Evaluation between flowable composite and conventional pit-and-fissure sealant among school children in Bengaluru City: Randomized controlled trail

Gaurav Gupta; Arun Paul; Gulam Anwar Naviwala; Deepa Prakash; Prijitha Alex

doi:10.4103/jdrr.jdrr_72_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 9 | Issue : 4 | Page : 286-290

Evaluation between flowable composite and conventional pit-and-fissure sealant among school children in Bengaluru City: Randomized controlled trail

Gaurav Gupta¹, Arun Paul², Gulam Anwar Naviwala³, Deepa Prakash⁴, Prijitha Alex⁵
¹ Department of Public Health Dentistry, RKDF Dental College, Bhopal, Madhya Pradesh, India
² Department of Public Health Dentistry, KMCT Dental College, Kozhikode, Kerala, India
³ Department of Public Health Dentistry, HKDET's Dental College and Hospital, Humnabad, Karnataka, India
⁴ Department of Public Health Dentistry, Oxford Dental College and Hospital, Bengaluru, Karnataka, India
⁵ Department of Public Health Dentistry, Educare Dental College and Hospital, Malappuram, Kerala, India

Date of Submission	07-May-2022
Date of Decision	14-Oct-2022
Date of Acceptance	01-Nov-2022
Date of Web Publication	12-Feb-2023

Correspondence Address:
Arun Paul
Department of Public Health Dentistry, KMCT Dental College, Mukkam, Manassery, Kozhikode - 673 602, Kerala
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jdrr.jdrr_72_22

Abstract

Introduction: Restorative dentistry has achieved remarkable developments in halting caries predominantly seen in pit and fissures. Flowable composite resin is predominantly used as pit-and-fissure sealants in recent years. The aim of our study was to compare the retentive properties of a flowable composite resin compared to a conventional sealant in 6–9 years school children over 18 months’ period. Materials and Methods: The study was a randomized controlled trail and conducted over a period of 18 months. Forty participants were randomly selected for this study from the private school. Flowable composite resin was used to seal the mandibular 1^st molars on one side and conventional resin sealant was used on the other side. Results: The differences in the retention status between the sealants after 12 and 18 months were found statistically significant with P = 0.02 and P = 0.03, respectively. When the retention status was compared within the materials at different intervals, it was found to be statistically significant (P < 0.001). Conclusion: Conventional resin-based sealants had better retention rate at 12 and 18 months’ duration than the flowable composite resin.

Keywords: Conventional resin sealant, flowable composite resin, retention status, school children

How to cite this article:
Gupta G, Paul A, Naviwala GA, Prakash D, Alex P. Evaluation between flowable composite and conventional pit-and-fissure sealant among school children in Bengaluru City: Randomized controlled trail. J Dent Res Rev 2022;9:286-90

How to cite this URL:
Gupta G, Paul A, Naviwala GA, Prakash D, Alex P. Evaluation between flowable composite and conventional pit-and-fissure sealant among school children in Bengaluru City: Randomized controlled trail. J Dent Res Rev [serial online] 2022 [cited 2023 Mar 26];9:286-90. Available from: https://www.jdrr.org/text.asp?2022/9/4/286/369589

Introduction

Recent years have witnessed exceptional developments in preventive dentistry coupled with a significant reduction of dental caries worldwide. Caries preventive strategies are largely depending on noninvasive techniques rather than invasive ones.^[1] Most effective method of caries prevention is the application of pit-and-fissure sealants along with periodic fluoride application, adequate diet and good oral hygiene.^[2]

Occlusal morphology of young permanent molars and premolars, inherent anatomical aberrations including deep and narrow fissures make young permanent susceptible to caries.

Pit-and-fissure sealants get adhered to tooth structure effectively and seal the morphological irregularities completely. Adherence and retention to tooth structure are very critical in preventing microleakage and caries.^[3],[4]

Sealants are economical and affordable preventive treatments when compared to other therapeutic treatments done before the caries progresses. Retention of the sealant is a determining factor for effective prevention of inception of any new caries lesion and its progression.^[5] Longevity depends on strict isolation, acid etching, micropore formation, flow of the material, and skill of the operator.

The three most commonly used materials as sealants are glass ionomer cements, compomers, and resins. Glass ionomer cements have the advantage of releasing active F− in the surrounding enamel and make them less susceptible to caries. Resin-based sealants provide mechanical barrier to the nutrients for microorganism and inhibit their growth. Compomers have the advantages of both glass ionomer cements and resins.^[3] The most susceptible periods for young permanent teeth is 2-year posteruptive maturation period and this critical period has to be seized by prompt placement of pit-and-fissure sealants. The aim of this clinical study was to evaluate the retention rate of a flowable composite resin as a pit-and-fissure sealant compared to a conventional resin based sealant in 6–9 years’ school children over 18 months period.

Materials and Methods

The study was conducted in the Pediatric Wing, The Oxford Institutions, J. P. Nagar, Bengaluru, from February 2013 to September 2014. The study duration was 18 months. The study design adopted was randomized controlled trial. Ethical clearance was obtained with number 315/2012-13 followed by permission to perform the study from the Ethical Review Committee and headmaster before the start of the study. Children in the age group of 6–9 years were included and those with fully erupted bilateral lower first permanent molar teeth. Among these children those with deep pit and fissure and which were caries free were included in the study. Children with one of the molar on either side is grossly carious or restored, molar teeth with antagonist teeth not present, uncooperative and mentally challenged patients were excluded from the study. Standardization and calibration was done before commencing the study. The Kappa co-efficient value (κ) was 0.81 and it reflected high degree of conformity in observation. A pilot study was carried out to check the relevance of the prepared format. The subjects who participated in pilot study were not included in the study.

A random selection of 38 children using computer-generated table of random numbers was done. They were included in the study based on inclusion criteria. Enamel preparation on the right and left side of the lower arch was done randomly using the lottery method. A split-mouth design was used by placing conventional light-cured resin on one side and a light-cured flowable composite resin sealant on the contralateral side [Figure 1]. All procedures were informed to the parents and written informed consent was obtained.

Figure 1: Flow chart of the study protocol

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Oral prophylaxis and thorough cleaning with brush was done for each child to ensure the removal of debris from the fissures before sealant application. All procedures were carried out by a single operator

Evaluation of the Sealant was done at 6, 12, and 18 months. The criteria were classified as complete present, partial present, or missing proposed by Richard J Simonsen.^[13]

Statistical analysis

All statistical procedures were performed using Statistical Package for Social Sciences (SPSS) 20.0 software (IBM, Armonk, NY, United States of America). Association between the materials and retention rate within and between the materials at 6, 12 and 18 months was assessed with chi-square test. Significance is assessed at 5% level of significance.

Results

Among the total participants, 26.4% belonged to 6 and 8 years group each, and 23.6% belonged to 7 and 9 years group. Females were 52.6% and males were 47.4%. [Table 1] shows that at 6 months follow-up, for both flowable composite resin and conventional resin sealant 89.5% teeth, showed complete retention (statistically not significant). At 12 months 63.2% of flowable composite resin showed complete retention whereas conventional resin (89.5%) had significantly higher retention (P = 0.02). Similarly, at 18-month follow-up conventional resin (68.4%) had significantly higher retention (P = 0.03) when compared to flowable (52.6%). [Table 2] depicts the comparison of retention status within the material (flowable composite resin) were significantly different at 12 (P < 0.001) and 18 (P = 0.04 and P < 0.001) months. Retention status for conventional resin sealant material were significantly different at 12 (P < 0.001) and 18 (P = 0.002 and P = 0.002) months.

Table 1: Distribution and comparison of materials based on retention status at 6, 12, and 18 months

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Table 2: Comparison of retention status of flowable composite resin and conventional resin sealant material at 6, 12, and 18 months

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Discussion

The current study showed that the retention status of conventional resin sealant was similar to the flowable composite resin at 6-month interval. The complete and partial retention was 89.5% and 10.5% for both flowable composite resin and convention resin sealant, respectively, at 6 months’ interval and it was statistically insignificant, whereas in other studies conducted by Corona et al.,^[1] total retention and partial loss was 100% and 0% for both flowable composite resin and conventional resin sealant, respectively. A study conducted by Puppin-Rontani et al.,^[6] total retention and partial loss was 60%–23%, respectively, for flowable composite resin whereas, total retention and partial loss were 53% and 31%, respectively, for conventional resin sealant. In a study of Jafarzadeh et al.,^[8] complete retention and partial loss were 94.9%–5.1%, respectively, for flowable composite resin whereas, complete retention and partial loss was 92.3% and 7.7%, respectively, for conventional resin sealant. The differences in retention status of two materials at 12 months were found statistically significant, similar to studies conducted by Erdemir et al (2014)^[5], Puppin et al (2006)^[6], do Rego MA et al (1996).^[9],[10] This could be attributed to the enhanced flowing and retentive properties of the conventional fissure sealant.

The present study revealed 0% missing of conventional resin sealant at 12 months interval which was similar to studies conducted by Corona et al (2005)^[1], Dukic et al (2007)^[4], Aguilar FG et al (2007)^[7], Jafarzadeh et al (2010)^[8] and Erdemir et al (2014)^[5]. At 18 month interval the retention status of conventional sealant was better compared to the flowable sealant. Similar results were reported by Koch MJ (1997)^[11], Autio-Gold (2002)^[12], Simonsen RJ (1991)^[13]. Our study is suggestive of the findings that flowable composite resin are not as retentive as the conventional resin sealant material. One reason could be that the fluidic property of the conventional sealants permit them to penetrate deeper fissures.^{[14],[15],[16]} They can resist masticatory forces. The presence of inorganic fillers prevent polymerization shrinkage to a larger extent.^[17],[18]

The partial retention and missing of flowable composite resin and partial retention of conventional resin sealant on the occlusal surface were observed at 12 and 18 months. The inability of the flowable sealant to adhere to the tooth structure resulted in premature fracture and failure. Uneven and asymmetrical acid etching resulted in incomplete etching, which compromised the quality of enamel for bonding.

Conclusion

Retention of the sealant determines the longevity and success invariably; however, other factors such as case selection, enamel irregularities, isolation too determine the success of the sealant. Conventional resin sealants can be a material of choice since retention is the key to the success of sealants in the long term. However, more research is recommended to ascertain the effectiveness and reliability of the flowable composite resin despite its widely suggested usage by taking a larger sample size and for a longer duration.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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