CURRENT TOPICS - Pediatric Dentistry

1 Pediatric Dentistry /Copyright 1982 byThe American Academy of Pedodontics/Vol. 4, No. 1 Retention of pit and fissure sealants placed in adental school pedodontic clinic: a retrospective studyRobert A. Anson, DDS, MA, MSClemens A. Full, BS, DDS, MSStephen H. Y. Wei, DDS, MS, MDSA bstractThe purpose of this study was to determine thecombined retention rates of two Bis-GMA sealants("Delton" and "Nuva-Seal") in a pedodontic in this study were 176 patients whose meanage was eleven years and five months. For all teethexamined, the relationship between the percentage ofteeth with "sealant all present" and longevity isalmost linear from the plotted value at six months(85%) to that at thirty-three months (67%). corresponds to an initial failure rate of 15% followedby a failure rate of about 4% at each six-month recallexam. Retention rates have also been reported for allpermanent teeth, maxillary versus mandibularpermanent teeth, and premolars versus molars.

2 Thehigh retention rates support the use of sealants as ameans of preventing pit and fissure caries in there have been numerous studies 22that have reported on occlusal sealant retention, thisstudy was conducted to assess the value of sealantsin a pedodontic clinic where a large number ofoperators and assistants with varying degrees ofknowledge and technical skills would use vast majority of previous studies have useda small number (mean -- 3) of professionals who werehighly trained in the sealant application technique,involving up to 4,462 teeth in one study~ and inexcess of 3,780 in The specialization ofthese operators may very well have resulted insuperior sealant retention rates. While clinical resultsobtained by trained and experienced personnel underoptimal conditions are of interest, it is also importantto know how well sealants are retained when appliedunder average practice conditions.

3 While theconditions of this study are not typical of conditionsin private practice, these results may be morerepresentative than those research studies that hada large number of sealants placed by a fewexperienced paper reports the results of a sealant retentionstudy that routinely used rubber dam whenever theteeth to be sealed were erupted sufficiently to allowits placement. Of the 20 "Nuva-Seal" and "Delton"studies reviewed, only one4 used. rubber damroutinely. Although Poulsen and Peltoniemi5 foundno significant difference in retention when sealantswere placed on primary teeth with isolation by cottonrolls on one side of the mouth versus rubber dam onthe other, one would expect improved retention ifrubber dam were routinely used for purpose of this study is to explore theadvantages and disadvantages of a retrospectivesealant retention study using a dental schoolpedodontic population.

4 Some potential advantagesare low cost, data collection over a short period oftime, and data that is representative of sealantsplaced throughout the year, rather than at one two studies~.7 were based on the placementof sealants by students in dental school pedodonticclinics, this is the first retrospective sealant and Materi~lsPatients receiving treatment in the Department ofPedodontics at the College of Dentistry of TheUniversity of Iowa were the subjects eligible for thisstudy. Their dental charts were checked for previoussealant application; patients who had sealants placedfive or more months earlier were included. Data wascollected over a five-month period during the summerand fall of a very large pedodontic clinic population, 176patients whose mean age was eleven years and fivemonths were included in this brands of sealants were used; "Delton,"aanautopolymerized sealant and "Nuva-Seal, b anultraviolet light polymerized sealant.

5 For the first sixmonths only "Nuva-Seal" was available; this wasfollowed by the introduction of "Delton," which soonbecame the only brand used.~Johnson and Johnson; East Windsor, L. D. Caulk Company; Milford, SEALANT RETENTION: Anson, Full, and Wei100069 12 15 18 21 24 27 30 33 36 39 42 LONGEVITY (MONTHS)N (Teeth)= 169 86 65 42 55 28 70 35 54 24 16 19 6 Total N=6~9n (Pati~ts)= 5933 26 23 25 14 27 2222 12 9 4 2 Total n=278 ,176" Figure 1. Sealant retention on all teeth examined at (Teeth)= 137n (Patient=)= 1009 12 15 18 21 24 27 30 33 36 39 42 LONGEVITY (MONTHS)27 21 2O 22 8 23 18 199 63 2 Total n-226",132 Figure 2. Sealant retention on permanent teeth examinedat 5-43 months.~ 40~= 20o6 9 12 15 18 21 24 27 30 33 36 39 42 LONGEVITY (MONTHS)N (Max+ teeth)= 7"/26302126102614305584 Total N-282n (Patients)= 1516151261512175322 Total n=157"N (Mand.)

6 Teeth)= 41221426936161914672 Total N=272n (Patients)=301914101761811107422 Total n=150"Figure 3. Sealant retention on maxillary (o) versus man-dibular t ) permanent teeth examined at 5-43 months.~0o ~o ~~o ~0 10069121518 21 24 27 30~~3942 LONGEVITY (MONTHS)(Premolars)= ~l N=2~n (Patients)= 231078617584210To~lN (Molars)= ~40183216~222812876 Totaln (Patients)= 221714~71814~57532To~l n=179"~igure 4. SeMant re~ntion on premol~s (ol versus mol~sexamined at a-4a the brand of sealant used was not routinelyrecorded on the patient s chart, the percentage thatare "Nuva-Seal" and "Delton" is not charts of all potential subjects were screenedto determine if a given patient met the criterion ofhaving had a sealant placed at least five the sealant was "all present" or "partlymissing," the status was recorded on the datacollection subjects were examined by one examiner( ) with a plane, number 4, front-surface dentalmirror and a sharp, number 23, explorer.

7 The teethwere air-dried and a high-intensity dental light wasused for the few occasions when there was doubt as towhether a sealant was "all present" versus "partlymissing" or "all missing" versus "partly missing,"the status that was consistent with sealant loss wasselected. This was done to be sure that the resultsreported were not an overstatement of the trueretention total of the number of patients seen in the 13time intervals is 278 (as opposed to the actual numberof 176} because some subjects had sealants placedon two or more 1 through 4 show graphically thepercentage of teeth with "sealants all present" (andthe corresponding percentage of combined sealantfailures) for each of the 13 three-month time only statuses about which a definite statementcan be made are "sealant all present" and "sealantpartly missing;" both were determined at the timeof the clinical examination.)

8 Only the values for"sealant all present" were graphed. All other valuesrepresented sealant failures, of one form or another,and were combined and graphed as "combinedsealant failures." Each figure reports the number Ofteeth and the number of patients examined for eachtime interval. The total number of teeth and the totalnumber of patients examined for all time intervalsare also 1 shows sealant retention on all teethexamined at 5 to 43 months. The relationshipbetween the percentage of teeth with "sealant allpresent" and longevity is almost linear from theplotted value at 6 months (85%) to that at 33 months(67%).The last three values (for 36, 39, and 42 months)represent only "Nuva-Seal" sealants, while theprevious values represent a combination of "Nuva-Seal" and "Delton" with a decrease in the number ofpatients as a function of greater longevity is thegeneral increase in each standard error of the mean{hereafter abbreviated SEM}.

9 Sealant retention at six months ranges {for oneSEM} from a low of 82% to a high of 88% andthereafter, results in combined failures of about 4%at each six-month recall all patients who met the criteria of the study,the mean number of teeth sealed per patient was {669 teeth were sealed on 176 patients}.Figure 2 shows sealant retention on permanentteeth examined at 5 to 43 months. Ignoring the lastthree plotted values {for "Nuva-Seal" only}, therelationship between the percentage of teeth with"sealant all present" and longevity is almost linearfrom the plotted value at six months {86%} to thatat 33 months {68%}.Sealant retention at six months ranges {for oneSEM} from a low of 83% to a high of 89% andthereafter, results in combined failures of about 3%at each six-month recall all patients who met the criteria of the study,the mean number of permanent teeth sealed perpatient was {553 teeth were sealed on 132patients}.

10 Figure 3 shows sealant retention on maxillaryversus mandibular permanent teeth examined at 5to 43 months. Ignoring the last three sets of plottedvalues {for "Nuva-Seal" only), those for maxillaryteeth {circles) and mandibular teeth Idots} showsimilar lalmost linear) relationships, althoughsealants were found to be better retained bymaxillary teeth. Loss over time does not appear tobe different for maxillary versus mandibular only reversal occurred at 42 months {in the"Nuva-Seal" only group} where the lowest numberof teeth were examined in both the maxillary {fourteeth on two patients) and mandibular {two teeth ontwo patients} 4 shows sealant retention on premolarsversus molars examined at 5 to 43 months. Ignoringthe last three sets of plotted values {for "Nuva-Seal"only}, those for premolars {circles} and molars Idots}show similar {almost linear) relationships, althoughsealants were found to be better retained bypremolars.}}