|Year : 2013 | Volume
| Issue : 3 | Page : 159-164
Comparative evaluation of retention ability of amorphous calcium phosphate containing and illuminating pit & fi ssure sealants in 6-9 year old age group
Amit Kishor1, Mousumi Goswami2, Seema Chaudhary3, Naveen Manuja3, Rachita Arora4, Mandeep Rallan5
1 Department of Pedodontics, Sarjug Dental College, Darbhanga, Bihar, India
2 Department of Pedodontics, ITS Dental College, Greater Noida, Uttar Pradesh, India
3 Department of Pedodontics, Kothiwal Dental College & Research Centre, Moradabad, Uttar Pradesh, India
4 Department of Pedodontics, Avadh Dental College, Jamshedpur, Jharkhand, India
5 Department of Pedodontics, Teerthankar Mahavir Dental College, Moradabad, Uttar Pradesh, India
|Date of Web Publication||11-Sep-2013|
E-173, Ashiana Suncity, Baliguma, Jamshedpur-831 012, Jharkhand
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aims: The primary aim of this study is to evaluate and to compare the retention of two different pit and fissure sealants on permanent mandibular 1 st molar teeth. Materials and Methods: A total of 110 children aged between 6-9 years were selected. In each child, Aegis with amorphous calcium phosphate sealant was applied on the permanent mandibular 1 st molar of the right side while Delton the illuminating sealant was applied on the permanent mandibular 1 st molar of the left side, keeping the permanent maxillary 1 st molars as control. The treated teeth were evaluated for retention of sealants at 3, 6 and 12 months interval. Statistical Analysis Used: The statistical analysis was performed using the Mann-Whitney U-test and Chi-square tests and Statistical Package for the Social Science version 15.0 statistical analysis software. Result: The results were showed that retention and loss of sealant from the occlusal surfaces of the sealed teeth in both groups was maximum between 3 and 6 months. Conclusion: Though statistically no significant difference was observed between the two groups, sealant with ACP showed better retention than the illuminating sealant.
Keywords: Amorphous calcium phosphate, Illuminating pit and fissure sealants, Retention
|How to cite this article:|
Kishor A, Goswami M, Chaudhary S, Manuja N, Arora R, Rallan M. Comparative evaluation of retention ability of amorphous calcium phosphate containing and illuminating pit & fi ssure sealants in 6-9 year old age group. J Indian Soc Pedod Prev Dent 2013;31:159-64
|How to cite this URL:|
Kishor A, Goswami M, Chaudhary S, Manuja N, Arora R, Rallan M. Comparative evaluation of retention ability of amorphous calcium phosphate containing and illuminating pit & fi ssure sealants in 6-9 year old age group. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2020 Feb 18];31:159-64. Available from: http://www.jisppd.com/text.asp?2013/31/3/159/117966
| Introduction|| |
Significant progress has been made in the prevention of dental caries in children and adolescents over the past 30 years.  Preventive measures, when applied properly, show significant results in reducing dental caries. However, as the prevalence of occlusal caries is still high, pit and fissure sealants are recommended and commonly utilized since their introduction into dentistry.  The main function of sealants is to modify pit and fissure morphology to form an efficient physical barrier between the enamel surface and oral environment for as long as possible.  It is generally believed that, if the adhesion property of the sealant material is high, the retention of the sealant is secured.  Therefore, retention is one of the most important pre-requisites of the pit and fissure sealants. 
The implementation of scientific innovations is most important in advancing both dental care systems and dental science. However, scientific knowledge in dentistry is not always well implemented.  Today in dentistry, many advanced sealant materials are available. They differ according to the base material used, the method of polymerization and whether or not they contain fluoride. 
During the last decade, research has been conducted to test materials that may stimulate the repair of tooth structure.  Amorphous calcium phosphate is referred to as a "smart material" because it only releases calcium and phosphate ions when the surrounding pH drops to a level where it could start to dissolve the tooth. Once the calcium phosphate is released, it will act to neutralize the acid and buffer the ph. Recent decade has introduced sealants that contain fluoride and ACP. 
As visual inspection is difficult on sealed surfaces, practitioners need adjunct diagnostic methods. There are various illuminating pit and fissure sealants available. Through the use of an ultraviolet (UV) light source, they fluoresces a blue color. The fluorescent glow provides clinicians with a visual verification of the sealant margins at the time of placement and offers the easiest way to verify retention and inspect margins during patient recall appointments. 
While pit and fissure sealants have been demonstrated to be effective in occlusal caries prevention, incorrect application of the sealant could result in leakage and microorganisms trapped underneath sealants could lead to caries lesion development. Consequently, undesirable outcomes, such as loss of tooth structure, larger restorations and endodontic treatment can occur. Besides this, incorrect application of sealants can lead to failure and sealant loss. Therefore, regular follow-up is required to ensure the long-term success of the sealant treatment. 
Hence, the purpose of this study was to compare between ACP releasing pit and fissure sealants and illuminating pit and fissure sealants in terms of retention among 6-9 years school children of Moradabad.
| Materials and Methods|| |
This study was reviewed and cleared by the Ethical Committee of Kothiwal Dental College and Research Center, Moradabad.
Screening of children was performed in 10 different schools of Moradabad city after seeking permission from the respective authorities. A sample consisting of 110 children aged between 69 years were selected for the study according to the inclusion and exclusion criteria. The examination was carried out in natural light with the child on a chair facing the examiner and away from direct sunlight.
- Study subjects aged between 6-9 years.
- Completely erupted and caries free right and left permanent mandibular and maxillary 1 st molars with deep pits and fissures.
- All four completely erupted permanent 1 st molars to be present in occlusion.
The selected children were then divided into two groups according to the sealants used:
- Subjects with restorations, grossly decayed teeth, attrited or with any preventive measures carried out in permanent 1 st molars.
- Subjects in whom the permanent 1 st molars were missing.
Group A: Sealant with ACP was applied
Group B: Illuminating sealant was applied
Both the sealants were placed under careful isolation with a rubber dam and salivary ejectors were used throughout the procedure. The tooth surfaces were first cleaned with pumice and water slurry. Acid-etching was performed and the sealant was carefully applied from the central fissure up towards the cusps in order to prevent voids, air entrapment or bubbles. A single application of two sealants was done randomly on the right and left lower 1 st permanent molars. After the sealants were placed, the rubber dam was removed and the occlusion was checked with a carbon marker. Any premature contact was removed to ensure that sealants did not produce occlusal interference. Oral hygiene instructions were given to all the study subjects.
The subjects were evaluated at every 3, 6 and 12 months intervals for a total period of a year. After drying, teeth were assessed using illuminating UV light and those with ACP sealant were assessed visually and with an explorer. The evaluation included the assessment of the sites of defective coverage for the effectiveness (retention) of the sealant. [Figure 1] represents the division of the occlusal fissure for a permanent mandibular molar, which was divided into five surfaces. A pre-tested standardized proforma, for collecting all the required and relevant information was carried out. The collected data was subjected to statistical analysis using the Mann-Whitney U test and Chi-square tests to evaluate the difference in retention rates between Group I and II.
|Figure 1: Division of the occlusal fissure system on permanent mandibular 1st molar for classification of sites of loss of sealant M=Mesial site, D=Distal site, B=Buccal site, K=Central site, L=Lingual site|
Click here to view
| Results|| |
[Table 1] and [Graph 1] [Additional file 1] showed more loss of sealants in Groups II at baseline to 3 rd visits (26%), while on comparing inter visits Group II showed more loss of sealants from 1 st to 3 rd visits (13.95%).
[Table 2] showed statistically highly significant difference on comparing both Group I and Group II with the baseline value to 1 st , 2 nd and 3 rd visits. Group I showed statistically significant value on comparing 1 st -2 nd and 1 st -3 rd visits whereas, statistically no significant difference was observed on comparing 2 nd -3 rd visits. Statistically no significant difference was observed on comparing 1 st 2 nd , 1-3 rd and 2 nd -3 rd visits.
[Table 3]a and [Graph 2] [Additional file 2] showed more loss of sealants from mesial sites in Group I at 2 nd visits, whereas Group II showed more loss of sealants at the 3 rd visits from mesial surfaces. [Table 3]b [Graph 3] [Additional file 3].
| Discussion|| |
Good oral health is an integral component of good general health. Although enjoying good oral health includes more than just having healthy teeth, many children have inadequate oral and general health because of active and uncontrolled dental caries. 
The development of a clinical carious lesion involves a complicated interplay among a number of factors in the oral environment and the dental hard tissues.  In many ways, it is considered a disease of modern times as its occurrence seems to be much higher in the last few generations. 
The disease is also increasingly isolated in specific teeth and tooth morphology types in both primary and mixed dentitions, with pits and fissures being the predominant diseased sites. The occlusal surface of a molar tooth is the most caries susceptible site, while buccal and palatal pits are the least susceptible. 
According to Sidney B. Finn; 63%, 75% and 93% of 6, 7 and 8 year old respectively showed occlusal fissure caries in their 1 st permanent molars. Therefore, it is important to prevent the occurrence of caries in pits and fissures as soon as tooth eruption starts. 
ACP was first described by Aaron S. Posner in 1963 and today they are used as components of calcium phosphate coated implants, dental ceramics, chewing gums, toothpastes, mouthwashes and sealants.  ACP-based materials, capable of providing the extended supply of Ca 2+ and PO4 3 ions needed to reform damaged mineral structures are particularly attractive as bioactive, anti-demineralizing and remineralizing composites. 
Hybridized ACP filler include urethane dimethcrylate (UDMA) or ethoxylated bisphenol a dimethacrylate as base monomers. UDMA has been shown to reduce water sorption and polymerization shrinkage while enhancing the mechanical properties of resin materials. 
Studies by Skrtic and Antonucci et al. Suggested that ACP appropriately formulated with polymeric resins and applied as a sealant to tooth surfaces may be an effective agent for establishing intra lesion fluoride ion concentrations.  In our study Aegis (Group I), an ACP containing pit and fissure sealant, was used.
As visual inspection for sealant detection is a subjective method, new methods are required to provide some objectivity. If a sealant is placed over a lesion, for a long-term success the practitioner needs to monitor and assess any changes in the status of a sealant.  Today, there are many types of clear, tinted photochromatic and illuminating sealants available, which can be easily appreciated by the patient and monitored by the dentist at subsequent visits.
Aguilar in 2007 combined a resin based sealant with a photochromatic dye that changed its color to green when exposed to halogen light for a period as short as 3sec. According to him this technique helped in better evaluation of sealant integrity.  In the present study, Delton-seal N-Glo (Group II) illuminating sealants was used, which can be easily monitored by UV light at subsequent visits.
The use of rubber dam in the present study for complete isolation of the tooth is similar to the study conducted by D. Locker who stated that isolation by rubber dam or cotton rolls is equally effective and results in an increase in retention rates. 
The school children chosen in this study were of age 6-9 years as the chances for decay, which appears 2-4 years after eruption, were high in permanent molars of children in this age group. The pits and fissures of 1 st permanent molars remain susceptible to primary decay into adolescence and beyond. 
Splieth et al. gave the indication regarding placement of sealant in erupting teeth and stated "until erupting teeth reach full occlusion, the fissure relief on occlusal surfaces, especially in molars, forms an almost perfect niche for plaque stagnation and preventive measures are not implemented at a sufficient level.  Considering these facts the present study incorporated children from the age group 6-9 years.
In the present study, both groups showed more loss of sealant between baseline and 2 nd visit (first 6 months), as compared with the baseline and 1 st visit (first 3 months), which is similar to the conclusions drawn by Morphis and Toumba who confirmed that the highest period of sealant failure is at baseline and at 6 months following sealant application. 
Subramaniam et al. also showed highest loss of sealants within the first 6 months. According to them sealant loss (retention failure) occurs in two phases: There is an initial loss due to faulty technique (such as moisture contamination), followed by a second loss associated with material wear under the forces of occlusion. 
Simonsen stated that a significant amount of wear takes place within the first 6 months which causes greater proportion of sealant loss prior to 1 year.  This was also supported by Komatsu et al who related decrease in retention rate to occlusal stress occurring during eruption. 
In the present study, partial loss of sealant in both groups from baseline to 2 nd visit (6 months) was 24% and from baseline to 1 st visit (3 months) was 14%, which is similar to the studies done by Futatsuki and others who found that the rate of partial and complete sealant loss on the observed surfaces was 14.4% at the 3 months recall, with further loss of 7% between 3 and 6 months recall. The loss is believed to result from fracture caused by a failure of adhesion between the sealant and tooth enamel, rather than wearing away of the sealant material. 
Comparing the loss of sealant in between 2 nd and 3 rd visits, Group I (Aegis) showed a similar pattern of retention while there was marked loss of retention in Group II (Delton).
On comparing Aegis, Delton and other sealants, James B reported lower microleakage values with Aegis sealant, which showed better retention than others. 
In the present study, at the final evaluation (12 months) both the Aegis and Delton groups showed 76% and 74% complete retention which is similar to the study conducted by Shashikiran et al. who observed high retention rates of 76-85% after 10 months.  Bendinskaite et al. concluded that in spite of all the efforts to seal the pits and fissures properly, measurable failure rates of 5-10% sealant/year were observed,  which was close to what we had observed in the present study.
Many clinical trials of sealants have not used the surface as the unit of analysis for measurement of retention, but have divided the surface into "sites" (anatomical regions) on morphological grounds. This approach allows the identification of "sites" on a surface most prone to failure. 
In the present study, the occlusal surface of sealed tooth showed that Group II (Delton) had significantly higher proportion of teeth with more sealant missing from mesial, lingual, distal and buccal than central sites of sealant as compared to Group I (Aegis), but the difference was not statistically significant. The loss of Delton sealant was easily observed with illuminating light, which was not so in ACP sealant wherein, reliability was there on naked eyes. It could be one of the reasons of the aforesaid observation.
Buccal pits and lingual grooves are the areas where application of sealant was difficult. Buccal and lingual surfaces are also more difficult to protect than the occlusal surfaces.
Though both sealants and fluoride are good preventive measures for caries; further studies are warranted to establish issues regarding sealant failure, like children of different ages, tooth surfaces that are more prone to contamination and longer follow-up periods.
| References|| |
|1.||Strassler HE. A unique moisture-tolerant, resin-based pit-and-fissure sealant: Clinical technique and research results. Dent In 2008;4:1-2. |
|2.||Silva KG, Pedrini D, Delbem AC, Ferreira L, Cannon M. In situ evaluation of the remineralizing capacity of pit and fissure sealants containing amorphous calcium phosphate and/or fluoride. Acta Odontol Scand 2010;68:11-8. |
|3.||Muller-Bolla M, Lupi-Pégurier L, Tardieu C, Velly AM, Antomarchi C. Retention of resin-based pit and fissure sealants: A systematic review. Community Dent Oral Epidemiol 2006;34:321-36. |
|4.||Beiruti N, Frencken JE, van't Hof MA, van Palenstein Helderman WH. Caries-preventive effect of resin-based and glass ionomer sealants over time: A systematic review. Community Dent Oral Epidemiol 2006;34:403-9. |
|5.||Aguilar FG, Drubi-Filho B, Casemiro LA, Watanabe MG, Pires-de-Souza FC. Retention and penetration of a conventional resin-based sealant and a photochromatic flowable composite resin placed on occlusal pits and fissures. J Indian Soc Pedod Prev Dent 2007;25:169-73. |
|6.||Nakata M, Kuriyama S, Mitsuyasu K, Morimoto M, Tomioka K. Transfer of innovation for advancement in dentistry: A case study on pit and fissure sealants' use in Japan. Int Dent J 1989;39:263-8. |
|7.||Komatsu H, Shimokobe H, Kawakami S, Yoshimura M. Caries preventive effect of glass ionomer sealant reapplication:Study presents three-year results. J Am Dent Assoc 1994;125:543-9 |
|8.||Sharma S, Kugel G. Amorphous calcium phosphate sealants-The potential to remineralize. Inside Dent 2009; 5:1-3. |
|9.||Pit and fissure sealant with ACP products restorative aegis® pit & fissure sealant with acp. Harry J. Bosworth Company, 2002-2013. |
|10.||Dentsply Pvt. Ltd. Product guide for delton seal n glo 2010. |
|11.||Diniz MB, Rodrigues JA, Hug I, Cordeiro RC, Lussi A. The influence of pit and fissure sealants on infrared fluorescence measurements. Caries Res 2008; 42:328-3. |
|12.||McDonald RE, Avery DR, Dean J A. Dentistry for the Child & Adolescent. 9 th ed. India: Elsevier; 2011. |
|13.||Axelsson P, Odont. Dr. Diagnosis and Risk Prediction of Dental Caries. Vol. 2. 551 Germany: Quintessence Publishing Co.; 2000. |
|14.||Tandon S. Textbook of Pedodontics. 2 nd ed. Hyderabad, India Paras Medical Publisher; 2008. |
|15.||Morgan A. Fissure sealants in children: A practical guide for the dental team. Dent Nurs 2010; 6:694-6. |
|16.||Finn SB. Epidemiology of dental caries. Clin Pedod 2003; 4 th ed.:454. |
|17.||Boskey AL. Amorphous calcium phosphate: The contention of bone. J Dent Res 1997;76:1433-6. |
|18.||Skrtic D, Antonucci JM. Dental composites based on amorphous calcium phosphate-Resin composition/physicochemical properties study. J Biomater Appl 2007;21:375-93. |
|19.||Skrtic D, Antonucci JM, Eanes ED, Eidelman N. Dental composites based on hybrid and surface-modified amorphous calcium phosphates. Biomaterials 2004;25:1141-50. |
|20.||Skrtic D, Hailer AW, Takagi S, Antonucci JM, Eanes ED. Quantitative assessment of the efficacy of amorphous calcium phosphate/methacrylate composites in remineralizing caries-like lesions artificially produced in bovine enamel. J Dent Res 1996;75:1679-86. |
|21.||Sönmez IS, Oba AA, Erkmen M, Ekici S. Effects of different fissure sealant applications on laser fluorescence measurements. Int J Paediatr Dent 2011;21:29-34. |
|22.||Locker D, Jokovic A, Kay EJ. Prevention. Part 8: The use of pit and fissure sealants in preventing caries in the permanent dentition of children. Br Dent J 2003;195:375-8. |
|23.||Splieth CH, Ekstrand KR, Alkilzy M, Clarkson J, Meyer-Lueckel H, Martignon S, et al. Sealants in dentistry: Outcomes of the ORCA Saturday afternoon symposium 2007. Caries Res 2010;44:3-13. |
|24.||Morphis TL, Toumba KJ. Retention of two fluoride pit-and-fissure sealants in comparison to a conventional sealant. Int J Paediatr Dent 1998;8:203-8. |
|25.||Simonsen RJ. Retention and electiveness of dental sealant after 15 years. J Am Dent Assoc 1991; 122: 34-42. |
|26.||Autio-Gold JT. Clinical evaluation of a medium-filled flowable restorative material as a pit and fissure sealant. Oper Dent 2002;27:325-9. |
|27.||20. Marks D, Owens BM, Johnson WW. Effect of adhesive agent and fissure morphology on the in vitro microleakage and penetrability of pit and fissure sealants. Quintessence Int 2009;40:763-72. |
|28.||Shashikiran ND,Subbareddy VV, Deshpande A. A clinical comparison of visible light activated unfilled, fluoride and non-fluoride containing and filled fluoride containing pit and fissure sealants. J Cons Dent 2004;7:70-6. |
|29.||Bendinskaite R, Peciuliene V, Brukiene V. A five year clinical evaluation of sealed occlusal surfaces of molars. Balt Dent Maxillofac J 2010;12:87-92. |
|30.||Deery C, Fyffe HE, Nugent ZJ, Nuttall NM, Pitts NB. A proposed method for assessing the quality of sealants-The CCC sealant evaluation system. Community Dent Oral Epidemiol 2001;29:83-91. |
[Table 1], [Table 2], [Table 3]