Clinical Evidence Shows No Difference Between Resin - And Glass Ionomer Based Fissure Sealant Efficacy

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SYSTEM Initiative: Systematic review evidence indicates no clinically meaningful difference between resin and glass-ionomer based methods in the sealing of pit and fissure to prevent the occurrence of dental caries.

SYSTEM Initiative

There is no clinically meaningful difference between resin and glass-ionomers when sealing pits and fissures to prevent dental caries.

For many years the dental community has operated under the widespread belief that glass-ionomers are inferior to the gold standard of resin materials when sealing pit and fissures to prevent the occurrence of dental caries.

This assumption has led to a worldwide distancing from alternative yet equally effective methods. Although no reliable clinical evidence exists to confidently determine the clinical superiority of resin-based sealants over glass-ionomers, the dental community continues to function on the basis of this conclusion.

The selective focus on clinical literature that favours resin composite materials in terms of high retention rates of the material in dental pits and fissures as a surrogate for caries preventive efficacy may be responsible for the development of this belief.

Dental professionals generally accept the information provided by scientific studies that have passed the peer review system. Thus, it is a natural conclusion that available dental literature, should it favour a more traditional approach, is relied upon and applied in daily dental practice.

However, such selective focus discounts other clinical evidence that offer an alternative view. Thus, in order to determine an objective response to the popular notion that resin sealants are superior to glass-ionomer based alternatives; it is essential that all the available literature to the topic be taken into account.

In an effort to appraise the clinical literature to this topic, the SYSTEM Initiative of the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, has conducted a systematic review of clinical trials that compare resin and glass-ionomers sealants in terms of caries preventive efficacy.

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 based sealants, because no difference beyond the play of chance 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.

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 dental caries. A subsequent investigation to the original systematic review in 2008 was conducted in 2013 and established that this conclusion remains current.

In addition, the SYSTEM initiative found that the retention rate is not a valid surrogate for the caries preventive efficacy of fissure sealants.

The published full reports of the new findings are available online:
[1] 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.

[2] 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.

[3] [Mickenautsch S, Yengopal V. Validity of sealant retention as surrogate for caries prevention – a systematic review. PLOS One 2013; 8: e77103.

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