Muñoz-Sandoval et al.

Journal of Dentistry

Pure Dentistry Dentists in Brisbane Journal club

■minimal intervention dentistry (MID) :

■preserve dental structures and restore form and function, keeping operative interventions at a minimum level

■maintain health, function and esthetics

Frencken 2017

■integrity of the pulp

■longer life expectancy →maintenance  of biological asset

■sealant → low caries progression rate

Bakhshandeh et al. 2015

■non-cavitated lesions treated with sealants

–progression →2.6% vs 12.6% for unsealed lesions

Griffin et al. 2008

■ need sealant to be intact

Bakhshandeh et al. 2015

■sealants →effective barrier between the external oral environment & dental biofilm within the body of the initially cavitated lesions

■controversial evidence : type of sealant material → affects the outcomes

Hiri et al. 2010

■conventional GIC may not be sufficiently effective to arrest lesion progression

Silveira et al. 2012

■low mechanical properties of GIC

Choi et al. 2006

■resin-based sealants →technique sensitive

Borges et al. 2010

■adhesive failure ,compromising retention

Bishara et al. 2002

■difficult moisture control → GI

Smith 1998

compare carious lesions progression and material retention between resin-based and GI sealants, for the management of ICDAS 3 occlusal carious lesions in school children

■RCT

■6-12 yrs old

■dental clinics of university of Talca

■ethics approval

■informed consent from parent  and assent from patient

■25% difference between study groups

■20% drop out rate

■n=74 lesions needed in each group

■6-12 yrs

■systemically healthy

■at least 1 ICDAS 3 lesion on occlusal of FPM

■25% difference between study groups

■20% drop out rate

■n=74 lesions needed in each group

■6-12 yrs

■systemically healthy

■at least 1 ICDAS 3 lesion on occlusal of FPM

■exclusion criteria:

–semi-erupted FPM

–enamel defects

–perio

–ortho

–other medications

■41 children , 151 ICDAS 3 lesions

■kappa value 0.9 intra and inter examiner

■standardized BWs

■customized positioning device

■1 lesion : randomised

■2 lesions: both type of material

■3 lesions: 2 types and third one randomised

■4 lesions: 2 of each type

■treatment by single operator

■not blinded

■followed manufactures instruction

■isolation

■resin-based: etch, rinse, dry, sealant

■GIC: conditioned, washed, dried GIC applied

■evaluated after 12 and 24 months

–lesion progression

–retention and integrity

–clinically & radiographically

■material retention

–successful: carious lesions, pits and fissures completely covered by the material.

–failure: carious lesions, pits and fissures partially or totally visible

■lesion progression

–original ICDAS 3 code changed to a greater code (ICADS 4, 5 or 6).

–code 1: Progression

–code 2: No progression

■radiographic evaluation

–radiolucent area larger than baseline →radiographic progression

–no change or ↓radiolucent → no radiographic progression

Only one of the lesions treated with resin-based sealants progressed

clinically (1.6%) to Code 5, without statistically significant differences

between the groups (χ2(1)=0.90,p=0.53). No lesion from the GI

group showed signs of clinical progression. Similarly, 1.9% (n=1) and

2.0% (n=1) showed radiographic progression in the resin-based and

GI group, respectively. This difference lacked statistical significance

(χ2(1)=0.93, p=0.93)

After 24 months, complete retention was observed in 77.4%

(n=48) of the resin and in 83.6% (n=46) of the GI sealants. There

was a trend for a better retention of the GI sealants (OR=1.49),

without statistically significant differences between the materials

(χ2(1)=0.71, p=0.48)

Location in the arch, sex and age of

the participant did not demonstrate any statistically significant relationship

with the radiographic or clinical success of the sealants (data

not shown). The multilevel binary regression model was statistically

significant (χ2(1)=24.98, p<0.001) and demonstrated that the type

of material and tooth surface did not influence sealant retention. Similarly,

the interaction between the type of material and tooth surface

did not result in significant risk values. Sealants placed in the buccal

surface showed a non-statistically significant trend for increased risk of

retention failure compared to those placed in occlusal or lingual surfaces

■change in treatment strategies

■moved from operative & restorative interventions to a non-operative and minimally invasive management which aims at the preservation of the tooth structure throughout the life-cycle

Giacaman 2017

■sealant over non-cavitated lesion

Griffin et al. 2008

We have moved from operative & restorative interventions to a non-operative and minimally invasive management which aims at the preservation of the tooth structure throughout the life-cycle using sealants over non cavitated lesions.

■this research showed that after 24 months, clinical progression of carious lesion treated with sealant was minimal, regardless of the type of material used

■one lesion showed clinical progression in the resin sealant group

■radiographically →progression of 1.9% of total lesions treated with resin sealant & 2.0% with GI

■similar findings in non-cavitated lesions at 12 months

Borges et al. 2010

 

■clinical efficacy of sealing →complete retention of the material

Bakhshandeh et al. 2012 & Borges et al. 2012 & Borges et al. 2010

■present study showed no progression when the sealant was partially or completely dislodged, which is consistent with previous studies

■64.7% of clinical success at 18 months, which is lower than this study

Hesse et al. 2014

■similar results

–on 7-10 yr olds

– carious lesions managed with resin sealants

–2 permanent molars

■ICDAS lesions scored up to 4

–radiographically less than halfway through the dentin

Fontana et al. 2014

A similar results have been reported in Fontana et al. study in 2014 that involved

7-10 yr olds in which carious lesions managed with resin sealants on 2 permanent molars with ICDAS lesions scored up to 4 and

radiographically less than halfway through the dentin

■their results:

–sealants were 100% effective at 12 months and 86% at 44 months

–low radiographic progression of 1% at 12 months, 3% at 24 months and 9% at 44 months

■Borges et al, 2012 found 11.5% progression in non-cavitated lesions when the sealant was dislodged at the 12-month follow-up

Borges et al. 2012

■studies showing that sealed carious lesions have a lower progression than unsealed lesions

–sealing in deep pits and fissures or with early enamel caries, only 10.8% of sealed lesions had progressed compared to 51.8% of unsealed lesions after 5 years

Holmgren et al. 2014

–non-cavitated lesions with resin sealants → 96% of the untreated lesions progressed compared to 3.8% of the sealed lesions

Borges et al. 2010

■Low evidence for use of GIC sealants on carious  lesions

■one study →use of GI sealants in 51 teeth

–the results showed 11.1% of radiographic progression compared to 50% of untreated lesions

Silveira et al. 2012

■sealants:

–may interrupt the nutritional supply of biofilm in dentin

–impairing bacterial growth

–subsequently lesion progression

Mertz-Fairhurst 1998

■professional monitoring is necessary

■retention continues to be a challenge

■the retention rate for either material used was relatively low with about 20% failure after 2 years, but without progression

■non-significant higher retention for GI over resin sealants was observed, with 83.6% and 77.4%, respectively

■irregular shapes of the lesion margins could alter sealant penetration and interlocking

■enamel quality of a previously acid-attacked tissue by bacterial acids may compromise optimal adhesion

Hevinga et al. 2008

■irregular shapes of the lesion margins could alter sealant penetration and interlocking

■enamel quality of a previously acid-attacked tissue by bacterial acids may compromise optimal adhesion

Hevinga et al. 2008

■irregular shapes of the lesion margins could alter sealant penetration and interlocking

■enamel quality of a previously acid-attacked tissue by bacterial acids may compromise optimal adhesion

Hevinga et al. 2008

■irregular shapes of the lesion margins could alter sealant penetration and interlocking

■enamel quality of a previously acid-attacked tissue by bacterial acids may compromise optimal adhesion

Hevinga et al. 2008

■ presence of a dental biofilm  could remain at the bottom of the pit and fissure of the microcavitated lesion and  reduce the adaptation of the sealants

■ studies have shown that demineralized & cavitated surfaces can ↓ the longevity of the sealant

■further research on microleakage and penetration of the sealant

■2% chlorhexidine does not increase survival of ART restoration

Farag et al. 2009

■cariogenic effect of GIC

Paulsen et al. 2001 & Chen et al. 2013

■remains of GIC in fissures allows release of fluoride

Simonsen et al. 2012

■in this study GI sealant showed higher retention rate (table 3)

–high viscosity of material

–digital pressure

–altered adhesion in microcavity with remains of biofilm

■limitations:

–radiographs: tooth replacement, bone growth

–BWs not suitable for occlusal lesions

–some studies have used it successfully

Maltz et al. 2007

■advantages of sealing microcavitated lesions

–patient- friendly

–no anesthesia

–lower cost

–higher access to treatment

–prevention of biological loss

Giacaman et al. 2017

–restorative death spiral

Brantley et al. 1995

■sealants effective in arresting progression of microcavitated  lesion

■no difference between resin and GIC

■more clinical studies

■title

–arrest→ progression

–retention

–different to aim in intro

■abstract

good outline of the study

has not mentioned aim

■keywords

retention, radiograph

How can they be sure it is arrested, and they have used progression mostly I think should have been consistent. ? Maybe caries in enamel under sealant material that does not show up on radiograph. Also in their aim they have mentioned progression and also evaluation of retention

 

introduction

good background of MIT

aim not consistent with title

recent studies have been used

methods and material

background of patients

wide age range

no rubber dam used for resin-based sealants

voids → additional material

follow ups single examiner

ICDAS 4

Aim : progression and retention

Patients all came to be treated at university no history on the background, diet, oral hyg, fluoridated water?

12 yr old has had the tooth in the mouth longer so microcavitiaiton may have been arrested even before sealant was placed. Maybe was best to just have 6 era olds that have just recently had teeth erupted less influenced by fluoride, etc..]

How big were the voids? Did the material flow into the voids?

Was the follow up examiner the same person? Calibrated?

Hard to see ICDAS 4 under sealant, maybe confined where the filling material is

methods and material

use of Diagnodent?

high risk patients? Risk assessment?

BWs for occlusal caries not very effective, could have used diagnodent? Especially for ICDAS 4? They have mentioned this in their limitations

Discussion

■reference 14 ( Borges)

looked at lesions in dentin (non cavitated)

fluoride releasing fissure sealant 

■

■reference 22

–primary teeth evaluated

–difference in teeth type

–better reference

■lengthy discussions and researched about non cavitated – not relevant

Ref 14: lesions in dentin are different from lesions of enamel.

Ref 22: maybe they could have looked at a reference that looked at the same tooth type, comparing retention of sealant in primary teeth with perman

Although there isn’t much study on cavitated (ICDAS3) they could have discussed it more briefly

■reference used for radiographic evaluation?

■no LA

Deep caries in dentin are different to enamel caries and the reference they have used for justifying bite wings for occlusal decay has looked at dentine caries

To use resin based fissure sealant and be effective rubberdam should be used and may be required to use LA

 

■sealants are very successful at preventing carious lesions

■covering the carious lesion completely is more important than the type of material

■retention is important is success rate

Bivariate :involving or depending on two variates.

Binary: Binary is a base 2 number system invented

Regression analysis is a form of predictive modelling technique which investigates the relationship between a dependent (target) and independent variable (s) (predictor). This technique is used for forecasting, time series modelling and finding the causal effect relationship between the variables

Wald test assesses constraints (condition of an optimization problem that the solution must satisfy)on statistical parameters (a quantity entering into the probability distribution of a statistic or a random variable) based on the weighted distance between the unrestricted estimate and its hypothesized value under the null hypothesis, where the weight is the precision of the estimate.[1][2] Intuitively, the larger this weighted distance, the less likely it is that the constraint is true. While the finite sample distributions of Wald tests are generally unknown,[3] it has an asymptotic χ2-distribution under the null hypothesis, a fact that can be used to determine statistical significance.[4]