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ORIGINAL ARTICLE
Year : 2016  |  Volume : 34  |  Issue : 2  |  Page : 111-114
 

Comparison of different methods of cleaning and preparing occlusal fissure surface before placement of pit and fissure sealants: An in vivo study


Department of Pedodontics and Preventive Dentistry, Bharati Vidyapeeth Deemed University Dental College and Hospital, Navi Mumbai, Maharashtra, India

Date of Web Publication14-Apr-2016

Correspondence Address:
Dr. Rahul J Hegde
Bharati Vidyapeeth Deemed University Dental College and Hospital, Sector - 7, CBD, Belpada, Navi Mumbai - 400 614, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.180403

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   Abstract 

Aim: To evaluate an individual method of cleaning and preparing occlusal fissure surface before placement of pit and fissure sealant and to determine a method for better retention of the sealant. Materials and Methods: The present study consisted of 100 young permanent molar teeth divided into four equal groups: Group 1-Brushing only, Group 2-Application of pumice slurry, Group 3-Surface conditioning, and Group 4-Control (without any preparation). Subsequent to fissure preparation, the fissures were etched using 37% phosphoric acid except for Group 3, which was etched using 10% maleic acid for 30 s. The samples were then rinsed for 10 s using air water spray of the three-way syringe and dried using oil-free compressed air with a hand pump air pressure syringe. After ensuring a frosted appearance of the enamel at the fissure entrance, pit and fissure sealants were applied on the surface according to manufacturer's instructions. All the cases were clinically evaluated for retention after 3 months, 6 months, and 12 months of application and the retention rate was assessed based on the criteria proposed by Simonsen. Results: The pumice slurry group and surface conditioning group showed results with 100%, 96%, and 92% complete retention seen at 3 months, 6 months, and 12 months, respectively. Conclusion: The pumice slurry group and surface conditioning group showed a significantly higher retention when compared to the brushing group, whereas the control group (without any preparation) showed the least retention when compared to all the other groups.


Keywords: Maleic acid, phosphoric acid, pit and fissure sealant, retention


How to cite this article:
Hegde RJ, Coutinho RC. Comparison of different methods of cleaning and preparing occlusal fissure surface before placement of pit and fissure sealants: An in vivo study. J Indian Soc Pedod Prev Dent 2016;34:111-4

How to cite this URL:
Hegde RJ, Coutinho RC. Comparison of different methods of cleaning and preparing occlusal fissure surface before placement of pit and fissure sealants: An in vivo study. J Indian Soc Pedod Prev Dent [serial online] 2016 [cited 2021 Dec 6];34:111-4. Available from: https://www.jisppd.com/text.asp?2016/34/2/111/180403



   Introduction Top


Despite diligent oral hygiene procedures, optimal fluoride environment and a realistic approach to dietary modifications, occlusal caries are inescapable for most children and adolescents as a result of the anatomy of pit and fissure surfaces, which favors stagnation of bacteria and substrates. [1] Sealing pits and fissures with a resin material in caries-susceptible teeth forms a micromechanically retained, physically protective layer that acts to prevent the demineralization of the enamel by blocking the interaction of cariogenic bacteria and their nutrient substrates, thus eliminating the harmful acidic byproducts and this is regarded as a definitive mode of treatment in the prevention of dental caries. The retention ability of the sealant should be such that it should not cause any undermining caries to the sound enamel structure. [2] This, in turn, depends on an optimal clinical technique by the dentist; therefore, evaluation should not be limited only to the physical, chemical or biological acceptance of the material used as a fissure sealant but emphasis should be placed also on the technique for cleaning and preparing the tooth surface to accept the sealant placement. [1] Residual material in the fissure, air entrapment, and fissure geometry itself contribute to the limiting of the sealant penetration, making it necessary to have a good clinical technique. The application of sealants involves tooth prophylaxis followed by conditioning with acidic agent. This protocol designed to remove deposits from the tooth and to enlarge existing microspores in the enamel to accommodate resin sealant may or may not completely and consistently remove deposits from pits and fissures. [1] Preparation of the tooth surface prior to etching may vary from different methods of cleaning the fissure surface and all are based on materials and instruments currently used in clinical practice. [2] Hence, there is a need to investigate and compare the effectiveness of different methods of cleaning and preparing occlusal fissures to receive pit and fissure sealants so as to make them more acceptable and reliable.


   Materials and Methods Top


The sample for the present study consisted of 100 permanent first molars in 25 children of age 6-9 years who visited the department of pedodontics and preventive dentistry. Completely erupted caries-free permanent first molar teeth were included in the study. Partially erupted teeth and teeth with cavitations or with any pathology were excluded from the study. Following the approval from the ethical committee of the institution, all subjects were verbally informed and written informed consent was taken for participation in the study. The 100 teeth were isolated with rubber dam and then divided into four equal groups: Group 1-Brushing only-the fissures were cleaned with a dry pointed bristle brush for approximately 15 s; Group 2-Application of pumice slurry-the fissures were cleaned with a slurry of pumice in water (5 g/4 mL water) using a rubber cup in a low-speed handpiece for approximately 15 s; Group 3-Surface conditioning-the fissures were cleaned with a dry pointed bristle brush using a low-speed handpiece and etched with 10% maleic acid; Group 4-Control group-the fissures were not cleaned before the application of sealants. Subsequent to fissure preparation, the fissures were etched using 37% phosphoric acid (3M) except for Group 3, which was etched using 10% maleic acid (3M) for 30 s. The samples were then rinsed for 10 s using air water spray of the three-way syringe and dried using oil-free compressed air with a hand pump air pressure syringe. After ensuring a frosted appearance of the enamel at the fissure entrance, pit and fissure sealant (Clinpro™ 3M ESPE, USA) was applied on the surface according to the manufacturer's instructions. All the cases were clinically evaluated for retention after 3 months, 6 months, and 12 months of application. The retention rate was assessed based on the criteria proposed by Simonsen: [3] [C: complete retention, P: Partial retention, M: Missing (no retention)].


   Result Top


The four groups were analyzed for differences using Kruskall-Wallis test followed by post hoc multiple comparisons between individual groups for differences using Mann-Whitney U test.

Retention after 3 months interval in Group 1 (brushing) showed complete retention in 22 teeth (88%) and partial retention in 3 teeth (12%), whereas Group 2 (pumice slurry) and Group 3 (surface conditioning) showed complete retention in 25 teeth (100%), which was significantly higher than Group 4 (control) that showed complete retention in 19 teeth (76%) and partial retention in 6 teeth (24%) (P < 0.05) [Table 1]. Retention after 6 months interval in Group 1 (brushing) showed complete retention in 19 teeth (76%) and partial retention in 6 teeth (24%), whereas Group 2 (pumice slurry) and Group 3 (surface conditioning) showed complete retention in 24 teeth (96%), which was significantly higher as compared to other groups (P < 0.05). Group 4 (control) showed complete retention in 13 teeth (52%) and partial retention in 12 teeth (48%) [Table 2]. Retention after a 12-months interval in Group 1 (brushing) showed complete retention in 9 teeth (36%), partial retention in 8 teeth (32%), and missing retention in 8 teeth (32%); a significantly higher number of teeth (92%) showed complete retention in Group 2 (pumice slurry) and Group 3 (surface conditioning) as compared to other groups (P < 0.05). Group 4 (control) showed complete retention in 5 teeth (20%) and partial retention in 10 teeth (40%). A significantly higher number of teeth (40%) showed missing sealant in the control group as compared to other groups (P < 0.05) [Table 3].
Table 1: Retention of pit and fissure sealant at an interval of 3 months


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Table 2: Retention of pit and fissure sealant at interval of 6 months


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Table 3: Retention of pit and fissure sealant at an interval of 12 months


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The significant mean difference in all the groups at 3-month interval period with the highest mean difference was seen in Group 4: Control (1.24) followed by Group1: Brushing (1.12) and lowest mean difference was seen in Group 2: Pumice slurry and Group 3: Surface conditioning (1.00). Group 2: Pumice slurry and Group 3: Surface conditioning were highly significant when compared to Group 1 and Group 4 (P < 0.05) [Table 4]. Significant mean difference in all the groups at a 6-month interval period with the highest mean difference was seen in Group 4: Control (1.48) followed by Group 1: Brushing (1.24) and lowest mean difference was seen in Group 2: Pumice slurry and Group 3: Surface conditioning (1.04). A significant difference was seen in Group 4: Control when compared to Group 2: Pumice slurry and Group 3: Surface conditioning (P < 0.05) [Table 5]. Significant mean difference in all the groups at 12-month interval period with the highest mean difference was seen in Group 4: Control (2.20) followed by Group 1: Brushing (1.96) and the lowest mean difference was seen in Group 2: Pumice slurry and Group 3: Surface conditioning (1.08). Group 2: Pumice slurry and Group 3: Surface conditioning showed higher significance when compared to Group 1: Brushing, whereas Group 4: Control showed the least retention when compared to all the other groups (P < 0.05) [Table 6].
Table 4: Intergroup comparison for retention score at an interval of 3 months


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Table 5: Intergroup comparison for retention score at an interval of 6 months


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Table 6: Intergroup comparison for retention score at interval of 12 months


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   Discussion Top


Pit and fissure sealant has been described as a resin material placed into the pits and fissures of caries-susceptible teeth that micromechanically bonds to the tooth, preventing access by cariogenic bacteria to their source of nutrients. [4] As the literature has strongly emphasized, the most appropriate period for the placement of occlusal sealants is soon after the eruption of permanent molars because recently erupted teeth are less mineralized than those exposed to the oral environment for several years and may thus be more prone to acid attack. In such a condition, early placement of sealant may prevent the development of carious lesions on occlusal pits and fissures. [5]

The present study consisted of 100 newly erupted permanent molars in children between 6 years and 9 years of age. Pointed bristle brush and prophy cup were used for cleaning of the pit and fissure surface with the use of phosphoric acid for etching. The prophy cup used in adjunct with pumice slurry showed better retention (92%) than the use of pointed bristle brush (36%) after the interval of 12 months. This was in accordance with Avinash et al. (2010) [6] who advocated the use of prophy cup or bristle brush and pumice to clean the surfaces of pits and fissures.

Long-term success of sealant therapy is dependent on vigilant recall and with such follow-up, sealant success rate is very high. Studies that incorporated routine recall and maintenance showed 80-90% success. To achieve long-term success through routine recall and maintenance appoint­ments, children should have a dental home where oral health care maintenance can be appropriately provided [7] and this was in accordance with the present study where regular recall was done at intervals of 3 months, 6 months and 12 months, which showed a higher retention score when teeth were cleaned with pumice slurry and conditioned with 10% maleic acid.

The pumice slurry group, which was etched with phosphoric acid and the surface conditioning group, which was etched with maleic acid for 15 s showed no significant difference in retention at the interval of 12 months. This was in accordance with the study conducted by Baralieri et al. (1994) [8] who found that the type of acid had no influence on the retention rate of a light-activated sealant 12 months after its application. Goes et al. (1998) [9] conducted a study to evaluate the morphological effect of the type, concentration, and etching time of acid solutions on the enamel and dentin surfaces and stated that 10% maleic acid gel etched for 15 s or 60 s showed better results than the conventional phosphoric acid gel.

The pumice slurry group and surface conditioning group showed significant difference with complete retention in 23 teeth after a 12-month interval period even without the application of bonding agent; this was in accordance with the study conducted by various authors who concluded that the use of a bonding agent prior to the application of a pit and fissure sealant does not increase the retention rate, [10] and they also concluded that one bottle dentin bonding system used as a sealant does not improve the retention of conventional fissure sealants [11] and stated that the use of a bonding agent prior to the application of pit and fissure sealant does not increase the retention rate. [12]

The pumice slurry group and the surface conditioning group showed better retention when compared to the brushing group and control group after the interval of 12 months. From the present study it was observed that we can either use pumice slurry or surface conditioning to achieve proper retention in young children.


   Conclusion Top


Based on the results of this study, the following conclusions were drawn:

  1. Retention was evident in the pumice slurry group and surface conditioning group. Therefore, superior results were obtained when occlusal surface was cleaned using these two groups as compared to the other groups.
  2. Pumice slurry group and surface conditioning group showed similar good results with 100%, 96%, and 92% complete retention seen in 3 months, 6 months, and 12 months, respectively.
  3. The pumice slurry group and surface conditioning group showed higher significance when compared to the brushing group, whereas the control group showed the least retention when compared to all the other groups.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Simonsen RJ. Pit and fissure sealant: Review of the literature. Pediatr Dent 2002;24:393-414.  Back to cited text no. 1
    
2.
Agarwal A, Shigli A. Comparison of six different methods of cleaning and preparing occlusal fissure surface before placement of pit and fissure sealant: An in vitro study. J Indian Soc Pedod Prev Dent 2012;30:51-5.   Back to cited text no. 2
    
3.
Simonsen RJ. Retention and effectiveness of dental sealant after 15 years. J Am Dent Assoc 1991;122:34-42.  Back to cited text no. 3
    
4.
American Academy of Pediatric Dentistry. Guideline on pediatric restorative dentistry. Pediatr Dent 2014;35:226-34.  Back to cited text no. 4
    
5.
Corona SA, Borsatto MC, Garcia L, Ramos RP, Palma-Dibb RG. Randomized, controlled trail comparing the retention of a flowable restorative system with a conventional resin sealant: One-year follow up. Int J Paediatr Dent 2005;15: 44-50.  Back to cited text no. 5
    
6.
Avinash J, Marya CM, Dhingra S, Gupta P, Kataria S, Meenu, et al. Pit and fissure sealants: An unused caries prevention tool. J Oral Health Comm Dent 2010;4:1-6.  Back to cited text no. 6
    
7.
Feigal RJ, Donly KJ. The use of pit and fissure sealants. Pediatr Dent 2006;28:143-50; discussion 192-8.  Back to cited text no. 7
    
8.
Baralieri LN, Monteiro Júnior S. Influence of acid type (phosphoric or maleic) on the retention of pit and fissure sealant: An in vivo study. Quintessence Int 1994;25:749-55.  Back to cited text no. 8
    
9.
Goes MF, Sinhoreti MA, Consani S, Silva MA. Morphological effect of the type, concentration and etching time of acid solutions on enamel and dentin surfaces. Braz Dent J 1998;9: 3-10.  Back to cited text no. 9
    
10.
Bokman L, McConnell RJ, Carson B, McCutcheon-Jones EF. A 2-year clinical evaluation of two pit and fissure sealants placed with and without the use of a bonding agent. Quintessence Int 1993;24:131-3.  Back to cited text no. 10
    
11.
Baca P, Bravo M, Baca AP, Jiménez A, González-Rodríguez MP. Retention of three fissure sealants and a dentin bonding system used as fissure sealant in caries prevention: 12-month follow-up results. Med Oral Patol Oral Cir Bucal 2007;12:E459-63.  Back to cited text no. 11
    
12.
Das UM, Vishwanath D, Venkatasubramanian R, Gopal S. Retention of Pit-and-fissure sealants with and without a seventh generation bonding agent: A clinical study. Dent India 2008;2:18-20.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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