New Evidence Questions Ruling Quality Criterion for Pit and Fissure Sealants

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SYSTEM Initiative: New clinical evidence is now available that questions the use of ‘material retention’ as the current ruling criterion for quality of placed pit and fissure sealants.

For decades the complete and flawless retention of sealant materials on pits and fissures of posterior teeth has been accepted by the dental profession as the most important factor in preventing the development of tooth caries. While sealant retention has indeed been shown to be a beneficial factor, among many in caries prevention, professional consensus has grown to accept it as the paramount quality criterion according to which different available sealant materials are either accepted or rejected. Consequently the dental material resin composite, shown to have the highest sealant retention rate in pits and fissures, is thus considered to be the current sealant material of choice.

Through a systematic search of the dental literature, a recently published meta-epidemiological study found 95 clinical trials that investigated the retention rate and related caries occurrence on resin-sealed teeth. The caries predictive power of losing resin material in pits and fissures, based on the combined data of these trials, was statistically compared to the predictive power of mere random guesses. To the surprise of the investigators, no significant difference beyond the play of chance was found. Thus sealant retention loss appears not to be a valid predictor of clinical outcome.

While the results do not question sealant retention as a beneficial factor in caries prevention, they shed grave doubt on the justification of its status as the ruling quality criterion for pit and fissure sealants. Such status can be justified only by a proven direct correlation of sealant retention with caries occurrence; an independence of such correlation from the type of sealant material and/or sealant techniques plus a strong predictive power (similar to clinical diagnostic tests) regarding true occurrence of tooth caries (with low numbers of false positive and false negative predictions not exceeding between 2.5 – 10.0% of total predictions).

The findings that the caries-predictive power of loss of resin material in pit and fissures was no different from that of mere random guesses suggests that ‘retention’ does not meet the most important requirement.

There is a danger that use of invalid quality criteria may lead to unjust rejection of valid sealant materials. In the past, several systematic reviews have compared the clinical, caries- preventive effect of the two most common sealant materials; resin and glass-ionomers, but found no difference between the two, despite the significantly inferior retention rate of glass-ionomers. Consequently, dental associations in many countries, such as Germany, have not accepted glass-ionomers as suitable pit and fissure sealants.

The conclusions of the new findings suggest that clinical outcomes, such as caries occurrence rates in formerly sealed teeth need to be adopted as the ruling quality criteria for pit and fissure sealants, instead of mere sealant material retention.

The full report of the meta-epidemiological study: Mickenautsch S, Yengopal V. Retention loss of resin based fissure sealants - a valid predictor for clinical outcome? Open Dent J 2013; 7: DOI: 10.2174/18742106201305130001 (e-publication ahead of schedule) is freely available online.

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