A review of the clinical applicationand performance of pit andfissure sealantsRichard J. SimonsenAustralian Dental Journal 56,2011
Introduction• Application of pit and fissure sealant tonewly-erupted posterior and anterior teethis the best method in dentistry to preventpit and fissure caries• When incipient lesions are sealed overwith resin, sealant can prevent thecontinued progression of incipient caries
Review of the literature• Questions– Under what circumstances should sealants beplaced to prevent caries?– Does placing sealants over early(non-cavitated) lesions prevent progression of thelesion?
Review of the literature• Questions– Are there conditions that flavour theplacement of resin-based versus glass-ionomer cement sealants in terms of retentionor caries prevention?– Are there any techniques that could improvesealants’ retention and effectiveness in cariesprevention?
Review of the literature• Reviewed contents– Fluoride used with sealants and fluoride-containing sealant– Choice of sealant– Filled versus unfilled sealants– Coloured versus clear sealants– Autocure versus light-initiated sealants– Cost-effectiveness– Underuse of sealants
Review of the literature• Conclusions– Placement of resin-based sealants on thepermanent molars of children andadolescents is effective for caries reduction– Reduction of caries incidence in children andadolescents after placement of resin-basedsealants ranged from 86% at 1 year to 78.6%at 2 years and 58.6% at 4 years
Review of the literature• Conclusions– Sealants are effective in reducing occlusal cariesincidence in permanent first molars of children,with caries reductions of 76.3% at 4 years, whensealants were reapplied as needed. Cariesreduction was 65% at 9 years from initialplacement with no reapplication during the last 5years– Pit and fissure sealants are retained on primarymolars at a rate of 74.0 to 96.3% at 1 year and70.6 to 76.5% at 2.8 years
Review of the literature• Conclusions– There is consistent evidence from privatedental insurance and federal dental plan(Medicaid) databases that placement ofsealants on first and second permanentmolars in children and adolescents isassociated with reductions in the subsequentprovision of restorative services
Review of the literature• Conclusions– Evidence from Medicaid claims for childrenwho were continuously enrolled for 4 yearsindicates that sealed permanent molars areless likely to receive restorativetreatment, that the time between receivingsealants and restorative treatment isgreater, and that the restorations were lessextensive than those in permanent molarsthat were unsealed
Summary• Pit and fissure sealant is best applied tohigh-risk populations by trained auxiliariesusing autocured (translucent or coloured)sealant, applied under the rubber dam orwith some alternative short-term buteffective isolation technique (e.g. Isolite),onto an enamel surface that has beencleaned and etched with 35% phosphoricacid for 15 seconds.