Clinical comparison of a flowable composite and fissure sealant: A 24-month split-mouth,randomized, and controlled study

Objectives

The aim of this clinical study was to evaluate the retention rate and caries-prevention effect of a flowable composite compared to a conventional resin-based sealant in a young population over a 24-month period.

Methods

Thirty-four patients, ranging in age from 16 to 22 years, diagnosed with at least 2 non-cavitated pit-and-fissure caries in the first and second molars were selected for this randomized split-mouth design trial. A total of 220 sealants, were placed in 117 upper molars and 103 lower molars. The teeth were sealed with a flowable resin composite (Tetric Evo Flow) or a sealant material (Helioseal F). Each restoration was independently evaluated in terms of retention and the presence of caries at baseline and at 1, 6, 12, and 24 months. Data were analyzed using non-parametric Mann–Whitney U and Friedman 1-way ANOVA tests at p < 0.05.

Results

Tetric Evo Flow showed complete retention with 100%, 95.5%, 93.8%, and 88.5% at 1, 6, 12, and 24-month evaluations, respectively, while Helioseal F retention rates were 98.1%, 95.5%, 94.8%, and 85.4%, respectively, for the same evaluation periods. At the 24-month recall, 4 (4.2%) total losses were observed in subjects treated with Tetric Evo Flow and 2 total losses (2.1%) for Helioseal F, respectively. No significant differences were observed between the materials in retention rates or caries incidence for each evaluation period (p > 0.05).

Conclusion

Placement of flowable composite as fissure sealants in the younger population seems to be as effective as conventional fluoride containing fissure sealants for the prevention of fissure caries.

Clinical relevance

The use of a flowable composite as a fissure sealant material, in conjunction with a total-etch, single bottle adhesive, yielded better retention than did the conventional fluoride containing resin-based fissure sealant over a 24-month period in young patients.     

Marginal seal evaluation of different resin sealants used in pits and fissures. An in vitro study

ATM: Oral health is important for everyone, but specially for children and people requiring special care owing to impaired manual ability. Primary prevention, with correct oral hygiene, proper diet, use of fluoride and pit and fissure sealants, can reduce caries risk thereby improving patients' quality of life. The first aim of this paper was to assess the marginal microleakage of different pit and fissure sealants after immersion in a cariogenic solution. The second aim was to evaluate the ability of the materials to penetrate into the bottom of the fissure. METHODS: 32 posterior teeth were divided into four groups based on the type of sealant tested: Concise, Clinpro, Fissurit, Fissurit F. Samples were immersed and stored in a lactic acid solution (pH 4.4, 0.1 M) at 37 degrees C for different periods: 1 day; 3 days; 7 days; 10 days. Then each sample was stored in erythrosine solution for 24 hours at 37 degrees C. Each sample was sectioned in a mesio-distal direction and evaluated at the stereomicroscope and subsequently at SEM. RESULTS: SEM analysis showed that Clinpro and Concise obtained a good penetration inside the fissure and a good adaptation to the enamel wall, while Fissurit and Fissurit F showed gaps at the sealant-enamel interface and voids. CONCLUSION: Sealant application is an important means for caries prevention but, for a lasting effect, it must be associated with good oral hygiene and regular dental check-ups.     

Effectiveness of combined preventive methods on erupting teeth in children in a fluoridated community

Several preventive methods were used in combination to reduce dental caries in children residing in a fluoridated area. The method included dental health education, prophylaxis, pit and fissure sealants, topical fluoride and restorative care. Prophylaxis, sealant and fluoride procedures were repeated every 6 months. Sealant was applied to all fully erupted caries free posterior teeth in the mouth. This report compares results obtained for teeth that erupted after the study began with those teeth that were already present at the time treatment procedures were applied. Percent reductions in caries increment for newly erupted teeth at the end of 3 years for treated 6th graders was 77.5% in DMFT and 79.2% DMFS as compared to 71% and 58.3% for previously erupted teeth. Results for children in 1st grade did not how such beneficial results. Permanent first molars in younger children appear to be highly susceptible to caries. Sealant retention for newly erupted teeth follows the same pattern as for teeth previously erupted.     

A combined approach to preventing dental caries in schoolchildren: caries reductions after 3 years

A combination of preventive methods have been used to reduce dental caries in children residing in a fluoridated area of Southeastern Michigan. These children had very low restorative treatment levels. The methods used include dental health education, prophylaxis, pit and fissure sealants, topical application of fluoride and restorative care. Prophylaxis, sealant and fluoride procedures were repeated every 6 months. Sealant was applied to all caries-free posterior teeth in the mouth. Three-year results show reduction of occlusal caries increments of nearly 73% for both 1st and 6th school grades. Although at baseline examination there was no statistically significant difference between the two groups in mean DMF teeth and surface scores, the difference in mean increments at the end of 3 years was statistically significant (P less than 0.01). Percent reductions in caries increment for permanent first molars in 1st graders were 65.6 for DMF teeth and 66.7 for DMF surfaces. Corresponding figures for permanent teeth among 6th graders were 71% and 58.3%.     

Porosity of pit and fissure sealants

The aim of this study was to investigate the bulk porosity of a range of pit and fissure sealants. The following materials were included in the study: Concise White Sealant and Delton (chemically cured); Delton (visible light-cured); Helioseal, Visioseal and Prolite (visible light-cured with delivery from the bottle via cannule); Delton, Luma Seal and Prisma Shield (visible light-cured with syringe-type direct delivery systems). Five cylindrical samples, 7 mm in diameter and 1 mm in thickness, were prepared from each sealant and the following parameters were analysed in a computer-controlled mercury porosimeter: (i) total cumulative pore volume; (ii) specific surface area of pores; (iii) percentage total porosity (iv) bulk density; and (v) pore radius distribution. According to the results, the chemically cured sealants exhibited total cumulative pore volume, specific surface area of pores and total porosity. Significant differences were detected within the group of visible light-cured materials. The visible light-cured sealants with syringe-type delivery exhibited the lowest porosity.     

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.     

Comparative evaluation of the marginal sealing ability of Fuji VII and Concise as pit and fissure sealants

AIM: The anatomical pits and fissures of the teeth have long been recognized as susceptible areas for the initiation of dental caries. The extreme vulnerability to decay of these pits and fissures on the occlusal surfaces has prompted dental scientists to seek methods of caries prevention. Motivated by the role of pit and fissure sealants in caries prevention, the aim of this study was to compare the efficacy of Fuji VII glass ionomer sealant and Concise resin-based sealant. METHODS AND MATERIALS: An in vitro study was undertaken using forty premolars extracted for orthodontic reasons. The teeth were divided into two groups and sealants were applied. One was an experimental group using Fuji VII as a pit and fissure sealant and the other a control group using Concise. The teeth were kept in gentian violet dye for 24 hours, the sectioned samples were observed for the extent of dye penetration, and scores were based on established scoring criteria. RESULTS: The comparison of the performance of the two groups showed a statistically significant difference. CONCLUSION: The Concise resin-based sealant performed better in terms of sealing ability than did the Fuji VII glass ionomer sealant.     

3种窝沟封闭剂微渗漏的实验研究

目的:比较3种窝沟封闭剂的微渗漏情况,为选择操作技术难度低且具良好边缘密合性的窝沟封闭剂提供实验依据.方法:收集正畸减数的上颌前磨牙40颗,随机分为5组,每组8颗.即:Helioseal F组、GC Fuji Ⅶ组、GC Fuji Ⅶ+唾液污染组、Embrace WetBond组、Embrace WetBond+唾液污...     

Effect of sealant viscosity on the penetration of resin into etched human enamel

This study was designed to investigate the relationship between the etched depth, penetration of sealants and marginal seal. Sixty unerupted lower first premolars extracted from patients for orthodontic reasons were thoroughly cleaned and stored in an antiseptic Ringer's solution at 4 degrees C. A "window" on the occlusal of 15 of the premolars, including both mesial and distal pits, was developed by painting nail varnish around the border of the occlusal surfaces. Etching was then done with 35% phosphoric acid for 60 seconds to all 60 premolars. Five of the "window" teeth were evaluated by microradiography to determine the etched depth of the superficial and subsurface enamel. Five were prepared for SEM analysis to observe the change of the superficial etched enamel surface. Another five "window" teeth were embedded in epoxy resin and sectioned parallel to the long axis of the tooth through the fissures in order to observe the subsurface depth of the etch by SEM analysis. The other 45 teeth were divided into three groups of 15 teeth each. Fissures of each group of teeth were sealed using Prisma-Shield (LD Caulk), Concise White Sealant (3M Dental Products) or Teethmate A (Kuraray) sealants and stored in water (37 degrees C) for 24 hours. They were then sectioned and demineralized before being examined by a scanning electron microscope. Photographs of secondary electron image (SEI) were done to gradate the resin-infiltrated enamel and resin tags for these sealants. After SEM observation, the 15 samples of each applied sealant were polished to a high gloss again and placed in a silver nitrate solution for 24 hours before being examined under the SEM equipped with a back-scatter electron detector. Data were then analyzed using the Welch and Student t-tests. Results showed that fissured enamel of unerupted human lower first premolars became porous after etching with 35% phosphoric acid. The low viscosity sealant Teethmate A (approximately 260 mPa.s), penetrated fully and formed a resin-infiltrated layer in enamel beyond the etched depth. However, the high viscosity sealants (Prisma-Shield and Concise White Sealant) did not penetrate enough to ensure that the acid-etched enamel was infiltrated sufficiently by the sealant to insure good marginal seals.     

Clinical radiographic evaluation of sealed carious and sound tooth surfaces

The results of a 2-year radiographic assessment of 113 carious posterior teeth that were sealed with one of two sealants are presented. Little or no difference was found in radiographic ratings of caries by type of sealant. Sealant loss between annual recall visits had little or no detectable effect on radiographic ratings of caries during the study. Radiographs suggested that caries may regress in sealed teeth with early caries. The results support the safety of sealing incipient caries in pits and fissures to increase the potential uses of sealants.     

Evaluation of microtensile bond strength of different fissure sealants to bovine enamel

Background: The aim of this study was to evaluate the microtensile bond strength (μTBS) of a new fissure sealant and compare it with conventional sealants which are applied to enamel alone, and also with self‐etch and etch‐and‐rinse adhesives. Methods: Enamel specimens were prepared and randomly distributed into three groups according to fissure sealant (Aegis, Helioseal F, Helioseal Clear). Each group was then subdivided according to adhesive system (Clearfil S3, Single Bond, no adhesive). A universal testing machine was used to measure μTBS, and data were analysed using one‐way ANOVA and Tukey’s tests. Results: μTBS values for all Aegis subgroups were significantly lower than for comparable Helioseal F and Helioseal Clear subgroups (p < 0.05). No differences were observed in μTBS of Helioseal F and Helioseal Clear (p > 0.05). In the Helioseal Clear group, μTBS values for Single Bond were significantly higher than for Clearfil S3 (p < 0.05). However, no significant differences were found between the μTBS values of the adhesive subgroups in the Aegis or Helioseal F groups (p > 0.05). Conclusions: Sealant μTBS values may be affected by material content. The addition of an adhesive may improve μTBS values of sealant to enamel.     

Fissure sealant wear at 30 months: new evaluation criteria.

The volume, depth and area of fissure sealant wear at 30 months is reported. Eighteen premolar teeth were included in the study. The teeth were sealed (Concise, White Sealant, 3M Dental Products Div., St Paul, MN, USA) and an impression taken, yielding a baseline record. Subsequent impressions were taken at 6 months and 30 months. Epoxy replicas were made from all impressions and the occlusal surface of each replica was digitized using a displacement stylus and programmable retrieval system. A goodness-of-fit routine was used to compare the digitized replicas and quantify wear. At 30 months, there was a mean sealant volume loss of 0.43 +/- 0.24 mm3 (mean of the maximum depth loss = 221.8 +/- 115.1 microns; mean area loss = 0.62 +/- 0.15 mm2) for all teeth. A new parameter, the Occlusal Stability Ratio (OSR), is discussed which describes the relationship between sealant area and sealant volume.     

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.     

自酸蚀黏结剂对恒牙窝沟封闭的疗效评价

目的观察自酸蚀黏结剂AdperTM和PromptTM涂布牙面后,窝沟封闭剂的1年随访保留率和龋降低率。方法选择62例6～14岁儿童、完全萌出的第一(或第二)恒磨牙156颗,采用自身对照方法,比较自酸蚀黏结剂涂布牙面后窝沟封闭(自酸蚀组)与磷酸酸蚀牙面后窝沟封闭(磷酸酸蚀组)的效果。治疗后随访3、6、12个月,应用SPSS12.0统计软件包对数据进行χ2检验及t检验。结果自酸蚀组封闭1颗牙的总操作时间为(122±13)s,较磷酸酸蚀组(219±13)s短(P<0.05)。自酸蚀组和磷酸酸蚀组封闭剂的3个月保留率分别为97.4%和96.2%,6个月保留率分别为94.9%和92.3%,12个月保留率分别为91.0%和88.4%;3个月时2组均未发现龋齿;6个月时磷酸酸蚀组发现1颗龋齿,自酸蚀组龋降低率为100%;12个月时自酸蚀组有3颗龋齿,磷酸酸蚀组有6颗龋齿,自酸蚀组龋降低率为50%。总龋齿发生率2组差异无统计学意义。结论应用自酸蚀黏结剂的窝沟封闭系统,可缩短临床操作时间;封闭剂保留率高,脱落率低,并可降低患儿依从性的要求。     

An evaluation of sealant restorations after 2 years.

AIM: To obtain evidence of the efficacy of sealant restoration used in the management of fissure caries. DESIGN: A controlled study in a UK dental hospital environment. METHODS: Suspect fissure lesions were investigated in 164 young adult patients attending for routine dental care. Only one test tooth per subject was included in the study. Patients were recalled after 6, 12 and 24 months at which time the fissure sealant retention and the performance of the restorative materials were noted. RESULTS: Successful recall was achieved with 91.5% of patients. Most teeth treated (92%) involved the preparation of an investigative cavity. The mean age of patients treated was 23.9 years and second permanent molar teeth were the most commonly affected teeth requiring treatment in this age group. The presence of small composite restorations did not adversely affect fissure sealant retention but after 2 years, significantly more sealant was lost from the surface of light cured glass-ionomer cement and larger composite restorations. CONCLUSIONS: Sealant restorations provide an effective method of management of fissure caries in young adult patients.     

In vitro evaluation of the effect of a surfactant-containing experimental acid gel on sealant microleakage.

OBJECTIVE: The purpose of this study was to compare the effects of experimentally derived surfactant-containing acid gel with those of different surface-conditioning agents on microleakage of unfilled and filled sealants applied to permanent teeth following noninvasive and invasive procedures. METHOD AND MATERIALS: Four main groups of surface-conditioning agents (NRC; NRC + Prime&Bond NT; Email Preparator Blue; and experimental acid gel) were subdivided into 16 subgroups (n = 8). Subgroups were designed according to the surface preparation procedures applied (noninvasive and invasive) and fissure sealants used (Helioseal and Helioseal F). After application of the test materials, the specimens were subjected to thermocycling and then immersed in 0.5% basic fuchsin dye. Following sectioning, specimens were examined under a stereomicroscope and microleakage scores were assigned. RESULTS: Subgroups 9 (Email Preparator Blue + Helioseal), 11 (invasive + Email Preparator Blue + Helioseal), 13 (experimental acid gel + Helioseal), and 15 (invasive + experimental acid gel + Helioseal) showed no microleakage. The differences between those subgroups and subgroups 1 (NRC + Helioseal), 2 (NRC + Helioseal F), 3 (invasive + NRC + Helioseal), 4 (invasive + NRC + Helioseal F), 5 (NRC + Prime&Bond NT + Helioseal), and 6 (NRC + Prime&Bond NT + Helioseal F) were statistically significant. CONCLUSION: Email Preparator Blue and surfactant-containing experimental acid gel, combined with an invasive/noninvasive surface preparation procedure and Helioseal, significantly prevented microleakage.     

Microleakage and sealant penetration using a vibrating probe

PURPOSE: To evaluate the effect of a vibrating probe on sealant penetration into pits and fissures. METHODS: Thirty-six extracted human third molars were used. The occlusal surface of each molar was cleaned with a rubber cup and pumice slurry. Scotchbond Etchant (35% phosphoric acid gel) was applied to the occlusal fissures of each molar for 20 seconds. Fissures were then sealed as follows: Group 1: Concise Light Cured White Sealant was applied without vibration; Group 2: same as in Group 1 but with vibration; Group 3: Single Bond Adhesive was applied, then Concise Light Cured White Sealant was applied without vibration; Group 4: same as in Group 3, but sealant was applied with vibration; Group 5: Concise Light Cured White Sealant was applied without vibration, then Z-100 composite was burnished over the sealant and light-cured; Group 6: same as in Group 5, but sealant was applied with vibration. Microvibe vibrating probe was used for sealant vibration. After 24-hour immersion in 2% basic fuchsin dye solution, specimens were sectioned, and dye and sealant penetration were scored using a stereomicroscope and color slides. Selected sectioned samples were observed under the SEM. RESULTS: No statistically significant differences between the groups were observed for either dye or sealant penetration scores. In all groups, sealant penetration was more influenced by the shape, depth and residual debris of fissures than by the use of a vibrating probe.     

Effectiveness of primer and bond in sealant retention and caries prevention

PURPOSE: The purpose of this clinical trial was to test the use of a primer and bonding agent to increase the retention of a fissuresealant in a group of Kuwaiti children. METHODS: In 78 6- to 9-year-old children who required sealants in all 4 permanent frst molars, sealants were placed in 2 teeth using a primer and bond (3M Scotch Bond) and in 2 teeth without primer and bond. Sealant retention was evaluated 1 and 2 years later. Sealant retention was scored as: (1) complete retention; (2) partial loss of sealant; and (3) complete loss of sealant Caries was scored for those teeth in which the sealant was partially or completely lost RESULTS: At the 2-year examination, in teeth sealed with primer and bond (a) 64% of the sealants were completely retained; (b) 23% were partially lost; and (c) 13% were completely lost. In teeth sealed without primer and bond: (a) 68% of the sealants were completely retained; (b) 20% were partially lost; and (c) 12% were completely lost There was no difference in sealant retention (P=.22) and caries (P=.56) in teeth sealed with and without bond. In multivariate analyses after controlling for age, gender, tooth surface, and arch, no differences in sealant retention and caries were seen. CONCLUSION: If a proper technique is used in sealant placement, primer and bond does not enhance sealant retention.     

Heat-treated glass ionomer cement fissure sealants: retention after 1 year follow-up

Objective.  The aim of this study was to assess the retention rate of glass ionomer cement (GIC) fissure sealants heated during setting time.
Methods.  One hundred and twelve teeth with well-delineated fissure morphology were sealed with composite resin and GIC. Composite resin (Helioseal F, Vivadent) was used in control group A (56 teeth). GIC (Fuji VII, GC) was applied using split-mouth design with conditioning in group B (26 teeth) and without surface conditioning in group C (30 teeth). GIC was heated with external heat source (Elipar Trilight, Espe) for 40 s during the setting time according to the manufacturer's instructions. Fissure sealants were evaluated 1 year after clinical service.
Results.  Retention rate in group A was 80.4% after 1 year of clinical service. Group B showed retention rate of 30.8%, and group C of 26.7%. Two new caries lesions were detected in groups B and C. Significant differences in retention between the composite group and GIC groups were obtained by Kruskal–Wallis and Mann–Whitney tests.
Conclusion.  It could be concluded that retention rate of GIC sealing treated with heat during setting time was significantly lower than retention of conventional composite resin. The heating procedure during setting of GIC sealants cannot be recommended as routine treatment in clinical practice.     

Evaluation of a pit- and fissure-sealing program in a public dental health service after 2 years

The aim of the present study was to test the caries-preventive effect of a bis-GMA type fissure sealant (Concise Enamel Bond System) in a public dental health service for children. The study compared one group of children, in which all sound permanent teeth were sealed, and a control group in which no sealants were placed. During the study period all children received systematic restorative care, while sealing was performed on the basis of diagnoses made at subsequent examinations by one of the authors. After 2 years a total of 187 children were available for re-examination. Sealant retention was comparable to that obtained in previous studies, but no statistically significant reduction in overall caries increment could be demonstrated. Further analysis showed that only 223 sites had been sealed, while the majority of all erupting sites (394) were either carious or filled before they were screened for the purpose of sealing. It is therefore assumed that only teeth less susceptible to occlusal decay were sealed, thereby explaining the lack of benefit derived from the sealing program.