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

BMC Oral Health

Edward Chin Man Lo¹  Chun Hung Chu¹  Yue Xiao¹  Bao Ying Liu¹ 

[1] Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Hong Kong, SAR, China

关键词: Atraumatic restorative treatment;    Preventive dentistry;    Dental fissures;    Dental caries;    Child;    Glass-ionomer cement;    Fissure sealants;   

Others  :  1118241
DOI  :  10.1186/1472-6831-14-54

 received in 2014-02-11, accepted in 2014-05-14,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Liu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 2.

【 参考文献 】

• [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. BioMed Central Full Text
• [2]Sheiham A, Sabbah W: Using universal patterns of caries for planning and evaluating dental caries. Caries Res 2010, 44:141-150.
• [3]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.
• [4]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.
• [5]Ripa LW: Occlusal sealing: rationale of the technique and historical review. J Am Soc Prev Dent 1973, 3:32-9.
• [6]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., 3CD001830
• [7]Ripa LW: Sealants revisted: an update of the effectiveness of pit and-fissure sealants. Caries Res 1993, 27(Suppl 1):77-82.
• [8]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.
• [9]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.
• [10]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. BioMed Central Full Text
• [11]Nagaraja UP, Kishore G: Glass ionomer cement – the different generations. Trends Biomater Artif Organs 2005, 18:158-165.
• [12]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.
• [13]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.
• [14]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.
• [15]Holmgren CJ, Lo ECM, Hu DY: Glass ionomer ART sealants in Chinese school children – 6-year results. J Dent 2013, 41:764-770.
• [16]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.
• [17]Mejàre I: Indications for fissure sealants and their role in children and adolescents. Dent Update 2011, 38:699-703.
• [18]Xiao Y: An oral health survey and prevention of dental caries among school children in Shenzhen. In PhD Thesis. Hongkong: The University of Hong Kong, Faculty of Dentistry; 2009.
• [19]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.
• [20]Lussi A, Hibst R, Paulus R: DIAGNOdent: an optical method for caries detection [abstract]. J Dent Res 2004, 83(Spec C):C80-C83.
• [21]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.
• [22]Frencken JE, Pilot T, Van Amerongen E, Songpaisan Y, Pilot T: Manual for the atraumatic restorative treatment approach to control dental caries. 3rd edition. Groningen: WHO Collaborating Centre for Oral Health Services Research; 1997.
• [23]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.
• [24]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.
• [25]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., 1CD002781
• [26]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.
• [27]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.
• [28]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.
• [29]Hannigan A, Lynch CD: Statistical methodology in oral and dental research: pitfalls and recommendations. J Dent 2013, 41:385-392.
• [30]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.
• [31]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.
• [32]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. http://dx.doi.org/10.1016/j.dental.2014.01.016 webcite. [Epub ahead of print]
• [33]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.
• [34]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.
• [35]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.
• [36]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.
• [37]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.
• [38]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.
• [39]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.
• [40]Michałowicz J: Bisphenol A - sources, toxicity and biotransformation. Environ Toxicol Pharmacol 2014, 37:738-758.
• [41]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.
• [42]FDI World Dental Federation: FDI approves five policy statements: a focus on prevention. In FDI News. Geneva: FDI; 2013.