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Meta-Analysis
. 2017 Jul 31;7(7):CD001830.
doi: 10.1002/14651858.CD001830.pub5.

Pit and fissure sealants for preventing dental decay in permanent teeth

Anneli Ahovuo-Saloranta  1 , Helena Forss, Tanya Walsh, Anne Nordblad, Marjukka Mäkelä, Helen V Worthington
Affiliations
Meta-Analysis

Pit and fissure sealants for preventing dental decay in permanent teeth

Anneli Ahovuo-Saloranta et al. Cochrane Database Syst Rev. .

Abstract

Background: Dental sealants were introduced in the 1960s to help prevent dental caries, mainly in the pits and fissures of occlusal tooth surfaces. Sealants act to prevent bacteria growth that can lead to dental decay. Evidence suggests that fissure sealants are effective in preventing caries in children and adolescents compared to no sealants. Effectiveness may, however, be related to caries incidence level of the population. This is an update of a review published in 2004, 2008 and 2013.

Objectives: To compare the effects of different types of fissure sealants in preventing caries in occlusal surfaces of permanent teeth in children and adolescents.

Search methods: Cochrane Oral Health's Information Specialist searched: Cochrane Oral Health's Trials Register (to 3 August 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 7), MEDLINE Ovid (1946 to 3 August 2016), and Embase Ovid (1980 to 3 August 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 3 August 2016. No restrictions were placed on language or date of publication.

Selection criteria: Randomised controlled trials (RCTs) comparing sealants with no sealant or a different type of sealant material for preventing caries of occlusal surfaces of premolar or molar teeth in children and adolescents aged up to 20 years. Studies required at least 12 months follow-up. We excluded studies that compared compomers to resins/composites.

Data collection and analysis: Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We presented outcomes for caries or no caries on occlusal surfaces of permanent molar teeth as odds ratio (OR) or risk ratio (RR). We used mean difference (MD) for mean caries increment. All measures were presented with 95% confidence intervals (CI). We conducted meta-analyses using a random-effects model for comparisons where there were more than three trials; otherwise we used the fixed-effect model. We used GRADE methods to assess evidence quality.

Main results: We included 38 trials that involved a total of 7924 children; seven trials were new for this update (1693 participants). Fifteen trials evaluated the effects of resin-based sealant versus no sealant (3620 participants in 14 studies plus 575 tooth pairs in one study); three trials with evaluated glass ionomer sealant versus no sealant (905 participants); and 24 trials evaluated one type of sealant versus another (4146 participants). Children were aged from 5 to 16 years. Trials rarely reported background exposure to fluoride of trial participants or baseline caries prevalence. Resin-based sealant versus no sealant: second-, third- and fourth-generation resin-based sealants prevented caries in first permanent molars in children aged 5 to 10 years (at 24 months follow-up: OR 0.12, 95% CI 0.08 to 0.19, 7 trials (5 published in the 1970s; 2 in the 2010s), 1548 children randomised, 1322 children evaluated; moderate-quality evidence). If we were to assume that 16% of the control tooth surfaces were decayed during 24 months of follow-up (160 carious teeth per 1000), then applying a resin-based sealant would reduce the proportion of carious surfaces to 5.2% (95% CI 3.13% to 7.37%). Similarly, assuming that 40% of control tooth surfaces were decayed (400 carious teeth per 1000), then applying a resin-based sealant would reduce the proportion of carious surfaces to 6.25% (95% CI 3.84% to 9.63%). If 70% of control tooth surfaces were decayed, there would be 19% decayed surfaces in the sealant group (95% CI 12.3% to 27.2%). This caries-preventive effect was maintained at longer follow-up but evidence quality and quantity was reduced (e.g. at 48 to 54 months of follow-up: OR 0.21, 95% CI 0.16 to 0.28, 4 trials, 482 children evaluated; RR 0.24, 95% CI 0.12 to 0.45, 203 children evaluated). Although studies were generally well conducted, we assessed blinding of outcome assessment for caries at high risk of bias for all trials (blinding of outcome assessment is not possible in sealant studies because outcome assessors can see and identify sealant). Glass ionomer sealant versus no sealant: was evaluated by three studies. Results at 24 months were inconclusive (very low-quality evidence). One sealant versus another sealant: the relative effectiveness of different types of sealants is unknown (very low-quality evidence). We included 24 trials that directly compared two different sealant materials. Comparisons varied in terms of types of sealant assessed, outcome measures chosen and duration of follow-up. Adverse events: only four trials assessed adverse events. No adverse events were reported.

Authors' conclusions: Resin-based sealants applied on occlusal surfaces of permanent molars are effective for preventing caries in children and adolescents. Our review found moderate-quality evidence that resin-based sealants reduced caries by between 11% and 51% compared to no sealant, when measured at 24 months. Similar benefit was seen at timepoints up to 48 months; after longer follow-up, the quantity and quality of evidence was reduced. There was insufficient evidence to judge the effectiveness of glass ionomer sealant or the relative effectiveness of different types of sealants. Information on adverse effects was limited but none occurred where this was reported. Further research with long follow-up is needed.

PubMed Disclaimer

Conflict of interest statement

Anneli Ahovuo‐Saloranta: none known. Helena Forss: none known. Tanya Walsh: none known. I am an Editor with Cochrane Oral Health. Anne Nordblad: none known. Marjukka Mäkelä: none known. Helen V Worthington: none known. I am one of the two Co‐ordinating Editors of Cochrane Oral Health.

Figures

1
1
Study flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias domain presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias domain for each included study
1.1
1.1. Analysis
Comparison 1 Resin‐based sealants versus no sealant, Outcome 1 Caries yes/no at 12 months.
1.2
1.2. Analysis
Comparison 1 Resin‐based sealants versus no sealant, Outcome 2 Caries yes/no at 24 months.
1.3
1.3. Analysis
Comparison 1 Resin‐based sealants versus no sealant, Outcome 3 Caries yes/no at 36 months.
1.4
1.4. Analysis
Comparison 1 Resin‐based sealants versus no sealant, Outcome 4 Caries yes/no at 48 to 54 months.
1.5
1.5. Analysis
Comparison 1 Resin‐based sealants versus no sealant, Outcome 5 Caries yes/no at 48 months, parallel group studies.
1.6
1.6. Analysis
Comparison 1 Resin‐based sealants versus no sealant, Outcome 6 24‐months DFS increment.
1.7
1.7. Analysis
Comparison 1 Resin‐based sealants versus no sealant, Outcome 7 24‐months DMFS increment.
1.8
1.8. Analysis
Comparison 1 Resin‐based sealants versus no sealant, Outcome 8 Caries yes/no at 5 years.
1.9
1.9. Analysis
Comparison 1 Resin‐based sealants versus no sealant, Outcome 9 Caries yes/no at 6 years.
1.10
1.10. Analysis
Comparison 1 Resin‐based sealants versus no sealant, Outcome 10 Caries yes/no at 7 years.
1.11
1.11. Analysis
Comparison 1 Resin‐based sealants versus no sealant, Outcome 11 Caries yes/no at 9 years, parallel group studies.
2.1
2.1. Analysis
Comparison 2 Glass ionomer‐based sealants versus no sealant, Outcome 1 Caries yes/no at 24 months.
2.2
2.2. Analysis
Comparison 2 Glass ionomer‐based sealants versus no sealant, Outcome 2 2 year DFS increment.
4.1
4.1. Analysis
Comparison 4 Glass ionomer‐based sealants versus resin sealants, Outcome 1 Caries yes/no at 12 months.
4.2
4.2. Analysis
Comparison 4 Glass ionomer‐based sealants versus resin sealants, Outcome 2 Caries yes/no at 24 months.
4.3
4.3. Analysis
Comparison 4 Glass ionomer‐based sealants versus resin sealants, Outcome 3 2 year DFS increment.
4.4
4.4. Analysis
Comparison 4 Glass ionomer‐based sealants versus resin sealants, Outcome 4 Caries yes/no at 36 to 48 months.
4.5
4.5. Analysis
Comparison 4 Glass ionomer‐based sealants versus resin sealants, Outcome 5 Caries yes/no at 5 years, high‐viscosity glass ionomer.
4.6
4.6. Analysis
Comparison 4 Glass ionomer‐based sealants versus resin sealants, Outcome 6 Caries yes/no at 7 years.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Amin 2008 {published data only}
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Dhar 2012 {published and unpublished data}
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Erdoğan 1987 {published data only}
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Forss 1998 {published and unpublished data}
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Ganesh 2006 {published and unpublished data}
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Guler 2013 {published data only}
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Hunter 1988 {published data only}
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Karlzén‐Reuterving 1995 {published data only}
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Kervanto‐Seppälä 2008 {published and unpublished data}
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Liu 2012 {published and unpublished data}
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Mills 1993 {published data only}
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Muller‐Bolla 2013 {published and unpublished data}
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Raadal 1996 {published data only}
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Rock 1978 {published data only}
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Sheykholeslam 1978 {published and unpublished data}
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Songpaisan 1995 {published data only}
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References to studies excluded from this review

Andjelic 1991 {published data only}
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Azul 1990 {published data only}
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Centenaro 2001 {published data only}
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De Puel 1983 {published data only}
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Hepp 1990 {published and unpublished data}
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Hickel 1989 {published data only}
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Hilgert 2015 {published data only}
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Hotz 1978 {published and unpublished data}
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Irmisch 1992 {published data only}
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Jodkowska 1984 {published data only}
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Marković 2012 {published data only}
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Morgan 1998 {published data only}
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Morrow 1997 {published data only}
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Noack 1997 {published data only}
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Pereira 1999 {published and unpublished data}
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Puppin‐Rontani 2006 {published data only}
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Vrbic 1983 {published and unpublished data}
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Yoshihara 2000 {published data only}
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Zhang 2003 {published data only}
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References to studies awaiting assessment

Gorseta 2014 {published data only}
    1. Gorseta K, Glavina D, Borzabadi‐Farahani A, Duinen RN, Skrinjaric I, Hill RG, et al. One‐year clinical evaluation of a glass carbomer fissure sealant, a preliminary study. European Journal of Prosthodontics and Restorative Dentistry 2014;22(2):67‐71. - PubMed
Ulusu 2012 {published data only}
    1. Ulusu T, Odabaş ME, Tüzüner T, Baygin Ö, Sillelioğlu H, Deveci C, et al. The success rates of a glass ionomer cement and a resin‐based fissure sealant placed by fifth‐year undergraduate dental students. European Archives of Paediatric Dentistry 2012;13(2):94‐7. - PubMed

References to ongoing studies

IRCT2013041611960N2 {published data only}
    1. IRCT2013041611960N2. Clinical evaluation of glass ionomer fissure sealants. en.search.irct.ir/view/13191 (first received 20 December 2013).
NCT02408601 {published data only}
    1. NCT02408601. A clinical trial to assess the retention and caries preventive effect of resin based sealants versus ART sealants. clinicaltrials.gov/ct2/show/NCT02408601 (first received 24 March 2015).
NCT02443896 {published data only}
    1. NCT02443896. The use of pit and fissure sealants in children requiring caries related dental extractions. clinicaltrials.gov/ct2/show/NCT02443896 (first received 1 April 2015).
NCT02795728 {published data only}
    1. NCT02795728. Fuji type VII sealant versus resin based sealant. A clinical trial. clinicaltrials.gov/ct2/show/NCT02795728 (first received 28 May 2016).
NCT02849925 {published data only}
    1. NCT02849925. Randomized controlled clinical trial on the treatment of caries lesions using resin or glass ionomer sealants in permanent teeth. clinicaltrials.gov/ct2/show/NCT02849925 (first received 21 July 2016).

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