NEUROQUANTOLOGY | NOVEMBER 2022 | VOLUME 20 | ISSUE 15 | PAGE 3964-3970| DOI: 10.14704/NQ.2022.20.15.

NQ88398
Dr. Kunal Jha / RETENTION OF PIT AND FISSURE SEALANTS WITH AND WITHOUT DENTIN BONDING AGENTS - A COMPARATIVE
SYSTEMATIC REVIEW

RETENTION OF PIT AND FISSURE SEALANTS WITH AND WITHOUT DENTIN

BONDING AGENTS - A COMPARATIVE SYSTEMATIC REVIEW
3964
Dr. Kunal Jha1, Dr Shrinidhi Jain2, Dr. Bhanu Pratap Valluri3, Dr. Soni Jha4, Dr. Alok Dubey5, Dr.
Bhasker N6,
1. Professor, Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, Kalinga
Institute of Industrial Technology (KIIT) Deemed to be University, Bhubaneswar,
Odisha. kunal.jha@kids.ac.in
2. Lecturer, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences
(ABSMIDS), Department of Prosthodontics and Crown and Bridge, Mangalore, India.
sjain7035@gmail.com
3. Department of conservative dentistry and endodontics, GSL dental college and hospital,
Rajhamundry, Andhra pradesh. bhanupratapv1988@gmail.com
4. (MDS, GDC Ahemdabad), Senior Lecturer, Department of Conservative dentistry and
Endodontics, Yashwantrao Chavan Memorial Medical & Rural Development Foundation's Dental
College & Hospital, MIDC, Ahmednagar, Maharashtra.soni.jha4000@gmail.com
5. Associate professor, Department of Preventive Dental Sciences, College of Dentistry, Jazan
University, Jazan, Saudi Arabia. dentaalok@yahoo.com
6. Associate Professor, Department of Conservative Dentistry And Endodontics, Tirumala institute
of Dental sciences, Nizamabad, Telangana. bhasker.naik88@gmail.com
Corresponding Author: Dr Shrinidhi Jain, Nitte (Deemed to be University), AB Shetty Memorial
Institute of Dental Sciences (ABSMIDS), Department of Prosthodontics and Crown and Bridge,
Mangalore, India. sjain7035@gmail.com

ABSTRACT
Aim
To summarize the available clinical evidence on effectiveness of retention of pit and fissure sealants
(PFS) on occlusal surfaces of permanent teeth when evaluated in clinical trials. Study selection
Electronic searches were performed in PubMed and Cochrane Library for the identification of
relevant studies, from their inception until February 2022 and an additional search was done with
the reference lists of included articles. The review protocol followed the PRISMA guidelines. Ten
articles were considered relevant for qualitative synthesis. The data extracted from two of the
included articles showed statistically significant difference between the two materials based on their
retention potential, of which one article favored superior retention of flowable composites and one
article favored higher retention of PFS and the other eight studies showed no significant difference
between the two materials. Results The current review has shown evidence suggesting the effective
retention of pit-and fissure sealants when applied to prevent occlusal caries in permanent molars,
however, this evidence is of low quality. Conclusion The clinical efficacy of sealants is directly linked
to their potential to retain and this systematic review focuses on comparing the relative
effectiveness of pit-and-fissure-sealants in permanent teeth.
Keywords Pit and fissure sealants, retention, permanent dentition.
DOI Number: 10.14704/NQ.2022.20.15.NQ88398 NeuroQuantology2022;20(15): 3964-3970

INTRODUCTION caries risk children and in deep, retentive pits

Pit and fissure sealants (PFS) are one of the and fissures (PF).1 They are widely accepted in
most effective non-invasive approaches to pediatric dentistry. Preservation of healthy
prevent and/or arrest occlusal caries in high tooth structure and prevention of dental

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NEUROQUANTOLOGY | NOVEMBER 2022 | VOLUME 20 | ISSUE 15 | PAGE 3964-3970| DOI: 10.14704/NQ.2022.20.15.NQ88398
Dr. Kunal Jha / RETENTION OF PIT AND FISSURE SEALANTS WITH AND WITHOUT DENTIN BONDING AGENTS - A COMPARATIVE
SYSTEMATIC REVIEW

caries is an essential measure of pediatric or in comparison with another type of sealant

dentistry. Permanent molars with complicated material and fluoride varnishes.
occlusal morphology which are highly AIM OF THE PRESENT STUDY
susceptible to dental caries are least Aim of the current systematic review was to
protected by fluoride application.2 Hence, PFS evaluate the relative effectiveness of 3965
is the important measure to protect the retention of pit and fissure sealants on
occlusal pits and fissures. Since pit and fissure occlusal surfaces of permanent teeth when
sealants were introduced and based on the evaluated in clinical trials.
pioneering studies reported by Buonocore on METHODOLOGY
acid etching, which improved the adhesion of This review followed the Preferred Reporting
resin materials to tooth structure.3 The pit Items for Systematic Reviews and Meta-
and fissure sealants serve by the adherence of Analyses statement for reporting systematic
the resin material to the acid-etched enamel reviews. For identification of studies for this
surface, thus, physically occluding the pits and review, a detailed search was performed in
fissures from the rest of the oral the following databases: PubMed and
environment.4 However, PFS is technique Cochrane Central Register of Controlled Trials,
sensitive.5 Furthermore, the failure of from their inception till Feb 2022. A
retention of the resin-based fissure sealants complementary search was also conducted by
over a period of time may be due to the screening the references of the selected
breakdown of the bond between the tooth articles, previously published reviews in the
and sealant.6,7 Several studies have reported topic, and textbooks to find any that did not
an increased retention rate 5,6,7,8 and reduced appear in the database search and also in the
effect of salivary contamination on the clinical trial registry (clinicaltrials.gov.in). The
microleakage 9 with the application of bonding research question for this review was
agent. Few studies showed no effect of formulated in PICOS format (participants,
improved retention rate with the use of interventions, comparisons, outcomes and
bonding agent before sealant.10-13 Bonding study design), based on PRISMA guidelines.
agent forms an intermediate layer between The following exclusion criteria were applied:
etched enamel and the sealant, as well as (1) Studies on primary teeth. (2) Studies with
increases the retention of the sealants to pits less than 12 months of clinical follow-up. (3)
and fissures.14 Application of bonding agent Studies not in the English language. (4)
allows optimal infiltration15 and formation of Reviews, case reports and case series,
longer resin tags which provide observational and descriptive studies, and
micro-mechanical retention to the sealant.16 laboratory research. The full text screening of
Although some studies have reported the articles was then performed to identify
improved bond strength with adhesive the articles that met the inclusion criteria.
systems,17 increased sealant retention on Studies with no ‘high risk of bias’ ratings were
saliva contaminated teeth,18 and minimized considered to have an overall low risk of bias,
micro-leakage 19 with the use of adhesive one ‘high risk of bias’ rating moderate risk of
systems, whereas others have shown a bias, and more than one ‘high risk of bias’
decrease in the bond strength, stating that rating a high overall risk of bias.
the primers get diluted by moisture.20,21 There RESULTS
have been systematic reviews in the past that With the defined criteria, the initial searches
have evaluated the clinical effectiveness and retrieved 143 potential articles. Four articles
safety of pit and fissure sealants, either alone were selected by manually screening the
references of previous reviews relevant to the

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NEUROQUANTOLOGY | NOVEMBER 2022 | VOLUME 20 | ISSUE 15 | PAGE 3964-3970| DOI: 10.14704/NQ.2022.20.15.NQ88398
Dr. Kunal Jha / RETENTION OF PIT AND FISSURE SEALANTS WITH AND WITHOUT DENTIN BONDING AGENTS - A COMPARATIVE
SYSTEMATIC REVIEW

title, making a total of 147 articles. After effectiveness of fluorides in the remineralizing
duplicate removal, 138 articles remained; the phases. Pit and fissure sealants have been
title and abstract screening revealed fourteen effective in reducing occlusal caries, but their
articles of relevance. After full-text screening, effectiveness may be precluded by technical
four articles were excluded with reasons, and problems during application, such as salivary 3966
ten articles that fulfilled the eligibility criteria contamination. Application under optimal
were included in the present qualitative conditions determines the success of pit and
review. The included ten articles involved 533 fissure sealant. The use of bonding agent
patients in the age group of 4–22 years and a under sealants on etched enamel surface
total of 1800 permanent molars were sealed increases bond strength, reduces
according to the intervention and comparison microleakage, and enhances flow of resins
group of each included study. The follow-up into fissures.25 Two studies 24 were single-
interval of the studies ranged from 1-24 blinded randomized clinical trials, where the
months, with a period minimum of up to 12 outcome assessor was blinded to the
months. Three studies had isolated the teeth treatment groups and only the study by
to be sealed with rubber dam, whereas the Kucukyilmaz et al 26 was double-blinded. In all
other studies had utilized cotton rolls and the included studies, the teeth surfaces were
saliva ejector as a means of isolation. Etching cleaned prior to treatment either by pumice
was done with 37% phosphoric acid at varying prophylaxis or by scaling. In the study by
time periods for each of the study, and the Corona et al, the dental surfaces were cleaned
bonding agents applied were cured for about with pumice in Robinson bristle brushes to
10 –20 s and the pit and fissure sealants and remove salivary pellicle and the remaining
the flowable composites were cured for about dental bio film. Singh C et al 27 had advocated
40 s in all the included studies. In the study by air abrasion as a measure to reach the deep
Amin 22, there was no loss of sealant in 96% of pits and fissures inaccessible with pumice
the sealed teeth in all the groups for upto 2 prophylaxis or acid etching and demonstrated
years. The permanent teeth that were sealed that this pseudo-mechanical method showed
with flowable composite remained fully- better retention of both conventional PFS and
sealed over a one-year follow-up period in the flowable composites. Isolation with rubber
randomized clinical trial by Corona et al 23, dam was done in three studies to prevent
whereas partial loss of sealant was noticed on salivary contamination and facilitate
two teeth in the conventional PFS group. operatory procedures. Several authors have
Jafarzadeh et al noted partial loss of flowable assessed the retention of sealants after one-
composite for four teeth at 12-month follow- year, which might be considered as a short
up, and for six teeth in the conventional period for evaluation of clinical success.
fissure sealant group, however, for both the According to Dennison et al, most sealant
materials, there was no total loss of sealants failures occur at six months following
over 12-months follow-up.24 application.28 Hence the duration of 12
DISCUSSION months was considered as a minimum period
The occlusal surface is at high risk for caries. required to be included in this review. Five
This is especially true for newly erupted studies had a follow-up of up to 24 months. In
molars, where anatomic characteristics cause one study, the author had reported the
difficult access for cleaning procedures and occurrence of caries and the salivary
incomplete maturation of enamel adds to antibacterial activity. It was found that,
caries susceptibility. The complex morphology despite the flowable composite performing
of the occlusal surface also reduces the better in retention rate, the caries occurrence

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NEUROQUANTOLOGY | NOVEMBER 2022 | VOLUME 20 | ISSUE 15 | PAGE 3964-3970| DOI: 10.14704/NQ.2022.20.15.NQ88398
Dr. Kunal Jha / RETENTION OF PIT AND FISSURE SEALANTS WITH AND WITHOUT DENTIN BONDING AGENTS - A COMPARATIVE
SYSTEMATIC REVIEW

was higher with flowable composite and least bonding agents: A clinical study of
with glass-ionomer sealant than resin-based two-bottle and single-bottle systems.
sealant. Similarly, there was a maximum J Dent Res 2000;79:1850-6.
reduction of salivary Streptococcus mutans 6. Barrie AM, Stephen KW, Kay EJ.
count for glass-ionomer sealants, which may Fissure sealant retention: A 3967
be reasoned out due to the fluoride-releasing comparison of three sealant types
property of the ionomeric materials. The under field conditions. Community
results of the included studies presented with Dent Health 1990;7:273-7.
large heterogenicity through different 7. McCafferty J, O’Connell AC. A
statistical analysis and variations in randomised clinical trial on the use of
methodology and scoring criteria, making it intermediate bonding on the
difficult to compare the results. Variables like retention of fissure sealants in
operator experience, familiarity and children. Int J Paediatr Dent
standardized scoring criteria should be 2016;26:110-5.
encouraged to validate the findings. 8. Pinar A, Sepet E, Aren G, Bolukbas N,
CONCLUSION Ulukap H, Turan N. Clinical
The current review has shown evidence performance of sealants with and
suggesting the effective retention of pit-and - without a bonding agent.
fissure sealants when applied to prevent Quintessence Int 2005;36:355-60.
occlusal caries in permanent molars. Long- 9. Hebling J, Feigal RJ. Use of one-bottle
term trials measuring the outcome of dental adhesive as an intermediate bonding
caries after sealant application in permanent layer to reduce sealant microleakage
teeth will provide better guidance for on saliva-contaminated enamel. Am J
clinicians. Dent 2000;13:187-91.
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NEUROQUANTOLOGY | NOVEMBER 2022 | VOLUME 20 | ISSUE 15 | PAGE 3964-3970| DOI: 10.14704/NQ.2022.20.15.NQ88398
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SYSTEMATIC REVIEW

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NEUROQUANTOLOGY | NOVEMBER 2022 | VOLUME 20 | ISSUE 15 | PAGE 3964-3970| DOI: 10.14704/NQ.2022.20.15.NQ88398
Dr. Kunal Jha / RETENTION OF PIT AND FISSURE SEALANTS WITH AND WITHOUT DENTIN BONDING AGENTS - A COMPARATIVE
SYSTEMATIC REVIEW

TABLES
Table 1- A flow diagram showing the process from identification to inclusion of the studies

Pubmed 91 Conchrane 19 Clinical trials-33 Additional search- 4

3969

Total articles identified through

database search (n=14)

Records after duplicates removed=138

Table 2- General
Records screened after title and abstract reading (n=14)
characteristics of the included
studies
Au De Age Tot
tho sig ran al
r n ge nu Studies included in the qualitative research= 10
an of of mb
d Stu par er
Ye dy tici of
ar pan part
ts icip
ant
s
Aut Spli 6– 32
io t- 11 chil
Gol mo yea dre
d uth rs n,
JT, des 118
20 ign teet
02 h
Cor RC 4–7 40
on T- yea chil
a hal rs dre
et f- n,
al, mo 80

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NEUROQUANTOLOGY | NOVEMBER 2022 | VOLUME 20 | ISSUE 15 | PAGE 3964-3970| DOI: 10.14704/NQ.2022.20.15.NQ88398
Dr. Kunal Jha / RETENTION OF PIT AND FISSURE SEALANTS WITH AND WITHOUT DENTIN BONDING AGENTS - A COMPARATIVE
SYSTEMATIC REVIEW

20 uth teet
05 des h
ign
Du Cli 7– 41
kic nic 17 part 3970
et al yea icip
al., tria rs ants
20 l ,
07 100
teet
h
Du Cli 6– 130
kic. nic 15 chil
Wa al yea dre
lter tria rs n,
et l 326
al, teet
20 h
07
Am Co 7– 15
in ntr 10 part
et oll yea icip
al., ed rs ants
20 clin , 90
08 ical teet
tria h
l
Jaf RC 6–9 40
arz T - yea part
ad spli rs icip
eh t ants
et mo , 80
al., uth teet
20 des h
09 ign
Sin RC 6–9 30
gh T yea part
C rs icip
et ants
al, ,
20 120
19 teet
h

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