Another critical summary from American Dental Association Centre for Evidence-based Dentistry – March 2013

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This latest critical summary prepared under the auspices of the ADA Center for Evidence Based Dentistry looks at a 2012 meta-analysis by Kühnisch et al that looks at the retention rates of pit and fissure sealants. The results of the meta-analysis suggest that resin-based sealants have the highest retention rates at 5-years.

The appraiser notes that while a large number of trials are included in this meta-analysis some methodological details such as inclusion or exclusion criteria or how disagreements are resolved are not noted. Also, if potential sources of bias were considered details were not given. No drop rates for the included studies were noted.  Overall the meta-analysis found that light-polymerizing resin-based dental sealants had a five-year retention rate of 83.8%. but the quality of evidence was considered to be poor.

Comment

An appraisal of this review is also available from the evidence-based Dentistry Journal  ( Deery 2012)  which notes that all the retention rates reported were higher than those reported by the 2008 Cochrane review (Ahovuo-Saloranta  et al) but wondered whether the review added any significant new information for clinicians.. The Cochrane review highlights how effective sealants are at reducing decay finding that after 4.5 years the sealed permanent molar teeth of children aged 5 to 10 had over 50% reduction in decay on occlusal surfaces compared to teeth without sealants.  The one study with data from 9 years of follow up showed that only 27% of sealed tooth surfaces were decayed compared to 77% of tooth surfaces without sealant.

The use of fissure sealants is recommended in a number of evidence-based guidelines. The SIGN Guidelines are currently under review but the American Dental Association (ADA) , Department of Health and  Scottish Dental Clinical Effectiveness Programme ( SDCEP) have evidence-based publications recommending their use for preventing caries.

Links

ADA-EBD – Five-year retention rates of resin-based dental sealants higher than glass-ionomers or compomers

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 Mar;28(3):298-303. doi:10.1016/j.dental.2011.11.002. Epub 2011 Dec 3. Review. PubMed PMID: 22137936.

Deery – EBD Commentary -Pit and fissure sealant retention

Ahovuo-Saloranta A, Hiiri A, Nordblad A, Mäkelä M, Worthington HV. Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD001830. DOI: 10.1002/14651858.CD001830.pub3.

 

Beauchamp J, Caufield PW, Crall JJ, et al. 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(3):257-67.

SDCEP – Prevention and Management of dental caries in children

Department of Health Delivering Better Oral Health An evidence-based toolkit for prevention – second edition

 

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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