Fissure sealing using flowable composite

Fissure sealant

The recent Cochrane review update by Ahovuo-Saloranta et al (Dental Elf – 31st Jul 2017) reaffirmed the effectiveness of fissure sealants for the prevention of occlusal caries in the permanent molars of children and adolescents. However, the authors noted that there was very low-quality evidence for the relative effectiveness of different types of sealant.

The aim of this review was to evaluate the retention of flowable composite used as fissure sealants compared with conventional resin-based sealants.


Searches were conducted in the PubMed, SCOPUS. Embase, Cochrane Database of Systematic Reviews, and ISI Web of Knowledge (All Database: Web of Science Core Collection, Current Contents Connect, Data Citation Index, Derwent Innovations Index, KCI Korean Journal Database, MEDLINE, Russian Science Citation Index, SciELO Citation Index) databases.  Two reviewers independently selected studies and assessed risk of bias using a modified Jadad scale.  Controlled clinical studies evaluating a flowable resin composite as a fissure sealant material on permanent teeth were considered with only randomised controlled trials (RCTs) with a follow up of longer than 12 months being included in the meta-analysis.


  • 11 studies were included
  • 4 were considered to have a low risk of bias, 7 a medium risk of bias.
  • Meta-analysis of sealant retention found higher odds of retention for flowable composites
    • Odds ratio = 2.387 (95%CI; 1.047-5.444) P = 0.039.
    • Risk difference = 0.093 (95%CI; 0.004 – 0.182) P = 0.04.


The authors concluded: –

It seems that
the use of flowable composite as a fissure sealing material can slightly increase the retention rate of sealants compared with conventional resin-based sealants.


The authors have used a broad search strategy to identify appropriate papers for inclusion in this review. They have chosen to use a modified version of the Jadad scale to assess the risk of bias in the included studies. This type of scoring system in no longer recommended and the more widely used and Cochrane risk of bias tool would have been a more appropriate tool to use. Consequently, the risk of bias assessment used in this review is likely to have been overly generous given that the authors themselves only indicate that appropriate randomisation was only used in 2 studies. This has implications for consideration of the findings in particular because of the wide confidence intervals for the odds ratio and the fact that the lower limit is close to the line of no effect, as is the risk difference.

While the Cochrane review focused on caries reduction as its primary outcome it also reported on retention  with 38 of the included trials reporting retention data; with 90% retention at 12 months, and 80% at 24 months with 70% after 48-54 months.


Primary Paper

Bagherian A, Shiraz AS. Flowable composite as fissure sealing material? A systematic review and meta-analysis. Br Dent J. 2018 Jan 26;224(2):92-97. doi: 10.1038/sj.bdj.2018.40. PubMed PMID:29372708.

Other references

Dental Elf – 31st Jul 2017

Fissure sealants effective in preventing caries in children and adolescents






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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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