Meta-analysis of the longevity of commonly used pit and fissure sealant materials

Abstract

Objective

This systematic literature review and meta-analysis compared the clinical retention of primed or adhesively bonded sealants to that of conventional sealant materials.

Methods

A search of the MEDLINE, EMBASE and CENTRAL databases identified 3707 abstracts published prior to 12/31/2017, of which 335 clinical publications were analysed in detail. A total of 67 studies included information about sealant retention after 24, 36, or 60 months of follow-up. A meta-analysis using a random effects model was conducted to calculate the pooled estimate of the retention rates for the five groups of sealants. Subgroup moderator analysis was performed to compare the pooled retention rate estimate (RRE) of primed sealants against those of the other groups.

Results

Primed sealants had a 2-year pooled RRE of 43.2% (95% CI: 30.5–55.8), which was significantly inferior to those of auto-polymerizing (80.8%, 95% CI: 72.2–89) and light-polymerizing sealants (68.4%, 95% CI: 60.2–76.7). Fluoride-releasing and light-polymerizing sealants had the highest 3-year pooled RREs (86.4%, 95% CI: 73.4–99.3 and 83.1%, 95% CI: 75.6–90.7, respectively).

Significane

The results of this meta-analysis suggest that primed sealants cannot be fully recommended for clinical practice due to their moderate survival rates. Auto-polymerizing, light-polymerizing and fluoride-releasing sealants continue to be considered the reference standards for pit and fissure sealants. However, future generations and developments of primed sealant materials may change this position.

Introduction

Pit and fissure sealants have been widely established to prevent or arrest occlusal caries. A recently updated Cochrane review concluded that resin-based sealants on occlusal surfaces of permanent teeth are effective for caries prevention [1]. Another review published by the American Dental Association in 2016 [2] determined that in addition to preventing pits and fissure caries, sealants minimize the progression of non-cavitated occlusal carious lesions. Clinical retention has been used to describe the ability of a sealant to protect pits and fissures and to quantify longevity [3]. An acceptable consensus exists that ‘complete retention’ of pit and fissure sealants is assumed to be a valid quality marker of sealant survival [[4], [5], [6]].

A focus of continuous research has been modifying the clinical sealant application method to simplify and shorten the procedure. Recently, a new group of primed or adhesively bonded sealants was introduced and tested in laboratory and clinical studies [7]. These sealants use acidic functional monomers, which simultaneously etch and prime enamel to create an adhesive compound on the outer prismless layer [8]. This approach aims to avoid conventional acid etching and decrease the technique sensitivity and application time [9,10]. This approach may also result in increased patient comfort during the placement of fissure sealant material, which is especially important in paediatric dentistry.

Our previous meta-analysis [3] on the retention rates of dental sealant materials did not include this new group of materials. Considering the published reports regarding this group of materials [11], the previous meta-analysis needs to be updated to ensure a current overview. This systematic review of the literature and meta-analysis aimed to compare the observed retention time for primed sealants to that of the conventionally used auto-polymerizing, light-polymerizing and fluoride-releasing sealants. The null hypothesis was that no difference existed among the groups of sealant materials.