There is good evidence for the effectiveness of fissure sealants in the prevention of caries (Dental Elf 8^th April 2013) and some evidence for its use in the treatment of carious lesions. There is also evidence for the effectiveness of partial rather complete caries removal (Dental Elf 13^th Apr – 2014).The aim of this study was to compare the effectiveness of fissure sealants verses partial caries excavation and restorative treatment in primary molars.

Children with at least one primary molar with occlusal active caries lesion (reaching outer half of dentine) with no pain history were included. Only one tooth per child was included. Children were randomised to either fissure resin-based sealant application, without removing caries tissue (sealant) or restorative treatment with composite resin, after partial dentinal caries removal (control). A final year dental student carried out treatment for both groups under rubber dam. Baseline radiographs were taken and patients followed up at 6, 12 and 18 months. Teeth that had partial sealant loss were re-sealed.Marginal integrity of sealants and restorations were assessed clinically by one examiner scores for clinical assessment were: partial loss and total loss (failure) or total retention (success). Radiographs were assessed by paediatric dental specialists blinded to chronological order.

• 36 children were randomised, 17 to sealant group, 19 to control.
• 2 children in the control group were lost to follow up.
• At 18 months
  • no radiographic progression of caries was noted in either group
  • 6 teeth in the sealant group were considered to be clinical failures compared to none in the test group.

The authors concluded

Sealing had similar efficacy in the arrestment of caries progression of cavitated occlusal lesions compared to partial excavation of the lesions, even though the frequency of re- treatments was significantly higher in sealed lesions.

Comment.

As the authors note this is a small study although they do report that a power calculation was carried out (giving a result of 0.9) but it is not clear whether this was done before or after the study was conducted. Other studies have shown that sealing occlusal surfaces can arrest dentinal caries but most of these have been in permanent teeth. This small trial suggests that sealing can also arrest dentinal lesions in primary teeth. However, more a larger high quality studies are needed before the results can be generalised.

Links

Hesse D, Mendes FM, Braga MM, Imparato JC, Raggio DP. Sealing versus partial caries removal in primary molars: a randomized clinical trial. BMC Oral Health 2014, 14:58 doi:10.1186/1472-6831-14-58

Dental Elf 8^th April 2013 – Review recommends fissure sealants for caries prevention in permanent teeth

Dental Elf 13^th Apr – 2014 – Trial found similar outcomes with total and partial caries removal in primary molars