Background
Dental sealants were introduced in the 1960s to help prevent dental caries, mainly in the pits and fissures of occlusal tooth surfaces. Sealants act to prevent bacteria growth that can ...lead to dental decay. Evidence suggests that fissure sealants are effective in preventing caries in children and adolescents compared to no sealants. Effectiveness may, however, be related to caries incidence level of the population. This is an update of a review published in 2004, 2008 and 2013.
Objectives
To compare the effects of different types of fissure sealants in preventing caries in occlusal surfaces of permanent teeth in children and adolescents.
Search methods
Cochrane Oral Health’s Information Specialist searched: Cochrane Oral Health’s Trials Register (to 3 August 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 7), MEDLINE Ovid (1946 to 3 August 2016), and Embase Ovid (1980 to 3 August 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 3 August 2016. No restrictions were placed on language or date of publication.
Selection criteria
Randomised controlled trials (RCTs) comparing sealants with no sealant or a different type of sealant material for preventing caries of occlusal surfaces of premolar or molar teeth in children and adolescents aged up to 20 years. Studies required at least 12 months follow‐up. We excluded studies that compared compomers to resins/composites.
Data collection and analysis
Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We presented outcomes for caries or no caries on occlusal surfaces of permanent molar teeth as odds ratio (OR) or risk ratio (RR). We used mean difference (MD) for mean caries increment. All measures were presented with 95% confidence intervals (CI). We conducted meta‐analyses using a random‐effects model for comparisons where there were more than three trials; otherwise we used the fixed‐effect model. We used GRADE methods to assess evidence quality.
Main results
We included 38 trials that involved a total of 7924 children; seven trials were new for this update (1693 participants). Fifteen trials evaluated the effects of resin‐based sealant versus no sealant (3620 participants in 14 studies plus 575 tooth pairs in one study); three trials with evaluated glass ionomer sealant versus no sealant (905 participants); and 24 trials evaluated one type of sealant versus another (4146 participants). Children were aged from 5 to 16 years. Trials rarely reported background exposure to fluoride of trial participants or baseline caries prevalence.
Resin‐based sealant versus no sealant: second‐, third‐ and fourth‐generation resin‐based sealants prevented caries in first permanent molars in children aged 5 to 10 years (at 24 months follow‐up: OR 0.12, 95% CI 0.08 to 0.19, 7 trials (5 published in the 1970s; 2 in the 2010s), 1548 children randomised, 1322 children evaluated; moderate‐quality evidence). If we were to assume that 16% of the control tooth surfaces were decayed during 24 months of follow‐up (160 carious teeth per 1000), then applying a resin‐based sealant would reduce the proportion of carious surfaces to 5.2% (95% CI 3.13% to 7.37%). Similarly, assuming that 40% of control tooth surfaces were decayed (400 carious teeth per 1000), then applying a resin‐based sealant would reduce the proportion of carious surfaces to 6.25% (95% CI 3.84% to 9.63%). If 70% of control tooth surfaces were decayed, there would be 19% decayed surfaces in the sealant group (95% CI 12.3% to 27.2%). This caries‐preventive effect was maintained at longer follow‐up but evidence quality and quantity was reduced (e.g. at 48 to 54 months of follow‐up: OR 0.21, 95% CI 0.16 to 0.28, 4 trials, 482 children evaluated; RR 0.24, 95% CI 0.12 to 0.45, 203 children evaluated). Although studies were generally well conducted, we assessed blinding of outcome assessment for caries at high risk of bias for all trials (blinding of outcome assessment is not possible in sealant studies because outcome assessors can see and identify sealant).
Glass ionomer sealant versus no sealant: was evaluated by three studies. Results at 24 months were inconclusive (very low‐quality evidence).
One sealant versus another sealant: the relative effectiveness of different types of sealants is unknown (very low‐quality evidence). We included 24 trials that directly compared two different sealant materials. Comparisons varied in terms of types of sealant assessed, outcome measures chosen and duration of follow‐up.
Adverse events: only four trials assessed adverse events. No adverse events were reported.
Authors' conclusions
Resin‐based sealants applied on occlusal surfaces of permanent molars are effective for preventing caries in children and adolescents. Our review found moderate‐quality evidence that resin‐based sealants reduced caries by between 11% and 51% compared to no sealant, when measured at 24 months. Similar benefit was seen at timepoints up to 48 months; after longer follow‐up, the quantity and quality of evidence was reduced. There was insufficient evidence to judge the effectiveness of glass ionomer sealant or the relative effectiveness of different types of sealants. Information on adverse effects was limited but none occurred where this was reported. Further research with long follow‐up is needed.
Although pit and fissure sealants are effective in preventing caries, their efficacy may be related to the caries prevalence in the population.
The primary objective of this review was to evaluate ...the caries prevention of pit and fissure sealants in children and adolescents.
We searched the Cochrane Oral Health Group Trials Register, CENTRAL (The Cochrane Library 2007, Issue 3) and MEDLINE (to October 2007); EMBASE (to June 2007); SCISEARCH, CAplus, INSPEC, NTIS, PASCAL, DARE, NHS EED and HTA (to February 2008). There were no language or publication restrictions.
Randomised or quasi-randomised controlled trials of at least 12 months in duration comparing sealants with no sealant or sealants from different classes of materials for preventing occlusal caries in children and adolescents under 20 years. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars.
Two review authors independently screened search results, extracted data and quality assessed trials. Risk ratios (RR) were calculated for differences between intervention and control groups and in split-mouth studies for differences of paired tooth surfaces being carious or not. The meta-analyses were conducted using a random-effects model.
Sixteen studies were included in the review; 7 studies provided data for comparison of sealant versus control without sealant and 10 studies for comparison of sealant versus sealant. Five split-mouth studies and one parallel group study with 5 to 10 year old children found a significant difference in favour of second or third generation resin-based sealants on first permanent molars, compared to a control without sealant, with a pooled RR of 0.13 (95% confidence interval (CI) 0.09 to 0.20), 0.22 (95% CI 0.15 to 0.34), 0.30 (95% CI 0.22 to 0.40), and 0.40 (95% CI 0.31 to 0.51) at 12, 24, 36 and 48-54 months follow up, respectively. Further, one of those studies with 9 years of follow up found significantly more caries in the control group compared to resin sealant group; 27% of sealed surfaces were decayed compared to 77% of surfaces without sealant.The results of the studies comparing different sealant materials were conflicting.
Sealing is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. The effectiveness of sealants is obvious at high caries risk but information on the benefits of sealing specific to different caries risks is lacking.
Background
Most of the detected increment in dental caries among children above the age of six years and adolescents is confined to occlusal surfaces of posterior permanent molars. Dental sealants ...and fluoride varnishes are much used to prevent caries. As the effectiveness of both interventions in controlling caries as compared with no intervention has been demonstrated previously, this review aimed to evaluate their relative effectiveness. It updates a review published originally in 2006 and updated in 2010 and in 2016.
Objectives
Our primary objective was to evaluate the relative effectiveness of dental sealants (i.e. fissure sealant) compared with fluoride varnishes, or fissure sealants plus fluoride varnishes compared with fluoride varnishes alone, for preventing dental caries in the occlusal surfaces of permanent teeth of children and adolescents.
Our secondary objectives were to evaluate whether effectiveness is influenced by sealant material type and length of follow‐up, document and report on data concerning adverse events associated with sealants and fluoride varnishes, and report the cost effectiveness of dental sealants versus fluoride varnish in caries prevention.
Search methods
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 19 March 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 2), MEDLINE Ovid (1946 to 19 March 2020) and Embase Ovid (1980 to 19 March 2020). We searched the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. There were no restrictions on the language or date of publication.
Selection criteria
We included randomised controlled trials with at least 12 months of follow‐up comparing fissure sealants, or fissure sealants plus fluoride varnishes, versus fluoride varnishes, for preventing caries in the occlusal surfaces of permanent posterior teeth (i.e. premolar or molar teeth), in participants younger than 20 years of age at the start of the study.
Data collection and analysis
At least two review authors independently screened search results, extracted data from included studies and assessed their risk of bias. We attempted to contact study authors to obtain missing or unclear information. We grouped and analysed studies on the basis of sealant material type: resin‐based sealant or glass ionomer‐based sealant (glass ionomer and resin‐modified glass ionomer sealant), and different follow‐up periods. We calculated the odds ratio (OR) for risk of caries on occlusal surfaces of permanent molar teeth. For trials with a split‐mouth design, we used the Becker‐Balagtas OR. One cluster‐randomised trial provided precise estimates in terms of risk ratio (RR), which we used. For continuous outcomes and data, we used means and standard deviations to obtain mean differences (MD). For meta‐analysis, we used the random‐effects model when we combined data from four or more studies. We presented all measures with 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE criteria.
Main results
We included 11 trials with 3374 participants aged five to 10 years when trials started. Three trials are new since the 2016 update. Two trials did not contribute data to our analysis.
Sealant versus fluoride varnish
Resin‐based fissure sealants versus fluoride varnishes
Seven trials evaluated this comparison (five contributing data). We are uncertain if resin‐based sealants may be better than fluoride varnish, or vice versa, for preventing caries in first permanent molars at two to three years' follow‐up (OR 0.67, 95% CI 0.37 to 1.19; I2 = 84%; 4 studies, 1683 children evaluated). One study measuring decayed, missing and filled permanent surfaces (DMFS) and decayed, missing and filled permanent teeth (DMFT) increment at two years suggested a small benefit for fissure sealant (DMFS MD –0.09, 95% CI –0.15 to –0.03; DMFT MD –0.08, 95% CI –0.14 to –0.02; 542 participants), though this may not be clinically significant. One small study, at high risk of bias, reported a benefit for sealant after four years in preventing caries (RR 0.42, 95% CI 0.21 to 0.84; 75 children) and at nine years (RR 0.48, 95% CI 0.29 to 0.79; 75 children). We assessed each of these results as having very low certainty.
Glass ionomer‐based sealants versus fluoride varnishes
Three trials evaluated this comparison: one trial with chemically cured glass ionomer and two with resin‐modified glass ionomer. Studies were clinically diverse, so we did not conduct a meta‐analysis. In general, the studies found no benefit of one intervention over another at one, two and three years, although one study, which also included oral health education, suggested a benefit from sealants over varnish for children at high risk of caries. We assessed this evidence as very low certainty.
Sealant plus fluoride varnish versus fluoride varnish alone
One split‐mouth trial analysing 92 children at two‐year follow‐up found in favour of resin‐based fissure sealant plus fluoride varnish over fluoride varnish only (OR 0.30, 95% CI 0.17 to 0.55), which represented a clinically meaningful effect of a 77% reduction in caries after two years; however, we assessed this evidence as very low certainty.
Adverse events
Five trials (1801 participants) (four using resin‐based sealant material and one using resin‐modified glass ionomer) reported that no adverse events resulted from use of sealants or fluoride varnishes over one to nine years. The other studies did not mention adverse events.
Authors' conclusions
Applying fluoride varnish or resin‐based fissure sealants to first permanent molars helps prevent occlusal caries, but it has not been possible in this review to reach reliable conclusions about which one is better to apply. The available studies do not suggest either intervention is superior, but we assessed this evidence as having very low certainty. We found very low‐certainty evidence that placing resin‐based sealant as well as applying fluoride varnish works better than applying fluoride varnish alone. Fourteen studies are currently ongoing and their findings may allow us to draw firmer conclusions about whether sealants and varnish work equally well or whether one is better than the other.
Background
Most of the detected increment in dental caries among children and adolescents is confined to occlusal surfaces of posterior permanent molars. Dental sealants and fluoride varnishes are ...much used preventive options for caries. Although the effectiveness of sealants and fluoride varnishes for controlling caries as compared with no intervention has been demonstrated in clinical trials and summarised in systematic reviews, the relative effectiveness of these two interventions remains unclear. This review is an update of one first published in 2006 and last updated in 2010.
Objectives
Primary objective
• To evaluate the relative effectiveness of fissure sealants compared with fluoride varnishes, or fissure sealants together with fluoride varnishes compared with fluoride varnishes alone, for preventing dental caries in the occlusal surfaces of permanent teeth of children and adolescents.
Secondary objectives
• To evaluate whether effectiveness is influenced by sealant material type and length of follow‐up.
• To document and report on data concerning adverse events associated with sealants and fluoride varnishes.
Search methods
We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 18 December 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 11), MEDLINE via Ovid (1946 to 18 December 2015) and EMBASE via Ovid (1980 to 18 December 2015). We also searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on language or date of publication when searching electronic databases. We screened the reference lists of identified trials and review articles for additional relevant studies.
Selection criteria
We included randomised controlled trials with at least 12 months of follow‐up comparing fissure sealants, or fissure sealants together with fluoride varnishes, versus fluoride varnishes for preventing caries in the occlusal surfaces of permanent premolar or molar teeth, in participants younger than 20 years of age at the start of the study.
Data collection and analysis
Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We attempted to contact study authors to obtain missing or unclear information.
We grouped and analysed studies on the basis of sealant material type (resin‐based sealant and glass ionomer‐based sealant: glass ionomer and resin‐modified glass ionomer) and different follow‐up periods. We calculated the odds ratio (OR) for caries or no caries on occlusal surfaces of permanent molar teeth. For trials with a split‐mouth design, we used the Becker‐Balagtas odds ratio. For continuous outcomes and data, we used means and standard deviations to obtain mean differences. We presented all measures with 95% confidence intervals (CIs).
We assessed the quality of the evidence using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods.
We conducted meta‐analysis using the fixed‐effect model, as data from only two studies were combined. We had planned to conduct meta‐analyses using a random‐effects model when more than three trials were included in the meta‐analysis.
Main results
In this review, we included eight trials with 1746 participants (four of the trials were new since the 2010 update). Seven trials (1127 participants) contributed to the analyses, and children involved were five to 10 years of age at the start of the trial.
Sealant versus fluoride varnish
Resin‐based fissure sealants compared with fluoride varnishes
Four trials evaluated this comparison (three of them contributing to the analyses). Compared with fluoride varnish, resin‐based sealants prevented more caries in first permanent molars at two‐year follow‐up (two studies in the meta‐analysis with pooled odds ratio (OR) 0.69, 95% confidence interval (CI) 0.50 to 0.94; P value = 0.02; I2 = 0%; 358 children evaluated). We assessed the body of evidence as low quality. The caries‐preventive benefit for sealants was maintained at longer follow‐up in one trial at high risk of bias: 26.6% of sealant teeth and 55.8% of fluoride‐varnished teeth had developed caries when 75 children were evaluated at nine years of follow‐up.
Glass ionomer‐based sealants compared with fluoride varnishes
Three trials evaluated this comparison: one trial with chemically cured glass ionomer and two with resin‐modified glass ionomer. Researchers reported similar caries increment between study groups regardless of which glass ionomer material was used in a trial. Study designs were clinically diverse, and meta‐analysis could not be conducted. The body of evidence was assessed as of very low quality.
Sealant together with fluoride varnish versus fluoride varnish alone
One split‐mouth trial analysing 92 children at two‐year follow‐up found a significant difference in favour of resin‐based fissure sealant together with fluoride varnish compared with fluoride varnish only (OR 0.30, 95% CI 0.17 to 0.55). The body of evidence was assessed as low quality.
Adverse events
Three trials (two with resin‐based sealant material and one with resin‐modified glass ionomer) reported that no adverse events resulted from use of sealants or fluoride varnishes. The other five studies did not mention adverse events.
Authors' conclusions
Currently, scarce and clinically diverse data are available on the comparison of sealants and fluoride varnish applications; therefore it is not possible to draw clear conclusions about possible differences in effectiveness for preventing or controlling dental caries on occlusal surfaces of permanent molars. The conclusions of this updated review remain the same as those of the last update (in 2010). We found some low‐quality evidence suggesting the superiority of resin‐based fissure sealants over fluoride varnish applications for preventing occlusal caries in permanent molars, and other low‐quality evidence for benefits of resin‐based sealant and fluoride varnish over fluoride varnish alone. Regarding glass ionomer sealant versus fluoride varnish comparisons, we assessed the quality of the evidence as very low and could draw no conclusions.
Background
Proximal dental lesions, limited to dentine, are traditionally treated by invasive (drill and fill) means. Non‐invasive alternatives (e.g. fluoride varnish, flossing) might avoid substance ...loss but their effectiveness depends on patients' adherence. Recently, micro‐invasive approaches for treating proximal caries lesions have been tried. These interventions install a barrier either on top (sealing) or within (infiltrating) the lesion. Different methods and materials are currently available for micro‐invasive treatments, such as sealing via resin sealants, (polyurethane) patches/tapes, glass ionomer cements (GIC) or resin infiltration.
Objectives
To evaluate the effects of micro‐invasive treatments for managing proximal caries lesions in primary and permanent dentition in children and adults.
Search methods
We searched the following databases to 31 December 2014: the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, EMBASE via OVID, LILACs via BIREME Virtual Health Library, Web of Science Conference Proceedings, ZETOC Conference Proceedings, Proquest Dissertations and Theses, ClinicalTrials.gov, OpenGrey and the World Health Organization (WHO) International Clinical Trials Registry Platform. We searched the metaRegister of Controlled Trials to 1 October 2014. There were no language or date restrictions in the searches of the electronic databases.
Selection criteria
We included randomised controlled trials of at least six months' duration that compared micro‐invasive treatments for managing non‐cavitated proximal dental decay in primary teeth, permanent teeth or both, versus non‐invasive measures, invasive means, no intervention or placebo. We also included studies that compared different types of micro‐invasive treatments.
Data collection and analysis
Two review authors independently screened search results, extracted data and assessed the risk of bias. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. We conducted meta‐analyses with the random‐effects model, using the Becker‐Balagtas method to calculate the odds ratio (OR) for lesion progression. We assessed the quality of the evidence using GRADE methods.
Main results
We included eight trials, which randomised 365 participants. The trials all used a split‐mouth design, some with more than one pair of lesions treated within the same participant. Studies took place in university or dental public health clinics in Brazil, Colombia, Denmark, Germany, Thailand, Greenland and Chile. Six studies evaluated the effects of micro‐invasive treatments in the permanent dentition and two studies on the primary dentition, with caries risk ranging from low to high. Investigators measured caries risk in different studies either by caries experience alone or by using the Cariogram programme, which combines eight contributing factors, including caries experience, diet, saliva and other factors related to caries. The follow‐up period in the trials ranged from one to three years. All studies used lesion progression as the primary outcome, evaluating it by different methods of reading radiographs. Four studies received industry support to carry out the research, with one of them being carried out by inventors of the intervention.
We judged seven studies to be at high overall risk of bias, primarily due to lack of blinding of participants and personnel. We evaluated intervention effects for all micro‐invasive therapies and analysed subgroups according to the different treatment methods reported in the included studies.
Our meta‐analysis, which pooled the most sensitive set of data (in terms of measurement method) from studies presenting data in a format suitable for meta‐analysis, showed that micro‐invasive treatment significantly reduced the odds of lesion progression compared with non‐invasive treatment (e.g fluoride varnish) or oral hygiene advice (e.g to floss) (OR 0.24, 95% CI 0.14 to 0.41; 602 lesions; seven studies; I2 = 32%). There was no evidence of subgroup differences (P = 0.36).
The four studies that measured adverse events reported no adverse events after micro‐invasive treatment. Most studies did not report on any further outcomes.
We assessed the quality of evidence for micro‐invasive treatments as moderate. It remains unclear which micro‐invasive treatment is more advantageous, or if certain clinical conditions or patient characteristics are better suited for micro‐invasive treatments than others.
Authors' conclusions
The available evidence shows that micro‐invasive treatment of proximal caries lesions arrests non‐cavitated enamel and initial dentinal lesions (limited to outer third of dentine, based on radiograph) and is significantly more effective than non‐invasive professional treatment (e.g. fluoride varnish) or advice (e.g. to floss). We can be moderately confident that further research is unlikely to substantially change the estimate of effect. Due to the small number of studies, it does remain unclear which micro‐invasive technique offers the greatest benefit, or whether the effects of micro‐invasive treatment confer greater or lesser benefit according to different clinical or patient considerations.
This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline ...panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits and fissures of occlusal surfaces.
This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the US market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions.
The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of noncavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others.
These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians reorient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.
Background
Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non‐selective removal and conventional restoration ...(CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non‐restorative cavity control (NRCC).
Objectives
To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro‐cavitated lesions, or occlusal lesions that are clinically non‐cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps.
Search methods
An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies.
Selection criteria
We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non‐ or micro‐cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions).
Data collection and analysis
Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta‐analysis to assess and rank the relative effectiveness of different interventions.
Main results
We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty‐four studies used a parallel‐group design and three were split‐mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non‐cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth.
Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing with sealant materials (2); sealant materials versus no sealing (2).
Follow‐up times varied from no follow‐up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months.
All studies were at overall high risk of bias.
Effect of interventions
Sealing using sealants versus other interventions for non‐cavitated or cavitated but not deep lesions
There was insufficient evidence of a difference between sealing with sealants and CR (OR 5.00, 95% CI 0.51 to 49.27; 1 study, 41 teeth, permanent teeth, cavitated), sealing versus SE (OR 3.11, 95% CI 0.11 to 85.52; 2 studies, 82 primary teeth, cavitated) or sealing versus no treatment (OR 0.05, 95% CI 0.00 to 2.71; 2 studies, 103 permanent teeth, non‐cavitated), but we assessed all as very low‐certainty evidence.
HT, CR, SE, NRCC for cavitated, but not deep lesions in primary teeth
The odds of failure may be higher for CR than HT (OR 8.35, 95% CI 3.73 to 18.68; 2 studies, 249 teeth; low‐certainty evidence) and lower for HT than NRCC (OR 0.19, 95% CI 0.05 to 0.74; 1 study, 84 teeth, very low‐certainty evidence). There was insufficient evidence of a difference between SE versus HT (OR 8.94, 95% CI 0.57 to 139.67; 2 studies, 586 teeth) or CR versus NRCC (OR 1.16, 95% CI 0.50 to 2.71; 1 study, 102 teeth), both very low‐certainty evidence.
CR, SE, SW for deep lesions
The odds of failure were higher for CR than SW in permanent teeth (OR 2.06, 95% CI 1.34 to 3.17; 3 studies, 398 teeth; moderate‐certainty evidence), but not primary teeth (OR 2.43, 95% CI 0.65 to 9.12; 1 study, 63 teeth; very low‐certainty evidence).
The odds of failure may be higher for CR than SE in permanent teeth (OR 11.32, 95% CI 1.97 to 65.02; 2 studies, 179 teeth) and primary teeth (OR 4.43, 95% CI 1.04 to 18.77; 4 studies, 265 teeth), both very low‐certainty evidence. Notably, two studies compared CR versus SE in cavitated, but not deep lesions, with insufficient evidence of a difference in outcome (OR 0.62, 95% CI 0.21 to 1.88; 204 teeth; very low‐certainty evidence).
The odds of failure were higher for SW than SE in permanent teeth (OR 2.25, 95% CI 1.33 to 3.82; 3 studies, 371 teeth; moderate‐certainty evidence), but not primary teeth (OR 2.05, 95% CI 0.49 to 8.62; 2 studies, 126 teeth; very low‐certainty evidence).
For deep lesions, a network meta‐analysis showed the probability of failure to be greatest for CR compared with SE, SW and HT.
Authors' conclusions
Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition. Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons.
Sealants for preventing dental caries in primary teeth Ramamurthy, Priyadarshini; Ramamurthy, Priyadarshini; Rath, Avita ...
Cochrane database of systematic reviews,
02/2022, Letnik:
2022, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Background
Pit and fissure sealants are plastic materials that are used to seal deep pits and fissures on the occlusal surfaces of teeth, where decay occurs most often in children and adolescents. ...Deep pits and fissures can retain food debris and bacteria, making them difficult to clean, thereby causing them to be more susceptible to dental caries. The application of a pit and fissure sealant, a non‐invasive preventive approach, can prevent dental caries by forming a protective barrier that reduces food entrapment and bacterial growth. Though moderate‐certainty evidence shows that sealants are effective in preventing caries in permanent teeth, the effectiveness of applying pit and fissure sealants to primary teeth has yet to be established.
Objectives
To evaluate the effects of sealants compared to no sealant or a different sealant in preventing pit and fissure caries on the occlusal surfaces of primary molars in children and to report the adverse effects and the retention of different types of sealants.
Search methods
An information specialist searched four bibliographic databases up to 11 February 2021 and used additional search methods to identify published, unpublished and ongoing studies. Review authors scanned the reference lists of included studies and relevant systematic reviews for further studies.
Selection criteria
We included parallel‐group and split‐mouth randomised controlled trials (RCTs) that compared a sealant with no sealant, or different types of sealants, for the prevention of caries in primary molars, with no restriction on follow‐up duration. We included studies in which co‐interventions such as oral health preventive measures, oral health education or tooth brushing demonstrations were used, provided that the same adjunct was used with the intervention and comparator. We excluded studies with complex interventions for the prevention of dental caries in primary teeth such as preventive resin restorations, or studies that used sealants in cavitated carious lesions.
Data collection and analysis
Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We presented outcomes for the development of new carious lesions on occlusal surfaces of primary molars as odds ratios (OR) with 95% confidence intervals (CIs). Where studies were similar in clinical and methodological characteristics, we planned to pool effect estimates using a random‐effects model where appropriate. We used GRADE methodology to assess the certainty of the evidence.
Main results
We included nine studies that randomised 1120 children who ranged in age from 18 months to eight years at the start of the study. One study compared fluoride‐releasing resin‐based sealant with no sealant (139 tooth pairs in 90 children); two studies compared glass ionomer‐based sealant with no sealant (619 children); two studies compared glass ionomer‐based sealant with resin‐based sealant (278 tooth pairs in 200 children); two studies compared fluoride‐releasing resin‐based sealant with resin‐based sealant (113 tooth pairs in 69 children); one study compared composite with fluoride‐releasing resin‐based sealant (40 tooth pairs in 40 children); and one study compared autopolymerised sealant with light polymerised sealant (52 tooth pairs in 52 children).
Three studies evaluated the effects of sealants versus no sealant and provided data for our primary outcome. Due to differences in study design such as age of participants and duration of follow‐up, we elected not to pool the data. At 24 months, there was insufficient evidence of a difference in the development of new caries lesions for the fluoride‐releasing sealants or no treatment groups (Becker Balagtas odds ratio (BB OR) 0.76, 95% CI 0.41 to 1.42; 1 study, 85 children, 255 tooth surfaces). For glass ionomer‐based sealants, the evidence was equivocal; one study found insufficient evidence of a difference at follow‐up between 12 and 30 months (OR 0.97, 95% CI 0.63 to 1.49; 449 children), while another with 12‐month follow‐up found a large, beneficial effect of sealants (OR 0.03, 95% CI 0.01 to 0.15; 107 children). We judged the certainty of the evidence to be low, downgrading two levels in total for study limitations, imprecision and inconsistency.
We included six trials randomising 411 children that directly compared different sealant materials, four of which (221 children) provided data for our primary outcome. Differences in age of the participants and duration of follow‐up precluded pooling of the data. The incidence of development of new caries lesions was typically low across the different sealant types evaluated. We judged the certainty of the evidence to be low or very low for the outcome of caries incidence.
Only one study assessed and reported adverse events, the nature of which was gag reflex while placing the sealant material.
Authors' conclusions
The certainty of the evidence for the comparisons and outcomes in this review was low or very low, reflecting the fragility and uncertainty of the evidence base. The volume of evidence for this review was limited, which typically included small studies where the number of events was low. The majority of studies in this review were of split‐mouth design, an efficient study design for this research question; however, there were often shortcomings in the analysis and reporting of results that made synthesising the evidence difficult. An important omission from the included studies was the reporting of adverse events. Given the importance of prevention for maintaining good oral health, there exists an important evidence gap pertaining to the caries‐preventive effect and retention of sealants in the primary dentition, which should be addressed through robust RCTs.
Tooth decay is an infectious disease which, in its initial phase, leads to the formation of cavities in the teeth through decalcification of the enamel and local tissue destruction. In addition to ...proper oral hygiene, prophylactic sealing of fissures and cavities with a sealant is a method of preventing the development of caries. The aim of this study is to summarise the effectiveness of fissure sealing of permanent teeth with fissure sealants compared to other preventive methods or no intervention.
An umbrella review was carried out to achieve the purpose of our study. Searches were performed in Medline (via PubMed), Embase (via OVID), and Cochrane Library databases. Quality assessment of the included studies was performed using the AMSTAR2 tool. In addition, a manual search for recommendations/clinical practice guidelines on dental prophylaxis was performed.
204 publications were identified, of which 15 met the inclusion criteria. Based on the results of 3 systematic reviews, there was a statistically significant reduced odds of caries occurrence or development with prophylactic sealing of permanent teeth compared with no intervention - depending on the review and follow-up period odds ratio (OR) ranged from 0.06 95%CI: (0.01-0.32) to 0.28 95%CI: (0.20-0.38). In the eight systematic reviews that analysed different sealants, there were no statistically significant differences between the types of materials used for prophylactic tooth sealing. For systematic reviews comparing the efficacy of fissure sealants with fluoride varnish, three reported no statistically significant difference in the efficacy of caries incidence, with only one systematic review based on 1 RCT finding a statistically significant difference in favour of fissure sealants.
Compared to the no intervention, dental sealing is an effective method for the prevention of dental caries. However, it is not possible to conclude conclusively which type of sealant and which of the available prophylactic methods is more effective in preventing caries.
Dental plaque is a biofilm composed of a complex oral microbial community. The accumulation of plaque in the pit and fissures of dental elements often leads to the development of tooth decay (dental ...caries). Here, potent anti-biofilm materials were developed by incorporating zinc methacrylates or di-n-butyl-dimethacrylate-tin into the light-curable sealant and their physical, mechanical, and biological properties were evaluated. The data revealed that 5% di-n-butyl-dimethacrylate-tin (SnM 5%) incorporated sealant showed strong anti-biofilm efficacy against various single-species (Streptococcus mutans or Streptococcus oralis or Candida albicans) and S. mutans-C. albicans cross-kingdom dual-species biofilms without either impairing the mechanical properties of the sealant or causing cytotoxicities against mouse fibroblasts. The findings indicate that the incorporation of SnM 5% in the experimental pit and fissure self-adhesive sealant may have the potential to be part of current chemotherapeutic strategies to prevent the formation of cariogenic oral biofilms that cause dental caries.
PDF
