Occlusal sealant success over ten years in a private practice: comparing longevity of sealants placed by dentists, hygienists, and assistants

Abstract

Purpose: The purpose of this 10-year, retrospective, cohort study was to evaluate the success of permanent molar sealants by comparing the effectiveness of sealants placed by dentists, dental hygienists, and dental assistants in a private dental practice, with all operators using an identical, standardized, application technique and 4-handed dentistry.

Methods: From 810 patient records that met entry criteria, the long-term follow-up records of 3,194 permanent first molars were evaluated. Data were collected and evaluated by survival analyses methods for: (1) time to first failure (caries or restoration of the sealed surface); (2) fluoride history; (3) caries experience; (4) operator type; (5) behavior at sealant placement; (6) tooth type; (7) age at placement; and (8) patient gender.

Results: Cumulative survival probability for 10 years in this practice was 87%, using Kaplan Meier analyses. The factors associated with an increased risk of failure included: (1) age (P<.001); (2) dmft (P<.003); (3) no fluoride (P<.001); (4) dentist (P<.001); and (5) registered dental assistant (P<.001). While all operator groups had success rates equal to or exceeding previous studies, dentists and registered dental assistants showed 3 times and 2 times the risk of failure, respectively, compared to the registered dental hygienists. The no-fluoride group showed almost twice the risk of failure as compared to the optimal fluoride group. Behavior showed a slightly higher risk of failure that approached significance. Age and dmft were highly significant, with slight increased risk of failure. Supplemental fluoride showed a protective effect, but this was marginally significant. Gender and tooth-type were not significant in this model. Major variations in success rates were observed in the dental assistant group, with 2 individuals accounting for most of the failures.

Conclusions: This study supports delegation of sealant delivery to auxiliaries, since dental assistants and dental hygienists were equal to or better than the dentists in long-term sealant effectiveness.