Sealing versus partial caries removal in primary molars: a randomized clinical trial

Daniela Hesse, Clarissa Calil Bonifácio, Fausto Medeiros Mendes, Mariana Minatel Braga, José Carlos Pettorossi Imparato, Daniela Prócida Raggio, Daniela Hesse, Clarissa Calil Bonifácio, Fausto Medeiros Mendes, Mariana Minatel Braga, José Carlos Pettorossi Imparato, Daniela Prócida Raggio

Abstract

Background: The resin-based pit and fissure sealant is considered a successful tool in caries prevention, however there is a growing evidence of its use in controlling already established caries in posterior teeth. The aim of this clinical trial is to verify the efficacy of pit and fissure sealants in arresting dentinal caries lesions compared to partial excavation and restorative treatment in primary molar teeth.

Methods: Thirty six patients with occlusal cavitated primary molar reaching outer half of dentin were selected. The patients were randomly allocated into two groups: sealant application (experimental group - n = 17) and restoration with composite resin (control group - n = 19). Clinical and radiograph evaluation were performed after 6, 12 and 18 months. The chi-square test was used to verify the distribution of characteristics variables of the sample among the groups. The survival rate of treatments was evaluated using Kaplan-Meier survival and log-rank test. Fisher's Exact and logistic regression tests were calculated in each evaluation period (α = 5%).

Results: The control group showed significantly better clinical survival after 18 months (p = 0.0025). In both groups, no caries progression was registered on the radiographic evaluations.

Conclusions: Sealing had similar efficacy in the arrestment of caries progression of cavitated occlusal lesions compared to partial excavation of the lesions, even though the frequency of re-treatments was significantly higher in sealed lesions.

Trial registration: Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-9kkv53.

Figures

Figure 1
Figure 1
Consort flow diagram of the trial.n number of children.
Figure 2
Figure 2
Kaplan-Meier survival curves for the clinical evaluation. Log-rank, p = 0.0053.

References

    1. Pitts NB. Are we ready to move from operative to non-operative/preventive treatment of dental caries in clinical practice? Caries Res. 2004;38:294–304. doi: 10.1159/000077769.
    1. Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch B, Ismail A, Kohn W, Siegal M, Simonsen R. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2008;139:257–268. doi: 10.14219/jada.archive.2008.0155.
    1. Kidd EA. How ‘clean’ must a cavity be before restoration? Caries Res. 2004;38:305–313. doi: 10.1159/000077770.
    1. Kervanto-Seppälä S, Pietilä I, Meurman JH, Kerosuo E. Pit and fissure sealants in dental public health - application criteria and general policy in Finland. BMC Oral Health. 2009;9:5. doi: 10.1186/1472-6831-9-5.
    1. Azarpazhooh A, Main PA. Pit and fissure sealants in the prevention of dental caries in children and adolescents: a systematic review. J Can Dent Assoc. 2008;74:171–177.
    1. Griffin SO, Oong E, Kohn W, Vidakovic B, Gooch BF, Bader J, Clarkson J, Fontana MR, Meyer DM, Rozier RG, Weintraub JA, Zero DT. CDC Dental Sealant Systematic Review Work Group. The effectiveness of sealants in managing caries lesions. J Dent Res. 2008;87:169–174. doi: 10.1177/154405910808700211.
    1. Oong EM, Griffin SO, Kohn WG, Gooch BF, Caufield PW. The effect of dental sealants on bacteria levels in caries lesions: a review of the evidence. J Am Dent Assoc. 2008;139:271–278. doi: 10.14219/jada.archive.2008.0156.
    1. Handelman SL, Washburn F, Wopperer P. Two-year report of sealant effect on bacteria in dental caries. J Am Dent Assoc. 1976;93:967–970.
    1. Jensen OE, Handelman SL. Effect of an autopolymerizing sealant on viability of microflora in occlusal dental caries. Scand J Dent Res. 1980;88:382–388.
    1. Mertz-Fairhurst EJ, Call-Smith KM, Shuster GS, Williams JE, Davis QB, Smith CD, Bell RA, Sherrer JD, Myers DR, Morse PK. Clinical performance of sealed composite restorations placed over caries compared with sealed and unsealed amalgam restorations. J Am Dent Assoc. 1987;115:689–694.
    1. Bakhshandeh A, Qvist V, Ekstrand KR. Sealing occlusal caries lesions in adults referred for restorative treatment: 2–3 years of follow-up. Clin Oral Investig. 2011;16:521–529.
    1. Ricketts D. Deep or partial caries removal: which is best? Evid Based Dent. 2008;9:71–72. doi: 10.1038/sj.ebd.6400592.
    1. Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database Syst Rev. 2013;28 CD003808.
    1. Lula EC, Monteiro-Neto V, Alves CM, Ribeiro CC. Microbiological analysis after complete or partial removal of carious dentin in primary teeth: a randomized clinical trial. Caries Res. 2009;43:354–358. doi: 10.1159/000231572.
    1. Kühnisch J, Mansmann U, Heinrich-Weltzien R, Hickel R. Longevity of materials for pit and fissure sealing-results from a meta-analysis. Dent Mater. 2012;28:298–303. doi: 10.1016/j.dental.2011.11.002.
    1. Feigal RJ, Quelhas I. Clinical trial of a self-etching adhesive for sealant application: success at 24 months with Prompt L-Pop. Am J Dent. 2003;16:249–251.
    1. Ram D, Mamber E, Fuks AB. Clinical performance of a non-rinse conditioning sealant in three paediatric dental practices: a retrospective study. Int J Paediatr Dent. 2005;15:61–66. doi: 10.1111/j.1365-263X.2005.00600.x.
    1. Borges BC, de Souza BJ, Braz R, Montes MA, de Assunção Pinheiro IV. Arrest of non-cavitated dentinal occlusal caries by sealing pits and fissures: a 36-month, randomised controlled clinical trial. Int Dent J. 2012;62:251–255. doi: 10.1111/j.1875-595X.2012.00117.x.
    1. Lam A. Increase in utilization of dental sealants. J Contemp Dent Pract. 2008;9:81–87.
    1. Splieth CH, Ekstrand KR, Alkilzy M, Clarkson J, Meyer-Lueckel H, Martignon S, Paris S, Pitts NB, Ricketts DN, van Loveren C. Sealants in dentistry: outcomes of the ORCA Saturday afternoon symposium. Caries Res. 2010;44:3–13. doi: 10.1159/000271591.
    1. Handelman SL, Buonocore MG, Hersck DJ. A preliminary report on the effect of fissure sealant on bacteria in dental caries. J Prosthet Dent. 1972;27:390–392. doi: 10.1016/0022-3913(72)90287-9.
    1. Going RE, Loesche WJ, Grainger DA, Syed SA. The viability of microorganisms in carious lesions five years after covering with a fissure sealant. J Am Dent Assoc. 1978;97:455–462.
    1. Handelman SL, Leverett DH, Iker HP. Longitudinal radiographic evaluation of the progress of caries under sealants. J Pedod. 1985;9:119–126.
    1. Mertz-Fairhurst EJ, Curtis JW Jr, Ergle JW, Rueggeberg FA, Adair SM. Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc. 1998;129:55–66. doi: 10.14219/jada.archive.1998.0022.
    1. Mertz-Fairhurst EJ, Schuster GS, Williams JE, Fairhurst CW. Clinical progress of sealed and unsealed caries. Part I: depth changes and bacterial counts. J Prosthet Dent. 1979;42:521–526. doi: 10.1016/0022-3913(79)90245-2.
    1. Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, Pitts NB. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol. 2007;35:170–178. doi: 10.1111/j.1600-0528.2007.00347.x.
    1. Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res. 1999;33:252–260. doi: 10.1159/000016526.
    1. SB Brasil. .
    1. Hilton TJ, Summitt JB. In: Operative Dentistry. Summitt JB, Robbins JW, Schwartz RS, editor. Chicago: Quintessence Publishing Co; 2000. Pulpal Considerations; p. 103.
    1. Houpt M, Fukus A, Eidelman E. The preventive resin (composite resin/sealant) restoration: nine-year results. Quintessence Int. 1994;25:155–159.
    1. Houpt M, Shey Z. The effectiveness of a fissure sealant after six years. Pediatr Dent. 1983;5:104–106.
    1. Kidd EAM, van Amerongen JP, van Amerongen WE. In: Dental Caries: The Disease and its Clinical Management. 2. Fejerskov O, Kidd EAM, editor. Oxford: Blackwell Munksgaard; 2008. The role of operative dentistry in caries control; pp. 356–365.
    1. Hitt JC, Feigal RJ. Use of a bonding agent to reduce sealant sensitivity to moisture contamination: an in vitro study. Pediatr Dent. 1992;14:41–46.
    1. Borem LM, Feigal RJ. Reducing microleakage of sealants under salivary contamination: digital-image analysis evaluation. Quintessence Int. 1994;25:283–289.
    1. Feigal RJ, Musherure P, Gillespie B, Levy-Polack M, Quelhas I, Hebling J. Improved sealant retention with bonding agents: a clinical study of two-bottle and single-bottle systems. J Dent Res. 2000;79:1850–1856. doi: 10.1177/00220345000790110601.
    1. Hebling J, Feigal RJ. Use of one-bottle adhesive as an intermediate bonding layer to reduce sealant microleakage on saliva-contaminated enamel. Am J Dent. 2000;13:187–191.
    1. Cehreli ZC, Gungor HC. Quantitative microleakage evaluation of fissure sealants applied with or without a bonding agent: results after four-year water storage in vitro. J Adhes Dent. 2008;10:379–384.
    1. Hevinga MA, Opdam NJ, Frencken JE, Bronkhorst EM, Truin GJ. Can caries fissures be sealed as adequately as sound fissures? J Dent Res. 2008;87:495–498. doi: 10.1177/154405910808700514.
    1. Burbridge L, Nugent Z, Deery C. A randomized controlled trial of the effectiveness of a one-step conditioning agent in fissure sealant placement: 12 month results. Eur Arch Paediatr Dent. 2007;8:49–54. doi: 10.1007/BF03262570.
    1. Hackshaw A. Small studies: strengths and limitations. Eur Respir J. 2008;32:1141–1143. doi: 10.1183/09031936.00136408.
    1. Ricketts DN, Kidd EA, Innes N, Clarkson J. Complete or ultraconservative removal of decayed tissue in unfilled teeth. Cochrane Database Syst Rev. 2006;19 CD003808. Update in: Cochrane Database Syst Rev 2013, 3:CD003808.
    1. Thompson V, Craig RG, Curro FA, Green WS, Ship JA. Treatment of deep carious lesions by complete excavation or partial removal: a critical review. J Am Dent Assoc. 2008;139:705–712. doi: 10.14219/jada.archive.2008.0252.
    1. Kidd EA. Clinical threshold for carious tissue removal. Dent Clin North Am. 2010;54:541–549. doi: 10.1016/j.cden.2010.03.001.
    1. Koutsi V, Noonan RG, Horner JA, Simpson MD, Matthews WG, Pashley DH. The effect of dentin depth on the permeability and ultrastructure of primary molars. Pediatr Dent. 1994;16:29–35.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa