Comparing the effectiveness of caries arrest by micro-operative treatment to operative treatment: A 2-year randomized controlled clinical trial.

OBJECTIVES: To compare the effectiveness of caries arrest by micro-operative treatment (sealing) to operative treatment (flowable resin composite restoration) through a 2-year randomized controlled clinical trial. MATERIALS AND METHODS: A prospective randomized controlled trial was conducted among 7-9-year-old children. At baseline, 630 subjects were screened and 92 children who had at least one carious lesion classified as ICDAS 3 on the pit and fissure of first permanent molar were included. Then they were randomly assigned to the sealant group (73 lesions) and the flowable resin composite group (76 lesions) to receive the corresponding intervention. Lesions status in each group was evaluated every 6 months up to 24 months. Clinical progression of dental caries and materials retention were the outcomes used for group comparisons at p-value < 0.05. RESULTS: After 24 months, three lesions (4.1%) in the sealant group clinically progressed to dentin caries. No lesion in the flowable composite group was observed a progression. The results of Life-table survival analysis show that the cumulative caries arrest rate had no statistically significant difference between the two groups (p = 0.075). However, the cumulative retention rate was 57.5% in the sealant group and 92.1% in the flowable composite group, with significant differences (p < 0.001). The multilevel mixed model showed the sealant had higher risk of retention failure than the flowable composite (OR = 8.66, p < 0.001), while tooth position did not influence material retention (p = 0.083). In addition, the results of Fisher Exact test show that dentin lesions had more retention failure than enamel lesions in the sealant group (p = 0.026). CONCLUSION: Although sealing microcavitated carious lesions of the first permanent molar achieved lower retention rate than resin composite restoration, both sealing and restoration effectively arrested caries progression for two years. CLINICAL RELEVANCE: To preserving dental structure and delaying or eliminating the need for operative procedures, microcavitated carious lesion can be arrested by sealing. TRIAL REGISTRATION: Registered at http://www.chictr.org.cn ; Feb 15th, 2020; No. ChiCTR2000029862.

Simultaneous detection of dental caries and fissure sealant in intraoral photos by deep learning: a pilot study.

BACKGROUND: Deep learning, as an artificial intelligence method has been proved to be powerful in analyzing images. The purpose of this study is to construct a deep learning-based model (ToothNet) for the simultaneous detection of dental caries and fissure sealants in intraoral photos. METHODS: A total of 1020 intraoral photos were collected from 762 volunteers. Teeth, caries and sealants were annotated by two endodontists using the LabelMe tool. ToothNet was developed by modifying the YOLOX framework for simultaneous detection of caries and fissure sealants. The area under curve (AUC) in the receiver operating characteristic curve (ROC) and free-response ROC (FROC) curves were used to evaluate model performance in the following aspects: (i) classification accuracy of detecting dental caries and fissure sealants from a photograph (image-level); and (ii) localization accuracy of the locations of predicted dental caries and fissure sealants (tooth-level). The performance of ToothNet and dentist with 1year of experience (1-year dentist) were compared at tooth-level and image-level using Wilcoxon test and DeLong test. RESULTS: At the image level, ToothNet achieved an AUC of 0.925 (95% CI, 0.880-0.958) for caries detection and 0.902 (95% CI, 0.853-0.940) for sealant detection. At the tooth level, with a confidence threshold of 0.5, the sensitivity, precision, and F1-score for caries detection were 0.807, 0.814, and 0.810, respectively. For fissure sealant detection, the values were 0.714, 0.750, and 0.731. Compared with ToothNet, the 1-year dentist had a lower F1 value (0.599, p < 0.0001) and AUC (0.749, p < 0.0001) in caries detection, and a lower F1 value (0.727, p = 0.023) and similar AUC (0.829, p = 0.154) in sealant detection. CONCLUSIONS: The proposed deep learning model achieved multi-task simultaneous detection in intraoral photos and showed good performance in the detection of dental caries and fissure sealants. Compared with 1-year dentist, the model has advantages in caries detection and is equivalent in fissure sealants detection.

The Assessment of Resin-Based Composite Sealants' Effectiveness in Arresting Non-Cavitated Dentin Carious Lesions (ICDAS 3)-A 12 Month Follow-Up Preliminary Study.

Background and Objectives: The therapeutic management of carious lesions remains a significant focus for researchers, given their persistently high prevalence despite being largely preventable. This study aimed to compare the effectiveness of a composite resin-based sealant material in halting extended non-cavitated dentin carious lesions when used therapeutically versus preventively on caries-free teeth over a period of twelve months. Materials and Methods: out of the 236 children examined, 45 were excluded from the study due to non-compliance with the inclusion criteria. Thus, the study included 191 children aged 10-12 years, and 764 molars in total. Results: among these molars, 171 were caries-free (ICDAS II code 0), forming the Control group, while 180 molars were classified with an ICDAS II score of 3, forming the Study group. All molars were sealed and evaluated at 6- and 12-month follow-up intervals. Both intervals revealed statistically significant differences (p < 0.05) in sealant retention and carious lesion development between sound (ICDAS code 0) and decayed (ICDAS code 3) teeth. Conclusions: the findings did not support the effectiveness of sealants in halting non-cavitated dentin carious lesions classified as ICDAS II with code 3 compared to their preventive application in sound teeth classified as ICDAS II with code 0.

Survival Analysis of Glass Ionomer Cement and Resin-Based Sealant Retention: A 10-Year Follow-Up Study.

Background and Objective: Sealant application is a proven method to prevent occlusal caries; however, long-term studies on this topic are scarce. This study aimed to assess the survival rate and clinical effectiveness of glass ionomer cement (GIC) and resin-based sealants (RBSs) on second permanent molars over a long-term follow-up period. Materials and methods: Sixteen patients aged 11-13 years with all four completely erupted permanent second molars were enrolled in the study. All patients attended 1-year and 3-year follow-ups; however, one participant did not respond after 10 years and was excluded from the final analyses. The oral health status evaluation was based on WHO criteria. A total of 32 teeth received an RBS (Clinpro), and a further 32 teeth were sealed with GIC (Fuji IX). The sealant retention was determined according to the Kilpatrick criteria after 1 year, 3 years, and 10 years, respectively. Statistical analysis included a chi-square test, the Kaplan-Meier method, and the Cox proportional hazard model. Results: At baseline, seven boys and eight girls participated in the study, with a mean age of 12.3 ± 0.9 years. The 1-year follow-up results revealed that 90% of the RBSs and 43.3% of the GIC sealants were completely retained, and no caries lesions were recorded (p = 0.01). The 3-year follow-up results showed that 23.3% of the RBSs and 0% of the GIC sealants demonstrated complete retention (p = 0.034). Moreover, 10.0% of the occlusal surfaces in the RBS group and 13.3% of the occlusal surfaces in the GIC group were filled (p > 0.05). A total of 6.7% of the RBSs showed complete retention. One-third of the sealed teeth (30.0% of the teeth sealed with RBSs and 36.7% of teeth applied with GIC) were filled after 10 years. The Kaplan-Meier analysis demonstrated a higher survival rate in the RBS group when compared with the GIC over the entire follow-up period (p = 0.001). Conclusions: Although the survival rate of RBSs was higher than GIC sealants, their effectiveness in preventing fissure caries in permanent second molars did not differ significantly over a 10-year follow-up.

Cost-Effectiveness of Pit and Fissure Sealing at Schools for Caries Prevention in China: A Markov Modeling Analysis.

The World Health Organization states that the application of pit and fissure sealants (PFSs) is an effective way to prevent dental caries. Estimates of potential health and economic impacts of PFS upon school-age children provide crucial evidence to support the extension of PFS coverage to all target populations. The China Children's Oral Disease Comprehensive Intervention Project was launched in 2009 to provide free oral health examinations, PFS application, and oral health education for children aged 7 to 9 years. However, the national-level health and economic impacts of the program are unclear. To provide higher quality evidence at the national level in China, we developed a multi-perspective, multistate Markov model to estimate the cost and effect of PFS application to prevent dental caries. The total cost of the PFS project was 2.087 billion CNY, which can prevent 16.06 million PFMs from caries lesions. Compared with no intervention, PFS application was cost-effective from payer and society perspectives (BCR = 1.22 from the payer's perspective, BCR = 1.91 from the societal perspective). The incremental cost-effectiveness ratio from both perspectives was negative (-61.46 CNY from the payer's perspective, and -125.75 CNY from the societal perspective), indicating that PFS was cost-effective and cost-saving. Expanding the coverage of PFS application in school can be a more cost-effective strategy for caries prevention in China.

Parents' Perception of Fissure Sealant Therapy in 6-12 Year Old Children: Evaluating a theory-driven intervention.

BACKGROUND: Dental caries is considered a major global health issue and among the most challenging diseases worldwide. An effective way of preventing dental caries is the fissure sealant (FS) therapy. OBJECTIVE: To determine the effectiveness of an educational intervention developed based on the health belief model (HBM) for parents' perception of FS therapy for their children. METHODS: Quasi-experiment among 300 parents of 6-12 year-old children, 150 in the intervention group (IG) and 150 in the control (CG), in the south of Iran recruited via both clustering and convenience sampling. Data were collected using a validated questionnaire collecting demographic information, knowledge and data on HBM constructs and FS behaviour. Eight intervention sessions, 40-60 minutes long, were held for over month. The primary outcome was child's receipt of fissure sealants 3 months after the intervention. RESULTS: The two groups had similar knowledge and the HBM constructs at baseline. After the intervention, the receipt of FS therapy was 65% and 12% in the IG and CG, respectively (p ⟨ 0.001, Chi Sq.). ANCOVA supported post-test differences between the intervention and control groups when accounting for baseline scores (p⟨0.05). CONCLUSIONS: The educational HBM-based intervention improved parents' perceptions and their children's receipt of FS therapy. The intervention affected the HBM constructs. Barriers to healthy oral/dental behaviours may be reduced by interventions at multiple layers (beyond the individual level).

Evaluation of the effectiveness of prophylactic sealing of pits and fissures of permanent teeth with fissure sealants - umbrella review.

BACKGROUND: Tooth decay is an infectious disease which, in its initial phase, leads to the formation of cavities in the teeth through decalcification of the enamel and local tissue destruction. In addition to proper oral hygiene, prophylactic sealing of fissures and cavities with a sealant is a method of preventing the development of caries. The aim of this study is to summarise the effectiveness of fissure sealing of permanent teeth with fissure sealants compared to other preventive methods or no intervention. METHOD: An umbrella review was carried out to achieve the purpose of our study. Searches were performed in Medline (via PubMed), Embase (via OVID), and Cochrane Library databases. Quality assessment of the included studies was performed using the AMSTAR2 tool. In addition, a manual search for recommendations/clinical practice guidelines on dental prophylaxis was performed. RESULTS: 204 publications were identified, of which 15 met the inclusion criteria. Based on the results of 3 systematic reviews, there was a statistically significant reduced odds of caries occurrence or development with prophylactic sealing of permanent teeth compared with no intervention - depending on the review and follow-up period odds ratio (OR) ranged from 0.06 [95%CI: (0.01-0.32)] to 0.28 [95%CI: (0.20-0.38)]. In the eight systematic reviews that analysed different sealants, there were no statistically significant differences between the types of materials used for prophylactic tooth sealing. For systematic reviews comparing the efficacy of fissure sealants with fluoride varnish, three reported no statistically significant difference in the efficacy of caries incidence, with only one systematic review based on 1 RCT finding a statistically significant difference in favour of fissure sealants. CONCLUSION: Compared to the no intervention, dental sealing is an effective method for the prevention of dental caries. However, it is not possible to conclude conclusively which type of sealant and which of the available prophylactic methods is more effective in preventing caries.

Evaluation of flexural strength, degree of conversion, and demineralization-prevention properties in adjacent tooth structures of an experimental fissure sealant containing nano-calcium-phosphate compounds.

BACKGROUND: The present study aimed to evaluate the flexural strength, degree of conversion, and demineralization-prevention ability of an experimental fissure sealant containing nano-calcium-phosphate compounds. METHODS: An experimental sealant was formulated using silica and nano hydroxyapatite filler particles. The control group consisted of the DENU Seal (n = 10, each group). The flexural bond strength was evaluated by UTM. DC was evaluated by FTIR. To evaluate the demineralization-prevention ability, Cl V cavities in 10 third molar teeth restored with two sealant products, followed by an acid challenge then the Vickers microhardness test was carried out. RESULTS: The mean flexural strength in the commercial group was higher than the experimental group. However, the mean flexural modulus was not significantly different between the two groups. In the experimental group, DC was significantly higher than the commercial group. Adjacent to the interface, the decrease in microhardness in the experimental group was significantly less than the commercial group. However, on the tooth surface, there were no significant differences between the two groups. In the experimental group, the decrease in microhardness at the interface was less than at the tooth surface, however the situation was opposite in the commercial group. CONCLUSIONS: Incorporating hydroxyapatite into the sealant structure might prevent demineralization, without adverse effects on flexural modulus and degree of conversion.

Clinical practice guideline adaptation for risk-based caries management in 18-55 year-old Iranian adults.

PURPOSE: To adapt an evidence-based clinical practice guideline (CPG) for risk-based management of caries in 18-55 year-old Iranian adults. METHODS: A multidisciplinary adaptation team reviewed evidence-based guidelines such as the NICE, SIGN, and ADA according to the defined clinical questions. In addition, databases such as the PubMed and Google Scholar were searched and CPGs were screened and appraised using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) tool. Clinical scenarios were developed and their level of evidence, clinical advantage and adaptability were assessed. Following a two-round ranking by experts, the final recommendations were selected using the RAND-UCLA appropriateness method. RESULTS: Of 17 CPGs, 5 were selected as the source guidelines for adaptation. To assess the risk of caries in the adult population, reduced Cariogram (without saliva tests) and CAMBRA were suggested as diagnostic tools. In addition, 53 risk-based recommendations on the preventive care (including the use of fluoride toothpaste, fluoride, and chlorhexidine mouthwash, at home and in-office fluoride gel, fluoride varnish, mouth buffering, and sealant), operative intervention threshold, and follow-up interval were adapted for Iranian adults. CONCLUSIONS: A guideline was adapted for risk-based management of dental caries in Iranian adults. This helps local dentists in decision making and promoting oral health of adults. Further research is needed to assess the external validity and feasibility of the adapted guideline in the Iranian population.

Cost-effectiveness of dental caries prevention strategies in South African schools.

BACKGROUND: In South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children. METHODS: The study uses a hypothetical South African population of school aged learners aged 5-15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective. RESULTS: The results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively. CONCLUSION: Based on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.

The role of income and frequency of dental visits in the relationship between dental sealant use and resin fillings after extended coverage: a retrospective cohort study.

BACKGROUND: Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship. METHODS: This retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA). RESULTS: The ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency. CONCLUSIONS: Income and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.

The combined effect of pit and fissure sealant application and oral health education on oral health status of children aged 6-9 years: a 12-month follow-up study in Northeast China.

BACKGROUND: Children aged 6-9 years are vulnerable to dental caries due to age-related limitations and a lack of adequate knowledge regarding oral health and hygiene practices. This study aimed to establish a cohort of children aged between 6 and 9 years and conducted a 12-month follow-up to examine the combined effect of pit and fissure sealant (PFS) application and oral health education on their oral health status. METHODS: A cohort study with 12-month follow-up was conducted in Liaoning province, China. A multi-stage stratified cluster sampling approach was employed in the study. The enrolled 6- to 9-year-old children were all from the selected primary schools, who had resided in the designated area for at least 6 months. Children who were unable to cooperate with the examiner or without informed consent from their guardians were excluded. Experienced dental professionals examined the oral health status of primary school children aged 6-9 years. All children and their guardians were mandated to complete a questionnaire (qualitative data) at the beginning of the study. In the experiment group, children underwent PFS application and chairside oral health education. Clinical examinations and questionnaire surveys were repeated at the 12-month follow-up. The chi-square test and binary logistic regression were conducted to investigate the potential risk factors associated with dental caries prevalence (dependent variable). Independent variables were items from the questionnaire (such as living place, parents' education level and children' birth weight). The significant variables identified in the chi-square tests were subsequently included in the binary logistic regression analysis. RESULTS: A total of 4,085 children aged 6-9 years were included in the study, with 1805 participants assigned to the experiment group and 2280 to the control group. At baseline, the caries rates of the experimental and control group were 77.95% and 80.35%, respectively without any statistically significant differences. However, at the 12-month follow-up, the caries rate in the experimental group (83.65%) was significantly lower than that in the control group (86.62%) (P < 0.05). The results from the binary logistic regression analysis indicated that parents with a college degree and children in the experimental group exhibited lower caries rates. Conversely, higher caries rates were associated with the consumption of sweet beverages and foods more than once a day and a lack of knowledge regarding the causes of caries (P < 0.05). CONCLUSIONS: In Liaoning, China, children aged 6 to 9 years exhibited a high prevalence of dental caries. Several factors, including the parent's education level, the frequency of consuming sweet beverages and foods, and the children's understanding of the cause of caries, significantly affected the caries prevalence rates. The implementation of PFS application and oral health education effectively reduce the caries rate among the surveyed children.

An economic evaluation of pit and fissure sealants and fluoride varnishes in preventing dental caries: a systematic review.

The aim was to systematically evaluate the cost-effectiveness of pit and fissure sealants (PFSs) compared with that of fluoride varnishes (FVs) in dental caries prevention. We searched four electronic databases including the Cochrane Oral Health Group's Trials Register (till 03 June 2022), Web of Science (from 1945 to 03 June 2022), PubMed (from 1996 to 03 June 2022), and EMBASE via Ovid (from 1980 to 03 June 2022) to identify the cost and effectiveness of PFSs and FVs in decreasing dental caries incidence. Two researchers independently screened search results, extracted data from the included studies, and conducted the risk of bias assessments. The main characteristics of the included studies were extracted and analyzed. The initial search produced 874 articles. After removing duplicates and full-text review, 19 studies were included. In this study: nine studies were on PFSs comparison with control; five on PFSs comparison with FVs; and five on FVs comparison with control. Regarding the type of economic evaluation (EE), 13 studies conducted cost-effectiveness analysis, five conducted cost-utility analyses, and one conducted both cost-effectiveness analysis and cost-utility analyses. The cost-effectiveness evaluation of PFSs and FVs in the available studies was limited. The prevalence of dental caries, payers' willingness to pay, length of follow-ups, delivery settings, retention rate of PFS, and application intervals of FV can affect the economic evaluation of these two methods for dental caries prevention. Therefore, more studies in the future are need to draw clear conclusions about which method is more cost-effective for the two preventive interventions in future.

Comparative evaluation of retention and cariostatic effect of glass ionomer, hydrophobic & hydrophilic resin-based sealants: a systematic review and meta-analysis.

OBJECTIVE: To compare the effectiveness of hydrophilic resin-based versus hydrophobic resin-based and glass-ionomer pit and fissure sealants. METHODS: The review was registered with Joanna Briggs Institute and followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Google Scholar, Virtual Health Library, and Cochrane Central Register of Controlled Trials were searched from 2009-2019 using appropriate keywords. We included randomized controlled trials and randomized split-mouth trials conducted among 6-13-year-old children. The quality of included trials was assessed using modified Jadad criteria and risk of bias using guidelines specified by Cochrane. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) guidelines were used to assess the overall quality of studies. We used the random-effects model for meta-analysis. Relative risk (RR) and confidence intervals (CI) were calculated & heterogeneity was tested using I² statistic. RESULTS: Six randomized clinical trials and five split-mouth trials met the inclusion criteria. The outlier augmenting the heterogeneity was omitted. Based on very-low to low-quality evidence, loss of hydrophilic resin-based sealants was less likely as compared to glass-ionomer fissure sealants (4 trials at 6 months; RR = 0.59; CI = 0.40-0.86), while it was similar or slightly lower than hydrophobic resin-based sealants (6 trials at 6 months; RR = 0.96; CI = 0.89-1.03); (6 trials at 12 months; RR = 0.79; CI = 0.70-0.89); (2 trials at 18 months; RR = 0.77; CI = 0.48-0.25). CONCLUSION: This study revealed that retention of hydrophilic resin-based sealants is better than glass ionomer sealants but similar to hydrophobic resin-based sealants. However, higher-quality evidence is necessary to underpin the outcomes.

Retention in fissure resin-based sealants in schoolchildren: the etching step importance.

DESIGN: Randomized controlled trial. STUDY POPULATION: Forty-seven schoolchildren aged 9-10 years with fully sound/noncavitated erupted first permanent molars were included and randomly allocated in control and experimental groups in a split-mouth design. CASES: 47 schoolchildren (94 molars) fissure sealants applied using self-etch universal adhesive system. CONTROLS: 47 schoolchildren (94 molars) fissure sealants applied using conventional acid-etching technique. OUTCOME MEASURE: Retention of sealants and secondary caries incidence (ICDAS). DATA ANALYSIS: Chi-square test. RESULTS: Conventional acid-etch sealants retention was superior to self-etch after 6 and 24 months (p < 0.001), but no differences were found in caries incidence after 6 and 24 months (p > 0.05). CONCLUSIONS: Clinical retention of fissure sealants using conventional acid-etch technique is greater than self-etch.

Sealants for preventing dental caries in primary teeth.

BACKGROUND: Pit and fissure sealants are plastic materials that are used to seal deep pits and fissures on the occlusal surfaces of teeth, where decay occurs most often in children and adolescents. Deep pits and fissures can retain food debris and bacteria, making them difficult to clean, thereby causing them to be more susceptible to dental caries. The application of a pit and fissure sealant, a non-invasive preventive approach, can prevent dental caries by forming a protective barrier that reduces food entrapment and bacterial growth. Though moderate-certainty evidence shows that sealants are effective in preventing caries in permanent teeth, the effectiveness of applying pit and fissure sealants to primary teeth has yet to be established. OBJECTIVES: To evaluate the effects of sealants compared to no sealant or a different sealant in preventing pit and fissure caries on the occlusal surfaces of primary molars in children and to report the adverse effects and the retention of different types of sealants. SEARCH METHODS: An information specialist searched four bibliographic databases up to 11 February 2021 and used additional search methods to identify published, unpublished and ongoing studies. Review authors scanned the reference lists of included studies and relevant systematic reviews for further studies. SELECTION CRITERIA: We included parallel-group and split-mouth randomised controlled trials (RCTs) that compared a sealant with no sealant, or different types of sealants, for the prevention of caries in primary molars, with no restriction on follow-up duration. We included studies in which co-interventions such as oral health preventive measures, oral health education or tooth brushing demonstrations were used, provided that the same adjunct was used with the intervention and comparator. We excluded studies with complex interventions for the prevention of dental caries in primary teeth such as preventive resin restorations, or studies that used sealants in cavitated carious lesions. 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 the development of new carious lesions on occlusal surfaces of primary molars as odds ratios (OR) with 95% confidence intervals (CIs). Where studies were similar in clinical and methodological characteristics, we planned to pool effect estimates using a random-effects model where appropriate. We used GRADE methodology to assess the certainty of the evidence. MAIN RESULTS: We included nine studies that randomised 1120 children who ranged in age from 18 months to eight years at the start of the study. One study compared fluoride-releasing resin-based sealant with no sealant (139 tooth pairs in 90 children); two studies compared glass ionomer-based sealant with no sealant (619 children); two studies compared glass ionomer-based sealant with resin-based sealant (278 tooth pairs in 200 children); two studies compared fluoride-releasing resin-based sealant with resin-based sealant (113 tooth pairs in 69 children); one study compared composite with fluoride-releasing resin-based sealant (40 tooth pairs in 40 children); and one study compared autopolymerised sealant with light polymerised sealant (52 tooth pairs in 52 children). Three studies evaluated the effects of sealants versus no sealant and provided data for our primary outcome. Due to differences in study design such as age of participants and duration of follow-up, we elected not to pool the data. At 24 months, there was insufficient evidence of a difference in the development of new caries lesions for the fluoride-releasing sealants or no treatment groups (Becker Balagtas odds ratio (BB OR) 0.76, 95% CI 0.41 to 1.42; 1 study, 85 children, 255 tooth surfaces). For glass ionomer-based sealants, the evidence was equivocal; one study found insufficient evidence of a difference at follow-up between 12 and 30 months (OR 0.97, 95% CI 0.63 to 1.49; 449 children), while another with 12-month follow-up found a large, beneficial effect of sealants (OR 0.03, 95% CI 0.01 to 0.15; 107 children). We judged the certainty of the evidence to be low, downgrading two levels in total for study limitations, imprecision and inconsistency. We included six trials randomising 411 children that directly compared different sealant materials, four of which (221 children) provided data for our primary outcome. Differences in age of the participants and duration of follow-up precluded pooling of the data. The incidence of development of new caries lesions was typically low across the different sealant types evaluated. We judged the certainty of the evidence to be low or very low for the outcome of caries incidence. Only one study assessed and reported adverse events, the nature of which was gag reflex while placing the sealant material. AUTHORS' CONCLUSIONS: The certainty of the evidence for the comparisons and outcomes in this review was low or very low, reflecting the fragility and uncertainty of the evidence base. The volume of evidence for this review was limited, which typically included small studies where the number of events was low. The majority of studies in this review were of split-mouth design, an efficient study design for this research question; however, there were often shortcomings in the analysis and reporting of results that made synthesising the evidence difficult. An important omission from the included studies was the reporting of adverse events. Given the importance of prevention for maintaining good oral health, there exists an important evidence gap pertaining to the caries-preventive effect and retention of sealants in the primary dentition, which should be addressed through robust RCTs.

Pit and Fissure Sealant versus Fluoride Varnish for the Prevention of Dental Caries in School Children: A Systematic Review and Meta-Analysis.

Children's dental health has become the main concern, due to the increase in caries prevalence amongst children. Pit and fissure sealant (PFS) and fluoride varnish (FV) are effective measures for preventing dental caries. However, the clinical efficacy of these interventions when compared to one another is uncertain. The aim of the present systematic review with meta-analysis was to compare pit and fissure sealants with fluoride varnish for caries prevention of first permanent molars among schoolchildren. This is a meta-Analysis, which involves randomized control trials that compare the effectiveness of PFS with FV within 24 months of follow-up. Five databases were searched from 1990 to 2019 to identify studies published in Arabic or English language. The risk ratio (RR) and 95% confidence intervals (CIs) were calculated using a random-effects model. A total number of 4 studies were included with overall of 1249 children in both groups. Three included trial reported caries increment of first permanent molars (FPM) with 24 months of follow-up, there was no statistical significance (RR: 0.65; 95% CI 0.31 to 1.35; P = 0.26 I2 = 89%). As regards DMFS increment, the analysis showed no statistical differences between FV and PFS in terms of lowering DMFS increment (MD: 0.09; 95% CI: -0.03 to 0.21). Findings of this meta-analysis proved there is no significant difference between PFS and FV in caries prevention efficacy of FPMs at 2 years' follow-up, emphasizing the use of FV since it is more affordable and easier to apply.

Clinical performance of a new fissure sealant-results from a 2-year randomized clinical trial.

OBJECTIVES: The aim of this randomized clinical trial (RCT) was to explore the clinical survival of a new, Bis-GMA-free pit and fissure sealant (Helioseal F Plus) in comparison to an established control material (Helioseal F). MATERIAL AND METHODS: This in vivo study was designed as a prospective, 2-year, two-centre RCT with a split-mouth design. The initial study population consisted of 92 adolescents who were followed up 1 month (N = 89), 6 months (N = 88), 1 year (N = 85) and 2 years (N = 82) after sealant application. The attrition rate was 10.9% after 2 years. At each examination, the sealant retention and presence of caries were recorded. The statistical analysis included the calculation of Kaplan-Meier survival curves, log-rank tests and a Cox proportional hazard regression model. RESULTS: No adverse events during the application or any of the follow-up visits were documented. The proportion of completely intact sealants and those with minimal loss was almost identical in both groups at 85.9% (Helioseal F Plus) and 86.5% Helioseal F) after 2 years of observation. The regression analysis revealed operator dependency; no significant differences were found between the materials, the study centres, the chosen isolation technique and patient age or sex. CONCLUSION: The newly developed sealant can be evaluated as at least equivalent in terms of survival and retention behaviour compared to the established control material. CLINICAL RELEVANCE: The new sealant can be recommended for clinical use. With respect to the material properties (Bis-GMA-free, less light polymerisation time and better thixotropic behaviour), it offers additional advantages with clinical relevance.

Management of initial carious lesions of hypomineralized molars (MIH) with silver diamine fluoride or silver-modified atraumatic restorative treatment (SMART): 1-year results of a prospective, randomized clinical trial.

OBJECTIVES: This study evaluated and compared the effect of silver diamine fluoride (SDF) and silver-modified atraumatic restorative treatment (SMART) sealants for the treatment of initial carious lesions of permanent molars affected by molar incisor hypomineralization (MIH). METHODS: One hundred and twelve hypomineralized permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF and SMART sealant groups (n = 56 teeth/group) in a split-mouth fashion. Hypersensitivity, formation of caries, and enamel breakdown were evaluated in both groups. Hypersensitivity was assessed by Schiff Cold Air Sensitivity Scale (SCASS), and clinical assessments of SMART sealants were performed according to modified USPHS criteria at 1, 6, and 12 months. The data were analyzed statistically using Fisher's exact test, Kaplan-Meier analysis, Mann-Whitney U test, and Friedman test. RESULTS: Twenty-six hypomineralized molars with marked baseline hypersensitivity showed significantly lower SCASS scores at all evaluation periods (p < 0.001). There was no significant difference in hypersensitivity scores between the groups at the repeated applications of SDF at 1, 6, and 12 months. The cumulative survival rates of SMART sealants on occlusal and palatal surfaces were 88.7% and 58.8%, respectively. CONCLUSIONS: In hypomineralized molars, both SDF and SMART sealants showed favorable short-term prevention against dental caries while providing effective desensitization. Marginal discoloration was the most common side effect of the SMART sealants as a result of SDF application. CLINICAL SIGNIFICANCE: Both SDF and SMART sealants showed similar short-term effectiveness as non-aerosol procedures in arresting enamel caries and reducing hypersensitivity in hypomineralized molars. TRIAL REGISTRATION: Clinical Trials Registration Number: NCT03862014.

Sealing of cavitated occlusal carious lesions in the dentine of deciduous molars: a two-year randomised controlled clinical trial.

OBJECTIVES: This two-arm, parallel-group, tooth-randomised, controlled noninferiority clinical trial aimed to compare survival rates between the sealing and restoring of cavitated occlusal carious lesions in dentine [International Caries Detection and Assessment System (ICDAS) 5] of deciduous molars using resin-modified glass-ionomer cement (RMGIC) and to assess caries progression radiographically. MATERIALS AND METHODS: A total of 68 molars with ICDAS 5 occlusal lesions were randomly allocated into two groups, a sealing group (n = 31), in which RMGIC was placed directly over the carious lesion, and a restoration group (n = 37), in which a restoration with the same material was placed after selective caries removal. During the baseline and follow-up visits, dental caries was registered and caries activity was assessed according to a visuotactile criterion. At baseline, patient caries status (dmf-t) and cavity depth and extent (mesiodistal and buccolingual) were measured before RMGIC placement. An independent and blinded examiner evaluated the treated teeth using the USPHS criteria after one and two years. Standardised interproximal radiographs were taken for caries progression assessments. RESULTS: During the follow-up period, no lesion progression was observed radiographically. After one year (n = 60; 27 sealed and 33 restored) and two years (n = 48; 23 sealed and 25 restored) of follow-up, the treatment success rates were 78.8% and 76.0% in the restoration group and 59.3% and 47.8% in the sealing group, respectively. Multivariate Cox regression showed that lesions smaller than 2 mm in the mesiodistal extent were less prone to fail after one year (p = 0.03). However, survival curves (log-rank test) were statistically significantly different only after two years (p < 0.001). CONCLUSIONS: Sealing ICDAS 5 occlusal lesions of deciduous molars using RMGIC achieved lower survival rates than restorations. Both sealing and restoration effectively arrested caries progression for two years. Clinical relevance Sealing dentine carious lesions can be effective for treating lesions involving the inner and outer half of the dentine. Ultraconservative treatments can arrest carious lesions presenting obvious cavitation in primary molars. TRIAL REGISTRATION: ReBEC Register no. RBR-225n35.