Sealing versus partial caries removal in primary molars: a randomized clinical trial

Abstract

BackgroundThe 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.MethodsThirty six patients with occlusal cavitated primary molar reaching outer half of dentin were selected. The patients were randomly 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%).ResultsThe 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.ConclusionsSealing 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 registrationRegistro Brasileiro de Ensaios Clínicos (ReBEC): RBR-9kkv53

A randomized clinical trial on the sealing of occlusal carious lesions: 3–4-year results

“…After 2-3 years, the authors observed that 9 out of a total of 10 failures were related to the clinical performance of the sealants: 7 cases showed loss of retention and 2 cases showed partial retention (annual failure rate of resin sealants of 7.4%). Similarly, Hesse et al 11 showed that all the failures detected in sealants placed in primary molars were clinical failures, resulting in a higher frequency of retreatments in this group. Collectively, these findings indicate that the use of dental sealants to control caries lesions requires patient compliance in attending regular follow-ups to assess the need for retreatment.…”

“…In primary molars, one study comparing sealing versus partial caries removal showed that both strategies had similar efficacy in arresting the caries progression of cavitated occlusal lesions. 11 However, the authors found a higher clinical survival rate at 18 months for restorations, with a higher frequency of retreatments in the sealant group. More randomized controlled clinical trials are needed to investigate whether the placement of a sealant may be seen as a clinical alternative to control caries progression in lesions with shallow-to-moderate depth.…”

Strategies for control and treatment of carious lesions in deciduous molars: a review of the literature

“…In this method, preparation of the cavity is limited to the minimal removal of the decayed tissue, the cavity then being restored with composite resin or glass ionomer cement before sealant is applied along the edges of the filled cavity, covering the entire occlusal surface 30 . However, given the various difficulties in managing children's behavior during conventional restorative therapy, sealing carious dentin lesions in deciduous teeth could be an interesting and less invasive option 8 . Some restorative materials used to seal carious lesions of the oral environment are reported to have cariostatic properties, guaranteeing reductions in the number of microorganisms and inducing structural alterations to the dentin, which leads to arrestment of the lesions.…”

“…However, there is growing evidence of their effectiveness in controlling caries already established in posterior teeth 8 and the recommendation for the application of occlusal sealants seems to be changing from primary prevention to Strategies for control and treatment of carious lesions in deciduous molars: a review of the literature to pulp exposure and, consequently, more invasive and complex procedures, such as direct pulp capping, pulp curettage and pulpotomy, which may trigger a series of reinterventions that could culminate in the premature extraction of teeth 40 .…”

“…Biological approaches to handling carious lesions in deciduous molars embrace several techniques, the most noteworthy being partial removal of decayed tissue with 3,5 or without reopening the tooth to supplement excavation 2,6 , sealing the carious lesion [7][8] , sealing the cavitated lesion with prefabricated steel crowns, known as the Hall technique [9][10][11][12] and, more recently, ultra-conservative treatment…”