ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Fluoride releasing properties of glass-ionomer sealants may have no additional benefit in preventing secondary caries in children over properly applied resin based materials.
Clinical Question In children needing sealants, are glass-ionomer and resin-based materials comparable in preventing secondary carious lesions?
Clinical Bottom Line Resin based sealants have been the biomaterial of choice over glass-ionomers for pit and fissure sealants due to their ease of application and high retention rates. Evidence has shown little superiority of either material in preventing secondary caries when proper patient selection, application, and maintenance techniques are applied. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22137936Kuhnish/2012Children & young individualsSystematic Review and Meta-Analysis
Key resultsGlass-ionomer materials were classified as mechanically inferior with 5- year retention rates <5.2%. In contrast, resin-based light polymerizing sealants had 5-year retention rates of 83.8%
#2) 20129029Yengopal/2010Children 6-16 y/oSystematic Review with Meta-Analysis
Key resultsResin based sealants were favored in 36 month data, however meta-analysis found no conclusive evidence that either material is superior in preventing recurrent carious lesions.
#3) 21564115Simonsen/2011ChildrenNarrative Review
Key resultsDue to the poorer retention rates and surface wear, glass-ionomer sealants are not preferred over resin-based sealants.
Evidence Search sealant glass ionomer retention
Comments on
The Evidence
Kuhnish, J. et al. was a systematic review with meta-analysis. It included 98 clinical reports, 12 field studies, and only those with follow-ups of 2 years or longer were considered. One hundred-ten clinical reports qualified for meta-analysis. Data on premolars was excluded. Heterogeneity of the studies was addressed using random effects model. Yengopal V. et al. was also a systematic review with meta-analysis using random effects model. Clinical trials in English, Portuguese, and Spanish that had a two arm-longitudinal study design were considered. Each tooth and the number of caries free teeth were assessed at 6, 12, 24 and 36 months. Heterogeneity was assessed using Cochrane guidelines and only homogeneous data sets were used for meta-analysis. 6 trials of the 212 found were considered for the meta-analysis, and 19 separate data sets were extracted. 36-month data was not pooled. Simonsen RJ & Neal RC was a literature review that considered several issues in sealant performance. Most levels of evidence were used including case studies, randomized control trials, cohort, case-control and cross sectional study designs.
Applicability There is little contention that resin based sealants are the superior material in preventing primary invasion of bacteria in dental caries. Retention rates have a large impact on sealant longevity due to their main function as physical barriers to caries causing bacteria. However, the concept of the fluoride releasing mechanism in glass-ionomer sealants has challenged the bacteria-barrier method with additional enamel fortifying effects. Resin based sealants have shown higher retention and wear rates than fluoride releasing glass-ionomer materials, though secondary caries prevention comparison showed inconclusive evidence due to the glass-ionomer’s continued fluoride releasing mechanism, even after loss of sealant. Patient/tooth selection, expert application, and regular maintenance are required for sealant success and these factors should be considered when selecting or studying your sealant material.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry) (Basic Science)
Keywords Pit Fissure Sealant, Resin, Glass ionomer, recurrent, secondary, carious, retention
ID# 2316
Date of submission: 08/08/2012spacer
E-mail trahans@uthscsa.edu
Author Stephanie Trahan
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author H. Ralph Rawls, PhD
Faculty mentor/Co-author e-mail rawls@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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by Stephanie Trahan (San Antonio, TX) on 09/17/2012
Fluoride is incorporated into the glass filler material of glass ionomer resins and thus associated with aluminum and sodium ions. Fluoride release from glass ionomers involves an interaction zone on the enamel or dentin surface. Fluoride ions have been readily visible in this interaction zone up to 5 years after placement of the restorative material. A concentration gradient exists between the surface of dentin and glass ionomer, driving the diffusion process of fluoride ions. While the quantity of fluoride migration has not yet been established, the extent of penetration reached 0.20 mm. This zone has also shown to contribute to the durability of glass ionomer adhesion and prevent microleakage, both important factors in overall sealant success. PMID: 22532098
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Jeff Paz (San Antonio, TX) on 12/09/2012
Any thoughts on the correlation between Rx toothpaste for children and potential resin composite failures on permanent dentition? Thank you for your assistance!
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