dispersed in the resin matrix enhanced the physicomechanical properties of RBS.

Economic evaluation of fluoride varnish application in preschoolers: A systematic review

BACKGROUND

Fluoride varnish (FV) is a convenient way of professionally applying fluoride in preschoolers. However, its modest anticaries effect highlights the need for economic evaluations.

AIM

To assess economic evaluations reporting applications of FV to reduce caries incidence in preschoolers.

DESIGN

We included full economic evaluations with preschool participants, in which the intervention was FV and the outcome was related to dentin caries. We searched in CENTRAL; MEDLINE via PubMed; WEB OF SCIENCE; EMBASE; SCOPUS; LILACS; BBO; and BVS Economia em saúde, OpenGrey, and EconoLit. Clinical trial registers, thesis and dissertations, and meeting abstracts were hand searched, as well as 11 dental journals. Risk of bias in the included studies was assessed using the Philips' and Drummond's (full and simplified) tools.

RESULTS

Titles and abstracts of 2871 articles were evaluated, and 200 were read in full. Eight cost-effectiveness studies were included: five modeling and three within-trial evaluations. None of the studies gave sufficient information to allow a thorough assessment using the bias tools. We did not combine the results of the studies due to the great heterogeneity among them. Four studies reported that FV in preschool children was a cost-effective measure, but in one of these studies, sealants and fluoride toothpaste were more cost-effective measures than the varnish, and three studies used limited data that compromised the generalizability of their results. The other four studies showed a large increase in costs due to the application of varnish and/or low cost-effectiveness.

CONCLUSION

We did not find convincing overall evidence that applying FV in preschoolers is an anticaries cost-effective measure. The protocol of this systematic review is available at Open Science Framework (https://osf.io/xw5va/).

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.

Synthesis and characterization of calcium-releasing elastomeric resin-based endodontic sealers

OBJECTIVES

To evaluate the incorporation of halloysite nanotubes (HNTs) loaded with one of two calcium sources (i.e., calcium hydroxide/CaOH2 or beta-tricalcium phosphate/β-TCP) on the physicochemical and biological properties of an experimental resin-based dual-cured endodontic sealer.

MATERIALS AND METHODS

HNTs were encapsulated with CaOH2 or β-TCP at 10 wt.%. HNTs containing CaOH2 or β-TCP were added into the experimental sealers at 50 wt.%. The control sealers were the calcium-free HNT-modified resin-based experimental sealer and AH Plus™, a commercially available endodontic sealer. Degree of conversion, setting time, flow, film thickness, radiopacity, dimensional stability, and calcium ions release were determined. Antibiofilm properties and cytocompatibility of the formulated sealers and commercial control were also evaluated. One and two-way ANOVA analysis followed by Tukey's post hoc test was conducted to evaluate the effect of the independent variable on the evaluated properties.

RESULTS

FTIR confirmed the encapsulation of calcium sources into HNTs. Regarding flow and film thickness, the values obtained from these sealers were in accordance with the specifications provided by ISO 6876. For radiopacity, AH Plus™ achieved the highest radiopacity (p<0.05). Among the experimental formulations, all experimental HNT-containing compositions exhibited values below 3 mm Al. The experimental sealers showed greater dimensional changes when compared to the commercial (AH Plus™) control. The release of calcium ions was observed for the HNT_CaOH2 and HNT_β-TCP sealers without statistical differences. Experimental sealers containing HNT_CaOH2 and HNT_β-TCP significantly reduced the CFU/mL count and showed cell compatibility.

CONCLUSIONS

The findings of this study demonstrate that the incorporation of HNT_CaOH2 or HNT_β-TCP into resin-based experimental sealers promoted antimicrobial effects and gradual calcium release without impairing cytocompatibility or physicochemical properties of the sealers. Still, an adjustment to reach the minimal radiopacity established by ISO 6876 is needed.

CLINICAL RELEVANCE

The experimental resin-based sealers seemed to be an alternative for endodontics. The incorporation of calcium sources exerts promising antimicrobial effects while displaying low cell toxicity.

Scanning electron microscope analysis to evaluate the effect of pretreatment with ozone and sodium hypochlorite on pits and fissures of primary teeth

Introduction

The cornerstone of preventative therapy is made up of pit and fissure sealants and fluorides. Resin sealants have been shown to help reduce fissure decay in both primary and permanent teeth. Etching of primary molars is not effective due to prismless enamel, higher organic content, and diversity in fissure shape. Methods of pretreatment of pits and fissures have been hypothesized to promote microporosities in etched enamel and hence sealant adherence. Examining the etching pattern and surface roughness of the enamel surface can be used to gauge these.

Objective

This study aimed to evaluate the effect of pretreatment with ozone gas and 5.25% sodium hypochlorite solution on pits and fissures of primary teeth to check for the etching pattern and surface roughness.

Materials and Methods

Thirty noncarious primary molars were sectioned to retain the crowns, and randomly divided into three groups, sodium hypochlorite, ozone gas, and control. Each sample was pretreated with the agent, washed, followed by etching with 37% phosphoric acid. Samples were sectioned and subjected to scanning electron microscope analysis to evaluate the etching pattern and surface roughness.

Results

Comparison of the etching pattern in three groups showed a statistically insignificant difference (P=0.364). Surface roughness was highest in the hypochlorite group followed by ozone and control which showed a statistically significant difference (P = 0.001). The surface area between the three groups showed a statistically insignificant difference.

Conclusion

Sodium hypochlorite is a better pretreatment agent compared to ozone gas and acid etching alone. However, as all results were not statistically significant further research must be carried out to prove the effectiveness of these agents.

Can music therapy and aroma therapy really reduce dental anxiety and fear?

DESIGN

This study was a randomised controlled trial (RCT) designed to evaluate the effectiveness of music therapy and aromatherapy on reducing dental anxiety and fear in children during a fissure sealant treatment.

CASE SELECTION

Participants were selected from three primary schools from the Phitsanulok Province in Thailand. These children were randomly allocated to a (1) Control group (n = 33), (2) Music Therapy Experimental Group (n = 33), (3) Aromatherapy Group (n = 33) and (4) Combination Experimental Group (n = 33). Measures included dental anxiety and fear scores as well as vital signs (blood pressure, heart rate and oxygen saturation level) pre- and post-fissure sealant treatment.

DATA ANALYSIS

Descriptive statistics were used for categorical data. Mean and standard deviations were calculated for continuous data. For the four arms, Chi-squared tests and one-way ANOVA were used to compare base line characteristics of the participants. Paired t-tests were used to compare changes within groups in dental anxiety and fear and vital signs pre- and post-treatment.

RESULTS

Overall, 128 participants took part in were in the final analysis (32, 33, 31 and 32 in groups 1-4, respectively). In the music therapy group and aromatherapy group, there was a decrease in dental anxiety and fear, blood pressure and increase in oxygen saturation level (p = 0.05). In the combination group, there was a decrease in dental anxiety and fear, heart rate, blood pressure and increase in oxygen saturation level (p = 0.05). A statistically significant interaction effect was found between combination therapy on dental anxiety and fear (F = 22.22; P < 0.001) and oxygen saturation level (F = 17.40; P < 0.001).

CONCLUSIONS

The authors conclude that the findings of this RCT suggest that the use of music therapy and aromatherapy reduces dental anxiety and fear in children, and is more effective when used in combination.

A Cluster Randomized Controlled Trial of the Dental Sealants Quality in Rural Schoolchildren Using Innovative Suction without Dental Assistance

This study examined whether the moisture control innovation (tongue and cheek retractors and saliva contamination (SS-suction)) used without dental assistance could improve the quality of dental sealant in rural Thai school children compared to a standard treatment, i.e., high power suction with dental assistance. A single blind, cluster randomized controlled trial was conducted. Participants were 15 dental nurses working in sub-district health promoting hospitals and 482 children. All dental nurses attended workshops of SS-suction and revised dental sealant procedures. Children with sound lower first permanent molar teeth were simple-randomly assigned to either an intervention or control group. The children in the intervention group were sealed with SS-suction, and the children in the control group were sealed with high power suction and dental assistance. There were 244 children in the intervention group and 238 children in the control group. Dental nurses' satisfaction on SS-suction was record by visual analogue scale (VAS) for each tooth during treatment. After 15-18 months, caries on sealed surfaces were examined. The results showed that the median satisfaction score of SS-suction was 9 out of 10, and 17-18% children experienced uncomfortable sensation during insertion or removal. The uncomfortable feeling disappeared once the suction was in place. Caries on sealed surfaces did not differ significantly between the intervention and control groups. Caries on the occlusal surface was present in 26.7% and 27.5%, and caries on the buccal surface was present in 35.2% and 36.4% of cases in the intervention and control groups, respectively. In conclusion, dental nurses were satisfied with SS-suction in terms of both function and safety. The effectiveness of SS-suction was compatible with the standard procedure after 15-18 months.

In vitro evaluation of fissure sealants' wear under erosive, abrasive and erosive/abrasive conditions

PURPOSE

To evaluate and compare the wear of selected resin-based fissure sealants with different compositions properties under erosive, abrasive, and erosive/abrasive conditions.

METHODS

Forty-five samples of the following resin-based fissure sealants were prepared: Fissurit (fluoride free), Fissurit F (with fluoride), Fissurit FX (55 wt.% filler content), Grandio Seal (70 wt.% nano-filler content) and bovine enamel. Fifteen samples from each material were randomly allocated into three groups according to the wear condition they would be subjected to as follows: erosive condition (citric acid, 1 min, pH 2.3), abrasive condition (120 brushing strokes at 2 N, toothpaste slurry RDA value = 69), and erosive/abrasive condition (combination of both). The wear challenges were repeated six times each day for 10 days. The material wear was measured using a stylus profilometer. Kruskal-Wallis and Conover's test was applied to compare the resulting material wear between the groups.

RESULTS

Under erosive conditions, Grandio Seal and Fissurit FX showed statistically significantly the least material wear. Under abrasive and erosive/abrasive conditions, Grandio Seal showed statistically significantly the least material wear. Fissurit F showed statistically significantly the highest material wear under abrasive and erosive/abrasive conditions, after dental enamel (p < 0.05).

CONCLUSION

Higher filler content in sealants leads to better wear resistance. Incorporating fluoride into sealants seems to reduce their wear resistance at similar filler contents.

The effects of disinfection with Er, Cr:YSGG laser, application of CPP-ACP and sodium hypochlorite on shear bond strength

BACKGROUND

The effects of commonly used antimicrobial and anticariogenic agents on the adhesion of pit and fissure sealants were investigated in this study.

AIMS

The aim of this study is to evaluate the effects of erbium, chromium: yttrium-scandium-gallium-garnet (Er, Cr:YSGG) laser disinfection, casein phosphopeptides-amorphous calcium phosphate (CPP-ACP) containing paste and sodium hypochlorite application before the placement of a resin-based pit and fissure sealant on the shear bond strength of primary tooth enamel.

MATERIALS AND METHODS

The shear bond strength test evaluated the bond strength of sealants on the buccal enamel surfaces of primary molar teeth. The study groups were pit and fissure sealant without any preapplication, pre application of disinfection with Er, Cr:YSGG laser, disinfection with Er, Cr:YSGG laser and CPP-ACP containing paste, sodium hypochlorite, sodium hypochlorite and CPP-ACP containing paste and CPP-ACP containing paste. The pit and fissure sealants were placed using 4 mm diameter, 2 mm height cylindrical plastic tubes. Shear force was applied to each sample. The surfaces of the broken samples were detected under stereomicroscope and were grouped as adhesive, cohesive, and mixed. The results of the study were evaluated using the SPSS 16.0 package program for statistical analysis.

RESULTS

The groups where sodium hypochlorite and sodium hypochlorite with CPP-ACP were applied showed the lowest bond strength (p < 0.05). It was observed that most of the failures in these groups were adhesive-type failures. No significant difference was observed between the shear bond strengths of the other groups (p < 0.05).

CONCLUSIONS

Er, Cr: YSGG laser and CPP-ACP containing paste are alternative methods for pre-application of fissure sealants.

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.

Influence of BPA exposure, measured in saliva, on childhood weight

INTRODUCTION

Endocrine disruptors such as bisphenol A (BPA), BPA glycidyl methacrylate, and other BPA acrylate-based derivatives have been related to type 2 diabetes, the metabolic syndrome, and obesity, among other metabolic disorders. The objective of this study is to examine the influence of BPA exposure by saliva analysis and daily physical activity on the risk of overweight/obesity in schoolchildren from southern Spain.

METHODS

The study included 300 children (53.5% girls) aged 7-10 years. Participants completed a questionnaire with four sections: participant data, including demographic information and life and family habits; semi-quantitative food frequency questionnaire; anthropometric variables; and physical activity variables. All participants underwent dental examination, when the presence of sealants/composites in each tooth and other dental alterations was recorded, and samples of whole saliva were collected for UHPLC-MS/MS analyses.

RESULTS

Risk of overweight/obesity was significantly influenced by body fat composition (OR = 10.77), not walking to and from school (OR = 1.38), lesser energy expenditure in sedentary activities (OR = 12.71), greater energy expenditure in sports (OR =1.62), and exposure to BPA from dental sealants/composites (OR = 1.38; p = 0.058).

DISCUSSION

Further research is warranted on this issue in children, who may be especially vulnerable to the negative health effects of endocrine disruption.

Effect of Aging on the Microhardness of Different Resin-based Fluoride-releasing Fissure Sealants: An In Vitro Study

AIM

The aim of the present study was to evaluate the effect of aging on the microhardness score [Vickers hardness number (VHN)] of different resin-based fluoride-releasing sealants compared to non-fluoride resin-based sealants.

MATERIALS AND METHODS

A total of 48 extracted sound molars that were sectioned mesiodistally were used. In the current study, four types of sealants were compared: Group A, a resin-based non-fluoride-releasing pit and fissure sealant (Eco-S sealant) served as a control. Groups B, C, and D received resin-based fluoride-releasing pit and fissure sealants Helioseal F, Fissurit F, and Embrace^™ WetBond, respectively. Subsequently, each group was further divided into immediate and aged subgroups. The samples had been evaluated regarding their microhardness using a pyramidal diamond indenter of a Vickers hardness test at two-time intervals: Immediately and after the aging process through thermocycling.

RESULTS

There were no statistically significant differences between mean VHN and material types (p = 0.72). Aging appeared to significantly increase the mean VHN (p = 0.001). The interaction model between material type and time factor showed that the effect of aging differs by the material type, where the VHN of the Embrace^™ group increased significantly after aging from 24.33 ± 5.60 to 31.70 ± 3.59 (p = 0.001).

CONCLUSION

While there were no significant differences in the microhardness of commonly used fluoride-releasing fissure sealants, time appears to significantly increase the mean microhardness score (VHN), especially in the Embrace^™ group.

CLINICAL SIGNIFICANCE

Embrace^™ WetBond fissure sealant showed a significant improvement in the mean microhardness score (VHN) with time. However, clinical studies with long-term follow-up are needed to confirm our results.

In vitro analysis of shear bond strength, adhesive remnant index and enamel etching patterns

Purpose

The aim of this study was to evaluate in vitro, the shear bond strength (SBS) and adhesive remnant index (ARI) of pit and fissure sealants (PFS) after enamel conditioning with different new-generation self-etching (SE) agents; additionally, enamel etching patterns were assessed.

Methods

Healthy unerupted third molars surgically removed for therapeutic reasons (n = 25p/g), were randomly assigned to six groups. Conventional etching (CE) or SE was applied prior to pit and fissure sealants bonding. Enamel conditioned surfaces were evaluated by SEM at × 500, × 1000, and × 2000 magnification to determine etching patterns. Subsequently, 25 PFS blocks (3 × 2 × 1.5 mm) p/g were bonded to enamel surface.

Samples were stored in water at 37 °C for 24 h, previous to SBS and ARI test. One-way ANOVA and Tamhane statistic tests were used for SBS; while Mann–Whitney U and Kruskal–Wallis were employed for ARI (p ≤ 0.05).

Results

For SBS test, CE_PFS_3M and SE1_PFS_Shofu groups showed the lowest values (8.74 ± 4.02 and 8.75 ± 3.90, respectively). The highest scores were observed in SE_PFS_Kuraray group (13.46 ± 5.83). Significant differences in SBS and ARI assessments were found. All experimental groups showed type 1 etching pattern.

Conclusion

The etching pattern was less pronounced in self-etching groups, which showed an equal or superior in vitro performance compared to conventional etching agents. The clinical use of self-etching agents could be recommended before pit and fissure sealants application in new dental protocols. The best in vitro performance was observed when both applied materials, self-etching agent and pit and fissure sealant have 10-methacryloyloxydecyl dihydrogen phosphate in their chemical composition.

Assessment of Penetration Depth and Microleakage of Different Pit and Fissure Sealants Using Dye Penetration Method: An In Vitro Study

AIM AND OBJECTIVE

The aim of this study was to evaluate the depth of penetration as well as the microleakage of three different pit and fissure sealant materials employing the dye penetration method.

MATERIALS AND METHODS

Sixty healthy human mandibular premolar teeth without dental caries that were extracted for orthodontic treatment constituted the study samples. These 60 premolar samples were subjected to an equal division (20 in every group) into three groups. Group I: self-adhering flowable composite, group II: flowable nanocomposites, group III: classical pit and fissure sealants. Every sample tooth underwent thermocycling amid 4°C ± 2°C and 60°C ± 2°C for 1,000 cycles. The samples were placed in 1% methylene blue solution for 24 hours to permit diffusion of the dye into probable gaps in between the restoration and the tooth. The teeth were sectioned and evaluated below a stereomicroscope at 10× magnification with image analysis software.

RESULTS

Flowable nanocomposites (3.69 ± 0.10) exhibited a slightly greater mean depth of penetration as compared to classical pit and fissure sealants (3.58 ± 0.16) and self-adhering flowable composites (3.51 ± 0.13) in that order. This difference between the three sealants was not significant statistical. Amid the three sealant study groups, the lowest mean marginal microleakage was exhibited by the flowable nanocomposites (1.06 ± 0.03), followed by self-adhering flowable composites (1.98 ± 0.06), and classical pit and fissure sealants (2.74 ± 0.11). Analysis of variance revealed statistically significant differences among the three sealants that were studied.

CONCLUSION

This study concludes that flowable nanocomposites depicted enhanced penetration and reduced marginal leakage as compared to the self-adhering flowable composites and classical pit and fissure sealants.

CLINICAL SIGNIFICANCE

An efficient approach to preventing dental caries on the occlusal surfaces of teeth is the use of pit and fissure sealants. The efficiency of sealants chiefly depends on the morphological characteristics of the fissures and properties of dental materials used.

Pit and fissure depth in the enamel of mandibular third molars: An open gate for microleakage?

The aim of this descriptive ex vivo study was to evaluate qualitatively the depth of pit and fissures (P&F) of the enamel in human mandibular third molars. Fifty (n=50) extracted human mandibular third molars were cleaned and disinfected. All tooth surfaces were coated with nail varnish except for a 1-mm margin around the periphery of the occlusal surface. The teeth were immersed for 48 hours at 37 °C in 1% methylene blue dye solution prepared in artificial saliva. After cleaning, the crowns were separated from the root at the cementoenamel junction and subsequently sectioned longitudinally in buccolingual direction at the location of the central fossa. All sections were examined using a stereoscopic microscope and photographed. The images were downloaded on a computer. The length of penetration of the P&F was recorded using the following scoring system: C1: P&F extended to half of the enamel thickness; C2: P&F extended beyond half of the enamel thickness without reaching the dentine-enamel junction; C3: P&F extended to the dentine-enamel junction. For pits, C1, C2 and C3 were observed in 35, 9 and 6 teeth, respectively, while for fissures, C1, C2 and C3 were observed in 15, 18 and 17 teeth, respectively. The P&F detected in the samples extended to the deepest portions of enamel, quite frequently reaching the enamel-dentine junction. Clinicians should recognize that even if pits and fissures are not clinically obvious, they penetrate deep into the enamel and frequently reach the dentine-enamel junction. Effective treatment is recommended to block access to P&F, thus preventing ingress of bacteria.

Adhesion of three types of fissure sealant in saliva-contaminated and noncontaminated conditions: an in vitro study

PURPOSE

To evaluate the proportion of microleakage (PM), shear bond strength (SBS), and the fissure sealant (FS) interface by scanning electron microscopy (SEM) in three kinds of FS when the enamel surfaces were contaminated with saliva.

METHODS

198 sound third molar teeth were randomly divided into three pretreatment condition groups (n = 66): dry, saliva contamination removed by cotton pellet, or saliva removed by air-drying. A resin-based FS (Clinpro™), amorphous calcium phosphate-containing FS (Aegis®), or glass ionomer-based FS (Fuji Triage®) was applied on the treated enamel, and PM and SBS were assessed. Two specimens from each group were observed with SEM. p values < 0.05 was considered statistically significant.

RESULTS

Glass ionomer-based FS showed the highest PM in all three surface conditions (p values < 0.05 were considered statistically significant). No significant difference in PM was observed between resin-based FS and amorphous calcium phosphate-containing FS (p > 0.05). Resin-based FS showed significantly greater SBS in all three surface conditions compared to glass ionomer-based FS. SEM observations showed that saliva contamination led to gaps at the enamel-sealant interface.

CONCLUSION

Neither cotton pellet-drying nor air-drying effectively removed saliva from the contaminated enamel surface. Glass ionomer-based FS showed the highest PM and the lowest SBS in contaminated and noncontaminated conditions. The highest SBS was obtained with resin-based FS.

The contribution of different permanent tooth types to untreated caries: Implications for public health surveillance and prevention

BACKGROUND

Untreated caries (UC), although highly prevalent, is largely preventable. Information on the contribution of different teeth to UC prevalence and severity could be helpful in evaluating UC surveillance protocols and the relative benefits of caries prevention interventions.

METHODS

The authors combined data from 3 cycles (2011-2016) of the National Health and Nutrition Examination Survey for participants aged 6 through 11 years, 12 through 19 years, 20 through 34 years, 35 through 49 years, 50 through 64 years, 65 through 74 years, and 75 years and older. For each age group the authors calculated the contribution of successive permanent tooth types (for example, first molars and second molars) to UC prevalence and severity.

RESULTS

UC prevalence and the percentage of prevalence detected by means of screening molars were, respectively, 5% and 95% among participants aged 6 through 11 years; 16% and 92% among participants aged 12 through 19 years; 29% and 86% among participants aged 20 through 34 years; 26% and 70% among participants aged 35 through 49 years; 21% and 48% among participants aged 50 through 64 years; 16% and 36% among participants aged 65 through 74 years; and 17% and 25% among participants 75 years and older. Among adults aged 50 years and older, no teeth appeared to capture a disproportionate share of UC prevalence. Molars accounted for 87%, 79%, and 56% of severity among participants aged 6 through 11 years, 12 through 19 years, and 20 through 34 years, respectively. After age 34 years, molars accounted for less than 50% of severity.

CONCLUSIONS

Molars are the tooth type most susceptible to UC well into adulthood.

PRACTICAL IMPLICATIONS

Molars could be used as sentinel teeth for surveillance of UC and adults could benefit from caries prevention that targets molars.

Effect of Fluoride Varnish in Caries Prevention on Permanent First Molars: A 36-Month Cluster Randomized Controlled Trial

Purpose: The purpose of this study was to evaluate the effect of fluoride varnish in preventing dental caries of permanent first molars (PFMs). Methods: The study was designed to be a stratified-cluster randomized controlled trial with classes used as the unit of randomization. Classes stratified by district were followed for 36 months. All eligible children of the selected classes were included in the trial. The children in the test group were applied fluoride varnish biannually. The outcomes were measured at the individual level. Results: In total, 107 classes (51 in the test group, 56 in the control group) were recruited for the trial. Among the 5,397 total subjects, 5,005 and 4,596 children completed the 24-month and 36-month course, respectively. There were no group differences at baseline (P>0.05). The mean decayed and filled surfaces scores of the test group were significantly lower than those of the control group at the 36-month follow-up (P<0.05). The caries processing speed of PFMs increased from 24 months to 36 months; however, group differences were not significant (β equals 0.01; P>0.05). Conclusions: Biannual application of fluoride varnish can effectively prevent dental caries of six- to seven-year-old children. Nevertheless, the use of fluoride varnish with additional treatments (such as pit and fissure sealants) should be considered for optimized benefit after 24 months.

A Randomized Controlled Pilot Study Examining Effects of Animal Assisted Therapy in Children Undergoing Sealant Placement

Purpose: The purpose of this study was to examine the effects of a companion canine on physiologic responses, discomfort level, and behavior in children undergoing sealant placement using a dental isolation system (Isodry^®). Methods: Forty-seven healthy six- to 10-year-olds who needed sealants were randomly assigned to a control group (N =23) or experimental group (N =24) that utilized an emotional support canine in the child's lap. Preoperative baseline anxiety was obtained. Pulse, pulse oximetry, and behavior (measured by Frankl and Houpt scales) were recorded at various time points (beginning, at first sealant placement, switching the isolation system to the other side, second side sealant placement, and end) throughout the procedure. Participants reported a comfort level utilizing the FACES scale. Participants in the intervention group were asked, "Did you like having the dog in your lap?" The dentist rated the difficulty of and time required for the procedure. Results: Baseline anxiety was similar; no significant differences in physiologic measurements or FACES ratings were found between groups. The intervention group had significantly lower Houpt ratings for all three variables when the isolation system was repositioned (P=0.002, P=0.03, and P=0.05) and had higher Frankl scores at isolation repositioning and when completing sealants on the second side (P=0.02 and P=0.03, respectively). Both groups had similar ratings from the dentist. Conclusions: Animal-assisted therapy (AAT) should be studied more rigorously to substantiate its effectiveness in enhancing cooperative behavior in children for dental procedures. High levels of satisfaction were observed among pediatric users of AAT.

Lasers to prevent dental caries: a systematic review

OBJECTIVE

To assess the effectiveness of lasers (at sub-ablative parameters) in reducing caries incidence compared with traditional prophylactic interventions (TPIs) when used alone or together with other TPIs such as pits and fissures sealant or fluoride gels or varnishes.

DESIGN

A systematic review. Data sources include Medline (via PubMed), Embase, Web of Science and the Cochrane Library (December 2019).

ELIGIBILITY CRITERIA

Only randomised trials (RCTs) and controlled clinical trials (CCTs) dealing with prophylactic lasers use (vs TPI or untreated teeth) were considered as eligible. We excluded in vitro and ex vivo studies.

DATA EXTRACTION

Eligible studies were selected and data extracted independently by two reviewers. Risk of bias was assessed adopting the Cochrane Risk of Bias tool. Data on caries incidence, sealant retention, fluoride uptake, adverse events, treatment duration, patients' discomfort and cost-effectiveness ratio was extracted.

DATA ANALYSIS

Extracted data were presented narratively due to the heterogeneity of included studies.

RESULTS

Seven RCTs and two CCTs, all with an evident risk of bias, met inclusion criteria, pooling together 269 individuals and 1628 teeth. CO₂, neodymium-doped yttrium aluminium garnet, erbium-doped yttrium aluminum garnet (Er:YAG), erbium, chromium: yttrium scandium gallium garnet (Er,Cr:YSGG) and Argon lasers were used. In the permanent dentition, lasers only when used in combination with TPIs were effective in reducing caries when compared with untreated teeth (risk ratio (RR)=0.44 (0.20-0.97); Er:YAG laser) or with TPIs used alone (RR=0.39 (0.22-0.71); CO₂ laser). Moreover, Argon laser significantly improved the fluoride uptake into the enamel surfaces (ANalysis Of VAriance (ANOVA) tests: 95%, p<0.0001). Likewise, sealant retention improved when acid etching was performed on previously irradiated enamel fissures by CO₂ laser (RR=0.63 (0.38-1.04)) or Er:YAG laser (RR=0.54 (95% CI: 0.34 to 0.87)). In addition, laser resulted safe and well tolerated by patients.

CONCLUSION

Despite some positive indications, an inadequate level of evidence was found in the included studies concerning the lasers' effectiveness in preventing caries. Further studies with a higher methodological quality level are required.

Caries-Preventive Effect of a Public Health Programme for Pit and Fissure Sealant

PURPOSE

The caries-preventive effect of pit and fissure sealant was found to be related to the incidence of caries in the population. The rate of caries in China has been very low, and a pit and fissure sealant public health programme has been widely carried out since 2005. This study aims to evaluate the caries-preventive effect of this dental public health programme in Beijing, the capital of China.

MATERIALS AND METHODS

A 3-year longitudinal study was conducted from 2012 to 2015. All students (n = 2973) in one district of Beijing were included. Children who received a sealant were categorised into the sealant group (n = 1648), and the other children were categorised into the no sealant group (n = 1325).

RESULTS

The dental caries risk levels in the sealant group and the no sealant group were balanced at baseline. The caries incidences of children only counting four first molars after 28 months were 18.1% and 13.6% for the sealant group and the no sealant group, respectively (Chi-square test, p = 0.001). The risk ratio in the sealant group versus the no sealant group for caries yes/no (only four molars) at 28 months was 0.73 (95% CI, 0.60-0.90; p = 0.001), based on binary logistic regression.

CONCLUSIONS

The pit and fissure sealant dental public health programme implemented in Beijing was effective in preventing dental caries in the first permanent molars.

Retention of flowable composite resins in comparison to pit and fissure sealants: a systematic review and meta-analysis

Despite the worldwide decline in dental caries, pit and fissure caries remains a cause of concern, and application of pit and fissure sealants is an important preventive measure. Due to the high wear rate of conventional unfilled sealants, various other materials have been tested for fissure sealing. The present meta-analysis was conducted to compare the effectiveness of flowable composite resins as a fissure sealant to that of conventional pit and fissure sealants. A literature search was performed in MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar. Clinical trials comparing the efficacy of flowable composite resins as fissure sealants to that of conventional pit and fissure sealants on permanent teeth with a follow-up of 12 or 24 months were included in this meta-analysis. The retention rates of the 2 groups were evaluated with a random-effects model using Cochrane Reviews software (Cochrane RevMan, version 5.3). Seven studies were included in the final review. Flowable composite resins proved to be a significantly better fissure-sealing material after 1 year of follow-up (odds ratio = 0.47; 95% CI = 0.22-1.01; P = 0.05; degree of inconsistency [I²] = 59%). The retention rates of flowable composite resins at the end of 2 years were similar to those of conventional pit and fissure sealants (odds ratio = 0.71; 95% CI = 0.13-3.95; P = 0.70; I² = 85%). Flowable composite resins proved to be a superior alternative to conventional sealants after 1 year of follow-up; however, no such difference between the 2 groups was observed after 2 years of follow-up. Further longitudinal studies should be conducted to evaluate the long-term retention and efficacy of flowable composite resins in fissure sealing.

How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement

This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia.

Epidemiology of Dental Caries and Disease Prevention Among 12-Year-Olds in Slovenia Over Thirty Years (1987-2017)

PURPOSE

The first large-scale epidemiological survey on dental caries in Slovenia was conducted in 1987 and repeated in 1993, 1998, 2003, 2008, 2013 and 2017, using the same methodology. The aim of the study was to examine the trend of caries in 12-year-olds in Slovenia during a 30-year time period. The changes over time in caries experience were compared with disease trends observed in other European countries. Study Populations and Methods: The WHO National Oral Health Pathfinder Survey was applied in all seven surveys (1987-2017). The surveys were carried out in all nine geographical regions of Slovenia. For each subject, the caries experience and presence of sealants were recorded.

RESULTS

The mean DMFT of 12-year-olds decreased significantly from 5.1 in 1987 to 1.5 in 2017 (p < 0.0001). The percentage of persons with sealed teeth increased from 6% in 1987 to 94% in 2017, and the percentage of caries-free persons increased from 6% to 42%.

CONCLUSION

The implementation of a nation-wide preventive programme was determined to significantly contribute to the effective control of caries and continuously improve the oral health of Slovenian children. In an international perspective, the Slovenian achievements in disease prevention in terms of caries prevalence reduction may be important for other countries of the region.

Evaluation of a novel instrument for placement of dental sealants

PURPOSE

To evaluate marginal seal, adaptation, surface texture, and bubble presence of pit and fissure sealants when using a novel instrument (C-Shape It) or the manufacturers' supplied applicators for sealant placement into occlusal fissures.

METHODS

Extracted molars with occlusal fissures were cleaned with pumice slurry and divided into six groups (n= 10/gp); three treatment and three control. Sealant materials placed included Ultraseal, Delton, and Helioseal. Excess water was removed per manufacturers' instructions. Sealants were applied with each applicator and with the C-Shape It to each group from cusp to cusp without covering marginal ridges, and the polymerization guidelines for photocuring were followed for all the groups. Samples were thermocycled at 500x between 5° and 55°C. Teeth were sectioned in a buccolingual direction with a minimum of four sections per tooth and examined under a light microscope at 50x and scored.

RESULTS

Marginal seal, adaptation, penetration ability, surface texture, bubble formation and location of the sealants were analyzed using two-way ANOVA on ranks with a 95% confidence interval. The C-Shape It instrument showed consistently smoother surface texture (P< 0.001), which was statistically significant versus all manufacturers' applicators for all materials. Bubble presence was statistically significantly less with the instrument C-Shape It versus the manufacturers' applicators for all materials (P< 0.001). Results also revealed significant differences in marginal sealant adaptation.

CLINICAL SIGNIFICANCE

C-Shape It demonstrated consistent ability to reduce bubbles and improve surface texture and adaptation in occlusal fissures for all pit and fissure products tested.

Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: the FiCTION three-arm RCT

BACKGROUND

Historically, lack of evidence for effective management of decay in primary teeth has caused uncertainty, but there is emerging evidence to support alternative strategies to conventional fillings, which are minimally invasive and prevention orientated.

OBJECTIVES

The objectives were (1) to assess the clinical effectiveness and cost-effectiveness of three strategies for managing caries in primary teeth and (2) to assess quality of life, dental anxiety, the acceptability and experiences of children, parents and dental professionals, and caries development and/or progression.

DESIGN

This was a multicentre, three-arm parallel-group, participant-randomised controlled trial. Allocation concealment was achieved by use of a centralised web-based randomisation facility hosted by Newcastle Clinical Trials Unit.

SETTING

This trial was set in primary dental care in Scotland, England and Wales.

PARTICIPANTS

Participants were NHS patients aged 3-7 years who were at a high risk of tooth decay and had at least one primary molar tooth with decay into dentine, but no pain/sepsis.

INTERVENTIONS

Three interventions were employed: (1) conventional with best-practice prevention (local anaesthetic, carious tissue removal, filling placement), (2) biological with best-practice prevention (sealing-in decay, selective carious tissue removal and fissure sealants) and (3) best-practice prevention alone (dietary and toothbrushing advice, topical fluoride and fissure sealing of permanent teeth).

MAIN OUTCOME MEASURES

The clinical effectiveness outcomes were the proportion of children with at least one episode (incidence) and the number of episodes, for each child, of dental pain or dental sepsis or both over the follow-up period. The cost-effectiveness outcomes were the cost per incidence of, and cost per episode of, dental pain and/or dental sepsis avoided over the follow-up period.

RESULTS

A total of 72 dental practices were recruited and 1144 participants were randomised (conventional arm, n = 386; biological arm, n = 381; prevention alone arm, n = 377). Of these, 1058 were included in an intention-to-treat analysis (conventional arm, n = 352; biological arm, n = 352; prevention alone arm, n = 354). The median follow-up time was 33.8 months (interquartile range 23.8-36.7 months). The proportion of children with at least one episode of pain or sepsis or both was 42% (conventional arm), 40% (biological arm) and 45% (prevention alone arm). There was no evidence of a difference in incidence or episodes of pain/sepsis between arms. When comparing the biological arm with the conventional arm, the risk difference was -0.02 (97.5% confidence interval -0.10 to 0.06), which indicates, on average, a 2% reduced risk of dental pain and/or dental sepsis in the biological arm compared with the conventional arm. Comparing the prevention alone arm with the conventional arm, the risk difference was 0.04 (97.5% confidence interval -0.04 to 0.12), which indicates, on average, a 4% increased risk of dental pain and/or dental sepsis in the prevention alone arm compared with the conventional arm. Compared with the conventional arm, there was no evidence of a difference in episodes of pain/sepsis among children in the biological arm (incident rate ratio 0.95, 97.5% confidence interval 0.75 to 1.21, which indicates that there were slightly fewer episodes, on average, in the biological arm than the conventional arm) or in the prevention alone arm (incident rate ratio 1.18, 97.5% confidence interval 0.94 to 1.48, which indicates that there were slightly more episodes in the prevention alone arm than the conventional arm). Over the willingness-to-pay values considered, the probability of the biological treatment approach being considered cost-effective was approximately no higher than 60% to avoid an incidence of dental pain and/or dental sepsis and no higher than 70% to avoid an episode of pain/sepsis.

CONCLUSIONS

There was no evidence of an overall difference between the three treatment approaches for experience of, or number of episodes of, dental pain or dental sepsis or both over the follow-up period.

FUTURE WORK

Recommendations for future work include exploring barriers to the use of conventional techniques for carious lesion detection and diagnosis (e.g. radiographs) and developing and evaluating suitable techniques and strategies for use in young children in primary care.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN77044005.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 1. See the NIHR Journals Library website for further project information.

Does Applying Fluoride Varnish Every Three Months Better Prevent Caries Lesions in Erupting First Permanent Molars? A Randomised Clinical Trial

PURPOSE

To determine the effectiveness of fluoride varnish (FV) in preventing caries lesions on the erupting first permanent molars (FPM) of high-risk children.

MATERIALS AND METHODS

A randomised parallel-blinded clinical trial was conducted with a sample of 180 children between 6 and 7 years of age with at least one sound erupting FPM attending a public school in the Dominican Republic. Children were randomly assigned to three groups, one control and two experimental groups, which received FV application every 3 or 6 months. All the children received fluoride toothpaste (1450 ppm), toothbrush, diet counseling, and oral health recommendations every three months. The development of caries lesions was assessed at twelve months using ICDAS.

RESULTS

A total of 157 children completed the study, of which 51.0% were female. At the end of the study, 53 participants comprised the control group, 54 were included in the every-3-months (3-month) FV group, and 50 belonged to the every-6-months (6-month) FV group. Adjusted ORs were calculated to compare lesion development between the groups. The results showed that the control group was more likely to develop caries lesions in comparison to the 3-month FV group, with an associated AOR of 1.46 (95% CI: 1.18 to 1.81, p = 0.001). Likewise, applying FV every six months as opposed to every three increased the odds of developing caries with a significant AOR of 1.29 (95% CI: 1.03 to 1.64, p = 0.029).

CONCLUSION

FV application every three months can be recommended to prevent caries lesions on the erupting first permanent molars of high-risk populations.

Comparison of Penetration Depth and Microleakage of Resin Infiltrant and Conventional Sealant in Pits and Fissures of Permanent Teeth In Vitro

AIM

To assess the penetration and microleakage of a resin infiltrant for the prevention of noncavitated white lesion progression in the fissure system of permanent teeth and compare it to a conventional sealant.

MATERIALS AND METHODS

Sixty extracted permanent teeth with artificially produced noncavitated white lesions were randomly distributed according to the restorative material into group I (experimental) which received ICON resin infiltration, and group II (control) which received Helioseal F fissure sealant. For the penetration test, restorative materials were mixed with a fluorescent dye (eosin H) before light curing; roots were then amputated, and three buccopalatal microscopic sections were obtained from each tooth. These were dipped in 0.001 mg of ethanolic sodium fluorescence solution. Material penetration depth was assessed through confocal microscopy. Thirty teeth (15 from each group) underwent a microleakage test. Teeth were thermocycled, and then immersed in 50% silver nitrate (AgNO₃) solution for 3 hours. Microleakage was evaluated using X-ray microtomography (micro-CT); AgNO₃ presence between the material and the tooth surface indicated microleakage.

RESULTS

The mean material penetration value in teeth treated with ICON (104.8571 ± 7.63360 μm) was significantly higher than that in teeth treated with Helioseal F (5.3158 ± 3.83825 μm) (p < 0.001). The mean microleakage value in demineralized enamel treated with Helioseal F (0.2238 ± 0.12561) was significantly greater than that in demineralized enamel treated with ICON (0.0119 ± 0.0097) (p < 0.001).

CONCLUSION

ICON displayed more penetration and less microleakage than Helioseal F in pits and fissures of permanent teeth.

CLINICAL SIGNIFICANCE

Resin infiltrant showed superior retention and can provide a good alternative for adhesives and fissure sealants. How to cite this article: Al-Tuwirqi AA, Alshammari AM, Felemban OM, et al. Comparison of Penetration Depth and Microleakage of Resin Infiltrant and Conventional Sealant in Pits and Fissures of Permanent Teeth In Vitro. J Contemp Dent Pract 2019;20(11):1339-1344.

Comparison and Clinical Evaluation of Two Pit and Fissure Sealants on Permanent Mandibular First Molars: An In Vivo Study

AIM

The aim of the study was to compare and evaluate the clinical efficacy of a microfilled pit and fissure sealant and a nanofilled pit and fissure sealant at 3, 6, and 12 months of interval.

MATERIALS AND METHODS

Samples consisting of 55 healthy 8- to 12-year-old children with deep pits and fissures in mandibular first permanent molars were selected for the study. It was a split mouth design and randomized clinical trial. A total of 110 mandibular first molars were divided into two groups of 55 each: group I Fissurit FX sealant and group II Grandioseal nanofilled fissure sealant. The sealed teeth were clinically evaluated at 3, 6, and 12 months of interval to assess marginal adaptation, sealant retention, fissure caries development, roughness of sealant surface, and change of color around the sealant.

RESULTS

The results showed that both Fissurit FX and Grandioseal pit and fissure sealants were effective in preventing dental caries. Marginal adaptation was significantly better with Fissurit FX when compared to Grandioseal pit and fissure sealant. There was no difference in sealant retention between the two groups. The surface roughness of Fissurit FX was high when compared to that of Grandioseal. Statistical analysis was done using the Chi-squared test for intra-group comparison and Fisher's exact test for inter-group comparison. Results were considered statistically significant if p ≤ 0.05.

CONCLUSION

Fissurit FX and Grandioseal pit and fissure sealants provided similar caries preventive effects and there was no difference in retention of sealants over a period of 1 year. However, surface roughness was better with Grandioseal fissure sealants.

CLINICAL SIGNIFICANCE

This study is significant because there is limited evidence about the efficacy of nanofilled pit and fissure sealants in vivo. It will also provide dental practitioners an insight into the clinical efficacy of nanofilled pits and fissure sealant when compared to micro-filled sealant enabling them to make the right choice for the betterment of their dental practice. How to cite this article: Smitha M, Paul ST, Nagaraj T, et al. Comparison and Clinical Evaluation of Two Pit and Fissure Sealants on Permanent Mandibular First Molars: An In Vivo Study. J Contemp Dent Pract 2019;20(10):1151-1158.

Bacterial microleakage of a bioactive pit &fissure sealant

PURPOSE

To compare the sealing properties of three pit and fissure (P&F) sealants, Embrace Wet Bond (EWB), a bioactive P&F sealant Embrace Wet Bond through the addition of modified calcium phosphate (MCP) (EWBMCP) and ClinPro (CLPR). The sealing properties of the materials were tested by means of a bacterial microleakage test.

METHODS

30 extracted intact human third molars were randomly assigned to three groups of 10 (n=10) teeth each. The teeth were cleaned with two passes of air abrasion, followed by rinsing for 20 seconds and then dried with compressed air for another 20 seconds leaving the enamel surface slightly moist. The coronal portion of each tooth was sectioned perpendicular to the long axis at the level of 4 mm below the top of the central fossa of the enamel. A parallel vertical channel 1 mm in diameter was prepared in the central fossa through the entire sample. All samples were sterilized with Gamma radiation. After etching the occlusal surface with 35% phosphoric acid gel followed by rinsing, the sealants were applied. The samples were stored at 37°C in SPB for 3 weeks, thermal cycled for 2,000× (5-55°C) and coated with nail varnish leaving 1 mm uncovered around the P&F material. Samples were then tested for microleakage of E. faecalis culture using a dual chamber leakage model. The broth in the lower chamber was checked daily for turbidity up to 90 days. Statistical significance was determined at P< 0.05.

RESULTS

The median survival time for EWBMCP was significantly higher (P< 0.05) than for EWB and CLPR. With respect to bacterial microleakage frequency, EWBMCP and CLPR behaved significantly better than EWB. The bioactive sealant EWBMCP outperformed the other two tested sealants in terms of resistance to bacterial microleakage. Long-term clinical studies are recommended to confirm these in vitro findings.

CLINICAL SIGNIFICANCE

Long term resistance to bacterial leakage of occlusal pit and fissure sealants will be beneficial to resisting the development of decay. A recently developed bioactive pit & fissure sealant offers that possibility and it is recommended that the findings are confirmed by clinical studies.

[Evaluation of the efficacy of sodium fluoride dental protective agent combined with pit and fissure sealant in prevention of dental caries in preschool children]

PURPOSE

To explore the effect of sodium fluoride tooth protector combined with pit and fissure sealing to prevent caries in preschool children.

METHODS

Two hundred preschool children who were treated with pit and fissure closure from January 2014 to September 2014 were selected as subjects. According to random number table method, 100 cases were divided into the combined group and the control group. Children in the control group were treated with pit and fissure sealant for prevention of caries, while children in the combined group were treated with sodium fluoride tooth protector combined with pit and fissure sealant for caries prevention. The incidence of dental caries, proximal caries, mean DMFT, and expulsion rate of the sealants were compared between the two groups at 1 year and 2 years. Data analysis was performed using SPSS 16.0 software package for data analysis.

RESULTS

At 1 year of follow-up, there was no significant difference in the incidence of dental caries, proximal caries, and mean DMFT between the two groups (P>0.05). The incidence of caries and mean DMFT in the combined group were significantly lower than those in the control group at 2 years of follow-up (P<0.05). The incidence of proximal caries in the combined group was not significantly different from that in the control group (P>0.05). The retension rate of the pit and fissure sealant in the combined group was significantly higher than that in the control group (P<0.05). There was no significant difference in the partial shedding rate and complete expulsion rate between the two groups (P>0.05).

CONCLUSIONS

Sodium fluoride tooth protector combined with pit and fissure sealing has better anti-caries effect than the use of pit and fissure sealant alone in preschool children.

[Effects of pit and fissure sealant combined with fluorine protective paint on prevention of children caries aged 5-8 years old]

PURPOSE

To investigate the effect of pit and fissure sealant combined with fluorine protective paint on prevention of children caries aged 5-8 years old.

METHODS

Convenience sampling method was used to select 120 children who received oral health care in the First Affiliated Hospital of Zhejiang University and Hangzhou Dental Hospital from January 2014 to January 2017. They were grouped by random number table method: the control group (60 cases, 109 teeth) underwent pit and fissure sealant, and the experimental group (60 cases, 112 teeth) underwent pit and fissure sealant combined with fluorine protective paint. The patients were followed up for 2 years to compare the incident of dental caries. SPSS20.0 software package was used to analyze the data.

RESULTS

The incidence of dental caries in the experiment group (2.68%) was significantly lower than that in the control group (10.09%) (P<0.05).The incidence of adjacent caries in the experiment group (1.79%) was significantly lower than that in the control group (9.17%) (P<0.05). At 1 and 2 years after sealing, the shedding rate(0.00%, 3.33%) of the sealant in the experiment group was significantly lower than that in the control group (10.00%, 15.00%)(P<0.05).The mean caries of the experiment group was significantly lower than that of the control group(P<0.05).

CONCLUSIONS

The effect of combined pit and fissure sealant and fluoride protective paint on the prevention of dental caries in children aged 5-8 years old is ideal, which can reduce the incidence of dental caries and adjacent caries, reduce the mean caries, and keep the sealant intact. It is worthy of clinical promotion.

Resin Infiltration May Reduce Proximal Carious Lesion Progression in Permanent Teeth With Ongoing Uncertainty for Primary Teeth

QUESTION

Is resin infiltration effective at arresting the progression of proximal caries lesions?

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

The effect of resin infiltration on proximal caries lesions in primary and permanent teeth. A systematic review and meta-analysis of clinical trials. Chatzimarkou S, Koletsi D, Kavvadia K. J Dent 2018; 77:8-17.

SOURCE OF FUNDING

None.

TYPE OF STUDY

Systematic review and meta-analysis.

Comparison Of The Adaptability Of Two Fissure Sealants In Various Tooth Fissure Morphology Patterns: An In Vitro Experimental Study

BACKGROUND

This study was conducted to compare the adaptation of resin-based sealants with that of Resin modified glass ionome-based sealants in various tooth fissure morphologies.

METHODS

It was an in vitro experimental study done at the Dow University and NED University, Karachi, Pakistan. Ten extracted human molars were randomly assigned to two groups, (n=5) each. Fissure sealant material (Resin based sealant or resin modified glass ionomer-based sealant) was applied on the occlusal surface of the tooth according to manufacturer's recommendations. Specimens were thermocycled and then sectioned into three longitudinal parts in the bucco- lingual direction. Specimens were examined using scanning electron microscope for the adaptation of the sealant in the occlusal fissure. Mann-Whitney -U test and Kruskall-Wallis test were applied to compare the adaptability scores of sealant materials in the tooth fissure. Level of significance was kept at 0.05.

RESULTS

There were no significant differences in the adaptability scores among U-shaped (p-value=0.35), V-shaped (p-value=0.89), IK-shaped (p-value=0.52), I-shaped (p-value- =0.41) and Y-shaped (p-value=1.00) fissure patterns. Similarly, there were no significant differences observed between the resin-based sealant (p-value=0.95) versus RMGIC based sealant (p-value=0.63) for the adaptability scores in various tooth fissure morphologies.

CONCLUSIONS

No significant difference was found between resin-based sealants and resin modified glass ionomerbased sealants for the adaptation in various tooth fissure patterns.

Comparative Evaluation of Hydrophobic and Hydrophilic Resin-based Sealants: A Clinical Study

AIM

The purpose of this study is to clinically evaluate and compare the retention and evidence of caries of three fissure sealants.

MATERIALS AND METHODS

A total of 150 children, between 7 and 13 years of age, with fully erupted permanent molars, had sealants placed using a full-mouth design. Sealant retention was evaluated at 1, 3, 6, 9, and 12 months later. Teeth were evaluated for retention and evidence of caries using Simonsen's criteria and results were subjected to statistical analysis using the Chi-square test.

RESULTS

At 1-year examination, in teeth sealed with Clinpro: (a) 8% were completely retained, (b) 74.4% were partially lost, and (c) 8.5% were completely lost; with Embrace Wetbond: (a) none of the sealants were completely retained, (b) 13.1% were partially lost, and (c) 59.1% were completely lost; with Champ: (a) 1% were completely retained, (b) 71.4% were partially lost, and (c) 10.9% were completely lost. All the three sealants showed evidence of caries from 9 months.

CONCLUSION

The retention of hydrophobic (Clinpro) sealant was superior to hydrophilic (Embrace Wetbond and Champ) sealants. The evidence of caries was less in the hydrophobic sealant group when compared with the hydrophilic sealant groups. There was no statistical difference in retention and evidence of caries between maxillary and mandibular teeth for all the three sealant groups.

CLINICAL SIGNIFICANCE

Sealants prevent the occurrence of caries in the majority of children. Though hydrophobic sealants appear to be more successful, hydrophilic sealants too may provide promising results in the near future.

Evaluation of Sealant Penetration in Relation to Fissure Morphology, Enamel Surface Preparation Protocol and Sealing Material

PURPOSE

The objective was to assess the effect of fissure depth and enamel surface preparation protocols on penetration of resin-based, giomer and glass-ionomer fissure sealants.

MATERIALS AND METHODS

Ninety extracted third molars were assigned into three groups according to the material used. All three groups were subsequently divided depending on tooth preparation: no pretreatment or surface preparation with 10% polyacrylic acid, 37% phosphoric acid, or self-etching adhesive. In addition, Er,Cr:YSGG laser or air abrasion were employed in all subgroups. The penetration was evaluated using scanning electron microscopy.

RESULTS

The groups that were pretreated with an appropriate acid resulted in superior penetration of glass-ionomer and resin-based sealants when compared with other surface preparation protocols (p < 0.05). The exception was teeth treated with both air abrasion and acid etching. Both preparation protocol and fissure depth significantly affected the sealant penetration (p < 0.05), but fissure depth had a greater impact on fissure penetration than did enamel surface pretreatment.

CONCLUSION

All investigated materials exhibit similar properties regarding sealant penetration. Penetration of a fissure sealant is significantly influenced by the fissure depth. In regard to enamel surface preparation protocol, a pretreatment with phosphoric acid in resin-based and polyacrylic acid in glass-ionomers appears to be essential in obtaining the adequate penetration of a sealing material.

Retention and remineralization effect of moisture tolerant resin-based sealant and glass ionomer sealant on non-cavitated pit and fissure caries: Randomized controlled clinical trial

INTRODUCTION/OBJECTIVES

Pit and fissure sealants are an essential part of preventive dentistry and should be adopted as a crucial part of the minimally invasive dentistry due to their profound benefit to our patients.

METHODS

The study design is a single-blind, split-mouth, randomized controlled clinical trial. Forty patients between age 6-9 were selected. First permanent molars' occlusal surfaces with scores of 1, or 2 according to the International Caries Detection and Assessment System II (ICDAS II) and with scores between 14-30 by using DIAGNOdent device (Kavo®, Biberach, Germany) were selected and readings recorded. One side of the mouth was randomly chosen to have either the moisture tolerant resin sealant or the glass ionomer sealant placed, and then the second material was placed on the other side. The retention of these materials was analyzed at 3 and 6 months. The sealants were then removed and DIAGNOdent readings were subsequently taken.

RESULTS

After three months, full retention was found in 38/40 (95%) teeth in Group A (Embrace™ WetBond™) and 35/40 (87.5%) teeth in Group B (Fuji TRIAGE®). Additionally, no sealant suffered a total loss in group A, whereas, three sealants were totally lost (7.5%) in group B. The difference in sealant retention in two groups in this period was not found to be statistically significant (P >  0.05). At six months, full retention was found in Group A 34/40 (85%) and 25/40 (62.5%) in Group B. Also, the partial loss in Group A was 2/40 (5%) whereas in Group B 7/40 (17.5%). Also, the total loss was 4/40 (10%) and 8/40 (20%) in Group A and B, respectively. The difference in sealant retention in two groups after six months follow-up was found statistically significant (P < 0.05). The initial mean values of DIAGNOdent readings were 22.42 and 22.8 in Group A and Group B, respectively. After six months, DIAGNOdent mean values revealed a drop in both groups, and this difference was statistically significant. Nevertheless, when Group A was compared to Group B in terms of remineralization effect, the differences were found not to be statistically significant (p > 0.05).

CONCLUSIONS

Within the limitation of this study, we affirmed that occlusal caries lesions, which is restrictive to enamel and in need of surgical intervention, can be arrested clinically by sealing the lesion with both a hydrophilic resin sealant and glass ionomer sealant materials. Embrace™ WetBond™ showed superiority over the glass ionomer sealant tested in retention after six months follow up.

Dental Sealant Prevalence Among Children with Special Health Care Needs: National Health and Nutrition Examination Survey (NHANES) 2013 to 2014

Purpose: The purpose of this study was to evaluate dental care access and sealants prevalence among children with special health care needs. Methods: The authors utilized the publicly available National Health and Nutrition Examination Survey (NHANES) 2013 to 2014 datasets collected by trained dental examiners for the Centers for Disease Control and Prevention. This study included 2,651 six- to 19-year-olds who provided demographic, dental visit, disability, and sealants information. Weighted prevalence estimates and odds ratios (OR) were calculated for sealant use by disability, gender, age, race, and economic status. Results: Approximately 68 percent of participants had a dental visit in the past six months, with 84 percent of them being routine dental visits; each had approximately two sealed teeth (mean equals 2.37). Children with a physical disability have lower odds of having a sealant (OR equals 0.5; P=0.04) compared to nondisabled children. Six- to 11-year-olds have lower odds of having a sealant versus older age groups. Sealant use prevalence was lowest among African American children (39 percent) versus Hispanic (47 percent) and Caucasian (54 percent; P=0.01) children. Conclusions: The findings indicate disparities in dental sealants use among those with physical disabilities and younger age groups. Further studies and strategies are needed to intervene at an early age and increase utilization of sealants among children with special health care needs. (Pediatr Dent 2019;41(3):186-90) Received September 15, 2018 | Last Revision February 24, 2019 | Accepted March 4, 2019.

Comparative Efficacy in Preventing Plaque Formation around Pit and Fissure Sealants: A Clinical Trial

AIM

The purpose of this study is to compare the clinical performance of an organo-selenium-containing pit and fissure sealant with that of a selenium-free sealant for clinical retention and prevention of plaque and caries development around the sealants.

MATERIALS AND METHODS

Following an in vitro study confirming the antimicrobial effect of an organo-selenium-containing pit/fissure sealant [DenteShield™ (DS)], 120 adolescents (7-20 years old) at varying caries risk status had DS sealant applied to a single tooth on the left or the right side of the dentition and UltraSeal™ XT Plus (UXT) on a corresponding tooth on the opposite side. Sealants' assessment was performed quarterly for 1 year for clinical retention, plaque, and caries formation around the sealant. Each sealant lost was replaced but considered as a failure in further analysis. McNemar's test was used to statistically analyze the outcome variables at each assessment time point.

RESULTS

While 7% and 12% plaque growth was observed around the UXT sealant at 9th and 12th months, respectively, DS exhibited 100% prevention of plaque growth. Both sealants exhibited 100% caries prevention. Clinical retention did not significantly differ between DS and UXT at all assessment time points except at 12 months when DS showed statistically significantly (p < 0.001) better retention (96%) than UXT (81%).

CONCLUSION

In this study, while both sealants are equally effective in caries prevention, DS completely prevented plaque growth around it with better clinical retention than UXT that offered only limited protection against plaque growth.

CLINICAL SIGNIFICANCE

Being antimicrobial, DS pit and fissure sealant may be the best sealant option for patients whose caries risk status is due to poor oral hygiene.