Glass Ionomer Sealants Research Articles

Sealants revisited: An efficacy battle between the two major types of sealants – A randomized controlled clinical trial

The aim of this study is comparing the retention and caries preventive effect of the glass-ionomer fissure sealant and resin-based fissure sealant. A randomized-controlled split-mouth study was conducted to compare the retention and the caries preventive effect of light-cured resin-based sealant (3M ESPE) and glass ionomer sealant (Fuji VII). The sealants were applied to either the right or the left lower mandibular molars (7-9 yrs of age) in 120 school children, based on the randomization process. They were recalled for assessment of clinical retention at intervals of 3, 6, and 12 months. The caries-preventive effect between the two materials was tested statistically by the McNemar's test for matched pairs, and the differences observed with regard to the retention of the materials was tested by Chi-square tests. The level of significance was set to be at P < 0.05. At the end of 12th month, sealant retention is found to be higher in the resin-based sealant group compared to the glass ionomer group. In the glass ionomer sealants placed, 101 (91%) were caries-free and 10 (9%) had caries. In the resin-based sealant, 105 (94.60%) had sound teeth and 6 (5.4%) had dental caries (P = 0.34). The glass ionomer sealant was less retentive when compared to resin sealants. The caries incidence between the glass ionomer and resin-based sealants was not statistically significant.

One-year Clinical Evaluation of Retention Ability and Anticaries Effect of a Glass Ionomer-based and a Resin-based Fissure Sealant on Permanent First Molars: An In Vivo Study.

ABSTRACTAimTo evaluate and compare the retention ability, anticaries effect and marginal discoloration when sealed with a glass ionomer-based sealant (Fusion i-seal) and a resin-based fissure sealant (Helioseal-F) on permanent first molars.Materials and methodsCaries free, fully erupted permanent first molars of 50 children between 6 years and 8 years were sealed with pit and fissure sealants under rubber dam isolation. Glass ionomer-based sealant was applied on a permanent first molar and the contralateral molar with resin-based sealant. The sealants were evaluated at regular intervals for a period of 1 year. Statistical analysis was done by Chi-square test.ResultsHigher retention rates were noted for resin-based sealant (88%) compared to glass ionomer-based sealant (78%). None of the teeth sealed with resin sealant developed caries whereas 2% of teeth sealed with glass ionomer sealant developed caries. Marginal discoloration was not noted in teeth sealed with glass ionomer sealant whereas slight marginal discoloration was noted for 6% of teeth sealed with resin sealant.ConclusionClinically a difference was noted in the retention rate, anticaries effect and marginal discoloration whereas statistically no significant difference was noted for the two sealants after 1 year.Clinical significancePit and fissure sealants are highly effective and economical in preventing occlusal caries in young permanent tooth with low failure rate.How to cite this articleMathew SR, Narayanan RK, Vadekkepurayil K, et al. One-year Clinical Evaluation of Retention Ability and Anticaries Effect of a Glass Ionomer-based and a Resin-based Fissure Sealant on Permanent First Molars: An In Vivo Study. Int J Clin Pediatr Dent 2019;12(6):553–559.

Physical characteristics of two moisture tolerant fissure sealants immersed in commercial products with different pH range

Objective This study aimed to evaluate and compare between four physical variables (sorption, solubility, color change and fluoride release) for glass ionomer (GI) sealant against moisture tolerant resin sealant in solutions with different pH in different time intervals. Materials and methods Thirty discs were prepared from GI Fuji Triage and Embrace WetBond (EWB) resin sealant. Sorption, solubility and color change were measured after different time intervals (1 day, 1 week, and 1 month) of immersion of the specimens in different solution having different pH. In addition 10 disks were assessed for fluoride release of both sealants after being immersed in distilled water. Results EWB showed greater sorption in all media after 1 day and 1 week. GI sealant showed highest water sorption after 1 week and this sorption decreased again after 1 month. GI showed greater initial solubility in Pepsi and water after 1 day (P = 0.016). Pepsi showed higher solubility for EWB while no significant effect was found for GI with different media. The color change was greater for EWB when immersed in Pepsi and ginger. After 1-month storage, the color change was the highest specially for Pepsi for both sealants. Fluoride release was greater for GI compared to EWB. Conclusion Both sealants showed different physical performance depending on the type of immersion media and time period. This is expected to affect their mechanical properties and hence their clinical performance.

Alternative of Lower-Cost Glass-Ionomer Sealant in the Prevention of Caries Lesions in Brazilian Children

Objective: To compare retention, preventive effectiveness and longevity of two different high-viscosity glass-ionomer sealants Ketac Molar ® and Maxxion R ® in the sealing of erupting and out-of-occlusion first permanent molar in children aged 5-7 years. Material and Methods: Children with past caries experience with healthy erupting first permanent molarwere included in the study. Teeth 16 and 46 were sealed with Ketac Molar ® and teeth 26 and 36 were sealed with Maxxion R ® . After 8 months, the retention of sealants was evaluated using the following criteria: total retention; presence of sealant in two thirds of the occlusal surface; presence of sealant in one third of the surface; and total absence of the sealant. Results: Statistical difference between materials was observed, and Ketac Molar ® retention was superior to that of Maxxion R ® (p<0.05). Regarding the development of caries in sealed first permanent molar , none of the teeth sealed with Ketac Molar ® or Maxxion R ® developed caries lesion. Conclusion: Ketac Molar ® retention is significantly superior to that of Maxxion R ® , but the preventive effectiveness in the development of carious lesions is similar for both, which is extremely interesting for the field of public health, since the cost of the material is significantly lower.

A comparative clinical study on efficacy of nanofilled resin-modified and conventional glass ionomer pit and fissure sealant in molar tooth

The present study compared the clinical performance of nanoparticulated resin modified glass ionomer and conventional glass ionomer pit and fissure sealant on permanent molars. Fifty patient having bilateral occlusal grooves in pits and fissures of the occlusal surface were included for this study where 50 teeth were treated with nanopaticulated resin modified and the remaining 50 teeth were subjected to conventional glass ionomer sealants. The color match, retention and marginal adaptation were assessed at 3, 6 and 12 months and statistical analysis was performed by Chi-square test to assess the difference between the two sealants; a values of &lt;0.05 was considered as statistically significant. The results showed that although there were no significant differences between two sealants at baseline and 3 months observation period but nanoparticulated resin modified glass ionomer sealants showed better clinical performance than that of conventional glass ionomer sealants at 12 months and the differences between two sealants were statistically significant (p&lt;0.05). It can be concluded that naqnoparticulated resin modified glass ionomer sealant exhibited better color stability, more retention, and better marginal adaptation than those of conventional glass ionomer sealants at 12 months observation period.

Microleakage of conventional light-cure resin-based fissure sealant and resin-modified glass ionomer sealant after application of a fluoride varnish on demineralized enamel.

BackgroundInternational guidelines on the prevention of caries recommend sealing of the pits and fissures of the permanent molars. There is no evidence on which type of material is most effective on demineralized enamel.AimTo evaluate the microleakage of a conventional light-cured, resin-based fissure sealant (LCRBS), GrandiO Seal, and a resin-modified glass ionomer sealant (RMGIS), Vitremer, after application of a fluoride varnish, Bifluorid 12, on demineralized enamel.Design80 human third molars were divided into eight groups. The groups combined the three study factors (1) type of enamel (intact or demineralized); (2) enamel non-varnished or varnished with Biflourid12; and (3) type of sealant (GrandiO Seal or Vitremer). The percentage of microleakage after thermocycling was measured using imaging analysis software. The Kruskal-Wallis plus Dunn tests were used to compare differences in microleakage in the different groups.ResultsThe lowest microleakage was in the unvarnished groups, and was the same for GrandiO Seal and Vitremer. When varnish was applied, microleakage was greater in demineralized enamel than in intact enamel for both LCRBS and RMGIS.ConclusionThe application of fluoride varnish on demineralized enamel increases the microleakage of both GrandiO Seal and Vitremer.

Glass-ionomer fissure sealants: Clinical observations up to 13 years

ObjectivesThe aim of this study was to clinically examine the retention and caries-preventive effect of a glass-ionomer material for fissure sealing in newly erupted permanent molars. MethodsA total of 1736 newly erupted permanent molars were sealed in 480 children aged 5–15 years. Sealants were evaluated yearly and recorded as “completely retained”, “partially retained”, or “completely lost”. Teeth were also evaluated for presence of caries. ResultsSealants were observed for 2–13 years. The mean follow-up time was 5 years. After one year, 69% of the sealants were fully retained and 21% were partially retained. Thereafter, the cumulative retention rate decreased. Starting from 8th year of follow-up, no “completely retained” sealant could have been observed. At the end of the 13-year follow-up period, 76% of sealants were “completely lost”. On the other hand, 99% and 65% of observed occlusal surfaces were caries-free after one and 13 years, respectively. During the observation period, 62 teeth developed caries in surfaces other than occlusal. Survival rates were significantly better for second permanent molars than for first permanent molars (p < 0.001). No influence of caries risk on caries incidence has been noted. ConclusionsAlthough the retention rate of the glass-ionomer material for fissure sealing was low, it appears to have prevented dental caries in 65% of newly erupted permanent molars evaluated after thirteen years of placement. Clinical significanceThe present study reports long-term clinical performance of glass-ionomer fissure sealants in patients with low, moderate and high caries-risk. The study shows that caries risk does not influence survival of glass-ionomer sealants, which proved to be beneficial for long-term caries protection.

Dental Sealants Part 3: Which material? Efficiency and effectiveness.

Determining the best choice between the different sealant materials might be complicated. The products that dentists can choose have different properties, such as caries' preventive effect, fluoride release and retention rate. According to the literature, fissure sealant materials fall into two main categories: resin-based sealants and glass ionomer sealants. Even if the "fluoride-releasing resin sealants" are better than "glass ionomer", with regards to retention of the material, the literature shows that their effectiveness in preventing fissure caries in permanent molars does not differ significantly over 24 months.

Caries prevention effectiveness of aresin based sealant and a glass ionomer sealants: a report of 5-year-follow-up

Objective: To evaluate and compare the caries prevention effectiveness of a resin-based sealant and a glass ionomer sealant on permanent first molars in 7- to 9-years-old school children. Methods: A randomized controlled, examiner-blinded, 5-year clinical trial was conducted in 19 primary schools in Dalian, Liaoning province. Totally 419 children (with 664 first molars) who had at least one sound permanent first molar with deep fissures or fissures with signs of non-cavitated lesions were recruited and stratified and allocated randomly into three parallel groups. A resin-based sealant was used in Group R (136 children with 219 first molars) and a glass ionomer sealant was used in Group G (130 children with 218 first molars). The third group (Group N, 153 children with 227 first molars) with none of the two sealants applied was served as blank control. Follow-up examinations were conducted at 0.5, 1, 2, and 5 years after sealing in order to assess the retention of the sealants and the incidence of caries occurrence. Chi-square test was adopted to compare the differences of caries incidence among the 3 groups. Generalized estimating equations (GEE) was used to analyze the effective factors of caries incidence. Results: During the 5-year follow-up period, 13.4% (23/172) of the teeth in Group R, 22.5% (40/178) of the teeth in Group G and 34.5% (57/165) of the teeth in Group N were diagnosed as having developed cavitated lesions. And the differences in the incidence of caries among the three groups was statistically significant (P<0.05). According to GEE, the resin-based sealant and the glass ionomer sealant were found to be the protection factors and the non-cavitated lesion before sealing was found to be the risk factor. The resin-based sealant was found to be the protection factor to the glass ionomer sealant when the blank control group was removed. Conclusions: Both resin-based sealant and glass ionomer sealant could effectively prevent the permanent first molars from the occurrence of carious lesions in 5 years. The resin-based sealant was superior to the glass ionomer sealant in caries prevention.

Comparative effectiveness of school-based caries prevention: a prospective cohort study

BackgroundDental caries is the world’s most prevalent childhood disease. School-based caries prevention can reduce the risk of childhood caries by increasing access to care. However, the optimal mix of treatment services, intensity, and frequency of care is unknown.MethodsData were derived from two prospective cohorts of US children participating in two caries prevention programs with different treatment intensities. One program provided primary and secondary prevention (glass ionomer sealants and interim therapeutic restorations) and one primary prevention only (glass ionomer sealants), both given twice yearly in six-month intervals. Primary study outcomes included untreated decay and the total observed caries experience. Analysis used generalized additive models to estimate nonlinear effects and trends over time. Results were compared to those estimated using generalized estimating equations and mixed-effects multilevel Poisson regression.ResultsPrimary and secondary prevention combined did not significantly reduce total caries experience compared to primary prevention alone, but did reduce the risk of untreated decay on permanent dentition. Additionally, the rate of new caries experience was slower in the primary and secondary prevention group. Nonlinear trends for dental caries across both programs were statistically significant from zero (p < .001).ConclusionCaries prevention consisting of primary and secondary prevention agents may be more effective than primary prevention alone in reducing the risk of tooth decay over time. Results suggest that the impact of caries prevention may not be constant over the medium- and long-term, suggesting reduced effectiveness with continued treatments.

Effect of surface protection on the permeability of eroded dentin.

Context:Eroded dentin might present the opening of dentinal tubules, increasing permeability, and consequently dentinal hypersensitivity.Aims:This study evaluated the permeability of dentin surfaces exposed to different levels of erosion and methods of surface protection.Materials and Methods:Dentine samples (3 mm × 3 mm × 1 mm) were prepared from bovine incisors (n = 90) and divided into three groups according to the method of controlling erosive challenge: Negative control, topical fluoride application, and glass ionomer sealant. Subsequently, they were randomly divided into three subgroups according to the exposure of simulated gastric acid solution (Demineralization – DES) (5% HCl, pH = 2.2), and remineralization (RE); negative control, 9 and 18 cycles DES-RE. The dentin permeability was measured by assessing the hydraulic conductance (μl/min.cmH2O.cm2). Statistical analysis was performed by two-way ANOVA and Tukey's test.Results and Conclusions:Greater permeability was observed after 18 erosive cycles, followed by exposure to 9 cycles and negative control (P < 0.0001). The application of glass ionomer sealant resulted in a major reduction of the hydraulic conductivity, regardless of the erosive challenge. Control groups and topical fluoride application showed similar results. In conclusion, the severity of erosive challenge contributed to the increase of dentin permeability. Besides, the glass ionomer sealant was the only protection agent that promoted significant effects in dentin permeability.

Effect of erosion and methods for its control on the surface roughness of composite resin

Objective: This study evaluated the surface roughness of a nanofilled composite resin submitted to different degrees of erosion and methods of control.Methods: 120 cylindrical composite specimens (6×1.5 mm) were randomly divided into four groups, according to the surface protection against the erosive challenge [negative control, topical application of fluoride, glass-ionomer sealant, resin sealant]. After the application of the respective method, specimens were divided into three subgroups (n=10): a) absence of erosive challenge; b) 9 cycles of DES-RE; c) 18 cycles of DES-RE. Surface roughness (Ra, μm) was recorded and statistically analyzed (2-way Anova/Tukey).Results: The glass-ionomer sealant exhibited less rough surfaces under all the conditions. However, the average roughness was significantly higher after 18 DES-RE cycles.Conclusion: Despite the potential shown by glass-ionomer sealant, it was concluded that no material prevented an increase in surface roughness of the nanofilled composite after an intense erosive challenge.

Economic evaluation of dental sealants: A systematic literature review.

To systematically review the literature on economic evaluations of dental sealants and examine the costs and effectiveness of caries prevention using sealants. Of 21 full-text articles examined, a total of 13 were included in this study. These studies are grouped by the type of intervention as follows: (i) sealants compared with no sealants; (ii) sealants compared with other forms of caries prevention; (iii) resin-based sealants compared with glass-ionomer sealants; (iv) different sealing strategies in primary teeth; (v) different sealing strategies in permanent teeth; and (vi) sealants based on school- or clinic-based setting of delivery. All currency is reported in constant 2010 US$. Cost-effectiveness analyses differed due to varying study designs, assumptions, sealant delivery settings, outcomes, caries risk assessment and study durations. Findings varied on the cost-effectiveness of sealants compared with other caries-preventive strategies. Under the assumption of equal caries risk, always sealing primary molars appeared to be the most effective strategy, whereas risk-based sealing was the optimal strategy with differing caries risk. Studies that assessed sealing strategies in permanent teeth reported that risk-based sealing was more cost-effective than not sealing, but they differed on the cost-effectiveness of risk-based seal compared with non-risk-based seal. Sealants delivered in school settings had mixed results on costs but were as equally effective as sealants delivered in private practices. The cost-effectiveness of sealants is dependent on the conditions of delivery. The list of cost-effectiveness ratios for each intervention can support policy makers to estimate expected returns on their investments in dental sealants.

Pit and fissure sealants for preventing dental decay in permanent teeth.

Pit and fissure sealants for preventing dental decay in permanent teeth.

Comparative efficacy of nanofilled and microfilled resin-modified glass ionomer as pits and fissure sealant in permanent molar teeth

The purpose of the present study was to compare the efficacy of nanofilled and microfilled resin- modified glass ionomer as pits and fissure sealants in permanent molar teeth. Ninety six teeth having fissure at the occlusal surface were randomly divided into two groups: Group I: Treated by nanofilled resin-modified glass ionomer sealant and Group II: Treated by microfilled resin- modified glass ionomer sealants. Clinical assessment was performed by modified Ryge´s criteria by means of retention, color match, marginal adaptation at 3, 6, and 12 months follow-up visit. Chi-square test was used for testing differences between the two groups; a value of p&lt;0.05 was considered as statistically significant. The results revealed that at 12 months observation period, nanofilled resin-modified glass ionomer sealant showed better retention, color stability and marginal adaptation than that of microfilled resin-modified glass ionomer sealants. Furthermore, the differences between two groups in respect to marginal adaptation and color match were statistically significant (p&lt;0.05). It can be concluded that nanofilled resin-modified glass ionomer sealant could be a better alternative to microfilled resin- modified glass ionomer sealant.

Clinical performance of a glass ionomer sealant protected with two different resin-based agents over a 2-year follow-up period.

To evaluate the effects of two different resin coating materials on the clinical performance of a conventional glass ionomer sealant. Permanent first mandibular molars of 60 children aged 6-9 years were sealed with Fuji VII. In each child, G-Coat Plus coating agent was applied to molars on one side and Heliobond coating agent to molars on the opposite side of the mouth. Clinical evaluations were carried out at 1, 6, 12, 18 and 24 months after sealant and coating application. At 1, 6, 12, 18 and 24 months after sealant and coating application, total sealant retention rates were 88%, 40%, 19%, 15% and 9% for molars coated with G-Coat Plus, and 93%, 47%, 17%, 15% and 7% for those coated with Heliobond. The differences between the two coating agents were not statistically significant (p>0.05). No incidence of caries was observed in either group during the two-year evaluation period. Wilcoxon signed rank test was used to compare differences in retention rates and caries incidence by coating agent. Although retention rates of Fuji VII were relatively low and similar for both resin coating agents tested, dental caries were not observed in either group during the 24-month study period. In children with a high risk of caries and partially erupted molars, the use of a glass ionomer sealant with a resin-based coating agent should be encouraged.

Comparative study of resin sealant and resin modified glass ionomer as pit and fissure sealant

The purpose of the present study was to compare the marginal integrity of resin modified glass ionomer cement with that of resin sealant, in vitro. Forty artificial pit and fissure cavities were prepared in occlusal surface of extracted premolar teeth by using ¼ round carbide bur. Cavities were condensed with artificial organic debris followed by cleaning with prophylaxis pumice brush and paste and then separated into two treatment groups. In Group A, 15 fissure cavities were sealed by resin sealant and in Group B, 15 fissure cavities were sealed by resin modified glass ionomer sealant. These specimens were subjected to thermo-cycling followed by dye penetration test. The remaining 5 cavities from each group were analyzed for debris score by the SEM. The results of the microleakage test showed that the efficacy of preventing microleakage of samples sealed by resin modified glass ionomer sealant was higher than the samples sealed by resin sealant. However, no significant differences were found. It can be concluded that use of resin modified glass ionomer sealant is a good alternative for sealing pits and fissures.

Effect of a resin-based and a glass-ionomer sealant on the treatment of noncavitated occlusal caries lesions in teenagers

Abstract Objectives: The aim of the study was to use clinical outcomes and digital radiographs to compare the effects of two types of sealant materials on the treatment of noncavitated occlusal caries lesions regarding their progression or arrest in teenage permanent molars. Methods: The sample consisted of 28 teeth from 20 patients aged 11-15 years with random distribution to receive either a resin-based sealant (Fluroshield ®, Dentsply, Philadelphia, PA, USA; Gres group) or a glass-ionomer sealant (RIVA Protect ®, SDI, São Paulo, Brazil; Ggis group). Caries progression was monitored by clinical evaluation and radiographic examination. Clinical outcomes were analyzed using the Mann-Whitney and Fisher′s exact test, and radiographic data were analyzed by Student′s t-test for paired data (P ≤ 0.05). Results: There were no significant differences between the clinical outcomes of both groups regarding the sealant retention, thermal sensitivity, and development of new caries lesions adjacent to the sealed surface. There was an increase in the radiographic density coefficient (carious dentin density/sound dentin density) at the end of the study for the Gres group (P = 0.003), but the coefficient for the Ggis group was similar for both time points (P = 0.49). Conclusions: Radiographic features showed an increase in the mineralization of the caries lesions when the teeth were sealed with a resin-based sealant; however, both techniques may be considered an adequate clinical approach for controlling the progression of the lesions.

Fissure seal or fluoride varnish?

Data sourcesCochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry PlatformStudy selectionRandomised controlled trials (RCTs) with at least 12 months follow-up, in which fissure sealants, or fissure sealants together with fluoride varnishes, were compared with fluoride varnishes alone for preventing caries in occlusal surfaces of permanent teeth of children and adolescents.Data extraction and synthesisTwo reviewers independently screened search results, extracted data and assessed risk of bias of included studies. Studies were grouped and analysed on the basis of sealant material type (resin-based sealant and glass ionomer-based sealant, glass ionomer and resin-modified glass ionomer) and different follow-up periods. Odds ratio were calculated for caries or no caries on occlusal surfaces of permanent molar teeth. Mean differences were calculated for continuous outcomes and data. Evidence quality was assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods.ResultsEight RCTs involving a total of 1747 children aged five to ten years of age were included. Three trials compared resin-based fissure sealant versus fluoride varnish. Results from two studies (358 children) after two years were combined. Sealants prevented more caries, pooled odds ratio (OR) = 0.69 (95%CI; 0.50 to 0.94). One trial with follow-up at four and nine years found that the caries-preventive benefit for sealants was maintained, with 26% of sealed teeth and 55.8% of varnished teeth having developed caries at nine years. Evidence for glass-ionomer sealants was of low quality. One split-mouth trial analysing 92 children at two-year follow-up found a significant difference in favour of resin-based fissure sealant together with fluoride varnish compared with fluoride varnish only (OR 0.30, 95% CI 0.17 to 0.55). The evidence was assessed as low quality. Three studies assessed but did not report any adverse effects.ConclusionsCurrently, scarce and clinically diverse data are available on the comparison of sealants and fluoride varnish applications; therefore it is not possible to draw clear conclusions about possible differences in effectiveness for preventing or controlling dental caries on occlusal surfaces of permanent molars. The conclusions of this updated review remain the same as those of the last update (in 2010). We found some low quality evidence suggesting the superiority of resin-based fissure sealants over fluoride varnish applications for preventing occlusal caries in permanent molars, and other low-quality evidence for benefits of resin-based sealant and fluoride varnish over fluoride varnish alone. Regarding glass ionomer sealant versus fluoride varnish comparisons, we assessed the quality of the evidence as very low and could draw no conclusions.

Nationwide 2.5-Year School-Based Public Health Intervention Program Designed to Reduce the Incidence of Caries in Children of Grenada

This paper describes an innovative public health intervention, called ‘Smile Grenada', targeting the oral health of children in Grenada utilizing the resources of a US dental school, several oral health care companies, local governmental and public health authorities, and Grenadian school personnel. Methods: Preintervention visual/tactile caries examinations were collected from 1,092 schoolchildren (mean age 9.9 years, standard deviation, SD = 3.7) in 2010. The intervention included: (1) classroom-based toothbrushing with fluoridated toothpaste, (2) fluoride varnish applied by trained dental students, teachers and local providers 3 times a year and (3) glass ionomer sealants placed on first permanent molars in children aged 6-8 years. Postintervention data were collected in May, 2013 (n = 2,301, mean age 9.8 years, SD = 3.7). Decayed and demineralized surfaces were examined for the whole sample and decay/demineralization and sealant retention on 6-year molars were examined separately (ages 6-8 in 2013 cohort). Results: The number of decayed/demineralized surfaces declined across all age groups. The average number of decayed surfaces dropped from 9 at baseline to just over 6 (F_{1, 3,393} = 69.8, p < 0.0001) and the average number of demineralized surfaces dropped from 6 to less than 2 (1.8 surfaces; F_{1, 3,393} = 819.0, p < 0.0001). For children aged 6-8 years, there were statistically significantly fewer decayed surfaces (t_{1, 2,086} = 12.40, p < 0.0001; mean baseline 0.93, SD = 1.75; mean follow-up 0.23, SD = 0.83) and demineralized surfaces (t_{1, 2,086} = 19.7, p < 0.0001; mean baseline 2.11, SD = 2.74; mean follow-up 0.50, SD = 0.97) on 6-year molars. The Smile Grenada program successfully demonstrated a locally sustainable model for improving oral health in children in a developing country.