26 October 2022

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The longevity of occlusal sealants

Lara Figini

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One of the milestones of preventing occlusal caries is the early application of sealants for pits and fissures. There are several types of sealants on the market, from self-curing to photopolymerizing ones, to fluorine-releasing ones. Recently, a new group of primed adhesive sealants have been introduced. These sealants are based on acid functional monomers, which simultaneously bite the enamel and create an adhesive compound on the outer prismatic layer. This approach aims to avoid conventional acid treatment by reducing its application time, resulting in greater patient comfort, a particularly important factor in pediatric dentistry.

Materials and methods

In a systematic review published in Dental Materials in May 2020, the authors compared the retention strength and survival of primed sealants compared to that of conventional sealants. The team performed a literature search via MEDLINE, EMBASE and CENTRAL of all relevant studies and identified 3707 abstracts published before 31/12/2017, of which 335 clinical publications were analyzed in detail. A total of 67 studies included information on sealant retention after 24, 36, or 60 months of follow-up. A meta-analysis was conducted using a random effects model to calculate the pooled estimate of retention rates for the five sealant groups.

Results

Primed sealants showed an estimated 2-year RRE retention rate of 43.2% (95% CI), significantly lower than that of self-curing sealants (80.8%, 95% CI) and that of light-curing sealants (68.4%, 95% CI: 60.2–76.7). Fluorine-releasing sealants and lightweight polymers demonstrated the highest 3-year RREs (86.4%, 95% CI and 83.1%, 95% CI respectively).

Conclusions

From the meta-analysis, researchers concluded that primed sealants cannot yet be fully recommended for clinical practice due to their moderate survival rates.

Auto-polymerizing, light-polymerizing and fluoride-releasing sealants continue to be considered the reference standards for pit and fissure sealants. However, future generations and developments of primed sealant materials may change this position.

Jan Kühnisch et al. "Meta-analysis of the longevity of commonly used pit and fissure sealant materials." Dent Mater. 2020 May;36(5): e158-e168. doi: 10.1016/j.dental.2020.02.001. Epub 2020 Feb 12.