A 2-year clinical evaluation of sealed noncavitated approximal posterior carious lesions in adolescents

Abstract

The objective was to evaluate the clinical performance of a therapeutic sealant to arrest the progression of noncavitated approximal posterior carious lesions. The study population comprised 50 adolescents in whom bitewing radiographs had been taken for diagnosis of caries. Approximal noncavitated lesions in premolars and molars (4d-7m) were selected. One group (n=17) had a sealant placed after tooth separation on all enamel lesions. A second group (n=7) received sealant and fluoride varnish in a split-mouth design. A control group (n=26) received a standard fluoride varnish treatment without tooth separation. Follow-up radiographs were taken after 2 years and were analyzed together with the baseline radiographs in a blind study setting. About 93% of the sealed initial carious lesions showed no progression. The corresponding value for the fluoride varnish control group was 88%. In the split-mouth study, 92 and 88% of the surfaces with enamel caries showed no progression after sealant or fluoride varnish treatment, respectively. The difference between the two treatment procedures was not statistically significant. The incidence rate for the transition from enamel caries to dentin caries or fillings was 3.5-3.9 surfaces/100 years in the sealant groups and 5.9-6.1 surfaces/100 years in the fluoride varnish groups. The results show the potential of sealants to act as a noninvasive treatment of early approximal enamel lesions.

Effectiveness of sealing active proximal caries lesions with an adhesive system: 1-year clinical evaluation

“…The present investigation did not detect any significant difference between the experimental and control groups, which is contrary to the findings of previous studies 3,4 One of the reasons that might explain this lack of difference between the groups in the present study is the short follow-up period. Gomez et al 3 followed-up the participants over a 2-year period, while the follow-up by Martignon et al 4 was an 18-month period.…”

“…For instance, one study found that caries lesions measured by radiographic assessment were more likely to regress under intact sealants than under defective sealants. 7 There are two technical aspects of the present study that differed from those of Gomez et al 3 and Martignon et al 4 The first was the use of rubber dam isolation in all cases in order to avoid contamination of the restorative field; and the second was the method used for tooth separation. While the previous authors used orthodontic elastic bands two days before the sealing procedure, in the present study, metal separators were used.…”

“…Gomez et al 3 followed-up the participants over a 2-year period, while the follow-up by Martignon et al 4 was an 18-month period. It is known that the caries progression rate of proximal lesions is rather low, particularly in adult patients who have received regular fluoride treatment or who consume fluoridated water.…”

“…It has been hypothesized that sealing an existing lesion from contact with the oral fluids should lead to eventual reduction and even death of these organisms, thereby arresting the lesion progression. 5 Although sealants have been successfully placed over non-cavitated caries lesions in occlusal surfaces, 2,6,7,8,9,10,11 few short-and long-term clinical evaluations have been reported on the method for managing proximal caries lesions 3,4 Therefore, the aim of this study was to evaluate the clinical performance of an adhesive system used as a sealant to arrest the progression of proximal caries lesions over a period of 1 year. The null hypothesis to be tested was that the two groups would have a similar performance in the course of 1 year.…”

“…Within this concept, contemporary protocols for the treatment of dental caries support the use of sealants, not only as preventive treatment for sound fissures, but also to arrest dental caries progression by sealing active occlusal and proximal caries lesions. 2,3,4 Carious disease results from the imbalance between causal and protective factors, including bacterial infection and, therefore, restoration of the decayed tooth does not cure the disease. Initial lesions occur beneath the enamel surface and can, to a large extent, be repaired by re-establishing the balance between demineralization and remineralization.…”