TYPES OF PIT AND FISSURE SEALANTS. INDICATIONS AND CONTRAINDICATIONS FOR SILANIZATION. REVIEW

Background: Dental sealants have been used to reduce the incidence and severity of dental caries in the pits and fissures of teeth for over 40 years. Since that time, numerous scientific discoveries have led to the development of multiple generations of new sealant materials. Aim: The aim of this paper is to summarize the findings of reviews regarding the types of pit and fissure sealants, indications and contraindications for their use. Methods and materials: Previous systematic reviews on this topic were used as the basis for the current review. Cochrane, MEDLINE, Embase, and a few other bibliographic databases were searched for English and Bulgarian-language articles. The year of publication of the searched articles was limited from 2000 to 2020. Only articles in English and Bulgarian languages were read in full. Results: A total of 114 articles were identified by the literature search, the title and abstract of the articles were examined. Twenty-four original research studies met the inclusion criteria. They were read in full, and evidence was extracted for types of pit and fissure sealants, as well as indications and contraindications for their use. Conclusion: Evidence derived from the literature led to the conclusion that sealants are effective in preventing pit and fissure occlusal carious. The selection of the material used for silanization is made depending on a few factors that should be considered, such as patient's and tooth age, child's behavior and ability to isolate the surfaces which are going to be sealed. Regular examinations are required to be able to determine the need for reapplication of sealants and to maximize the effectiveness and results of the treatment.

Release of Bisphenol A from Pit and Fissure Sealants According to Different pH Conditions

Changes in intraoral pH can cause changes in the chemical decomposition and surface properties of treated resin-based pits and fissure sealants (sealant). The purpose of this study is to evaluate the release of bisphenol A (BPA) from sealants under three different pH conditions over time. The test specimen was applied with 6 sealants 5 mg each on a glass plate (10 × 10 mm) and photopolymerized. The samples were immersed for 10 min, 1 h, and 24 h in solutions of pH 3.0, 6.5, and 10.0 at 37 °C. BPA release was measured using a gas chromatography-mass spectrometer. A statistical analysis was performed by two-way ANOVA and one-way ANOVA to verify the effect of pH conditions and time on BPA release. The BPA concentration in the pH 3.0 group was higher at all points than with pH 6.5 and pH 10.0 (p < 0.05), and gradually increased over time (p < 0.05). As a result, it was confirmed that low pH negatively influences BPA release. Therefore, frequent exposure to low pH due to the consumption of various beverages after sealant treatment can negatively affect the sealant’s chemical stability in the oral cavity.

Pit and fissure sealants — A review

Caries on the occlusal surface of dentition is a significant dental health problem. Among all of the teeth particularly molars and premolars have greater susceptibility to caries. Their susceptibility to caries is probably related to its occlusal morphology. Use of fissure sealant and fluoride have been shown to play an important role in reducing caries. This can be possible through converting the caries susceptible areas like pits and fissures into glazed surface which prevent bacterial colonization and makes the tooth easy to clean. Pit and fissure areas of enamel do not receive sufficient protection from topical or systemic fluorides, the reason for ineffectiveness of fluorides in the pit and fissure caries may be due to inaccessibility to these areas and due to the differences in enamel thickness. The most efficient way to prevent pit and fissure caries is by effectively sealing the fissures using resins called pit and fissure sealants.

Effect of Saliva/Blood Contamination on Enamel Bond Strength

In the routine clinical situation, the contamination by blood and/or saliva in restorative procedures can be happen in non-cooperation of the patient in dental office. The aim of the study was to assess in vitro shear bond strength of a resin sealant associated with two types of adhesives contaminated with saliva and blood. Healthy human molars were used and the specimens and the crowns were sectioned in the bucco-lingual direction, thus obtaining two segments of similar proportions (mesial and distal), totaling 60 surfaces, and the surfaces were randomly divided into 4 groups (n = 15). Group I (control) received no type of contamination and the sealant was applied. In group II, the surfaces were contaminated with 10 μl of saliva/blood and the sealant was applied. In group III, the surfaces were contaminated with 10 μl of saliva/blood and the Single Bond total-etch adhesive system was applied followed by application of sealant. In group IV, the surfaces were contaminated with 10 μl of saliva/blood and the Prime & Bond NT total-etch adhesive system was applied followed by the application of sealant. Samples were tested in the universal testing machine and the analysis of shear bond strength was performed. A difference between Group I (12.61MPa) and the other groups was found; Group II (2. 28MPa) was different than Groups III (7.07MPa) and IV (7.79MPa), but Groups III and IV were similar. The application of an adhesive system when there is contamination with saliva/blood is required prior to application of pit and fissure sealants. Keywords: Pit and Fissure Sealants. Biological Contamination. Shear Strength. ResumoNa situação clínica de rotina, a contaminação por sangue e/ou saliva em procedimentos restauradores pode ocorrer em pacientes que não colaboram no consultório odontológico. O objetivo do estudo foi avaliar a resistência ao cisalhamento in vitro de um selante de resina associado a dois tipos de adesivos contaminados com saliva e sangue. Foram utilizados molares humanos saudáveis e os espécimes e as coroas foram seccionados na direção bucal-lingual, obtendo assim dois segmentos de proporções semelhantes (mesial e distal), totalizando 60 superfícies, e as superfícies foram divididas aleatoriamente em 4 grupos (n = 15). O Grupo I (controle) não recebeu nenhum tipo de contaminação e o selante foi aplicado. No grupo II, as superfícies foram contaminadas com 10 μl de saliva / sangue e o selante foi aplicado. No grupo III, as superfícies foram contaminadas com 10 μl de saliva / sangue e o sistema adesivo Single-Bond foi aplicado seguindo a aplicação de selante. No grupo IV, as superfícies foram contaminadas com 10 μl de saliva / sangue e o sistema adesivo de ataque total Prime & Bond NT foi aplicado seguido da aplicação de vedante. As amostras foram testadas na máquina de ensaio universal e a análise da resistência à ligação ao cisalhamento foi realizada. Uma diferença entre o Grupo I (12,61MPa) e os outros grupos foi encontrada; O Grupo II (2,28 MPa) foi diferente dos Grupos III (7,07MPa) e IV (7,79 MPa), mas os Grupos III e IV foram semelhantes. A aplicação de um sistema adesivo quando existe contaminação com saliva / sangue é necessária antes da aplicação de selantes de fissura e fissura.. Palavras-chave: Selantes de Fossas e Fissuras. Contaminação Biológica. Resistência ao Cisalhamento.

Evaluation of Dental Students' Awareness and Attitude About Preventive Dental Treatments: Survey Research

Aim: Determination of dental students' approaches to fissure sealant applications; the widespread use and evaluation of their effectiveness of protective dental practices is extremely important. This research aims to evaluate the level of understanding and clinical attitudes of 3rd, 4th and 5th grade students of Necmettin Erbakan University Faculty of Dentistry on preventive dental treatments. Methods: The first part of the questionnaire consists of 10 questions aimed at assessing the students' technical levels of knowledge with data on age, gender and educational level. In the second section analyzing students' clinical behaviors, 11 questions were asked for answers to multiple choices (always, often, sometimes, never). This questionnaire was used on the internet in an anonymous way. Results: The questionnaire was received by 68 3rd grade, 67 4th grade and 75 5th grade students who were previously educated on fissure sealant applications. The vast majority (96.2 percent) of the students involved in the study indicated that the effectiveness of fissure sealants in preventing the development of tooth decay was confirmed by strong scientific evidence. Again, 99.5 percent of the students participating in the study indicated that the justification of the application procedures for the fissure sealant was identified and understood. With the assumption that only new teeth can be applied to fissure sealants, a statistically significant difference between the classes was observed (p<0.05); 3rd graders responded "yes" mainly. Conclusion: Although dental students have sufficient knowledge of protective dental practices and fissure sealants, variations in understanding and implementing clinical practice procedures may be found between classes. Standardization should be provided and education / lectures on preventive dental practices should be increased to obtain the equivalent of theoretical education at the clinical level.

Three Dimensional Evaluation of Marginal Microleakage at the Adhesive Interface between Different Fissure Sealants and Enamel: Micro-CT Analysis

Summary Background/Aim: Sealing ability and adhesion to enamel of fissure sealants are quite critical in prevention of dental caries. The objective of the present study was to assess the marginal microleakage of different material-based pit and fissures with non-invasive and invasive techniques by using the Micro-CT method. Material and Methods: 30 extracted human permanent molars were randomly assigned to three sealant groups (n=10) as resin-based ClinPro, giomer-based BeautiSealant, and glass ionomer-based Fuji IX-GP. Half of each group was randomly divided into two parts as non-invasive and invasive techniques. The volumetric analysis of marginal microleakage between the enamel-material interface was performed by using Micro-CT. The results were analyzed with Student’s t, One-Way ANOVA, Tukey and Games-Howell tests. Statistical significance level was considered as 0.05. Results: In non-invasive technique, Fuji IX-GP showed statistically significantly lower marginal microleakage values than Clinpro (p=0.022). Other comparisons were not significant (p>0.05). However, in invasive technique, microleakage values both of Fuji IX-GP and BeautiSealant were significantly lower than Clinpro (p<0.001, p<0.001). Besides, regardless of the sealant material, the invasive technique showed significantly superior results than non-invasive technique regarding marginal microleakage. Conclusions: Considering the clinical conditions, it was concluded that glass ionomer-based Fuji IX-GP and giomer-based BeautiSealant could be used as alternative to resin based sealants. Additionally, invasive technique (fissure preparation) can be recommended to reduce marginal microleakage.

Minimal intervention dentistry for managing carious lesions into dentine in primary teeth: an umbrella review

Purpose This umbrella review systematically appraised published systematic reviews on Minimal Intervention Dentistry interventions carried out to manage dentine carious primary teeth to determine how best to translate the available evidence into practice, and to provide recommendations for what requires further research. Method An experienced information specialist searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Epistemonikos, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, and the NIHR Journals Library. In addition, the PROSPERO database was searched to identify forthcoming systematic reviews. Searches were built around the following four concepts: primary teeth AND caries/carious lesion AND Minimal Intervention Dentistry AND systematic review/meta-analysis. Searches were restricted to English language, systematic reviews with/without meta-analyses published between January 2000 and August 2020. Two reviewers independently screened all titles and abstracts. Interventions included involved no dentine carious tissue removal (fissure sealants, resin infiltration, topical application of 38% Silver Diamine Fluoride, and Hall Technique), non-restorative caries control, and selective removal of carious tissue involving both stepwise excavation and atraumatic restorative treatment. Systematic reviews were selected, data extracted, and risk of bias assessed using ROBIS by two independent reviewers. Studies overlap was calculated using corrected covered area. Results Eighteen systematic reviews were included in total; 8 assessed the caries arresting effects of 38% Silver Demine Fluoride (SDF), 1 on the Hall Technique (HT), 1 on selective removal of carious tissue, and eight investigated interventions using atraumatic restorative treatment (ART). Included systematic reviews were published between 2006 and 2020, covering a defined time frame of included randomised controlled trials ranging from 1969 to 2018. Systematic reviews assessed the sealing efficacy of fissure sealants and resin infiltration in carious primary teeth were excluded due to pooled data reporting on caries arrest in both enamel and outer third of dentine with the majority of these carious lesions being limited to enamel. Therefore, fissure sealants and resin infiltration are not recommended for the management of dentinal caries lesions in primary teeth. Topical application of 38% SDF showed a significant caries arrest effect in primary teeth (p < 0.05), and its success rate in arresting dental caries increased when it was applied twice (range between 53 and 91%) rather than once a year (range between 31 and 79%). Data on HT were limited and revealed that preformed metal crowns placed using the HT were likely to reduce discomfort at time of treatment, the risk of major failure (pulp treatment or extraction needed) and pain compared to conventional restorations. Selective removal of carious tissue particularly in deep carious lesions has significantly reduced the risk of pulp exposure (77% and 69% risk reduction with one-step selective caries removal and stepwise excavation, respectively). ART showed higher success rate when placed in single surface compared to multi-surface cavities (86% and 48.7–88%, respectively, over 3 years follow-up). Conclusion Minimal Intervention Dentistry techniques, namely 38% SDF, HT, selective removal of carious tissue, and ART for single surface cavity, appear to be effective in arresting the progress of dentinal caries in primary teeth when compared to no treatment, or conventional restorations. There is clear need to increase the emphasis on considering these techniques for managing carious primary teeth as a mainstream option rather than a compromise option in circumstances where the conventional approach is not possible due to cooperation or cost.

Sealant Utilization and its Influence on Caries Reduction in First Permanent Molars in Saudi Female School Children

Purpose: This study aimed to assess the utilization of fissure sealants and their influence on caries reduction in first permanent molars (FPMs) among 6-9 years old female schoolchildren in Dammam, Eastern Province of Saudi Arabia. Materials and Methods: First to fourth grade female children from public schools in Dammam participated in this cross-sectional study. Dental caries and fissure sealants in FPMs were examined clinically using the World Health Organization guidelines. In addition, the parents of the participants responded to a self-reported questionnaire. Results: The study analyzed the data of 449 children. Almost 44.3% of the participants had at least one FPM affected with caries. There were 8.7% of the participants who had fissure sealants in at least one FPM, and out of these, only 2.2% had four FPMs filled with sealants. A significantly greater proportion of participants with sealed FPMs had no caries than the lower proportion of participants without sealants who had caries (P=<0.05). The use of sealants increased significantly from first grade (10.3%) to second grade (30.8%), third grade (38.5%), and fourth grade (20.5%) (P=0.006). High monthly family income (P= 0.047) and having insurance (P=0.017) were significantly associated with increased sealant application. Nearly 21.9% of participants’ parents were aware of caries protective effects of dental sealants. Conclusion: The application of sealants was significantly associated with reduced caries in FPMs. Class year, monthly family income, and insurance were significantly associated with having sealants. Caries prevention programs for children should incorporate sealant application.

CARIES PREVENTION THROUGH THE APPLICATION OF PIT AND FISSURE SEALANTS FOR MAKASSAR ELEMENTARY SCHOOL STUDENTS

Background: Dental and oral diseases are progressive and accumulative diseases that can affect all age groups. Dental caries is the most common dental disease in Indonesia. One of the preventive measures is to apply pit and fissure sealants to teeth with deep pits and fissures. Objective: The purpose of this activity is to help improving the oral health of the community through preventive efforts in the form of pit and fissure sealant applications. Methods: The implementation of this community service activity was conducted through several stages, namely preparation, data collection, problem identification, and implementation of activities. Results: The average caries index of the targeted students was in the high category. There were 5 children who need pit and fissure sealant application. Conclusion: This community service activity had been conducted according to plan. The community, in this case elementary school students, got preventive services in the field of dental health, especially the application of pit and fissure sealants.