Sealant retention and effects on occlusal caries after 2 years in a public program

A clinical trial of one application of Nuva-Seal fissure sealant was conducted under School Dental Service conditions in a low-income area of London. The sealant was applied to one of a cariesfree pair of permanent teeth by schools' dentists, the other tooth being left as a control. One examiner, who did not apply the sealant, conducted examinations at baseline, after 6 months, and after 2 years. There were 118 children, initially aged 5-12, who remained in the trial after 2 years. The sealant was fully retained on 27.4 % of the teeth, partially retained on 40.6 %, and missing on 17.9 %. The remaining 14.1 % of teeth had been restored. There was no statistically significant difference between subjects who had less decay in sealed teeth and those who had less decay in control teeth. The sealant was 13.6 % effective (not significant, P less than 0.4) in preventing caries in sealed teeth. These results are less favorable than those in other trials reported. The potential role of fissure sealants in a School Dental Service is discussed.     

A comparison of sealant placement techniques and 12-month retention rates

OBJECTIVE: This study compared time required and 12-month retention for two methods of sealant placement: traditional acid-etch technique and air-abrasion technique without acid etch. METHODS: Sealants were placed on the permanent first molars of 84 children in grades 1-4 who were randomly assigned to treatment groups. All sealants were placed in a school setting by the same clinician. Chair time required for sealant placement was recorded, and retention rates were determined for each technique 12 months after placement. RESULTS: Mean chair time for placement of sealants on four first molars using the air-abrasion technique was significantly less than for the acid-etch technique (7:36 minutes vs 10:56 minutes). Fifty-eight children were available at 12-month follow-up; an examiner not involved in sealant placement and masked as to the technique used determined retention. Rates of complete retention for occlusal surfaces were not significantly different for the two techniques, although the rate for acid etch was higher than that for air abrasion (95% vs 87%). The complete retention rates for the acid-etch technique were significantly higher than air abrasion for buccal and distolingual surfaces. These rates were 65 percent and 58 percent, respectively, for acid etch and 6 percent and 28 percent, respectively, for air abrasion. CONCLUSION: Although more research is needed to improve air-abrasion applications, it does not appear that air abrasion without acid etching offers a significant advantage over traditional sealant placement methods and, in fact, appears to be inferior to the acid-etch technique for use in public health settings.     

Effect of an autopolymerizing sealant on viability of microflora in occlusal dental caries

A total of 106 molars with occlusal caries were sealed with an autopolymerizing scalant. Samples of the carious dentin were obtained 1, 3, 7, 14 and 28 d, and 2, 4, 6, and 12 months after sealant placement. The samples were cultured on enriched nonselective medium, a streptococcal medium, a Streptococcus mutans medium, and a medium for acidogenic microorganisms. The bacterial counts, were compared with control samples obtained from nonsealed occlusal carious lesions, half of which had acid conditioner applied to the occlusal surface for 1 min prior to sampling. The mean total viable counts decreased by approximately 99.9% during the 1-year study period, from 925.1 × 10⁴ CFU/mg of sample to 0.9 × 10⁴ CPU/mg of sample. Statistically, there was a very strong linear relationship (P < 0.001) between the reduction in bacterial counts and time. A similar reduction was observed for the total streptococcal count and the S. mutans count. The etching procedure itself reduced the number of cultivable organisms by about 75%. Sealant material that was polymerized directly in culture media did not result in any inhibition of bacterial growth. Although slight fluctuations in the relative proportion of the microflora were observed at the different sampling intervals, there were no significant changes in the relative distribution of bacterial types with time.     

Evaluation of the retention of two types of pit and fissure sealants

The aim of this study was to statistically compare the retention of a chemically polymerized sealant (Delton, Johnson & Johnson Co., East Windsor, N.J.) with a widely tested UV-polymerized system (Nuva-Seal, L.D. Caulk Co., Milford, Del.) Two hundred children aged 5-16 years who resided in Fairfax County, Virginia (a fluoridated community) and who had one or more pairs of homologous permanent posterior teeth free of decay or fillings were admitted to the study. Posterior teeth on one side of the mouth of each subject were randomly assigned to receive Nuva-Seal; teeth on the other side were treated with Delton. Treated teeth were examined for sealant loss approximately every 6 months for a period of 2 years. Scores for complete retention of Nuva-Seal were 86% after 6 months and 78% at the end of 2 years. The corresponding values for Delton-treated teeth were 96% and 92%. For both sealants, scores of total retention were highest in mandibular first premolars and lowest in mandibular second molars. The greatest rate of sealant loss occurred within the first 6 months after placement. A comparison of overall retention scores (net gain) for Delton and Nuva-Seal revealed that Delton scores were significantly higher than Nuva-Seal at each semi-annual examination. The McNemar test was used to compare the retention of the two sealants for each tooth type. The test showed that the retention scores for Delton were significantly higher than those for Nuva-Seal only on maxillary and mandibular first molars.     

Effectiveness of fissure sealant 3 years after application

abstract – Findings 3 years after the application of a fissure sealant revealed that of the 166 sealed permanent first molars, 7.8 % of the sealants were missing or partly missing, 14.5 % were in fair condition, and 77.8 % had remained in good condition. During the 3-year test period, 7.8 % of the sealed permanent molars had become carious, while 63.3 % of the respective control teeth had decayed. The teeth which had sealants in good condition showed no caries, whereas 92.3 % of the teeth which had sealants missing or partly missing showed carious fissures. The net gain in the study was 104, and the percentage effectiveness of the method was 88.1 %. The treatment effect was found to be very significant when analyzed on the basis of homologous paired test-control teeth (P < 0.001). The sealing of pits and fissures was found to have a positive treatment effect on 60.2 % of the subjects when evaluated on an individual basis (0.1 < P < 0.05).     

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.     

Tentative analysis of the efficiency of fissure sealant in a public program in London

A tentative analysis was made of the efficiency of allocating resources to fissure sealing, rather than to restorative care, in a public dental program. Data for the study were taken from a 2-year clinical trial in London. The analysis is necessarily tentative because the clinical trial employed the half-mouth design, which does not represent a true-life situation. Over the 2 years of the study, it was found that sealing the population of study teeth took from 24.9% to 33.8% more time than treating the lesions which developed in the control teeth would have. Reasons are given why this finding cannot be accepted as conclusive; rather, it is presented to raise questions and to stimulate additional studies into the efficiency of preventive programs. Guidelines for such studies, which should be conducted in different populations with varying caries prevalence, are suggested.     

Caries reduction over 5 years from a singie application of a fissure sealant

ABSTRACT – This paper is a continuation of three previously published papers giving a long-term clinical evaluation of an ultraviolet hght polymerizable fissure sealant method. The present findings revealed that of the 156 permanent teeth available for study 5 years after initiation, 59.6% retained the sealants in good condition, while 25.6% of the sealants were missing or partly missing. During the test period, 37 (32.2%) of the 115 sealed permanent first molars had become carious, while 92 (80.0%) of the respective paired controls had decayed. An analysis of the efficacy of the treatment on the test-control tooth pairs showed a net gain of 55 and a percentage effectiveness of 59.8%. The sealed teeth were found to be highly significantly less decayed than the respective controls ( P < 0.001). Of the individual subjects, 73.4% were found to have benefited from the treatment.     

Use of adhesive sealants over occlusal carious lesions: radiographic evaluation

Abstract 108 carious and noncarious first permanent molar teeth were sealed with Nuva-Seal®. Presealant and the latest postsealant radiographs were rated for occlusal caries penetration for time intervals from 2 to 5 years. With sealants that were sound at the most recent recall visit, there was a significant decrease in the rating of caries penetration. With sealants evaluated as being defective, there was a slight increase in caries penetration.     

Retention and caries preventive effects of a GIG and a resin-based fissure sealant

Abstract Fissure sealing using partially filled resins is an established caries preventive practice. Glass ionomer cement (GIC) sealants may offer additional advantages due to their ability to bond chemically to enamel and release fluoride. The aim of this study was to compare the caries preventive effect and retention of a GIC and a resin-based sealant. Ketac-fil® was tested against a chemically cured resin-based material (Delton®) using a split mouth design. Perth (Western Australia) schoolchildren (n= 465), mean age 7 yr±0.72 (S.D.), received sealants on the occlusal surfaces of sound homologous permanent first molar pairs. Test (GIC) and control (resin) sealants were systematically allocated to left and right sides based on the child's month of birth, and were placed by dental therapists. After 3.64±0.11 yr, 415 children were examined by different clinicians, and the clinical status of the teeth and the extent of sealant retention recorded. Sealants were deemed retained when at least 2/3 of the fissure pattern was still sealed. In 252 tooth pairs, neither sealant was retained to this extent. In 71 pairs, the GIC was not retained and the resin sealant retained. In 40 pairs the reverse occurred (McNemar's test, χ²= 8.66, P < 0.005). Net gain (additional lesions prevented by the test agent per 100 treatments) was 6.1%(95% CI 3.3%, 8.9%). Effectiveness of the GIC was 80.6% (95% CI 59.6%, 90.7%). The relative risk of caries in test teeth was 0.19 (95% CI 0.09, 0.40). The study suggests that complete retention of GIC sealant is not necessary for caries prevention in newly erupted permanent first molars.     

Retention of a glass ionomer cement and a resin-based fissure sealant and effect on carious outcome after 7 years

Abstract– The aim of this study was to compare the retention and caries preventive efficacy of glass ionomer (Fuji III; GIC) and light-cured resin-based (Delton; LCR) fissure sealants. One hundred and sixty-six 5–14-year-old schoolchildren received sealants on their newly erupted first or second molars; a split mouth design was used. Previously reported 2-year results showed low retention rates for GIC sealants, but no difference in the caries increment between the groups. The same persons were invited to a dental check-up 6.1 to 7.8 (mean 7.1) years after the application of sealants; 111 persons (66.8% of the original group) participated in the study. The retention of sealants, and the caries status of occlusal surfaces and adjacent proximal surfaces was recorded. On the sealed occlusal surfaces, 10% of GIC and 45% of LCR sealants were totally and 9% of GIC and 20% of LCR sealants partially present. Twenty-three (23.5%) of the occlusal surfaces sealed with GIC and 16 (16.5%) of those sealed with LCR were carious or filled. Compared to LCR sealants, the effectiveness of GIC sealants was –44% (95% CI –71%, 16%) and net gain –7% (95% CI –18%, 4%). The relative risk of caries occurring was –44 (95% CI 0.96, 2.14).     

On the retention and effectiveness of fissure sealant in permanent molars after 15-20 years: a cohort study

The aim of the present study was to clinically evaluate fissure sealants on the occlusal fissures and buccal pits of permanent first and second molars after 20 and 15 years, respectively. The population consisted of 72 children, each of whom had had their four first molars sealed between 1977 and 1980. At the annual examinations, all caries-free, newly erupted second molars were sealed. When sealant was applied to the second molars, the first molars were checked and sealant was reapplied to those that had deficient sealants. At the follow-up, when the subjects were 26-27 years of age, 27 in the original group had moved from the community. Thus, the present result is based on 45 subjects. One hundred and fifty-three sealed first molars and 161 sealed second molars were available for inspection. At the follow-up examination of the first molars 20 years after sealant had been applied, 65% showed complete retention, 22% partial retention without caries, and 13% caries or restoration in the occlusal fissures or buccal pits. At the 15-year follow-up of the second molars, the corresponding figures were 65%, 30%, and 5%, respectively. Of the restored or carious molars, significantly more were found in the mandible than in the maxilla (P<0.001). This longitudinal study showed that pit and fissure sealants--applied during childhood--have a longlasting, caries-preventive effect.     

Time of Development of Occlusal and Proximal Lesions: Implications for Fissure Sealants

Analysis of surface and tooth-specific data from NHANES I and HHANES shows that the pattern of dental caries differs greatly from tooth to tooth and surface to surface. Occlusal caries precedes all other types, and increases most rapidly and to the highest levels in the molars. Caries on the proximal surfaces comes later. For sealants to be of value, they must reduce the need for restorations. Therefore, the value of sealants will be determined by the balance between high enough levels of potential caries on occlusal surfaces to give them something to prevent, and low levels of, or sufficiently delayed, proximal lesions to prevent the loss of the otherwise saved occlusal surface. The data presented demonstrate that as of the time of NHANES I, the number of permanent molars that could have had surfaces saved from restoration, at least for a number of years, appears to be sufficient to warrant widespread use of sealants on those teeth. More recent data (HHANES) suggest that the current decline in caries prevalence is likely to reduce the value of sealants in the short run because there are fewer occlusal lesions in young children, but may increase the value of sealants in the long run because proximal caries in older children and adults is also declining.     

Retention and effectiveness of a chemically polymerized pit and fissure sealant after 2 years

abstract — Following a single application of a chemically polymerized fissure sealant (Concise Enamel Bond System®) 60% of the sealants were present after 2 years of examination. The effectiveness of the treatment was highly significant and the caries reduction, irrespective of the sealant status, was found to be about 5096. The caries reduction was 98% in sealed pairs where the material was fully retained.     

Methods and preliminary findings of a cost‐effectiveness study of glass‐ionomer‐based and composite resin sealant materials after 2 yr

The cost‐effectiveness of glass‐carbomer, conventional high‐viscosity glass‐ionomer cement (HVGIC) [without or with heat (light‐emitting diode (LED) thermocuring) application], and composite resin sealants were compared after 2 yr in function. Estimated net costs per sealant were obtained from data on personnel time (measured with activity sampling), transportation, materials, instruments and equipment, and restoration costs for replacing failed sealants from a community trial involving 7‐ to 9‐yr‐old Chinese children. Cost data were standardized to reflect the placement of 1,000 sealants per group. Outcomes were the differences in the number of dentine caries lesions that developed between groups. The average sealant application time ranged from 5.40 min (for composite resin) to 8.09 min (for LED thermocured HVGIC), and the average cost per sealant for 1,000 performed per group (simulation sample) ranged from $US3.73 (for composite resin) to $US7.50 (for glass‐carbomer). The incremental cost‐effectiveness of LED thermocured HVGIC to prevent one additional caries lesion per 1,000 sealants performed was $US1,106 compared with composite resin. Sensitivity analyses showed that differences in the cost of materials across groups had minimal impact on the overall cost. Cost and effectiveness data enhance policymakers’ ability to address issues of availability, access, and compliance associated with poor oral‐health outcomes, particularly when large numbers of children are excluded from care, in economies where oral health services are still developing.     

(牙合)面可疑龋诊断不同方法比较

目的:比较临床检查(CE),常规X线片(CR),(牙合)翼片(BW)和牙科X线影像诊断系统(RVG)诊断可疑(牙合)面龋的精确性.方法:44个可疑面龋的离体牙作为研究对象,以病理组织学检查为标准,测定计算真、假阳性率(TP,FP)和预测值(TP/FP).结果:TP和FP是:CE=0.63和1.91,CR=0.59T和0.88,BW=0.39和0.58,RVG=0.68和1.85.TP/FP是:CE=1.91,CR=0.88,BW=0.58,RVG=2.06.RVG与CE及CR无显著性差异(P>0.05).结论:RVG可期望增加诊断效果,并可减少X线剂量和产生即刻影像.     

Clinical effectiveness of an autopolymerized fissure sealant after 2 years

The clinical effectiveness of Delton fissure sealant was studied in 205 children, ages 6--10 years (mean age 71/2). 993 children in grades 1, 2, 3 and 4 were screened and subjects were selected if there was evidence of previous dental caries in the mouth, and a pair of contralateral maxillary or mandibular first permanent molar teeth were free of caries. Two pedodontists independently examined the children in a mobile van equipped with two operatories, and each applied sealants to approximately half of the subjects. After 11 months, in 186 subjects there were 10 sealants partially lost, five experimental teeth carious or filled and 53 control teeth carious or filled. After 24 months, in 175 subjects there were four sealants completely lost, 12 sealants partially lost, 11 experimental teeth carious or filled and 89 control teeth carious or filled. Consequently, sealant retention was 92% after 11 months and 85% after 24 months. Percent effectiveness in caries reduction was 90% after 11 months and 88% after 2 years.     

Twelve-month sealant retention in a school-based program using a self-etching primer/adhesive

OBJECTIVES: Very little independent research has been done on the new self-etching primer/adhesives in dentistry. A recent clinical study compared two sealant application techniques involving self-etching primer adhesives and the traditional phosphoric acid etch. The purpose of this study was to compare these two techniques in an Iowa school-based sealant program. METHODS: Twelve-month sealant retention data on 208 students from the Des Moines, Iowa, school-based sealant program were analyzed retrospectively. RESULTS: Sealant retention reported at the person level showed that 60 percent of the students who received sealants at the five schools had to be recalled at one year to have one or more surfaces resealed. A logistic regression model at the person level demonstrated that the phosphoric acid technique was six times as likely to have retention of all the sealed tooth surfaces as those sealed with Prompt-L-Pop. CONCLUSIONS: In this study, many students had to be recalled to the chair 12 months after sealant application due to incomplete retention. Though sealants were retained in larger numbers with phosphoric acid, overall sealant retention at the tooth level was lower than previously published for clinical studies and school-based programs. Examining retention data at the person level, however, allows program administrators to plan resources more effectively and reevaluate sealant protocol to ensure as few children return for sealant reapplication.