New Evidence Shows No Scientific Difference Between Ruling Fissure Sealant Options and Alternative Materials

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SYSTEM Initiative: New findings indicate absence of clinical evidence that glass-ionomers are inferior in their caries preventive effect to resin composites as current gold standard for the placement of dental pit and fissure sealants.

Glass-ionomer based sealants may offer an alternative in the prevention of tooth caries to placing resin in pits and fissures.

For decades the dental community has operated under the assumption that glass-ionomers are inferior to the current gold standard of resin composite materials when sealing pit and fissure to prevent the development of tooth caries due to its low material retention.

Although sealant retention has been shown to be a beneficial factor, among many in caries prevention, professional opinion has championed its unquestioned superiority. This has led to a rejection of alternative sealant approaches.

In an effort to appraise the current clinical evidence regarding the merits of placing glass-ionomers as tooth restorations, the SYSTEM Initiative of the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, has conducted a systematic review of clinical trials.

The systematic review included a literature search in eight scientific databases. Besides searching the global databases, such as PubMed/Medline and the Cochrane library, the searched additional open-access data sources comprised of Biomed Central; the Directory for Open Access Journals and Science Direct.

In total, 16 clinical trials were accepted as evidence, comprising the investigation of more than 7 000 placed fissure sealants. The outcome shows that glass-ionomers cannot be regarded as inferior to resin. No statistically significant difference was found in the caries failure rate between glass-ionomer and resin sealed teeth after follow-up periods ranging from six months to seven years.

Throughout the systematic review clinical trials were assessed and subsequently accepted or rejected according to criteria related to study validity. All clinical evidence was closely examined for risk of systematic errors and several trials were excluded on the basis of high bias risk and low precision of results.

The overall outcome offered no evidence to support the notion that glass-ionomer cements are inferior to resin as the current gold standard when sealing pit and fissure to prevent the development of tooth caries. A subsequent investigation to the original systematic review in 2008 was conducted in 2013 and established that its conclusion remains current.

There is a danger in the dental community that invalid criteria may lead to an unjust rejection of valid sealant materials.

The new findings suggest that placing glass-ionomer based sealants may offer an alternative in the prevention of tooth caries to placing resin in pits and fissures of permanent teeth.

The published full reports of the new findings are available online:
[Mickenautsch S, Yengopal V. Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: An update of systematic review evidence. BMC Res Notes 2011; 4: 22.

And:
Mickenautsch S, Yengopal V. The modified Ottawa method to establish the update need of a systematic review: Glass-ionomer versus resin sealants for caries prevention. J Appl Oral Sci 2013; 21: 482-9.

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Dr S Mickenautsch
SYSTEM Initiative, Univ. of the Witwatersrand, Johannesburg
+27 823363214
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