|Year : 2019 | Volume
| Issue : 4 | Page : 372-377
Retention of pit and fissure sealant versus flowable composite: An in vivo one-year comparative evaluation
Charanjeet Singh1, Kamalpreet Kaur2, Kavisha Kapoor2
1 Department of Pediatrics, SGRD, Amritsar, Punjab, India
2 Department of Pedodontics, SGRD, Amritsar, Punjab, India
|Date of Web Publication||7-Nov-2019|
Dr. Charanjeet Singh
Assistant Professor at Department of Pediatrics, SGRD, Amritsar, Punjab
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Pits and fissures are extremely vulnerable to the development of caries. Resin-based materials for sealing pits and fissures (pit and fissure sealants and flowable composites) are helpful in caries control by physical barrier formation, which prevents metabolic exchange between fissure microorganisms and oral environment. Retention is one of the most important prerequisites for pit and fissure sealants. Debris and pellicle might not be removed by conventional prophylaxis and etching; therefore, air abrasion (AB) for fissure preparation has been advocated for sealant retention. This in vivo study was aimed to compare the retention of resin-based pit and fissure sealant to flowable resin composition occlusal pits and fissures of all first permanent molars with and without air-abrasion over a 12-month follow-up. Materials and Methods: A randomized controlled clinical trial was done after obtaining ethical committee approval and informed and written consent. Thirty children with the age of 6–9 years, with all four caries-free first permanent molars without any hypoplasia/fracture but with pits and fissures prone to caries were included in this study. The four first molars were divided into the following four groups: Group A (tooth 16; sealant + AB), B (tooth 46; composite + AB), C (tooth 36; sealant), and D (tooth 26; composite). Assessments were made at 3, 6, 9, and 12 months for partial or total loss of sealant and caries according to Modified Simonsen's Criteria. Results and Conclusions: Flowable composite was relatively better retained than sealant at 12 months' follow-up although results were statistically insignificant. AB followed by acid etching brought superior retention than acid etching. Mandibular teeth have shown relatively superior retention. Future studies should aim at investigating better techniques and materials for sealing pit and fissures.
Keywords: Air abrasion, dental caries, flowable composite, pit and fissure caries, pit and fissure sealants
|How to cite this article:|
Singh C, Kaur K, Kapoor K. Retention of pit and fissure sealant versus flowable composite: An in vivo one-year comparative evaluation. J Indian Soc Pedod Prev Dent 2019;37:372-7
|How to cite this URL:|
Singh C, Kaur K, Kapoor K. Retention of pit and fissure sealant versus flowable composite: An in vivo one-year comparative evaluation. J Indian Soc Pedod Prev Dent [serial online] 2019 [cited 2020 Jan 20];37:372-7. Available from: http://www.jisppd.com/text.asp?2019/37/4/372/270471
| Introduction|| |
Occlusal surfaces represent only 12.5% of total surfaces of permanent dentition, but they account for almost 50% of caries in school children, making pits and fissures extremely vulnerable to the development of caries. Buonocore's bonded resin-based material for sealing pits and fissures (pit and fissure sealants and flowable composites) proved helpful in caries control by physical barrier formation, which prevents metabolic exchange between fissure microorganisms and oral environment.
Retention is one of the most important prerequisites for pit and fissure sealants. Debris and pellicle might not be removed by conventional prophylaxis and etching; therefore, air abrasion (AB) for fissure preparation has been advocated for sealant retention. Thus, the purpose of this in vivo study was to compare the retention of resin-based pit and fissure sealant (Clinpro™, 3M ESPE) to flowable resin composite (Filtek™ Z350XT, 3M ESPE) on occlusal pits and fissures of all first permanent molars with and without air-abrasion over a 12-month follow-up.
| Materials and Methods|| |
The present in vivo study includes a randomized controlled clinical trial with assessments made at 3, 6, 9, and 12-month follow-up. Prior to the inclusion of patients, approval from institution ethical committee, and informed and written consent was obtained from parent/guardian. Thirty children with the age of 6–9 years, with all four caries-free first permanent molars without any hypoplasia/fracture but with pits and fissures prone to caries were included in this study.
Lignocaine gel (2%) was applied, and teeth were isolated using a rubber dam. The four first molars were divided into four groups: Group A, B, C, and D.
For Group A and B, AB of was done with AB device (Micro Etcher™ ERC, Danville materials) using 50 μm aluminum oxide particles stream perpendicular to the surface at 90–120 psi air pressure for 15 s. Teeth were then rinsed thoroughly with water spray to clean the surface from residual alumina particles.
For all groups (after AB for Group A and B), teeth were acid etched with 35% phosphoric acid (Scotchbond multipurpose etchant, 3M ESPE) for 15 s. Etched teeth were then rinsed and dried.
For Group A and C, sealant (Clinpro™, 3M ESPE) was applied to the pit and fissures and polymerized for 20 s using light-emitting diode dental light-curing unit (Ivoclar, Vivadent) with a wavelength of 430–490 nm.
For Group B and D, bonding agent (Adper single bond 2 adhesive system, 3M ESPE, USA) was applied in two consecutive coats, with a clean microbrush and was allowed to dry for 5 s and polymerized for 10 s, then flowable composite (Filtek™ Z350XT, 3M ESPE) was applied in pit and fissures and polymerized for 20 s.
After the placement of sealing materials, occlusal surfaces were checked for high points with articulating paper, and if found, were reduced with composite finishing stone (Shofu, Shofu Dental Corporation).
The clinical evaluation of sealants was done by pedodontist (single-blind study) with the aid of dental explorer no. 5 and intraoral mirror for partial or total loss of sealant and caries according to Modified Simonsen's Criteria at 3, 6, 9, and 12 months' follow-up.
- Score 0: No loss of sealant and no evidence of caries
- Score 1: Partial loss of sealant and no evidence of caries
- Score 2: Partial loss of sealant and evidence of caries
- Score 3: Complete loss of sealant and no evidence of caries
- Score 4: Complete loss of sealant and evidence of caries.
The data were then compiled and statistically analyzed with Mann–Whitney test and Kruskal–Wallis test.
| Results|| |
[Table 1] shows the sample characteristics and [Table 2], [Table 3] and [Table 4] show the comparisons of retention among different materials at different time intervals. Retention of sealant in groups materials both composite and sealant that were placed without AB showed approximately 30% of loss by 12 months whereas sealing materials both composite and sealant that were placed with AB followed by acid etching showed approximately 20% of loss by 12 months. It was also concluded that composite placed with air-abrasion Group B (73.3%) showed maximum retention followed by sealant placed with air-abrasion Group A (70%).
|Table 2: Comparison of retention scores in terms of mean (SD) among different materials at different time intervals using Kruskal-Wallis test|
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|Table 3: Multiple comparisons of different groups for the retention at 3, 6, 9 and 12 months using Mann-Whitney test|
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|Table 4: Comparison of retention scores in terms of Mean (SD) of different materials at different time intervals using Kruskal-Wallis test|
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At 6th month, it was found that when composite was compared with sealant without air-abrasion and composite with air-abrasion showed significant results (P = 0.046 and P = 0.023). A significant result was also seen when sealant without air-abrasion was compared with composite without air-abrasion (P = 0.046) and when composite with air-abrasion was compared with composite without air-abrasion (P = 0.023).
Only Group D (composite without air-abrasion) compared at 3rd, 6th, 9th, and 12th month showed the mean value of 0.11 with P = 0.001 which came out to be highly significant (P < 0.001).
| Discussion|| |
Despite a considerable reduction in the prevalence of dental caries, it continues to be one of the main public health problems worldwide. In children and adolescents, caries mainly affects deep and narrow pits and fissures on occlusal surfaces of first and second permanent molars due to difficulty in cleaning, thinner and immature enamel during eruption phase., Fissure sealing is a safe and effective preventive measure  and is based on physical barrier formation that prevents metabolic exchanges between microorganisms in the fissures and the oral cavity.
The clinical success of fissure sealing relies on enamel bonding, tooth anatomy, and retentive capacity.
The goal of fissure sealing is to reduce the dental decay risk from any external source. Proper isolation is done to prevent salivary contamination. Enamel pretreatment provides optimal retention by preventing marginal microleakage, providing access to deep pits and fissures, removing stains and organic debris, and increasing surface roughness. It involves various techniques such as pumice prophylaxis, acid etching, air-abrasion, and air-abrasion with acid etching.
Deep pits and fissures are inaccessible with pumice prophylaxis or acid etching, thus affecting the ability of the sealant to isolate these fissures. AB, initiated by Robert Black, is a pseudo-mechanical, nonrotary method of cutting and removing dental hard tissue. It shows better bonding of enamel and dentin surfaces. With flowable and nanofilled composites, it is easier to restore cavities which do not confer with GVBlack's specifications.
One of the reasons for selecting the sealant material Clinpro was that it is an unfilled sealant. This was supported by Rock et al. (1990) who use a split-mouth design concluded that an unfilled light-cured resin-based sealant was significantly better retained than a filled one. An unfilled resin would penetrate deeper into the fissure system because of its lower viscosity and therefore would, perhaps, be better retained. This fact was also ascertained by Kumaran who reported that the fillers increase the viscosity and that the viscosity of the sealant materials affected the penetration into the microporosities created by acid etching which is a prerequisite for sealant placement. Another reason may be that Clinpro presents with a unique property of color change from the original color of pink to white on being light-cured. The pink color allows for the better visualization of the sealant in the fissures, which would ensure that the pits and fissures are completely covered with the sealant.
Superior results of AB followed by acid etching compared to acid etching technique have been seen by Yazici et al. The reason may be that air-abrasion may induce a more retentive etching pattern and enhance etchant penetration to deep fissures, as this system widens and deepens the pits and fissures, eliminates organic material/contamination and exposes a more reactive tooth enamel. The AB technique removes the prism less enamel layer and enhances the development of resin tags to obtain better bonding results.
In our study, there was difference of approximately 3% between sealant and flowable composite placed with or without air-abrasion in 12 months' follow-up. Jafarzadeh et al. have shown similar results of 89.7% and 84.6% retention with flowable composite and conventional sealant, respectively, concluding that flowable composite was superior than sealants.,
Like our study, Reddy et al. have concluded that flowable composites show relatively better retention on mandibular teeth. This could be because of direct vision, gravity-aided flow of sealant, and well-defined pits and fissures.
Fatima also concluded superior results with flowable composite than pit and fissure sealant due to a better degree of conversion during curing. Aguilar et al. concluded better retention and penetration of material with a higher percentage of filler than conventional sealant. Oba et al. attributed it to higher viscosity, less polymerization shrinkage, greater microhardness, and better abrasion resistance of filled material.
The maximum sealant was lost during the first 6 months in our study, similar to a study by Dhar and Chen. The reason could be attributed to the lack of proper isolation, diet differences, dental health awareness, and use of indigenous oral hygiene practices.
| Conclusions|| |
The flowable composite was relatively better retained than sealant at 12 months' follow-up, although results are statistically insignificant. Moreover, AB followed by acid etching brought superior retention than acid etching. Flowable composites, due to higher wear resistance, reduce office, and patient expenditure. Mandibular teeth have shown relatively superior retention. Future studies should aim at investigating better techniques and materials for sealing pit and fissures.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]