Caries‐preventive effect of fissure sealants: a systematic review

Abstract

The objectives of this study were to evaluate systematically the evidence of the caries-preventive effect of fissure sealing of occlusal tooth surfaces and to examine factors potentially modifying the effect. The search strategies included electronic databases, reference lists of articles, and selected textbooks. Inclusion criteria were randomized or quasi-randomized clinical trials or controlled clinical trials comparing fissure sealing with no treatment or another preventive treatment in children up to 14 years of age at the start; the outcome measure was caries increment; the diagnostic criteria had been described; and the follow-up time was at least 2 years. Inclusion decisions were taken and grading of the studies was done independently by two of the authors. The main measure of effect was relative risk reduction. Thirteen studies using resin-based or glass ionomer sealant materials were included in the final analysis. The results showed that most studies were performed during the 1970s and a single application had been utilized. The relative caries risk reduction pooled estimate of resin-based sealants on permanent 1st molars was 33% (relative risk = 0.67; CI = 0.55-0.83). The effect depended on retention of the sealant. In conclusion, the review suggests limited evidence that fissure sealing of 1st permanent molars with resin-based materials has a caries-preventive effect. The evidence is incomplete for permanent 2nd molars, premolars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations with a low and a high caries risk, respectively.

Atraumatic restorative treatment - glass ionomer sealants survival after a postgraduate training program in Ecuador: 2-year follow-up

“…Mejàre and Mjör (1990) recorded clinically extensive loss of 61% of low-viscosity glass ionomer sealants after 6-12 months, but all occlusal surfaces sealed with this material remained caries-free. No difference in dentine lesion development between the teeth sealed with a resin composite and those sealed with a lowviscosity glass-ionomer could be observed (Mejàre et al 2003). The same was observed for high-viscosity glass ionomers sealants.…”

“…Sealing caries prone pits and fissures is an effective approach for preventing carious lesion development (Ahovuo-Saloranta et al 2008). In this aspect, resin based and low viscosity glass ionomer sealants have been extensively studied showing promising results (Mejàre et al 2003;Beiruti et al 2006;Chen et al 2012). However, the ability to perform sealants using ART technique seems to be highly dependent of sufficient practical skills and it might limit a wider implementation of this approach in oral health care services.…”

Health promotion and dental caries

“…An alternative to allow a more efficient biofilm control in this area is the use of dental sealants. 43 The sealing of occlusal surfaces in a preventive approach has shown positive results (caries risk reduction of 33-65%); [44][45][46][47][48] however, it will depend on a series of variables. Ahovuo-Saloranta et al, 48 through a systematic review of the literature, showed that the effectiveness of sealants is obvious for high caries-risk individuals, but information on the benefits of sealing to patients with different caries-risk levels is lacking.…”

“…The material used to seal the surface is also an important factor, and resinbased sealants are preferable when compared to glass ionomer cement. 45 Loss or fracture of sealants should be considered, since a significant relation has been established between intact sealants and a reduction in caries risk. 45 There is evidence indicating that a much better effect is observed if re-sealing is performed.…”

No evidence to support use of glass ionomer as a fissure sealant in primary molars

“…This recommendation is adopted by most of clinical guidelines for caries prevention in pre-school children. [2][3][4] On the other hand, recent systematic reviews 5,6 have found insufficient evidence to support the use of GI sealants. The present study helps to fill the gap in the evidence in this respect.…”