|Year : 2012 | Volume
| Issue : 3 | Page : 227-230
Evaluation of two resin based fissure sealants: A comparative clinical study
MR Bhatia, AR Patel, DD Shirol
Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Pune, India
|Date of Web Publication||21-Dec-2012|
M R Bhatia
Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Pune
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objective: To evaluate retention of two resin based fissure sealants (Embrace and Delton FS+) for a period of twelve months. Materials and Methods: Sixty eight first permanent molars were sealed for seventeen healthy children in the age group of six-eight years. According to random selection, the first permanent molars on the right side of both arches were sealed with Embrace (Group A) and on the left side of both arches were sealed with Delton FS+ (Group B). Results: The total retention of Embrace was 23.50% and for Delton FS+ was 17.60% at one year. Conclusion: At one year the total retention of Embrace was 23.50% and for Delton FS+ was 17.60%, however the results were statistically insignificant.
Keywords: Moisture dependant chemistry, pit and fissure, retention, sealants
|How to cite this article:|
Bhatia M R, Patel A R, Shirol D D. Evaluation of two resin based fissure sealants: A comparative clinical study. J Indian Soc Pedod Prev Dent 2012;30:227-30
|How to cite this URL:|
Bhatia M R, Patel A R, Shirol D D. Evaluation of two resin based fissure sealants: A comparative clinical study. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2020 Oct 19];30:227-30. Available from: https://www.jisppd.com/text.asp?2012/30/3/227/105015
| Introduction|| |
Dental caries, an infectious, microbial and multifactorial disease, is still a highly prevalent pathology in the worldwide population, in spite of traditional and innovative prevention methods. In the field of preventive dentistry, significant progress has been made with the introduction of fluorides which has become one of the most important caries preventive agents. A review of dental literature indicates that the main caries inhibiting effect of fluoride used either systemically or applied topically is on smooth surfaces of teeth.  Hence, caries of the pit and fissure still remains a significant problem.
Sealant placement is considered as an effective modality for prevention of caries on occlusal pits and fissures. Sealants provide 'physical' protection of the tooth structure against cariogenic factors, inhibiting bacterial growth and providing smooth surface that increases the probability that the surface will stay clean. , A recent development with resin based sealant is one whose chemistry is moisture dependant, which forms chemical and micromechanical bonds to tooth and restorative surfaces in a slightly moist field. The material is activated in the presence of moisture and is recommended for use on surfaces that are slightly moist. The following study has been done to evaluate two different sealant materials based on a wetbond technology and with a conventional placement technique.
| Materials and Methods|| |
The study was conducted on seventeen children in the age group of six-eight years, fulfilling the following criteria, were selected at random from those reporting to the Department of Paediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Pune, after obtaining informed consent.
Sixty-eight sound first permanent molars on right and left side of both the arches were chosen to receive pit and fissure sealants. According to random selection, the first permanent molars on the right side of both arches (16 and 46) were sealed with Embrace (Group A) and the left side first permanent molars of both arches (26 and 36) were sealed with Delton FS+ (Group B).
- The children (six-eight years of age) should have bilaterally erupted permanent first molars with deep retentive pits and fissures
- Teeth selected should be free of caries
- Teeth selected should be healthy, non hypoplastic with complete tooth structure intact
Procedure for sealant application
The sealant was applied according to the manufacturer's instructions.
Teeth in Group A and B were isolated using cotton rolls and suction. Before commencement of sealant application, oral prophylaxis was carried out, followed by using slurry of pumice and rubber cup. The occlusal surfaces of first permanent molars were thoroughly flushed with water to remove any traces.
In Group A the occlusal surface was dried using compressed air and etched with 38% phosphoric acid (Pulpdent Etch-Rite Etching Gel) for 15 seconds, following which the tooth was rinsed with copious water for 30 seconds to remove all etching gel. Excess moisture was removed with a cotton pellet from the tooth surface but was not desiccated which left the tooth surface slightly moist, glossy or shiny. Sealant Embrace WetBond (Pulpdent Corporation, Watertown, USA) was applied on the pits and fissures of occlusal surface with the help of syringe applicator which was supplied by the manufacturer. In Group B the occlusal surface was dried using compressed air and etched with 34% phosphoric acid (Delton EZ Etch Etching Gel) through brush tip applicator for 30 seconds, followed that the tooth was rinsed with copious water for 30 seconds to remove all etching gel. The conditioned areas were dried and the etched enamel was noted for a dull frosty-white appearance. Sealant Delton FS+ - (Dentsply International, York, PA) was applied with the help of a brush tip applicator which was supplied by the manufacturer. With the help of light curing unit- (hilux), held at 1 mm vertical to the sealant surface, was cured for 20 seconds. The retention was checked with the help of an explorer and it was also ensured that all margins were sealed. Occlusion was checked with the articulating paper.
Retention was evaluated using the mouth mirror and an explorer; the status of the sealant was checked and scored as:
- Total retention (TR) - Total retention on the occlusal surface
- Partial retention (PR) - Sealant is present but as a result of either wear or loss of the material, part of a previously sealed pit or fissure or both has been exposed
- Complete loss (CL) - Absence of sealant on the occlusal surface. No trace of sealant can be detected
| Results|| |
The results were noted, tabulated and analyzed statistically. The data was entered and cleaned in MS excel before it was processed. The entire statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 11.5 for MS Windows.
The retention rates were evaluated at recall intervals of three, six, nine and twelve months. In order to test the statistical significance of difference of categorical variables across two study materials, Chi-square test of independence of attributes was used if cell frequency was larger than five and Fisher's exact test was used where the cell frequency was less than five. As the teeth showing partial retention and complete loss were considered as a failure, they were not subjected to next follow up evaluation and were excluded from the recall which resulted into a lesser sample size at the next follow up month.
At the end of three months, on clinical examination, Embrace showed total retention of twenty-two teeth (64.7%), whereas Delton FS+ showed total retention of twenty teeth (58.8%).
At twelve months the sealed teeth that were evaluated, total retention were seen in eight teeth (23.5%) for Embrace whereas, for Delton FS+ were seen in six teeth (17.6%). Partial retention and complete loss results were seen in one tooth (2.9%) for Embrace. Delton FS+ showed partial retention in three teeth (8.8%) and complete loss in one tooth (2.9%) [Table 1].
The evaluation at the end of one year determining the status of overall retention of both the sealant materials showed total retention of 23.50% for Embrace and 17.60% for Delton FS+. Teeth showing partial retention and complete loss were 38.25% for Embrace and 41.20% for Delton FS+.
Relatively, Embrace shows better retention compared to Delton FS+ at twelve months follow up, but it is not statistically significant [Table 2].
| Discussion|| |
The anatomical pits and fissures of the teeth have long been recognized as susceptible areas for the initiation of dental caries. Occlusal caries is most prevalent in children as a result of the morphology of pit and fissure surfaces: They are stagnation areas, where plaque formed is anatomically protected from even a single toothbrush filament by the dimension of the fissure. ,
Many efforts towards prevention of dental caries have been made in the name of topical and systemic fluoride, plaque control and use of fissure sealants. However use of fluorides has been minimal in the pits and fissures. Hence, the rationale of using fissure sealant is, when applied on caries prone fissures, it penetrates these pits and fissures and seals them from the oral environment. , It has been shown that the efficacy of fissure sealing is related to the retention of the material on the teeth, and the retention is dependent on the clinical procedure as well as on the quality of the sealing material.
The procedure was carried out according to the manufacturer's instructions. The teeth were cleaned with pumice and handpiece and then rinsed with water spray. , Donnan and Ball demonstrated that cleaning the debris from the teeth by gently running an explorer through the fissures and forcefully rinsing with water resulted in retention rates comparable to those achieved when teeth had been cleaned by a prophy brush and pumice.  Levels of sealant retention after surface cleaning with toothbrush prophylaxis or a dry brushing were as high as those associated with hand piece prophylaxis. , An evidence-based clinical recommendation for use of pit and fissure sealants did not specifically address surface-cleaning methods, although supporting information acknowledged that manufacturer's sealant placement instructions should be consulted and that a surface-cleaning step typically is included in these instructions.  Isolation by rubber dam or cotton rolls are equally effective in retention rates. , Lygidakis et al., demonstrated that rubber dam isolation and cotton roll isolation provide comparable retention rates.  William and Mark recommended instead of replacing moisture soaked cotton rolls, merely place the high volume evacuation tip against the secured rolls for a few seconds, it will evacuate the excess moisture from the cotton. 
It is postulated that penetration of the acid etchant and subsequently sealant material to the base of the fissure maximizes sealant retention. It has been proved that the different etching times did not appear to affect the retention of fissure sealants and that the teeth can be etched for a much shorter period than conventionally recommended.  The sealants were applied with the applicator tips provided by the manufacturer, cured by a light cure unit and the occlusion was checked with the articulating paper.
This clinical study examined the retention of sealants over a twelve-month period. In this study, at the end of one year, Embrace showed 23.50% total retention, 38.25% partial retention and 38.25% complete loss. Delton FS+ showed 17.60% total retention, 41.20% partial retention and 41.20% complete loss. Although the figures for Embrace were higher than the Delton FS+, there was no statistical significant difference in the retention rates of the two groups.
The finding is in accordance with an in vitro study by Barbara et al. that showed Embrace to have superior adaptation and penetration than Clinpro.  Similarly Joseph P. O'Donnell in his evidence-based, longitudinal study of two years on clinical performance of Embrace sealant, results showed that 95% remained in the same condition as when they were originally placed. 
Antonson SA et al. in an in vitro study showed total 37.5% total loss of Delton FS+ compared to GC Fuji Triage. 
Subramaniam et al. reported 14.6% complete retention, 39.3% partial retention and 46% complete loss for a resin sealant (Delton) as compared to Fuji VII. The highest rate of sealant loss was seen at the sixth month; with only 38% of sealant completely retained.  Previous review of sealant clinical trials shows a failure rate to be between 5 and 10% each year. 
Simonsen has reported on the retention and effectiveness of a single application of sealant to permanent first molars at both ten and fifteen years.  The results indicated that at ten years, 56.7% of sealants were completely retained and 20.8% were partially retained and 6.9% complete loss. At fifteen years, 27.6% of the teeth still had complete sealant retention with a further 35.4% maintaining partial retention and 10.9% complete loss.
It is however clear that the highest preventive effect depends on total sealant retention and in keeping with this school of thought, regular check-ups on recall basis is advised. Further the greater the total retention the sealant, greater the efficacy of that particular material. ,
| Conclusion|| |
At twelve months follow-up Embrace was relatively better (but not statistically significant) than Delton FS+ in having total retention, however the clinical assessment showed that both the materials had no statistical significant difference in terms of retention.
| References|| |
|1.||Brown LJ. The impact of recent changes in the epidemiology of dental caries on guidelines for the use of dental sealants. J Public Health Dent 1995;55:274-91. |
|2.||Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch B, et al. Evidence-based clinical recommendations for the use of pit-and-fissure sealants. J Am Dent Assoc 2008;139:257-68. |
|3.||Ripa LW. Sealants revisted: An update of the effectiveness of pit-and-fissure sealants. Caries Res 1993;27:77-82. |
|4.||Robert F. The use of pit and fissure sealants. Pediatr Dent 2002;24:415-22. |
|5.||Subramaniam P, Konde S, Mandanna DK. Retention of a resin-based sealant and a glass ionomer used as a fissure sealant: A comparative clinical study. J Indian Soc Pedod Prevent Dent 2008;26:114-20. |
|6.||Ganesh M, Shobha T. Clinical evaluation of Fuji VII sealant material. J Clin Pediatr Dent 2006;31:52-7. |
|7.||Donnan MF, Ball IA. A double-blind clinical trial to determine the importance of pumice prophylaxis on fissure sealant retention. Br Dent J 1988;165:283-6. |
|8.||Gillcrist JA, Vaughan MP, Plumlee GN Jr, Wade G. Clinical sealant retention following two different tooth-cleaning techniques. J Public Health Dent 1998;58:254-6. |
|9.||Kolavic Gray S, Griffin SO, Malvitz DM, Gooch BF. A comparison of the effects of tooth brushing and hand piece prophylaxis on retention of sealants. J Am Dent Assoc 2009;140:38-46. |
|10.||Lygidakis NA, Oulis KI, Christodoulidis A. Evaluation of fissure sealants retention following four different isolation and surface preparation techniques: Four year clinical trial. J Clin Pediatr Dent 1994;19:23-5. |
|11.||Waggoner WF, Siegal M. Pit and Fissure sealant application: Updating the technique. J Am Dent Assoc 1996;127:351-61. |
|12.||Eidelman E, Shapira J, Houpt M. The retention of fissure sealants using twenty-second etching time: Three-year follow-up. ASDC J Dent Child 1988;55:119-20. |
|13.||Kane B, Karren J, Garcia-Godoy C, Garcia-Godoy F. Sealant adaptation and penetration into occlusal fissures. Am J Dent 2009;22:89-91. |
|14.||Donnel JP. A longitudinal study assessing the clinical performance of a new pit and fissure sealant material: Embrace Wetbond (Two-year report, May 2005). |
|15.||Conry JP, Pintado MR, Douglas WH. Quantitative changes in fissure sealant six months after placement. Pediatr Dent 1990;12:162-7. |
|16.||Feigal RJ. Sealants and preventive restorations: Review of effectiveness and clinical changes for improvement. Pediatr Dent 1998;20:85-92. |
|17.||Simonsen RJ. Retention and effectiveness of dental sealant after 15 years. J Am Dent Assoc 1991;122:34-42. |
[Table 1], [Table 2]