Glass ionomer ART sealant and fluoride-releasing resin sealant in fissure caries prevention--results from a randomized clinical trial

Bao Ying Liu, Yue Xiao, Chun Hung Chu, Edward Chin Man Lo, Bao Ying Liu, Yue Xiao, Chun Hung Chu, Edward Chin Man Lo

Abstract

Background: The relative performance of ART sealant and fluoride-releasing resin sealant in preventing fissure caries in permanent molars was compared in a randomized clinical trial conducted in southern China (ClinicalTrials.gov NCT01829334).

Methods: After obtaining ethical approval, healthy schoolchildren who had permanent first molars with occlusal fissures which were sound but deep or presented with only incipient caries were recruited for the study. Included molars were randomly allocated into one of four parallel study groups in units of left/right teeth per mouth. Two of the four groups adopted the methods of ART or fluoride-releasing resin sealant placement while the other two groups adopted the topical fluoride application methods. Fissure status of the molars in each group was evaluated every 6 months. Development of dentine caries and sealant retention over 24 months in the molars in the two sealant-using groups was compared in this report. Outcome on cost-effectiveness of all four groups over 36 months will be reported elsewhere.

Results: At baseline, a total of 280 children (383 molars) with mean age 7.8 years were involved for the two sealant groups. After 24 months, 261 children (357 molars) were followed. Proportions of molars with dentine caries were 7.3% and 3.9% in the ART sealant and fluoride-releasing resin sealant groups, respectively (chi-square test, p = 0.171). Life-table survival analysis showed that sealant retention (full and partial) rate over 24 months for the resin sealant (73%) was significantly higher than that (50%) for the ART sealant (p < 0.001). Molar survival (no development of dentine caries) rates in the ART sealant (93%) and fluoride-releasing resin sealant (96%) groups were not significantly different (p = 0.169). Multilevel logistic regression (GEE modeling) accounting for the effects of data clustering and confounding factors confirmed this finding.

Conclusions: Though the retention of fluoride-releasing resin sealant was better than that of the ART sealant, their effectiveness in preventing fissure caries in permanent molars did not differ significantly over 24 months. ART sealants could be a good alternative when and where resources for resin sealant placement are not readily available.

Figures

Figure 1
Figure 1
Subjects flow until 24 months in the two sealant groups in the study (n- number of subject, N-number of molar).
Figure 2
Figure 2
Cumulated proportions of molar survival and sealant retention over 24 months in the two sealant groups, resin sealant (RS) and ART sealant (GIS) (error bars show the 95% confidence intervals of the estimated mean).

References

    1. Batchelor PA, Sheiham A. Grouping of tooth surfaces by susceptibility to caries: a study in 5–16 year-old children. BMC Oral Health. 2004;4:2. doi: 10.1186/1472-6831-4-2.
    1. Sheiham A, Sabbah W. Using universal patterns of caries for planning and evaluating dental caries. Caries Res. 2010;44:141–150. doi: 10.1159/000308091.
    1. Wang JD, Chen X, Frencken J, Du MQ, Chen Z. Dental caries and first permanent molar pit and fissure morphology in 7- to 8-year-old children in Wuhan, China. Int J Oral Sci. 2012;4:157–160. doi: 10.1038/ijos.2012.34.
    1. Komiyama E, Kimoto K, Arakawa H. Relationship between duration of fluoride exposure in school-based fluoride mouthrinsing and effects on prevention and control of dental caries. ISRN Dent. 2012;2012:183272.
    1. Ripa LW. Occlusal sealing: rationale of the technique and historical review. J Am Soc Prev Dent. 1973;3:32–9.
    1. Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington HV. Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev. 2013;3 CD001830.
    1. Ripa LW. Sealants revisted: an update of the effectiveness of pit and-fissure sealants. Caries Res. 1993;27(Suppl 1):77–82.
    1. Beiruti N, Frencken JE, Van’t Hof MA, Van Palenstein Helderman WH. Caries-preventive effect of resin-based and glass ionomer sealants over time: a systematic review. Community Dent Oral Epidemiol. 2006;34:403–409. doi: 10.1111/j.1600-0528.2006.00321.x.
    1. Yengopal V, Mickenautsch S, Bezerra AC, Leal SC. Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: a meta analysis. J Oral Sci. 2009;51:373–382. doi: 10.2334/josnusd.51.373.
    1. Mickenautsch S, Yengopal V. Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: an update of systematic review evidence. BMC Res Notes. 2011;4:22. doi: 10.1186/1756-0500-4-22.
    1. Nagaraja UP, Kishore G. Glass ionomer cement – the different generations. Trends Biomater Artif Organs. 2005;18:158–165.
    1. Frencken JE, Pilot T, Songpaisan Y, Phantumvanit P. Atraumatic restorative treatment (ART): rationale, technique, and development. J Public Health Dent. 1996;56(Spec 3):135–40.
    1. Weerheijm KL, Kreulen CM, Gruythuysen RJ. Comparison of retentive qualities of two glass-ionomer cements used as fissure sealants. ASDC J Dent Child. 1996;63:265–267.
    1. Van’t Hof MA, Frencken JE, Helderman WH, Holmgren CJ. The atraumatic restorative treatment (ART) approach for managing dental caries: a meta-analysis. Int Dent J. 2006;56:345–351. doi: 10.1111/j.1875-595X.2006.tb00339.x.
    1. Holmgren CJ, Lo ECM, Hu DY. Glass ionomer ART sealants in Chinese school children – 6-year results. J Dent. 2013;41:764–770. doi: 10.1016/j.jdent.2013.06.013.
    1. Beiruti N, Frencken JE, Van’t Hof MA, Taifour D, Van Palenstein Helderman WH. Caries-preventive effect of a one-time application of composite resin and glass ionomer sealants after 5 years. Caries Res. 2006;40:52–9. doi: 10.1159/000088907.
    1. Mejàre I. Indications for fissure sealants and their role in children and adolescents. Dent Update. 2011;38:699–703.
    1. Xiao Y. PhD Thesis. Hongkong: The University of Hong Kong, Faculty of Dentistry; 2009. An oral health survey and prevention of dental caries among school children in Shenzhen.
    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. Lussi A, Hibst R, Paulus R. DIAGNOdent: an optical method for caries detection [abstract] J Dent Res. 2004;83(Spec C):C80–C83.
    1. Chu CH, Lo ECM, You DSH. Clinical diagnosis of fissure caries with conventional and laser-induced fluorescence techniques. Lasers Med Sci. 2010;25:355–362. doi: 10.1007/s10103-009-0655-6.
    1. Frencken JE, Pilot T, Van Amerongen E, Songpaisan Y, Pilot T. Manual for the atraumatic restorative treatment approach to control dental caries. 3. Groningen: WHO Collaborating Centre for Oral Health Services Research; 1997.
    1. Forss H, Saarni UM, Seppä L. Comparison of glass-ionomer and resin-based fissure sealants: a 2-year clinical trial. Community Dent Oral Epidemiol. 1994;22:21–24. doi: 10.1111/j.1600-0528.1994.tb01563.x.
    1. Murray DM, Varnell SP, Blitstein JL. Design and analysis of group-randomized trials: a review of recent methodological developments. Am J Public Health. 2004;94:423–432. doi: 10.2105/AJPH.94.3.423.
    1. Marinho VCC, Higgins JPT, Sheiham A, Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2004;1 CD002781.
    1. Liu BY, Lo EC, Chu CH, Lin HC. Randomized trial on fluorides and sealants for fissure caries prevention. J Dent Res. 2012;91:753–8. doi: 10.1177/0022034512452278.
    1. Pardi V, Pereira AC, Ambrosano GM, Meneghim Mde C. Clinical evaluation of three different materials used as pit and fissure sealant: 24-months results. J Clin Pediatr Dent. 2005;29:133–7.
    1. Erdemir U, Sancakli HS, Yaman BC, Ozel S, Yucel T, Yıldız E. Clinical comparison of a flowable composite and fissure sealant: a 24-month split-mouth, randomized, and controlled study. J Dent. 2014;42:149–157. doi: 10.1016/j.jdent.2013.11.015.
    1. Hannigan A, Lynch CD. Statistical methodology in oral and dental research: pitfalls and recommendations. J Dent. 2013;41:385–392. doi: 10.1016/j.jdent.2013.02.013.
    1. Chen X, Du MQ, Fan MW, Mulder J, Huysmans MC, Frencken JE. Caries-preventive effect of sealants produced with altered glass-ionomer materials, after 2 years. Dent Mater. 2012;28:554–60. doi: 10.1016/j.dental.2012.01.001.
    1. Oba AA, Dülgergil T, Sönmez IS, Doğan S. Comparison of caries prevention with glass ionomer and composite resin fissure sealants. J Formos Med Assoc. 2009;108:844–8. doi: 10.1016/S0929-6646(09)60415-0.
    1. Zhang W, Chen X, Fan MW, Mulder J, Huysmans MC, Frencken JE. Do light cured ART conventional high-viscosity glass-ionomer sealants perform better than resin-composite sealants: A 4-year randomized clinical trial. Dent Mater. 2014. . [Epub ahead of print]
    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. Frencken JE, Makoni F, Sithole WD, Hackenitz E. Three-year survival of one-surface ART restorations and glass-ionomer sealants in a school oral health programme in Zimbabwe. Caries Res. 1998;32:119–26. doi: 10.1159/000016441.
    1. Frencken JE, Makoni F, Sithole WD. ART restorations and glass ionomer sealants in Zimbabwe: survival after 3 years. Community Dent Oral Epidemiol. 1998;26:372–81. doi: 10.1111/j.1600-0528.1998.tb01975.x.
    1. Holmgren CJ, Lo EC, Hu D, Wan H. ART restorations and sealants placed in Chinese school children–results after three years. Community Dent Oral Epidemiol. 2000;28:314–20. doi: 10.1034/j.1600-0528.2000.280410.x.
    1. Frencken JE, Wolke J. Clinical and SEM assessment of ART high-viscosity glass-ionomer sealants after 8–13 years in 4 teeth. J Dent. 2010;38:59–64. doi: 10.1016/j.jdent.2009.09.004.
    1. Mejàre I, Lingström P, Petersson LG, Holm AK, Twetman S, Källestål C, Nordenram G, Lagerlöf F, Söder B, Norlund A, Axelsson S, Dahlgren H. Caries-preventive effect of fissure sealants: a systematic review. Acta Odontol Scand. 2003;61:321–30. doi: 10.1080/00016350310007581.
    1. Kloukos D, Pandis N, Eliades T. In vivo bisphenol-A release from dental pit and fissure sealants: a systematic review. J Dent. 2013;41(8):659–67. doi: 10.1016/j.jdent.2013.04.012.
    1. Michałowicz J. Bisphenol A - sources, toxicity and biotransformation. Environ Toxicol Pharmacol. 2014;37:738–758. doi: 10.1016/j.etap.2014.02.003.
    1. Jedeon K, De la Dure-Molla M, Brookes SJ, Loiodice S, Marciano C, Kirkham J, Canivenc-Lavier MC, Boudalia S, Bergès R, Harada H, Berdal A, Babajko S. Enamel defects reflect perinatal exposure to bisphenol A. Am J Pathol. 2013;183:108–18. doi: 10.1016/j.ajpath.2013.04.004.
    1. FDI World Dental Federation. FDI News. Geneva: FDI; 2013. FDI approves five policy statements: a focus on prevention.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi