Dental sealants have been used as a preventative for dental caries, retention and marginal integration are key to decreasing the incidence of caries in pit and fissures that have been sealed. It has been postulated that the adoption of pit and fissure sealants as a part of minimally invasive dentistry to arrest and re-mineralize non-cavitated carious lesions. In a recent randomized controlled clinical trial published in 2019 in the Journal of Dentistry the authors aimed to compare two types of sealant material for retention and re-mineralization parameters.1
The sample size included 40 participants/80 teeth; permanent mandibular first molars were the teeth used for the trial. Participant inclusion criteria included, cooperative children aged 6- 9 years, healthy patients with no systemic diseases that could affect oral health. Tooth related inclusion criteria included, both mandibular-symmetric first permanent molars fully erupted, scores of 1 to 2 according to the ICADS II, and scores between 14-30 using DIAGNOdent device (Kavo®).
Participants were put in two separate groups. Group A’s teeth were sealed with Embrace™ Wetbond™ sealant following the manufacturer’s instructions. Group B’s teeth were sealed with Fuji TRIAGE® following manufacturer’s instructions. Follow-up evaluations were done at 3 and 6 months. At both evaluations investigators assessed retention, at the 6-month evaluation in addition to assessing retention the investigators removed the sealants to determine remineralization. Remineralization was measured using DIAGNOdent device (Kavo®).
The results showed a 95% retention rate in the Embrace™ Wetbond™ group (group A) and an 87.5% retention rate in the Fuji TRIAGE® (group B) at the 3-month evaluation. At the six-month evaluation group, A had an 85% retention rate and group B had a 62.5% retention rate. Upon assessment of the remineralization effect the DIAGNOdent device (Kavo®) readings indicated a substantial remineralization effect.
Resin-based sealant material is commonly used though it has drawbacks due to the very technique specific application. Glass ionomers are hydrophilic which allows for easy placement however, the poor retention is a drawback. Additionally, glass ionomer has a high fluoride release that allows for better remineralization and the particles have been shown to remain in the bottom of the pits and fissures allowing for an advantage in blocking deep pits and fissures even after the sealant isn’t detectable clinically. Hydrophilic resin-based sealant material with continuous fluoride release has been developed. This material provides a combination of benefits found in Bis-GMA and glass ionomer sealant material; it provides the best of both materials.
Overall, the study showed both materials were able to remineralize incipient caries with no significant difference in the remineralization effect. The limitations noted by the authors include limited follow-up time span. Also, only participants were blinded, investigators could not be blinded due to the technique specific application of each material.
The authors conclude by stating, “Within the limitation of this study, we affirmed that occlusal caries lesions, which is restrictive to enamel and in need of surgical intervention, can be arrested clinically by sealing the lesion with both a hydrophilic resin sealant and glass ionomer sealant materials. Embrace™ Wetbond™ showed superiority over the glass ionomer sealant tested in retention after six months follow up.”
Alsabek L, Al-Nerabieah Z, Bshara N, Comisi JC. Retention and remineralization effect of moisture tolerant resin-based sealant and glass ionomer sealant on non-cavitated pit and fissure caries: Randomized controlled clinical trial. J Dent. 2019 Jul;86:69-74. doi: 10.1016/j.jdent.2019.05.027. Epub 2019 May 25. PMID: 31136817.