Marginal Microleakage of a Sealant Applied to Permanent Enamel: Evaluation of 3 Application Protocols

Resident: Swan

Article Title: Marginal Microleakage of a Sealant Applied to Permanent Enamel: Evaluation of 3 Application Protocols

Journal: Pediatric Dentistry

Volume (Number): 30 (1) 2008

Major Topic: Sealant Microleakage Using different application protocols

Main Purpose: Compare microleakage after placement of light-curing sealant to unground permanent enamel that has been conditioned with 1) phosphoric acid, 2) phosphoric acid and a bonding agent, or 3) a self-etching adhesive (L-Pop).

Type of Article: In vitro study

Overview of method of research: 60 intact 3^rd molars were embedded in resin blocks. The occlusal surfaces were cleaned using pumice slurry and rubber cups, rinsed, and air dried. 20 teeth were randomly assigned to each of three treatment groups

1) Clinpro sealant following acid etching with 38% phosphoric acid

2) Clinpro sealant following etching and application of Adper Single Bond Plus Adhesive

3) Clinpro sealant following application of Adper Prompt L-Pop self-

Materials were applied according to manufacturers’ instructions. Samples were thermocycled and immersed in methyl blue for 24 hours. Marginal leakage was determined by sectioning each tooth mesiodistally through the center of the sealant, then taking a photograph of each section. Each slide was twice show randomly on a screen to two independent evaluators, who scored dye penetration based on this scale:

0= no dye penetration

1=penetration down mesial OR distal wall

2=penetration down mesial AND distal wall

3=penetration underneath sealant and down mesial or distal wall

4=penetration all around the sealant

**Within- and between-examiner reliability was determined using Cohen’s kappa and ANOVA was used to evaluate the significance of the results

Findings: Etch and sealant group—25% had no microleakage. Etch, bond, sealant group—59% had no microleakage. L-pop and sealant group—40% had no leakage.

Only statistically significant difference was that between groups 1 and 2.

Key Points/Summary:

1) Use of an adhesive prior to sealant placement significantly reduces microleakage in vitro; its clinical application is supported

2) Use of self etch adhesives is a good alternative in specific situations, as it reduces chair time and the risk of salivary contamination

3) This is an in vitro study, so long-term clinical studies are still needed

Assessment of Article: A solid study, with limitations a) subjectivity of scoring using a number system, b) in vitro, thus done under perfectly controlled circumstances (a bit different than what we encounter). This study highlights the fact that even under perfect circumstances (zero saliva), there was still substantial leakage with ALL three groups. Highlights importance of excellent isolation. We should be aware of L-pop technique but wait for longer-term clinical studies to come out.