Abstract
BackgroundThe 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).MethodsAfter 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.ResultsAt 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.ConclusionsThough 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.
Highlights
The relative performance of atraumatic restorative treatment (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)
A total number of 280 children (44% boys) with 383 permanent first molars were included into the two sealant groups in the study (Figure 1)
No statistically significant differences were found between the involved children for the two groups regarding their background and oral health behaviors as well as the distribution of included molars, except that a higher proportion of molars in the ART sealant group than in the resin sealant group had signs of incipient caries (19.6% vs. 12.2%, p = 0.047) (Table 1)
Summary
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). Sealing the pits and fissures of molars and premolars for prevention of dental caries was first introduced in the 1960s [5] It is accepted as a highly effective method in preventing dental caries [6]. For high-quality resin sealant placement, electrically powered dental equipment and good clinical conditions are required. This may be difficult to achieve in places where access to a modern dental clinic is limited. This problem may be overcome by using GIC sealants because they can be placed without the use of electrically powered dental equipment
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