There is good quality review evidence (Ahovuo-Saloranta et al.  2013) that resin-based fissure sealants are effective at preventing or controlling occlusal caries. The aim of this trial was to assess whether sealing first permanent molars with fluoride releasing compounds reduced the caries increment on the distal surface of the second primary molars.

Children with at least two sound permanent first molars and the presence of at least 1 sound distal surface of adjacent second primary molar were eligible. 2776 were enrolled and randomised into 3 groups. In the first group first permanent molars were sealed with a high-viscosity glass ionomer cement (GIC group; n = 926), the second group received a resin-based fluoride containing sealant (RBF group; n = 923) the third group received a resin-based sealant without fluoride (RB group; n = 927). Clinical examinations were conducted at baseline and at 30 months by two blinded examiners. Caries in was assessed at D₁-D₃ levels and bitewings were taken. Sealant retention was also assessed.

• Dropouts were similar in each group (GIC group; n = 75), (RBF group; n = 67), (RB group; n = 77).
• Prevalence of affected surfaces was significantly lower in in the GIC (p = .03) and FRB groups (p = .04)
• The distal surfaces of the second primary molars developed fewer new caries in the GIC group than in the other 2 groups. Incidence rate ratios (IRRs) were: –
  • 0.70 (95% CI: 0.50, 0.68; p < .01) for GIC vs. RB
  • 0.89 (95% CI: 0.89, 1.28; p = .10) for GIC vs. FRB.
  • 0.79 (95% CI: 0.53, 1.04; p = .005) for FRB vs. RB.
• 76 molars in the GIC group (2.95%), 52 in the fluoride-RB group (1.41%), and 50 in the RB group (1.35%) had partial sealant loss.

The authors concluded

Fluoride-releasing sealants (high-viscosity GIC and fluoride RB) were demonstrated to provide protection against caries on the distal surface of second primary molar. This preventive strategy might contribute to maintain the integrity of the mesial surfaces of the first permanent molar.

Comment

Previously (Dental Elf – 11^th June 2013) we reported on earlier results from this study that showed that high-viscosity GIC raised interproximal fluoride concentration more than FRB sealants. The results suggest that this increase in fluoride concentration leads to a clinical benefit. While high-viscosity GIC did results in fewer carious lesions it also had the greatest proportion of partial sealant loss which should be taken into consideration in relation to longer term benefit as this study is relatively short term.

Links

Original trial protocol

Cagetti MG, Carta G, Cocco F, Sale S, Congiu G, Mura A, Strohmenger L, Lingström P, Campus G; Italian Experimental Group on Oral Health. Effect of Fluoridated Sealants on Adjacent Tooth Surfaces: A 30-mo Randomized Clinical Trial. J Dent Res. 2014 May 20. pii: 0022034514535808. [Epub ahead of print] PubMed PMID: 24846910.

Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington HV. Sealants for preventing dental decay in the permanent teeth. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD001830. DOI: 10.1002/14651858.CD001830.pub4

Dental Elf – 11^th June 2013 – High-viscosity glass-ionomer cements increased interproximal fluoride concentration more than resin-based fluoride-containing