Efficacy of pit and fissure sealants for preventing dental decay in permanent teeth
Level of evidence: A
Pit and fissure sealants are effective in preventing caries in occlusal surfaces of permanent molars in children and adolescents.
A systematic review and meta-analysis has shown that resin/composite-based fissure sealants significantly prevent caries in occlusal surfaces of permanent molars «Ahovuo-Saloranta A, Forss H, Walsh T ym. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev 2017;7:CD001830 »1. The quality of evidence is high. The caries-preventive effect was maintained long, even 4.5 years, but evidence quality and quantity reduced with longer follow-up. Applicability of the evidence to the Finnish population is good.
If 16 % of first permanent molars would develop caries over 24 months, using resin-based sealants reduces the corresponding risk to 5.2 % (95 % CI 3.1–7.4). If 40 % of first permanent molars would develop caries over 24 months, using resin-based sealants reduces the corresponding risk to 6.3 % (95 % CI 3.8–9.6). If 70 % of first permanent molars would develop caries over 24 months, using resin-based sealants reduces the corresponding risk to 18.9 % (95 % CI 12.3–27.2).
The relative effectiveness of sealant types (glass-ionomer-based versus resin-based) is inconclusive and seems often to be correlated with retention of sealant material «Ahovuo-Saloranta A, Forss H, Walsh T ym. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev 2017;7:CD001830 »1.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT = randomized controlled trial; SR = systematic review; MA = meta-analysis | |||||
| «Ahovuo-Saloranta A, Forss H, Walsh T ym. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev 2017;7:CD001830 »1 | SR/MA | Included studies were RCTs with at least 12 months follow-up. Studies that compared compomers to resins/composites and studies in which fissure sealants were used concurrently with fillings or other caries-preventive treatments were excluded.
Population: In the included studies, the children represented general populations and were aged 5 to 16 years. | Pit and fissure sealants compared to no sealant or a different type of sealant material. Application of sealants was done either on sound surfaces or on enamel lesions. | Caries prevention on occlusal surfaces of permanent first or second molars | All the included studies were assessed as being at high risk of bias because the persons who measured the outcomes could see whether sealant had been used. |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect(95 % CI) |
|---|---|---|---|---|---|
| Level of evidence: high
Even though the risk of bias is high (blinding of outcome assessment is not possible because outcome assessors can see and identify sealant), the level of evidence is high due to large magnitude of effect shown by high number of studies. I = intervention; C = comparison; CI = confidence interval OR = Odds Ratio RR = Risk Ratio | |||||
| «Ahovuo-Saloranta A, Forss H, Walsh T ym. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev 2017;7:CD001830 »1 | Number of studies: 15 (11 were pooled for meta-analysis) Number of patients: 3620 in 14 studies plus 575 tooth pairs in one study | 12-108 months | OR: 12 months 0.17 (0.10-0.30) (pooled data from 7/7 studies) 24 months 0.12 (0,08-0.19) (pooled data from 7/7 studies) 32 to 36 months 0.17 (0.11-0.27) (pooled data from 7/7 studies) 48 and 54 months 0.21 (0.16-0.28) (pooled data from 4/4 studies) Becker-Balagtas marginal OR: 60 months 0.31 (0.23-0.43) (data from one study) 72 months 0.23 (0.16-0.35) (data from one study) 84 months 0.20 (0.12-0.32) (data from one study) RR: 108 months 0.35 (0.22-0.55) (data from one study) | ||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect(95 % CI) |
|---|---|---|---|---|---|
| Level of evidence: low
The quality of evidence is downgraded due to inconsistency. I = intervention; C = comparison; CI = confidence interval OR = Odds Ratio RR = Risk Ratio | |||||
| «Ahovuo-Saloranta A, Forss H, Walsh T ym. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev 2017;7:CD001830 »1 | 21 studies (N = 3883) 12 months: 6 studies 24 months: 16 studies 36-48 months: 9 studies 60 months: one small parallel-group study (36 participants) 84 months: one split-mouth study | 12-84 months | 12 months (pooled BB OR) 1.47 (0.64-3.37) 24 months (low and high viscosity glass ionomers to resins) OR 1.67 (0.87-3.20) and 1.36 (0.56-3.32) respectively 24 months (resin-modified glass ionomer to resin-based sealant) OR 2.92 (1.77-4.81) 36 to 48 months (no pooled data) 60 months RR 0.38 (0.09-1.6) 84 months RR 1.44 (0.88-2.35) | ||
References
- Ahovuo-Saloranta A, Forss H, Walsh T ym. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev 2017;7:CD001830 «PMID: 28759120»PubMed