Clinical and economic analysis of dental caries prevention using fluorine-containing sealants

Aim. To conduct a clinical and economic analysis of the effectiveness of the program fissure sealing of first permanent molars with fluorine-containing sealants among schoolchildren of 78 years old in six cities of the Republic of Tatarstan. Methods. Between 2007 and 2011, dentists of six cities of the Republic of Tatarstan performed fissure sealing of permanent first molars using a fluorine-containing sealant in 24,394 schoolchildren aged 78 years according to the manufacturer's instruction. A clinical assessment of fluorine-containing sealant retention during tooth eruption was carried out annually, the results were submitted to the organizational and methodological office of the Republican Dental Clinic. The analysis of the complex of signs that have a normal distribution and characterize four degrees of sealant retention on the occlusal surfaces of teeth in children from several cities was carried out by using one-way ANOVA (analysis of variance) with the calculation of a p-value and F-test (according to Ronald Fischer). Statistical data processing was performed using the Microsoft Office Excel 2017 software. The economic analysis was performed by using mathematical modelling. Results. The use of sealants at the age of 78 years ensured the complete safety of the sealant in 80% of children; the development of dental caries in 1.7%; complete and partial loss 14.3%; disturbance of fit without the development of caries in 4.1% of cases [р=0.0095 (0.01); f-test 3.09839]. Clinical and economic analysis using a mathematical hypothesis in sealing with a fluorine-containing composite sealant determined the preservation of the conditionally spent funds for the treatment of 80% of healthy teeth for 4 years of the project in the amount of 6,001,177 rubles. Notional saved costs for the treatment of one tooth with a sealant amounted to 23.7 rubles. Conclusion. Implementation of the program fissure sealing of first permanent molars with fluorine-containing sealants among schoolchildren of 78 years old allows a total of 98.3% of healthy teeth to be preserved and notionally saved costs of sealing fissures to be reduced.

Effect of Bonding Agent on Retention of Different Sealants: An in Vitro Study

Objectives: To investigate the effect of Co-curing versus Staged-curing and No-bonding on retention of different resin-based sealants (RBS). Study design: For shear bond strength (SBS) and microleakage tests, 90 extracted premolars were divided equally into 3 groups (I, II, III). Each group was further subdivided equally into 3 subgroups (a, b, c). No-bonding subgroups did not receive a bonding agent, Staged-curing subgroups received a bonding agent that was cured before sealant application, while Co-curing subgroups received a bonding agent that was cured after sealant application. Seal-it was applied for group I, Helioseal-F for group II and Clinpro for group III. SBS buttons were tested using Instron machine, while microleakage specimens were examined using micro-CT. Results: Clinpro showed the highest SBS values in Staged-curing and No-bonding groups (8.72±2.39, 12.51±3.16) respectively. Staged-curing was significantly greater in SBS values than those for other groups (P<0.05). There was a significant difference in microleakage values of Staged-curing among different RBS (P = 0.003), while there was no significant difference in values of No-bonding and Co-curing among different RBS (P = 0.541, P = 0.521). Conclusions: The use of a bonding agent as Staged-curing was more effective in improving sealant retention than No-bonding and Co-curing.

Lasers to prevent dental caries: a systematic review

ObjectiveTo assess the effectiveness of lasers (at sub-ablative parameters) in reducing caries incidence compared with traditional prophylactic interventions (TPIs) when used alone or together with other TPIs such as pits and fissures sealant or fluoride gels or varnishes.DesignA systematic review. Data sources include Medline (via PubMed), Embase, Web of Science and the Cochrane Library (December 2019).Eligibility criteriaOnly randomised trials (RCTs) and controlled clinical trials (CCTs) dealing with prophylactic lasers use (vs TPI or untreated teeth) were considered as eligible. We excluded in vitro and ex vivo studies.Data extractionEligible studies were selected and data extracted independently by two reviewers. Risk of bias was assessed adopting the Cochrane Risk of Bias tool. Data on caries incidence, sealant retention, fluoride uptake, adverse events, treatment duration, patients’ discomfort and cost-effectiveness ratio was extracted.Data analysisExtracted data were presented narratively due to the heterogeneity of included studies.ResultsSeven RCTs and two CCTs, all with an evident risk of bias, met inclusion criteria, pooling together 269 individuals and 1628 teeth. CO2, neodymium-doped yttrium aluminium garnet, erbium-doped yttrium aluminum garnet (Er:YAG), erbium, chromium: yttrium scandium gallium garnet (Er,Cr:YSGG) and Argon lasers were used. In the permanent dentition, lasers only when used in combination with TPIs were effective in reducing caries when compared with untreated teeth (risk ratio (RR)=0.44 (0.20–0.97); Er:YAG laser) or with TPIs used alone (RR=0.39 (0.22–0.71); CO2 laser). Moreover, Argon laser significantly improved the fluoride uptake into the enamel surfaces (ANalysis Of VAriance (ANOVA) tests: 95%, p<0.0001). Likewise, sealant retention improved when acid etching was performed on previously irradiated enamel fissures by CO2 laser (RR=0.63 (0.38–1.04)) or Er:YAG laser (RR=0.54 (95% CI: 0.34 to 0.87)). In addition, laser resulted safe and well tolerated by patients.ConclusionDespite some positive indications, an inadequate level of evidence was found in the included studies concerning the lasers’ effectiveness in preventing caries. Further studies with a higher methodological quality level are required.

A Two-Year Clinical Evaluation of Fluoride and Non-Fluoride Resin-Based Pit-and-Fissure Sealants

The aim of this study was to evaluate and compare for 24 months, the retention and surface characteristics of two pit-and-fissure sealants: Helioseal Clear and Helioseal F (Ivoclar Vivadent). The correlation between the different stages of eruption and sealant retention was also verified. Fifty children aged 6 to 8 years participated in the study, totalizing 153 teeth divided into two groups: HC (Helioseal Clear) and HF (Helioseal F). After 6, 12, 18 and 24 months, a clinical examination was performed by previously calibrated examiners. The surface characteristics and the retention of the sealants (modified RYGE & SNYDER criteria) were assessed. Analyzing the occlusal surface, HC exhibited a statistically significant higher retention at 12 (p=0.0345) and 24 months (p=0.0076). Concerning the surface characteristics, only the superficial discoloration of HC was smaller than HF, during the entire studied period. For all the other characteristics, the results of the Mann-Whitney test were highly significant at different periods (p=0.0000 to 0.0421). The frequency of air bubbles within the sealant surfaces, determined by Chi-square test, was significantly higher in HF (p=0.000:12 and 18 months to p=0.002: 6 and 24 months). HC sealant material exhibited the best performance regarding the retention and surface characteristics on the occlusal surface.

Retention evaluation of two glass ionomer cement sealants: six-month clinical follow-up

Objective: The aim of this study was to evaluate the retention of glass ionomer sealant, Vitro Molar(r) (DFL) and Ketac Molar Easy Mix(r) (3 m ESPE) as pit and fissure sealants on first permanent molars, fully or partially erupted. Methods: The study sample consisted of 412 molars, among 110 children. The sealant retention was evaluated after 6 months of the application. Results: The results were collected through digital photographs and the retention results were assessed by the following System: score 0 - total retention; score 1 - sealant present in more than 50% of the pit and fissure system; score 2 - sealant present in less than 50% of the pit and fissure system; score 3 - missing sealant. Regarding the presence of the sealants in less than 50% of the occlusal surface, lower percentages were found for the two materials used as follows: score score 2 - Vitro Molar(r) (9,52% examiner 1 and 11.9% examiner 2) and score 2 - Ketac Molar Easy Mix(r)(9.52% examiner 1 and 10.71% examiner 2). Approximately 90% of the teeth sealed with Ketac Molar Easy Mix(r)or Vitro Molar(r) presented total loss (score 3). Thus, there was no statistical difference between the materials and between the examiners (p>0.05). Conclusion: Therefore it was concluded that the sealant retention in the studied population was not satisfactory for any of the materials used.