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Title Adhesive Systems, Preferably Etch-and-Rinse Systems, Are Valuable Underneath A Fissure Sealant For Sealant Retention
Clinical Question For a child with deep occlusal anatomy, would placing an adhesive bonding agent, as compared to traditional sealant placement, be more effective in long-term sealant retention?
Clinical Bottom Line Sealant retention is important in helping to prevent dental decay on susceptible grooves in children with deep occlusal anatomy. In order to improve sealant retention, two systematic reviews have concluded that using a thin layer of adhesive, preferably an etch and rinse system, is beneficial.
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) 26993212Bagherian/201612 StudiesSystematic review and meta-analysis
Key resultsA meta-analysis of five studies evaluated fissure sealant retention with and without the use of an adhesive system. “The OR was 3.294 (95% CI, 1.292-8.401; P=.013)…and the risk difference was 0.180 (95% CI, 0.067-0.292; P=.002).” This showed that the “the use of adhesive systems had a positive effect on fissure sealant” placement. A second meta-analysis of three studies compared fissure sealant retention using etch-and-rinse adhesive systems versus self-etching adhesive systems. “The OR was 14.569 (95% CI, 2.616-81.131; P=.002) and the risk difference was 0.516 (95% CI, 0.269-0.763; P=.000).” This indicated “the superiority of using etch-and-rinse adhesive versus self-etching adhesive in the fissure sealant placement.”
#2) 26590954Botton/20165 StudiesSystematic review and meta-analysis
Key results"This systematic review compared the retention rate of sealants placed on occlusal surfaces following the use of self‐etch adhesive systems and traditional acid etching, with or without the application of adhesive system.“ The pooled estimate (95% CI) for failure rate in the retention of occlusal fissure sealants favored the control (traditional acid-etching) group, with an odds ratio of 4.46 (1.31, 15.20). This showed that retention of the sealant is higher when the sealant material is applied right after phosphoric acid etching.
Evidence Search (("Pit and Fissure Sealants"[Mesh] AND “Adhesive”) AND “Retention”
Comments on
The Evidence
Both systematic reviews had clearly stated research questions, clearly stated search strategies, and clearly stated inclusion and exclusion criteria. In Bagherian/2016, “the primary outcome was to determine the success rate of using fissure sealant with and without the addition of an adhesive system. The second outcome was to determine the success rate of fissure sealant according to the type of adhesive system used.” The aim of Botton/2016 was to “systematically review the literature for randomized clinical trials studies that compared the retention rate of sealants combined with self‐etch adhesive systems versus sealants with prior application of phosphoric acid, with or without adhesive systems combined.” Both systematic reviews were based on a search of multiple databases. Both authors assessed their included studies for quality or risk of bias. Bagherian/2016 included only randomized or quasi-randomized clinical trails and used the Jadad scale to assess study quality; “all 12 of the included trials attained at least 5 ‘yes’ responses” and were concluded to provide good evidence for this systematic review. Botton/2016 included only RCTs; the authors used a scoring system to determine study quality as strong, good, or reasonable. The majority of included studies showed good evidence, and one study exhibited strong evidence. It is important to note that a high level of heterogeneity was found in the meta-analysis – I-squared=85% - which the authors attributed to variation in the lengths of the included studies (between 6 months and 24 months).
Applicability The main purpose of fissure and pit sealants is to prevent decay on susceptible tooth surfaces. In the interest of guaranteed effectiveness on tooth surfaces prone to dental caries, it is important to place an adequate sealant that is retentive. This requires ideal isolation and a clean tooth surface. Botton et al. showed that occlusal sealants placed using the traditional self-etch methodology have high retention rates when contamination can be prevented. According to Begherian et al., applying a thin layer of adhesive after etch is advantageous in sealant retention on any susceptible tooth surface. Therefore, when placing sealants on vulnerable fissure systems the treatment approach is contingent on the oral environment. In an optimal dental environment where contamination is minimal, traditional sealant placement is preferred and proper recall and follow up is indicated to optimize preventing dental decay. If the dental environment is less than optimal, use of adhesive could be beneficial in helping with sealant retention. Bagherian et al. concluded that “the increased time involved in the procedure and the cost of the fissure sealant therapy are the 2 main disadvantages of using adhesive systems under fissure sealants.”
Specialty/Discipline (Pediatric Dentistry) (Restorative Dentistry)
Keywords Pit and fissure sealants, dental adhesive, retention, etching
ID# 3330
Date of submission: 09/24/2018spacer
E-mail muellerc@livemail.uthscsa.edu
Author Christina A. Mueller, BS, MPH, DDS
Co-author(s) e-mail
Faculty mentor/Co-author Kevin Donly, DDS,MS
Faculty mentor/Co-author e-mail donly@uthscsa.edu
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