Microcavitated (ICDAS 3) Carious Lesion Arrest with Resin or Glass Ionomer Sealants in First Permanent Molars: A Randomized Controlled Trial
A main strategy for minimally invasive treatment (MIT) for carious lesions is sealants. Sealing non-cavitated carious lesions has shown to be effective at arresting the decay process and preventing more invasive treatments which would undermine the integrity of the tooth. Maintaining as much tooth structure as possible is goal of minimally invasive dentistry (MID). In a recent randomized controlled trial published in February 2019 in the Journal of Dentistry, the authors aimed to “compare the efficacy of resin or glass ionomer sealants in arresting microcavitated carious lesions (ICDAS 3) in first permanent molars.”1
Trial design included participants that were between the ages of 6 and 12 that attended a dental clinician Chile. Participants were systemically healthy with at least 1 ICDAS 3 lesion on the occlusal surface of a permanent first molar. Exclusion criteria included semi-eruption, enamel defects, periodontal disease, orthodontic appliances, or children that were using any medications. All examinations were carried out by a single pediatric dentist, 41 children with 151 ICDAS 3 lesions were include in the RCT. All lesions were randomized, treatment groups included resin-based sealant or glass ionomer sealant. A single operator applied the sealant material, this operator was not blinded due to the different application techniques required for the material.
The results showed only one lesion in the resin-based group progressed clinically while none in the glass ionomer group progressed at the 24-month follow-up assessment. One lesion in each group showed progression upon radiographic examination. After 24 months, 77.4% complete retention of the sealants was observed in the resin-based group while 83.6% of the glass ionomer sealants were completely retained.
Despite the recommendation of the American Dental Association and the American Academy of Pediatric Dentistry for us of sealants in non-cavitated carious lesions the practice is not utilized regularly. This study aimed to broaden the recommendation to include lesions with localized enamel breakdown. The result of this RCT appears to be an attractive alternative to invasive restorative dental procedures for ICDAS 3 lesions. The results show that progression after 24 months was minimal. However, the authors note that the follow up may be too short and further studies need to be conducted to confirm these findings.
The authors conclude by stating, “The use of therapeutic sealants appears to be effective in arresting progression of microcavitated lesions (ICDAS 3), without noticeable differences between resin and GI sealants. Since clinical sound evidence supporting the use of this type of therapeutic approach is rather weak, further studies, with longer follow-up are strongly suggested.”
Are you interested in a similar study with a longer follow-up? Does this study change your current stance on sealants? What evidence would you like to see that would encourage you to adopt MIT using sealants for non-cavitated lesions?
- Muñoz-Sandoval C, Gambetta-Tessini K, Giacaman RA. Microcavitated (ICDAS 3) carious lesion arrest with resin or glass ionomer sealants in first permanent molars: A randomized controlled trial. J Dent. 2019 Sep;88:103163. doi: 10.1016/j.jdent.2019.07.001. Epub 2019 Jul 2. PMID: 31276747.