Compomer as a Pit and Fissure Sealant: Effectiveness and Retention after 24 Months

Resident: J. Hencler
Date: 08/20/2010

Article title: Compomer as a Pit and Fissure Sealant: Effectiveness and Retention after 24 Months

Author(s): Puppin-Rontani et al.

Journal: Journal of Dentistry for Children-73: 1, 2006

Major topic: Sealants

Type of Article: Clinical Study

Main Purpose:
To verify the retention and effectiveness of caries prevention in the occlusal surfaces after the use of 2 fluoride-containing materials: 1) FluroShield, a resin-based sealant and 2) Compoglass, a polyacid-modified, resin based composite.

Overview of method of research:
A convenience sample from 57 children aged 7-9 years were selected from an elementary school from a community with a fluoridated water supply. 228 sound permanent molars were chosen from the sample. The 228 teeth were divided into 2 grps. Group 1: #14 and 30 were sealed using a resin-based sealant, FluroShield and Group 2: #3 and 19 were sealed using a compomer, Compoglass. The teeth were cleaned using a child-sized toothbrush and water before applying sealants under relative isolation (cotton rolls and portable saliva ejector). The retention was assessed at 6, 12, 24 months. The incidence of caries was also reported at 12 and 24 months.

Findings:
There was a significant difference between lower and upper teeth for both materials concerning total retention. (See tables for specific values)

Key points in the article discussion:
Sealed pits and fissures have reduced the incidence of dental caries in occlusal surfaces. Compomers combine the best properties of composites and glass ionomers. Characteristics include better adhesion to enamel and dentin, lower water solubility, low dehydration susceptibility, and fluoride release at the tooth sealant interface. The total retention rate for FluroShield, the resin-based sealant used in this study, was similar to that found for Compoglass, a polyacid-modified, resin-based composite. Although the total retention rates could be considered low, an increase in dental caries was not observed during the study period. This could be due to sealant remaining in the microporosities, even after it had been considered clinically lost. In these situations, the resin tags embedded in the etched enamel may still offer bacterial invasion protection to the pits and fissures. Considering the overall low retention rates in this study, the authors report that the tooth-color appearance of the sealant material tested may have made clinical detection of the sealant at follow up more difficult and led to an under estimation of the sealant retention. In addition the authors also report that due to the isolation technique chosen in this study, the upper arch presented a greater moisture control problem compared to the lower arch. This study was poorly designed. Read on for amazing conclusions.

Summary of conclusions:
When evaluated at 24 months, total sealant retention was significantly different b/t FluroShield and Compoglass concerning upper and lower teeth. FluroShield showed significantly higher total retention rates when applied in lower teeth and Compoglass showed significantly higher total retention rates when applied in upper teeth. During the follow-up period, both materials effectively prevented caries in occlusal surfaces, although both showed low retention rates.

Assessment of article:
One of many major flaws in this study is that a rubber dam was not used during sealant application. How can these authors draw any solid conclusions about sealant retention when they were not applied under RDI? Double shenanigans!