Comparison of blind and non-blind assessments of occlusal sealant retention

A comparison was made of scoring the retention status of BIS-GMA occlusal sealants 5 years after they had been placed, according to a non-blind and blind method of identification of teeth that had been sealed. Subjects were 175 children ages 15--18. One examiner made all the assessments. Retention of sealant was classified as all present, partly missing or all missing. There was 90.5% complete agreement between non-blind and blind examinations in scoring the retention status of 893 occlusal sites. Essentially no difference in agreement was found between sites on maxillary and mandibular teeth nor according to sites in specific teeth. There was only a slight tendency to classify more sites as having sealant present at the non-blind examinations than at the blind examinations, 56.7% and 55.1%, respectively. These findings would seem to indicate that whether examinations are done blindly or non-blindly is of minor importance in making an accurate assessment of sealant retention.     

Long term retention of sealants applied by inexperienced operators in Minneapolis

A clinical trial of 4047 single applications of Nuva Seal placed on the occlusal surfaces of primary molars, permanent first and second molars and premolars by 250 dental students showed that the sealants were not well retained. The sealant was fully retained on 86% of all permanent posterior teeth at 3 months, on 76% at 6 months, 58% at 12 months, 52% at 24 months and 41% at 36 months. At 4 years, complete sealant coverage was shown by 14% of primary molars, 25% of permanent molars and 68% of premolars. Permanent mandibular molars and premolars were superior to permanent maxillary molars and premolars in fully retaining sealants. Following sealant failure, i.e. providing partial coverage or missing, permanent maxillary molars and premolars were more prone to occlusal caries than permanent mandibular molars and premolars. At 4 years, caries was diagnosed in 40% of applications to permanent molars and in 9% of applications to premolars. Twelve instances of caries under apparently intact sealants were seen.     

Effectiveness of visible light fissure sealant (Delton) versus fluoride varnish (Duraphat): 24-month clinical trial

Abstract The present study compares visible-light Delton with Duraphat fluoride varnish for the prevention of occlusal caries in permanent first molars. A clinical trial was carried out in three groups of 6–8-yr-old schoolchildren: a sealant group (100 children), in which Delton light-polymerized fissure sealant was applied to permanent first molars; a varnish group (98 children), in which Duraphat was applied to permanent first molars; and a control group (116 children). Replacement (sealant) and reapplication (varnish) was carried out every 6 months. Percent effectiveness at 24 months (percentage of saving from caries taking molars as analysis unit) for those molars initially healthy and with complete occlusal eruption was analyzed. 272, 252 and 238 molars met the inclusion criteria in the control, varnish and sealant groups, respectively. Of these, 45.2%, 28.2% and 10.5% developed caries after 24 months. The effectiveness was greater in the sealed molars than in the varnished molars (62.7%i).     

Six-year clinical evaluation of polyacid-modified composite resin used as fissure sealant

The aim of this study was to evaluate retention and efficacy of polyacid-modified composite resin used as fissure sealant (Variglass V.L.C.) after six years. Three-hundred and seventy permanent first molars were sealed. After six years, 42.0% of the original group was re-examined and the sealant was found to be totally present in 3.4%, partially present in 16.2% and absent in 70.4% of the previously sealed occlusal surfaces. During the 6 years period, 9.5% of the sealed surfaces became carious, 25.0% were filled and 65.5% remained sound. Although the retention rate of the material has been very low, it appears to have prevented dental caries in 2/3 of the teeth evaluated after six years of placement.     

The New Mexico Sealant Program: A Progress Report

In 1979, the dental health program of the New Mexico Health and Environment Department began a school-based sealant activity. Children in the first, second, third, sixth, and seventh grades in selected New Mexico communities were offered sealants through this sealant activity. During the 1984-85 school year, program staff began seeing several hundred sixth-grade students who had received sealants in either the first, second, or third grade. Tooth- and surface-specific data on the current condition of all the previously sealed occlusal surfaces were collected from all these previous recipients of sealants. During the 1985-86 school year, we found that sixth-grade students who received sealants as first, second, or third graders had 5.6 percent of the occlusal surfaces of their first permanent molars either decayed, missing, or filled. Their classmates who had not previously received sealants had 26.85 percent of the same tooth surfaces either decayed, missing, or filled. During the 1985-86 school year, the complete retention rates for sealants were found to be 67.36 percent after six years, 78.53 percent after five years, and 93.47 percent after one year. The partial retention rates were found to be 10.46 percent after six years, 10.63 percent after five years, and 3.04 percent after one year.     

Two-year clinical evaluation of a pit and fissure sealant. Part II. Caries initiation and progression.

For the study, 479 paired permanent teeth and 20 paired deciduous teeth were coated under controlled clinical conditions with Nuva-Seal. A red dye was added to assist in placement and subsequent evaluation over a two-year period. Eighty-four children (ages 10 to 14) participated in the study. Caries was evaluated 3, 6, 12, and 24 months later with the same rating scale used at the baseline examination (0, caries free, to 4, severe caries), except when the sealant was found completely present and intact; then caries evaluation was limited to visual inspection through the sealant. The caries rate for control teeth was 6.9% at 3 months, 16.1% at 6 months, 26.4% at 12 months, and 37.6% at 24 months. Corresponding percent effectiveness figures for the sealant were 63.6%, 66.6%, 61.7%, and 54.6%, respectively. At 24 months, effectiveness rates for all types of teeth were at least 52% with the exception of the maxillary second molars (only 27% sealant effectiveness). Overall, caries protection as reflected by percent effectiveness was higher for mandibular teeth and premolars than for maxillary teeth and molars. There was significant effect on the incidence of dental caries when the sealant remained completely intact. Percentage effectiveness rates in this case were 90.7% at 12 months and 90.9% at 24 months. There was little gain or loss in caries protection when the sealant was partially or completely missing. Twenty-four percent of the children had a positive net gain or treatment effect at three months. This increased to 52% at 6 months, 62% at 12 months, and 70% at 24 months. With the use of half-mouth caries rates, the corresponding figures for positive treatment effects were slightly higher (30%, 64%, 70%, and 80% respectively).     

青岛市市南区小学生群体性窝沟封闭质量评价

目的研究群体性窝沟封闭的质量。方法参照第三次全国口腔健康流行病学抽样调查方案中分层、整群和随机抽样相结合的方法,从青岛市市南区4所学校抽取由青岛市口腔医院医务人员做过第一恒磨牙窝沟封闭的2～5年级小学生,各年级人数均为400名,男女各半。检查第一恒磨牙窝沟封闭剂的保留、脱落情况,填写统一记录表,对所得的数据进行统计学分析。结果随着窝沟封闭术后时间的延长,封闭剂的脱落率逐渐增加,封闭剂完全保留率逐渐降低;窝沟封闭术后3年,封闭剂完全保留率为60.0%,部分脱落率为24.0%,完全脱落率为16.0%。封闭剂在颊舌面的脱落率明显高于牙合面脱落率(P<0.05)。结论窝沟封闭后,随着时间延长,封闭剂的保留率降低,颊舌面封闭剂脱落率高于牙合面脱落率。窝沟封闭后应该加强复查复治,以保证防龋效果。     

Sealant effectiveness for children receiving a combination of preventive methods in a fluoridated community: two-year results.

A series of preventive methods in combination have been used to reduce dental caries in children including dental health education, prophylaxes, pit and fissure sealants, topical application of fluoride and restorative care. Prophylaxes, sealant, and fluoride procedures are repeated every six months. Two-year results show reductions of occlusal caries increments of 74.3% for first graders and 77.1% for sixth graders. Sealant loss, as defined in this study, varied from 33% to 90% with the highest loss occurring in the newly erupted permanent molars during the first six months of the project. These high sealant loss rates are thought to be related to the age of the population which was designed to include children at the ages of peak eruption of permanent molar teeth (ages six and twelve). These teeth were often only minimally erupted and maintaining the dry field required for sealant retention was extremely difficult. However, in spite of these high rates of sealant loss, caries reduction on occlusal surfaces was highly significant in comparision to that of children who did not receive sealants.     

Change in occlusal height resulting from placement of pit and fissure sealants.

This in-vitro study was done to identify the amount of change in occlusal height resulting from standard sealant application technique and to determine whether this change was uniform for both a filled and an unfilled sealant material. Twelve dental hygienists experienced in sealant technique each applied 10 filled sealants and 10 unfilled sealants in standardized artificial teeth mounted in a dentiform and mannikin setup in a dental unit. The teeth were measured with a digital caliper before and after sealant placement. Measurements were from a predetermined point at the apical area of the teeth to the depth of the central fossa. For the sample of 240 teeth, the mean sealant thickness was 0.43 +/- 0.20 mm. When the data for the filled and unfilled sealants were examined separately, the means were 0.47 +/- 0.23 mm and 0.38 +/- 0.16 mm, respectively. A t-test indicated a significant difference at p < 0.001. Analysis of variance revealed significant interoperator differences in sealant thickness (p < 0.01).     

The retention of pit and fissure sealants placed in primary school children by Dentl Health Services, Victoria

The benefit of a public sector sealant programme for children in Australia is yet to be established. This study evaluated sealants placed by therapists of the School Dental Service in Victoria, between 1989 and 1994, on permanent teeth of children in 15 primary schools in Melbourne. Seven hundred and seventy four children aged 6–12 years were examined in school dental clinics by six calibrated examiners. A total of 5363 sealants placed on 2875 permanent teeth (including 2616 first molars, 91 per cent of sample) up to four and a half years previously was examined. Values for complete and partial sealant retention were highest for premolars (86 per cent, 9 per cent respectively, total 95 per cent); similar for occlusal surfaces of maxillary and mandibular first molars (63 per cent, 30 per cent; 62 per cent, 32 per cent respectively) and buccal pits of mandibular molars (66 per cent); and low for pits/fissures of Carabelli's cusps of maxillary molars (44 per cent). Cross-sectional examination up to 24 months for both maxillary and mandibular first molars indicated average values of 67 per cent complete retention, 27 per cent partial retention, 6 per cent missing; thereafter complete retention decreased and partial retention increased. Sealant failures in the six months post-placement were attributed to technique failure. Regardless of sealant retention, caries experience was low under partially retained or missing sealants (4.5 per cent) and completely retained sealants (0.4 per cent). It is concluded that the SDS sealant programme is a sound preventive dental public health approach.     

Clinical application of visible light-cured fluoride-releasing sealant to non-etched enamel surface of partially erupted permanent molars.

A visible light-cured fluoride-releasing sealant was applied to non-etched enamel surfaces of partially erupted permanent molars. A scanning electron microscope was used to find an effective procedure to clean pits and fissures of the occlusal surfaces prior to application of the sealant. This procedure proved clinically acceptable and effective for prevention of dental caries immediately after eruption of permanent molars.     

The role of sealants in caries prevention programs

Pit-and-fissure sealants have been employed as an element in dental prevention programs for more than 30 years. The technique for sealant placement has evolved over time to become somewhat more invasive today. However, a meticulous technique is still required for success. Practitioners recently estimated that their one- and three-year sealant success rates were 89 percent and 78 percent, respectively. Grand medians for sealant success rates after one year in clinical trials have been reported to be as high as 83 percent for effectiveness and 92 percent for complete retention. Seven-year rates were 55 percent and 66 percent, respectively. Several changes in caries epidemiology have had an impact on the use of sealants. These changes include: * Declines in overall caries rates in U.S. schoolchildren during the latter decades of the 20th century; * A relative increase in the percentage of the population DMFS constituted by occlusal caries; and * A general slowing in the rate of lesion progression. Dentists' abilities to diagnose occlusal surface status also affect the decision to seal. Sealant cost-effectiveness can be improved by: * Targeting at-risk populations; * Using sealants on incipient lesions and minimally defective restorations; and * Training more dental auxiliaries to place sealants under a dentists' supervision. Concerns about sealing over decay and the estrogenicity of sealant components are addressed. Sealant guidelines, as promulgated by the Workshop on Guidelines for Sealant Use, are reviewed; and conclusions are presented about the role of sealants in prevention programs.     

A comparative study of two pit and fissure sealants: three-year results in Augusta, Ga.

A total of 254 children were examined 36 months after a single application of sealant. In 128 children, 201 permanent first molars were treated with Delton, and, in 126 children, 205 permanent first molars were treated with Nuva-Seal. Delton was completely retained on 80% of all paired permanent first molars, partially retained on 10%, and completely lost on 10% of the study teeth. Nuva-Seal was completely retained on 60% of all paired permanent molars, partially retained on 21%, and completely lost on 19% of the study teeth. Delton was 69% effective in preventing occlusal caries on permanent first molars three years after a single application. Nuva-Seal was 39% effective in preventing occlusal caries on permanent first molars three years after a single application. Both sealants have been shown to prevent dental caries on permanent first molars of children three years after a single application.     

A 5-year clinical evaluation of the effectiveness of a fissure sealant in mentally retarded Canadian children

The occlusal fissures of 812 permanent and primary posterior teeth were sealed with an ultraviolet polymerisable resin. A half mouth technique was used to evaluate the effectiveness of the sealant in the prevention of fissure caries. At the end of 5 years 19.3% of 409 teeth in 103 children had the sealant completely intact and fissures were partially sealed in 20.8%. Retention was greatest in the mandibular pre-molars. The decay rate was less than half in the treated teeth compared to the control teeth. The net gain was 62 teeth and the percent effectiveness was 57.9%. Thus there was still a highly significant effect of a single application of the fissure sealant after 5 years. Simple cost benefit calculations indicate that the technique is not suitable as a public health measure but has merit for mentally retarded persons and in private practice situations.     

Effectiveness of sealant treatment over five years in an insured population

BACKGROUND: The authors analyzed an insurance claim database to evaluate the use and effectiveness of placing sealants on first and second permanent molars of children in private dental practices. METHODS: A retrospective study was conducted using an insured population with sealant coverage at 70 percent of the usual fee in a preferred provider organization than that limited reapplication to once every three years. Children were selected who were eligible for sealant benefits from July 1, 1990, to June 30, 1991. Two groups were selected for analysis, based on age, as determined by permanent molar eruption dates. Children who received sealants were compared with those who did not to determine post-sealant restorative outcomes after five years. RESULTS: During the full year of coverage, sealants were used in only 16.3 percent of first permanent molars and 11.6 percent of second permanent molars. The five-year incidence of an occlusal restoration having been placed was 13.7 percent and 20.8 percent, respectively, on nonsealed first and second molars and 6.5 percent and 10.4 percent, respectively, on sealed first and second molars. From years three to five, sealant placement provided only nominal additional preventive effect. CONCLUSIONS: In the population selected, both the incidence of occlusal caries and the use of sealants were lower than expected for both age groups. However, within these groups, molar occlusal surfaces were only half as likely to have been restored in sealed teeth than in nonsealed teeth after five years. CLINICAL IMPLICATIONS: Based on the five-year data from a population with a low incidence of caries, the authors found that 15 sealed first permanent molars or 10 sealed second permanent molars prevented placement of one occlusal restoration. Therefore, sealants are more effective when placed in patients with risk factors for occlusal caries.     

Comparison of antibacterial properties of two fluoride-releasing and a nonfluoride-releasing pit and fissure sealants

Occlusal pits and fissures are the most susceptible sites for the development of dental caries and prevention is difficult in the areas of occurrence. Although only 12.5% of all the tooth surfaces are occlusal, these surfaces develop more than two-thirds of total caries experienced by children. The fate of the bacteria is of significance when they are inadvertently sealed by a dental sealant. This study aimed in examining the antibacterial properties of three commercially available sealants, viz., Teethmate-F, Helioseal-F and Helioseal. Antibacterial testing was done by disc diffusion method. Selective agars were used to grow Streptococcus mutans and Lactobacillus acidophilus, which are implicated in the pathogenesis of dental caries. Statistical analysis was carried out using student's t test. The study proved that Helioseal-F and Helioseal did not possess antibacterial properties and Teethmate-F was the only sealant that showed antibacterial properties.     

Factors related to prosthetic restoration in patients with shortened dental arches: a multicentre study

The aim of this study was to identify the factors related to prosthetic restoration in patients with shortened dental arches (SDA). SDA patients with 2-12 missing occlusal units were consecutively enrolled from seven university-based dental hospitals in Japan. Of the 145 subjects (mean age; 63·4 years), 41% chose no treatment and 59% sought to replace their edentulous spaces with removable partial dentures or implant-supported fixed partial dentures. Restoration decisions were related to tooth loss patterns. Only 3% of subjects missing just second molar(s) sought to receive prosthetic treatment, while the percentage increased to 58% in subjects who were missing first and second molars and 93% in subjects missing premolar(s). Logistic regression analyses found that young age, increased number of missing occlusal units, asymmetric arch and presence of chewing complaint were significant predictors for prosthetic restoration (P<0·05). Increased number of missing occlusal units and asymmetric arch were significant predictors for the presence of chewing complaint (P<0·05). These results suggest that perceived impairment of chewing ability owing to missing occlusal units is a critical factor for prosthetic restoration in SDA patients.     

The Effectiveness of Pit and Fissure Sealants

This review addresses two major issues related to the use of pit and fissure sealants. First, the epidemiology of occlusal caries for children and adults is examined to determine if there is a basis for administering sealant programs to different age groups. Second, the effectiveness of pit and fissure sealants in fluoridated and non-fluoridated communities is compared. Changes in effectiveness of sealant over time are evaluated in terms of percent effectiveness, complete retention, caries incidence, and reapplication rates. Based on epidemiologic evidence, sealant programs can be justified for children and young adults, but not for older age groups. Based on the literature reviewed, following one application of autopolymerized or visible-light-cured sealant, the median percent effectiveness declines from 83 percent after one year to 55 percent after seven years. Similarly, the median complete retention declines from 92 percent after one year to 66 percent after seven years. Conversely, the median percent of sealed first molars becoming carious and/or restored increases from 4 percent after one year to 31 percent after seven years. Large differences in sealant effectiveness are not apparent between studies performed in fluoridated and fluoride-deficient communities.     

A filled pit and fissure sealant: 18-month results.

One hundred and forty-three patients ranging in age from 5 to 8 years participated in a pit and fissure sealant study using a half-mouth design. At the end of 18 months, for all permanent first molars, there was a 75.9% effectiveness with a net gain of 82, which was statistically significant. The sealant was present on the surfaces to which it was applied in 74% of the teeth. Application time was 8 minutes per quadrant and 5.5 minutes per tooth. The effect of treatment was similar to that reported for an unfilled BIS-GMA sealant in patients with similar teeth and similar ages. Loss of sealant from the permanent maxillary first molars did not appear to contribute to the initiation of dental caries. However, in 6 of 38 mandibular tooth surfaces, sealant loss may have been a factor.