Strong evidence for the effectiveness of resin based sealants

Abstract

Cochrane Oral Health Group's Trials Register, CENTRAL, Medline via OVID, EMBASE via OVID; SCISEARCH, CAplus, INSPEC, NTIS and PASCAL via STN Easy and DARE, NHS EED, HTA (all to September/ November 2012) and ClinicalTrials.gov (to July 2012). There were no restrictions on language or date of publication. Randomised and quasi-randomised controlled trials of at least 12 months duration comparing no sealant with sealant, or different types of sealants, for preventing caries of occlusal or approximal surfaces of premolar or molar teeth in children and adolescents under 20 years of age. Screening of search results, data extraction and assessment of trial quality (using GRADE methods) were by two reviewers independently. There were 34 trials of children aged five to 16 years, with 12 trials (2575 participants) comparing sealants with no sealant, 21 trials (3202 participants) comparing one sealant with another and one trial (752 participants) comparing two types of sealant with no sealant.Resin sealants compared with no sealants prevented caries in the first permanent molars of children five to 10 years old (six trials at low risk of bias with two years follow up), (odds ratio (OR) 0.12, 95% confidence interval (CI) 0.07 to 0.19). At 48 to 54 months follow-up, the caries preventive effect was maintained (OR 0.21, 95% CI 0.16 to 0.28) although there were only four trials (two were at low and two at high risk of bias).No conclusions could be drawn as to whether glass ionomer sealants compared with no sealants prevented caries at 2 year follow-up. The mean difference in DFS was -0.18, 95% CI -0.39 to 0.03.The relative effectiveness of one type of sealant compared to a different type of sealant was inconclusive as there was great variation in comparisons, outcomes, times of outcomes and background fluoride levels in the 21 studies. There was insufficient evidence for the relative superiority of glass ionomer and resin sealants (very low event rate in many of the 15 trials). There were inconsistent results for resin-modified glass ionomer sealants compared with resin sealants. No difference in caries increments were found in the two small trials of polyacid-modified resin sealants compared with resin sealants. Sealants compared with no sealants, on the occlusal surfaces of permanent molars in children and adolescents, are effective at reducing caries up to 48 months. There is less evidence for longer term follow-up and little for the relative effectiveness of sealing in less high caries risk children. No conclusions could be drawn on the relative effectiveness of different types of sealants.