Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: An update of systematic review evidence Retention of a glass ionomer cement and a resin-based fissure sealant and effect on carious outcome after 7 years. The success rates of a glass ionomer cement and a resin-based fissure sealant placed by fifth-year undergraduate dental students Comparing the caries-preventive effect of two fissure sealing modalities in public health care: a single application of glass ionomer and a routine resin-based sealant programme. A randomized split-mouth clinical trial. Effectiveness of a glass ionomer cement used as a pit and fissure sealant in recently erupted permanent first molars. Retention and caries preventive effects of a GIC and a resin-based fissure sealant. Retention and effectiveness of a chemically polymerized pit and fissure sealant after 2 years. Clinical evaluation of three different materials used as pit and fissure sealant: 24-months results. Sealing versus partial caries removal in primary molars: a randomized clinical trial Evidence-based Clinical Practice Guideline for the Use of Pit-and-Fissure Sealants. Pit and fissure sealants in high-caries-risk individuals. Pit and fissure sealants: results at five and ten years. Clinical evaluation of sealants and preventive resin restorations in a group of environmentally homogeneous children. Use of Pit-and-Fissure Sealants. Effects of glass ionomer cement, resin-based pit and fissure sealant and HF applications on occlusal caries in a developing country field trial. [Clinical evaluation of fluor protector and glass-ionomer cement used as pit and fissure sealant for preventing pit and fissure caries in children]. Caries-preventive effect of sealants produced with altered glass-ionomer materials, after 2 years.
Background This article constitutes a partial up date of the original systematic review evidence by Yengopal et al. from 15 January 2008 ( published in the Journal of Oral Science in 2009 ) with primary focus on research quality in regard to bias risk in trials . Its aim is to up date the existing systematic review evidence from the English literature as to whether caries occurrence on pits and fissures of teeth sealed with either GIC or resin is the same . Methods In addition to the 12 trials included during the original systematic review , 5 new trials were identified during the data base search ( up to 26 August 2010 ) and 2 further trials were included from a h and search and reference check . Of these , 3 trials were excluded and 16 were accepted for data extraction and quality assessment . The quality of accepted trials was assessed , using up date d quality criteria , and the risk of bias was investigated in more depth than previously reported . In addition , the focus of quantitative synthesis was shifted to single data sets that were extracted from the accepted trials . Results Twenty-six dichotomous and 4 continuous data sets were extracted . Meta- analysis and cumulative meta- analysis were used in combining clinical ly homogenous data sets . The overall outcome of the computed data sets suggest no difference between the caries-preventive effects of GIC- and resin-based fissure sealants . Conclusions This overall outcome is in agreement with the conclusions of the original systematic review . Although the findings of the trials identified in this up date may be considered to be less affected by attrition- and publication bias , their risk of selection - and detection-/performance bias is high . Thus , verification of the currently available results requires further high quality r and omised control trials 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 1.44 ( 95 % CI 0.96 , 2.14 ) AIM : To evaluate retention and caries prevention of a glass-ionomer cement ( GIC ) and a resin-based fissure sealant placed by fifth-year undergraduate dental students . METHODS : The study was conducted according to a split-mouth , r and omised clinical trial . Children with at least one pair of caries-free permanent first molars with deep pits and fissures were included in the study . The children were selected from a population that had a high risk for dental caries .  Sealant material s were applied by fifth-year undergraduate dental students on 346  fissures of the first permanent molars in 173 children . The ages of the children ranged from 7–15 years ( mean 9.4 ) . Two research ers at the clinics supervised all of the procedures . Intra-examiner reproducibility and inter-examiner reproducibility were 0.90 and 0.86 , respectively , for the clinical assessment of sealant retention and caries evaluation . RESULTS :  GIC sealants were completely lost in 31.9 % and resin-based sealants in 16.6 % ( p<0.05 ) . The total retention rates of GIC sealants and resin-based sealants were 13.8 % and 20.8 % , respectively . After 24 months , the caries increment was 3.4 % for GIC sealants and 4.8 % for resin-based sealants ( p>0.05 ) . CONCLUSIONS : The retention of GIC sealants was markedly inferior to the retention of resin-based sealants ; however , GIC when used as a pit and fissure sealant was slightly more effective in preventing occlusal caries AIM The aim of this study was to compare the caries-preventive effect of two types of sealant modalities and to evaluate whether the caries-preventive effect is related to sealant retention . A hypothesis was tested in which a glass ionomer sealant , once applied to the occlusal surface , was able to protect the fissure from caries even if the sealant appeared lost at visual inspection . DESIGN A 3-year r and omized split-mouth trial evaluating two sealant modalities was performed at a public health centre in Finl and . A chemically curing glass ionomer cement ( GIC ) and light-curing resin-based ( RB ) sealant material were applied r and omly to the permanent second molars . Sealant application as a routine treatment procedure was carried out to 599 children in the age group of 12 - 16 years .  Caries rate of the sealed teeth and sealant retention with both material s were analysed by a modified McNemar 's test . The effectiveness , rate difference , and relative risk with both sealant material s were measured . RESULTS The difference in caries rate between the two modalities was highly significant . When compared to the GIC sealant method , the effectiveness of  RB sealant method was 74.1 % and the rate difference 3.2 % ( 95 % CI 1.44 % , 4.98 % ) . The relative risk for RB-sealed surfaces vs. GIC-sealed surfaces of having detectable dentin caries was 0.26 ( 95 % CI 0.12 , 0.57 ) . The retention rate of sealants was higher with RB than GIC ( P < 0.001 ) . The effectiveness of the retention rate for RB sealants was 94.8 % and the rate difference 87.2 % ( 95 % CI 83.86 % , 90.50 % ) . The relative risk during the 3-year study period of having a defective or lost RB sealant  was 0.052 ( 95 % CI 0.036 , 0.075 ) when compared to having a defective or lost GIC sealant . CONCLUSION It is concluded that in preventing dentin caries a RB sealant programme including resealing when necessary was more effective than a single application of GIC . The original hypothesis was thus falsified PURPOSE This study 's purpose was to evaluate the caries-preventive effect of a glass ionomer cement ( GIC ) used as an occlusal sealant on recently erupted permanent first molars . METHODS A double-blind , r and omized , controlled , clinical trial was undertaken that included 36 5- to 8-year-olds ( and 92 permanent first molars ) who were r and omly allocated to the test group ( GIC ) or the control group ( auto-polymerized resin-based sealant [ RBS ] )  . The Mann-Whitney test was used to compare the number of new carious or filled occlusal surfaces in the 2 groups . RESULTS After 6 months , 1 occlusal surface in the test group and 2 occlusal surfaces in the control group showed carious lesions ( P=.15 ) . In the fifth year of follow-up , 2 occlusal surfaces in the test group and 7 occlusal surfaces in the control group were filled or carious ( P=.42 ) , and the mean number of sealed surfaces that became carious or filled was 0.2 ( 95 % confidence interval [CI]=0.02 - 0.70 ) for the GIC-sealed teeth and 0.6 ( 95 % CI=0.20 - 1.30 ) for the RBS-sealed teeth ( P=.30 ) . CONCLUSION High-viscosity glass ionomer cement can provide some level of protection against dental caries when used as a dental sealant in newly erupted permanent first molars 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 systematic ally 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 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 50 % . The caries reduction was 98 % in sealed pairs where the material was fully retained To evaluate the retention and caries experience effects of three different material s used as fissure sealants after 24 months of clinical application : a resin-modified glass ionomer cement ( A ) , a flowable resin composite ( B ) and a compomer ( C ) .  One hundred and seventeen ( 117 ) teeth were sealed with material A , 119 teeth with material B and 120 teeth with material C. Children were r and omly assigned . Each one received only one of the material s studied .  Plaque index , dmft score and socioeconomic level were scored at baseline . The clinical exams were conducted 6 , 12 and 24 months after application of the sealant . Statistical analysis ( Kruskal-Wallis ) revealed that there were statistically significant differences between the retention rates of groups A and B and between groups B and C after 2 years , with material B showing better results . After 2 years , 3.1 % of the teeth of group A , 4.3 % of group B and 6.7 % of group C were Carious+Filled . There was no evidence of association between caries presence after 2 years and plaque index , dmft score and socioeconomic level . These results suggest that flowable resin composite had a satisfactory retention after this period of evaluation and all three material s were effective on occlusal caries prevention Background The resin-based pit and fissure sealant is considered a successful tool in caries prevention , however there is a growing evidence of its use in controlling already established caries in posterior teeth . The aim of this clinical trial is to verify the efficacy of pit and fissure sealants in arresting dentinal caries lesions compared to partial excavation and restorative treatment in primary molar teeth . Methods Thirty six patients with occlusal cavitated primary molar reaching outer half of dentin were selected . The patients were r and omly allocated into two groups : sealant application ( experimental group – n = 17 ) and restoration with composite resin ( control group – n = 19 ) . Clinical and radiograph evaluation were performed after 6 , 12 and 18 months . The chi-square test was used to verify the distribution of characteristics variables of the sample among the groups . The survival rate of treatments was evaluated using Kaplan – Meier survival and log-rank test . Fisher ’s Exact and logistic regression tests were calculated in each evaluation period ( α = 5 % ) . Results The control group showed significantly better clinical survival after 18 months ( p = 0.0025 ) . In both groups , no caries progression was registered on the radiographic evaluations . Conclusions Sealing had similar efficacy in the arrestment of caries progression of cavitated occlusal lesions compared to partial excavation of the lesions , even though the frequency of re-treatments was significantly higher in sealed lesions . Trial registration Registro Brasileiro de Ensaios Clínicos ( ReBEC ) : BACKGROUND 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 . TYPES OF STUDIES REVIEW ED This is an up date 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 r and omized controlled trials reporting on the effect of sealants ( available on the U.S. 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 . RESULTS 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 non-cavitated 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 . Conclusions and practical implication s : These recommendations are design ed 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 re-orient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents This paper examines the evidence demonstrating the effectiveness of sealants in high-caries-risk children and discusses the Research Triangle Institute/University of North Carolina 's ( RTI/UNC ) systematic review . The strict RTI/UNC protocol limited the number of sealant studies that could be included . This analysis exp and ed their criteria to permit additional methods of determining caries risk ( for example , past caries experience , less than two pairs of sound first permanent molars available/child in half-mouth design s ) and outcome measures in addition to DMFS ( that is , percent sealant retention , survival rates , cost-effectiveness , changes in salivary S. mutans levels ) . Nine clinical studies with a r and omized , half-mouth , clinical trial design and seven studies with observational study design s were included . There is good evidence that  sealants can be used efficaciously and effectively in high-risk  children as long as the sealant is retained . Sealants are more effective in preventing further caries and providing cost savings in a shorter time span if placed in children who have high rather than low caries risk AIM This was to evaluate the efficacy of pit and fissure sealant ( FS ) using two different application techniques for caries prevention assessed at five and ten years . METHODS The study was conducted using Delton(R ) pit and fissures sealant applied with either rubber dam ( RD )  ( Group A : 50 children , 200 first permanent molars , 120 second permanent molars ) or cotton wool rolls ( CR )  ( Group B : 50 children , 200 first permanent molars , 112 second permanent molars ) . At five and ten years FS were evaluated for retention , loss and incidence of occlusal and proximal carious lesions recorded . STATISTICS The data were analysed with the Chi- square test comparing the results obtained for first permanent molars and second permanent molars at five and ten years . RESULTS There was no statistical difference between results in the two groups ( p < or = 0.05 ) . The highest retention rate , 81.7 % , was found for second permanent molars sealed under RD at the five year assessment . The lowest , 64.3 % also for second molars sealed under CR humidity control at ten years . CONCLUSIONS Pit and fissure sealants are a valid preventive approach that can be applied with similar results with rubber dam or cotton rolls PURPOSE Pit and fissure sealants reduce occlusal caries when proper patient selection and application techniques are followed . To increase retention rate of sealants over time , good adaptation and deep sealant penetration are important . Studies remain inconclusive , however , as to determining if the bur preparation of pits and fissures would increase the adaptation and penetration thus improving sealant retention . The aim of this study was to assess if tooth preparation prior to sealant application improves sealant retention . METHODS In this prospect i ve cohort study , 43 children and adolescents from 4 Hutterites colonies were , for 3 years , bussed to the University of Manitoba pediatric dental clinic , Winnipeg , Manitoba , Canada , for comprehensive dental care including  sealant placement  using st and ard procedures . These came from a community with homogeneous social economical status , dietary habits , fluoride intake , and lifestyles . The decision of tooth preparation prior to sealant application was made ad hoc . Of 122 treated permanent posterior teeth , 54 had been treated as preventive resin restorations ( PRRs , type A or B ) and 68 were nonprepared sealants .  RESULTS After 1 year , teeth prepared ( type B PRRs ) and restored with flowable composite resins had significantly ( P<.01 ) lower retention rates ( 27 % vs 63 % ) than did teeth with nonprepared sealants or typeA PRRs . Teeth prepared ( type B PRRs ) were also significantly ( P<.001 ) more likely to have caries on follow-up examination ( 50 % vs 11 % ) than were teeth with nonprepared sealants or type A PRRs . CONCLUSIONS These results suggest that preventive resin type B restorations restored with flowable composites are not helpful in terms of retention or caries reduction BACKGROUND 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 . TYPES OF STUDIES REVIEW ED This is an up date 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 r and omized controlled trials reporting on the effect of sealants ( available on the U.S. 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 . RESULTS 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 non-cavitated 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 . Conclusions and practical implication s : These recommendations are design ed 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 re-orient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents The aim of this community-oriented study was to evaluate different methods to prevent fissure caries . The following products and measures were tested : 1 ) glass ionomer cement ( GIC ) applied by dentist ; 2 ) same material applied by short term ( 3 days ) trained personnel ( teachers ) ; 3 ) application of a 0.5 % HF solution three times ; 4 ) an established autopolymerized resin based sealant ( Delton ) . The study was performed in Bangkok , Thail and , a city in a developing country experiencing increasing caries prevalence . Children with at least three sound permanent molars from two age groups , 7 - 8 and 12 - 13-yr-olds respectively were chosen from very low to medium socioeconomic level families . 1264 children were systematic ally assigned to experiment or control groups based on school and DMFT . For the younger age group , the 2 yr mean DFS occlusal increment in the Control group was 0.66 surfaces . Significantly lower increments were observed in the GIC experimental group : 0.17 surfaces applied by the teachers and 0.32 applied by dentist , corresponding to 74 % and 52 % reductions , respectively . The mean increment in the HF group was 0.44 surfaces , a 33 % reduction in relation to the Control group . For the 12 - 13-yr-olds , the mean occlusal surface DF increment was 0.70 surfaces in the Control group . Almost no occlusal increment was found in the Delton group , 0.05 DFS , a 93 % reduction . In the GIC Dentist group , the DFS increment was 0.48 and in the Teacher group 0.56 , corresponding to 31 % and 20 % reduction , respectively . A slight and nonsignificant increase of caries in relation to the Control group was observed in the HF group . ( ABSTRACT TRUNCATED AT 250 WORDS PURPOSE To study the clinical effect of the fluor protector and glass-ionomer cement used as pit and fissure sealant for preventing pit and fissure caries in children . METHODS 622 health permanent teeth in 6 - 8 years old children were divided into three groups . Children in the experimental group A ( n=207,335 teeth ) underwent fluor protector every six months , experimental group B(n=205 , 327 teeth ) with glass-ionomer cement used as pit and fissure sealant and children in the control group(n=210 , 354 teeth ) underwent no treatment . The incidence of caries were compared among the three groups using SPSS10.0 software package after 3 years . RESULTS After 3 years , the incidence of caries in A and B experimental groups were lower than in the control group , the difference was significant ( P<0.01 ) , but there were no significant difference between group A and group B ( P>0.05 ) . CONCLUSION Fluor protector and glass-ionomer cement used as pit and fissure sealant also have good clinical effect in preventing caries OBJECTIVES The aim of the present study was to investigate the caries-preventive effect of sealants produced with a high-viscosity glass-ionomer with an elevated powder-liquid ratio ( ART ) , of having energy added to this glass-ionomer , and that of glass-carbomer , in comparison to that of resin composite sealants . METHODS The r and omized controlled trial covered 407 children , with a mean age of 8 years . At a school compound three dentists placed sealants in pits and fissures of high caries-risk children . Evaluation by two independent evaluators was conducted after 0.5 , 1 and 2 years . The Kaplan-Meier survival method , ANOVA and t-test were used in analyzing the data . RESULTS 1352 first permanent molars were sealed . 6.6 % of children and 6.8 % of sealants dropped out within 2 years . 27 re-exposed pits and fissures , 20 in occlusal and 7 in smooth surfaces , in 25 children , developed a dentin carious lesion . The cumulative survival of dentin carious lesion-free pits and fissures in the  glass-carbomer sealant group was statistically significantly lower ( 97.4 % ) than those in the high-viscosity glass-ionomer with energy supplied ( 99 % ) and the resin-composite ( 98.9 % ) sealant groups . There was no statistically significant difference in the cumulative survival of dentin carious lesion-free pits and fissures , between the high-viscosity glass-ionomer with ( 99 % ) and without ( 98.3 % ) energy supplied sealant groups , after 2 years . SIGNIFICANCE The survival of dentin carious lesion-free pits and fissures was high in all sealant types . More dentin carious lesions were observed in the glass-carbomer sealant group
The content of these signals suggest that higher precision of the current systematic review results might be achieved if an up date of the current review were conducted at this point in time .
However , these signals further indicate that such systematic review up date , despite its higher precision , would only confirm the existing review conclusion that no statistically significant difference exists in the caries-preventive effect of GIC and resin-based fissure sealants .
In conclusion , this study demonstrated the modified Ottawa method as an effective tool in establishing the up date need of the systematic review .
OBJECTIVE To demonstrate the application of the modified Ottawa method by establishing the up date need of a systematic review with focus on the caries preventive effect of GIC versus resin pit and fissure sealants ;  to answer the question as to whether the existing conclusions of this systematic review are still current ; to establish whether a new up date of this systematic review was needed .