Effect of a NONrinse Conditioner on the Durability of a Polyacid-modified Resin Composite Fissure Sealant

Resident: Adam J. Bottrill
Date: 27AUG10
Region: Providence
Article title: Effect of a NONrinse Conditioner on the Durability of a Polyacid-modified Resin Composite Fissure Sealant
Author(s): Lampa, Ewa DDS et al
Journal: Journal of Dentistry for Children
Page #s: 152-157
Year: 71:2, 2004
Major topic: Conditioners and Sealants
Minor topic(s): NA
Type of Article: Comparative Study
Main Purpose: The aim of the study was to evaluate the effects of the simplified conditioning on durability of poly-acid-modified resin composite (PMRC) fissure sealants. The effectiveness of a non-rinsing conditioner (NRC) on retention of PMRC sealants was studied in a split-mouth design.

Key points in the article discussion:

I. Methods:

A. 92 teeth treated in Sweden.
1. Split-mouth study design.
2. First Side: NRC+PMRC (prime&bond NT)
3. Second Side: Acid etch+Sealant
B. An additional 49 treated with etch and PMRC
C. Performed by TWO SEPARATE PRACTITIONERS
1. ...but both were "experienced" so they must have the EXACT same technique... right?
D. Teeth evaluated at baseline, 3, 6, 12 and 24 months.
1. given a score based on presence, fracture, caries etc...

II. Results:

A. The argument used in favor of NRC+PMRC is: sensitive steps are eliminated from the procedure leading to a more efficient chair-side experience.
B. HOWEVER... SIGNIFICANTLY higher loss rate was found for the NRC+PMRC method when compaired to the acid etch+sealant method. Even the etch+PMRC showed better sucess than the NRC method.
C. The article concludes... "Conditioning with NRC prior to sealant application cannot be recommended."
D. Bottom line?.... NRC=Shenanigans

Assessment of article: Nice to know, but we don't use it at St Joseph. Closest thing to it might be the L-POP self etching adhesive... but even that is only used at the ED in emergent situations.

Occlusal Sealant Success Over Ten Years in a Private Practice: Comparing Longevity of Sealants Placed by Dentists, Hygienists, and Assistants

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Chad Abby Date: 3/13/2009
Article title: Occlusal Sealant Success Over Ten Years in a Private Practice: Comparing Longevity of Sealants Placed by Dentists, Hygienists, and Assistants
Author(s): Bernadette Folke, James Walton, Robert Feigal
Journal: Pediatric Dentistry
Volume (number): 26:5
Month, Year: 2004
Major topic: Sealants
Minor topic(s): Comparing longevity of sealants placed by dentists, hygienists and assistants
Type of Article: retrospective cohort study
Main Purpose: To evaluate the success of permanent molar sealants by comparing the effectiveness of sealants placed by dentists, dental hygienists, and dental assistants in a private dental practice, with all operators using identical, standardized, application technique and four-handed dentistry.
Overview of method of research: The selection criteria for this study were fully erupted permanent first molars treated with occlusal pit and fissure sealants, patients between 5-16 years of age, no caries or previous restorations on the sealed teeth and patients who returned for at least one follow-up appointment at least 6 months after initial placement. After review 810 patients met the criteria. Each tooth was treated the same with an enamelplasty performed by a dentist prior to placing the sealant. From the selected group of patients a total of 3,194 permanent first molars were treated. The data was collected and evaluated by survival analyses methods for – time to first failure, fluoride history, caries experience, operator type, behavior at sealant placement, tooth type, age at placement and patient gender.
Findings: Pits and fissures account for 88% of childhood caries in populations with overall low caries risk. With excellent application technique and follow-up care, it has been reported that caries protection approaches 100% in pits and fissures in which sealant has been retained. While many studies have been done on sealant effectiveness based on the material type and controlled variables, few have been done determining the effectiveness of various providers.
Key points/Summary: The estimated survival rate for one year approached 100% while the cumulative survival probability for 10 years was 87%. The mean survival time for sealants placed in this study was 5 years. When considering operator type, dentists and RDAs had a mean survival time of 3.45 years and 3.65 years respectively, whereas RDHs had a mean survival time of 7.71 years. The risk for sealant failure was significantly lower in sealants placed by RDHs compared to those placed by dentists or RDA. Previous caries experience at time of sealant placement and no fluoride exposure at placement were highly correlated to increased sealant failure. Children in nonfluoridated areas showed almost twice the risk of failure as compared to children in optimal fluoridated areas. Behavior showed a slightly higher risk of failure, age and dmft were highly significant with slight increased risk in failure. Supplemental fluoride showed a protective effect but was marginally significant. This study supports delegation of sealant delivery to auxiliaries, since dental assistants and dental hygienists were equal to or better than the dentists in long term sealant effectiveness.
Assessment of article: Good article

: Evaluation of Initial Caries Score and Caries Incidence in a Public Health Sealant Program: A Retrospective Study

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Laura Randazzo Sabnani Date: March 13, 2009
Article title: Evaluation of Initial Caries Score and Caries Incidence in a Public Health Sealant Program: A Retrospective Study
Author(s): Makhija, S et al.
Journal: Pediatric Dentistry
Volume (number): 28:5
Month, Year: 2006
Major topic: Success of Sealant
Minor topic(s:
Type of Article: Retrospective
Main Purpose: To investigate the relationship between the dmft/DMFT score and the success of a Sealant
Overview of method of research: Children aged 5.5 to 15 years old, were examined twice by the school-based sealant program between 1997 and 2002, and had least one sealant placed on a permanent first molar were included in the study. The dentist diagnosed the need for a sealant, a hygienist (94%) or a senior dental student placed the sealants and all sealants were checked that day by the supervising dentist. Follow-up visits ranged from 6 months to 5 years. Teeth were then classified as a success if the tooth that was sealed initially now was still completely or partially sealed or was caries free, or a failure if the tooth appeared carious or restored on the second examination.
Findings: For the primary dentition and permanent dentition, for teeth that were examined within the first year of placement there was no difference between a dmft/DMFT of 0 or a dmft/DMFT>0. After a follow-up period of more than 1 year children with a dmft/DMFT of 0 were half as likely to have a sealant failure than children with a dmft/DMFT score of >0.
Key points/Summary: Children with a high caries risk are more likely to get caries on teeth that were sealed after the first year of placement and should be monitored regularly. Assessment of article: Interesting to note that if the sealant was partially present or no longer there it was still considered a success.

Clinical Evaluation of Sealants and Preventive Resin Restorations in a Group of Environmentally Homogenous Children

Author(s): Lekic et al.
Journal: Journal of Dentistry for Children
Volume (number): 73:1
Month, Year: 2006
Major topic / Purpose of Study: To assess if tooth preparation prior to sealant application improves sealant retention
Methods and Materials:
43 children and adolescents (ages 6 to 18 years) from 4 Hutterite colonies were transported by bus to the University of Manitoba pediatric dental clinic in Winnipeg, Manitoba. These patients came from communities considered homogenous in terms of economic status, dietary habits, fluoride intake, and lifestyle.
Sealants were placed on permanent molars during a 4 year time period (8/98 to 4/01); it was decided during the initial appt. whether or not to prep teeth.
Preparations were done with a 1/2 or 1/4 round bur. Tooth surfaces were cleaned with pumice slurry. Rubber dam isolation was used for all teeth. After acid etching for 20 seconds and rinsing for 30 seconds, non-prepped teeth were sealed with BIS-GMA.
PRRs were categorized into three types: (A) minimal fissure prep (1/4 to 1/2 round burs), (B) caries removal with 1 or 2 round bur.
Types (A) and (B) PRRs were sealed with flowable composite using bonding agent first.
122 total teeth were treated; 54 were PRR and 68 were nonprepared sealants
Teeth were all evaluated at least 6 months after initial sealant placement
Results:
1 year after placement PRR’s type B PRRs had significantly lower retention rates (27%) compared with type A or nonprepared teeth (63%). Type B restorations were also more likely to have caries on follow-up examination (50% vs 11%).
Conclusions:
Type B preventative resin restorations are not helpful in terms of retention or caries reduction
Assessment of article: Fair article. Would have been nice to assess all teeth at the same time intervals as well as compare different sealant techniques in the same mouth.

Shear bond strength of pit-and-fissure sealants to saliva-contaminated and noncontaminated enamel

Author(s): Machado Barroso, J et al.
Journal: Journal of Dentistry for Children
Volume (number): 72:3
Month, Year: 2005
Major topic: Strength of Sealants filled vs unfilled
Minor topic(s: Saliva contaminated vs. non-saliva contaminated
Type of Article: Scientific
Main Purpose: To determine shear bond strength of an unfilled resin based sealant Clinpro vs. a filled resin based sealant Fluroshield in saliva contaminated and non-saliva contaminated enamel.
Overview of method of research: 40 permanent molars were sectioned in half and embedded in polyester resin. They were divided into 2 groups without contamination and with contamination of saliva. These were further subdivided into Clinpro and Fluroshield. Shear bond strength was then tested.
Findings: Fluroshield provided higher bond strength in the absence of contamination. There was no statistically significant difference between the two groups in that were contaminated with saliva.
Key points/Summary: Under dry conditions the filled sealant yielded better bonding performance. If contaminated with saliva both materials yielded lower bond strengths.
Assessment of article: Good article

Laura Randazzo DMD

Effect of a nonrinse conditioner on the durability of a polyacid-modified resin composite fissure sealant

Resident’s Name: Chad Abby Date: 3/6/2009

Article title: Effect of a Nonrinse Conditioner on the Durability of a Polyacid-modified Resin Composite Fissure Sealant

Author(s): Ewa Lampa DDS, Anna Brechter DDS, Jan W. V. van Dijken DDS

Journal: Journal of Dentistry for Children

Volume (number): 71:2

Month, Year: 2004

Major topic: Sealants

Minor topic(s: effect of a nonrinse conditioner on sealants

Type of Article: clinical study

Main Purpose: The purpose of this study was to evaluate the effect of the simplified conditioning on durability of polyacid-modified resin composite fissure sealants

Overview of method of research: A split mouth design was used placing fissure sealants on caries free first and second molars. One molar was randomly assigned to receive a Polyacid-Modified Resin Composite (PMRC) sealant, while the opposite molar received a resin sealant. 92 teeth were treated – the occlusal surface of the PMRC fissure sealant tooth was pretreated with the nonrinse conditioner and one coat of the primer Prime & Bond NT, which is a self-etching primer. The contralateral tooth was then conditioned with phosphoric acid and sealed with Delton sealant. The sealant was then evaluated during a two year period. In addition 49 pairs were sealed with Prime & Bond NT/PMRC after conditioning with 36% phosphoric acid and evaluated after one year.

Findings: A nonrinse conditioner reduces the risk of inadvertent contamination of the tooth tissue by eliminating the necessity of acid etching, rinsing with water and the change of cotton rolls. Instead no water rinsing is performed but a subsequent application of a separate adhesive is necessary. PMRC was developed as a direct esthetic restorative material with desirable properties of resin composites and those of fluoride-releasing glass ionomer cement. Advantages of the PMRC sealants compared to traditional resin fissure sealants include its low stress developed during polymerization, lower E-modulus, and fluoride release from the material.

Key points/Summary : Significantly higher loss rates at 1 and 2 years were observed for the nonrinse conditioner/Prime & Bond NT/ PMRC sealants. At 2 years, partial and total loss rates for Delton sealant were 23% and 11%, and for the nonrinse conditioner/ Prime & Bond NT/ PMRC sealants were 44% and 40% respectively. At one year, phosphoric acid-conditioned Prime & Bond NT/ PMRC sealants showed significantly better retention than the nonrinse conditioned PMRC sealants and the phosphoric acid-conditioned Delton sealants. Results from the study show that conditioning with nonrinse conditioner prior to sealant application cannot be recommended.



Assessment of article: Newer products now may show different results – would be an interesting study to do again.

Effect of Preparation technique, fissure morphology, and Material Characteristics on the In Vitro Margin Permeability and Penetrability of Pit and Fis

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 3/6/2009
Article title: Effect of Preparation Technique, Fissure Morphology, and Material Characteristics on the In Vitro Marginal Permeability of Pit and Fissure Sealants
Author(s): Selecman JB, Owens BM, Johnson WW.
Journal: Pediatric Dentisty
Volume (number): 29:308-14
Date: July, August 2007
Major topic: Compare 5 different sealants for permeability and penetration
Type of Article: Research article
Main Purpose: This in vitro study evaluated the effect of preparation techniques, fissure morphology and material characteristics on the marginal permeability and penetrability of 5 different pit and fissure sealants
Materials and Methods: 100 extracted permanent molars assigned to ten groups consisting of 5 sealants Aegis , Conseal f, Admira-seal,Triage, and Delton opaque divided into two groups, pumice prophy and acid etch (PP) vs air abrasion (AA). Microleakage was assessed by thermocycling for 1000 cycles protecting the root apex with utility wax and nail varnish and immersing in methylene blue dye for 24 hours and preparing for microscopic evaluation to assess dye penetration, sealant penetrability, and fissure morphology.
Findings: Leakage: The Aegis PP group had significantly lower leakage that most sealants while no leakage was measured in 44% of the specimens and 18% had minimal leakage. Admira-seal had 90% with some leakage and 70% with the maximum leakage. Penetrability: Delton PP had the highest penetrability while Aegis PP had the lowest penetrability. Fissure type analysis: no significant differences between fissue types and microleakage and penetrability although flatter grooves tended to have better penetrability. Observations made by the authors include the fact that Triage glass ionomer sealant showed cracking and exhibited the highest microleakage and poorest retention rates. Interestingly Triage and Aegis had higher surface absorption of methylene blue but did not indicate a relationship with microleakage per se, only esthetics. In most cases, surface preparation did not affect microleakage or penetrability. However the results indicate that air abrasion is too aggressive in conditioning enamel for sealant bonding. There was no correlation between microleakage and penetrability of the sealants.
Key points/Summary : Aegis sealants show the least microleakage and inferior penetrability. Delton and Triage have superior penetrability. Fissure morphology significantly influences selant penetrability but no correlation to microleakage. Flatter grooves have deeper penetrability.
Assessment of article: Fair particle. Conclusions do not offer much clinical applicability.

Natural History of Treatment outcomes of Permanent First Molars

Department of Pediatric Dentistry
Lutheran Medical Center
Date: 02/27/2009
Article title: Natural history of treatment outcomes of permanent first molars: A study of sealant effectiveness
Author(s): Bhuridej, Damiano, Kuthy, Flach, Kanellis, Heller, Dawson
Journal: Journal of Dentistry for Children
Volume (number): 136
Month, Year: Sept. 2005
Major topic: Sealant effectiveness
Minor topics: Caries
Type of Article: Retrospective review
Main Purpose: Compare natural progress of teeth without intervention with teeth treated with sealants.
Overview of method of research: Insurance claim data was reviewed and treatment outcome trees were generated. The source was IOWA medicaid claims from 1996-2000. The authors compared the treatments for 1st molars receiving sealant and 1st molars not sealed.
Findings:
40% of patients who routinely utilized medicaid for dental had sealants placed on their molars. 25% of all molars reviewed received some form of restorative treatment. Sealed molars were less likely to require further restorative treatment (13% vs 29%) Sealed molars had fewer endodontic treatments, crowns and extractions.

Key points/Summary :
Very few studies have utilized insurance data to retrospectively review treatment outcomes.
The Healthy People 2010 goal is to have 50% of high risk kids get sealants.
The Treatment Outcome Trees developed by the authors made for a graphical representation of the progression of teeth.
The more often a child utilizes the medicaid system, the more likely they are to receive sealants.
Not all unsealed molars required future restorative treatment (risk levels are different)
The authors suggest that outreach sealant programs could reduce restorative needs of high risk populations.
Inclusion criteria mandated that kids be enrolled in Medicaid during the entire study period and that they were seen at least 3 times during the study period.
The data can’t be generalized beyond a medicaid population.
Assessment of article: I think it’s universally accepted that sealants can reduce caries in high risk populations. The problem with this kind of research is that it quantifies the treatment--sealant, restorative, etc--into billing codes and doesn’t recognize subtle differences in treatment provided. This type of research is useful, but has a lot of limitations.

The Use of Pit and Fissure Sealants

Author(s): Robert J Feigal DDS PhD and Kevin J Donly DDS MS
Journal: Pediatric Dentistry
Volume (number): 28:2
Month, Year: 2006
Major topic: everything you ever wanted to know about sealants but were too afraid to ask
Type of Article: Review
Overview of method of research: Literature Review
Findings: In the 1950’s, 60’s and 70’s, 70% of all occlusal surfaces were expected to become carious within 10 years of eruption and many of these occurred within 3 years. This supported the Council of Dental Research’s policy on universal sealant application within 3-4 years of eruption. Occlusal decay accounts for 88% of decay but only 13% of tooth surfaces. Upon review of several papers, Feigal and Donly have come up with the following recommendations concerning sealant use: Sealants are an effective although underused form of prevention when applied by a professional and proper follow up is performed. Sealant benefit is exemplified by placement on high risk surfaces and those with incipient lesions. The best evaluation of risk includes tooth morphology, clinical diagnostics, caries hx, fluoride hx and oral hygiene. Primary and permanent teeth must both be evaluated for caries and considered for sealant placement. Occlusal surfaces should be cleaned prior to placement; minimal enameloplasty techniques have also been advocated. Proper bonding will greatly improve the retention and efficacy of sealants. Glass ionomer materials can be used as transitional sealants and have shown some promise as long term sealants.
Key points/Summary: Sealants are an extremely effective method of caries prevention when performed properly, especially on high risk teeth and those with incipient lesions. Proper recall and sealant repair is essential to long term sealant success.
Assessment of article: A lot of good info.

Brian Schmid DMD

Microleakage at Sealant/Enamel Interface of Primary Teeth: Effect of Er:YAG Laser Ablation of Pits and Fissures

Department of Pediatric Dentistry
Lutheran Medical Center
Date: 02/27/2009
Article title: Microleakage at Sealant/Enamel Interface of Primary Teeth: Effect of Er:YAG Laser Ablation of Pits and Fissures
Author(s): Borsatto MC, et al
Journal: Journal of Dentistry for Children
Volume (number): 71:2
Month, Year: 2004
Major topic: Sealant enamel microleakage
Minor topics: etch technique and laser ablation
Type of Article: clinical study
Main Purpose: To compare microleakage of sealants using 3 etching techniques
Overview of method of research: Primary molars were split into 3 groups to have sealant placed on the occlusal surfaces. The 1st group was etched with 37% phosphoric acid, group 2 acid etch and laser preparation, and group 3 laser preparation alone.
The molars were placed in a dye solution after a round of thermal-cycling. The teeth were then sectioned and polished into .25mm strips and looked at under a microscope and analyzed with computer software for degree of dye penetration.
Findings:
Group 1 and 2 had equal levels of microleakage. Group 3, however, had almost twice the degree of microleakage.

Key points/Summary :
Sealants success depends on its ability to:
fill pits, fissures and anatomical defects
remain bonded to enamel and not allow microleakage and consequent development of caries.
Lasers have been shown to alter enamel surface anatomy--microscopically--similar to etching in both permanent and primary teeth.
It has been speculated that laser ablation could produce a similar effect to etching
All preparations experienced some degree of microleakage.
The laser and etch technique had slightly less microleakage, but it was not statistically significant.
The authors thought that although the laser “etched” the tooth surface, it was probably irregular, which might explain the leakage.
Assessment of article: Good article. I like lasers (laser-cats) and it’s good to have some articles to ground the promoters of the product.