Abstract
The aim of this study was to investigate the retention rates and effect on occlusal caries incidence of two glass ionomers used as sealants, placed according to the Atraumatic Restorative Treatment (ART) approach, in a high caries-risk community. A total of 150 newly erupted first molars of 42 schoolchildren, between 6-8 years of age were selected. The teeth were divided into two groups: experimental and control groups. In the experimental group, 76 teeth were sealed using Vidrion R-SS White (conventional GIC) and in the control group, 74 teeth were sealed using ChemFlex–Dentsply (high-viscosity conventional GIC). The sealants were applied by one operator following the "press finger technique", described in the ART-WHO manual. Two calibrated independent examiners carried out the evaluation according to the ART criteria. The intra and inter-examiner agreements were 0.84 and 0.81, respectively. Data were submitted to Mann-Whitney and Chi-square tests (p<0.05). At the 1-year follow-up, 136 (90.7%) sealants were evaluated. In the control group: 28 (41.8%) of the sealants were partially or completely retained, 38 (56.7%) completely lost, and 1 (1.5%) was replaced by another treatment. In the experimental group, 30 (43.5%) of the sealants were partially or completely retained, 38 (55.1%) were clinically scored as complete loss and 1 (1.4%) were replaced by another treatment. Seven sealants in both groups were not evaluated. Secondary caries was not observed in both groups. There was no statistically significant difference between the retention (p=0.49) and effect on caries incidence rates for both groups (p=0.84). The clinical performance of the glass ionomer sealants of both groups was considered satisfactory with a high success rate (98.5%). Although the sealants placed according to the ART approach showed retention rates lower than 50% after 1 year in newly erupted first molars, this approach seems to be appropriate for communities with high caries experience.
Highlights
Occlusal surfaces of erupting molars are highly susceptible to dental decay[4,17,22]
Longitudinal studies of a single application of resin sealants demonstrated the remarkable effectiveness in caries prevention[21], caries still occurs in pit and fissures where the sealant was completely or partially lost[12]
Glass ionomer sealants are recommended: (1) where there is fissure caries restricted to the enamel; (2) for caries-free teeth with a deep pit and fissures morphology; (3) in patients who are assessed to be of high caries-risk[11]
Summary
Occlusal surfaces of erupting molars are highly susceptible to dental decay[4,17,22] This caries susceptibility period comprehends a 1.0–1.5-year-long eruption phase[4]. Mejàre and Mjör[16] (1990) using a replica scoring technique recorded clinically extensive loss of 61% of the glass ionomer sealants after 6-12 months, but all occlusal surfaces sealed with this material remained cariesfree. This finding may be explained by the fact that even after the glass ionomer sealant had been clinically registered as lost, the replicas revealed areas of retained sealant remnants in 93% after 30-36 months
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