Abstract
The purpose of this study was to evaluate the clinical success of fissure sealants (SR) and preventive resin restorations (PRR) which were applied over occlusal carious lesions and to discuss the availability of these methods in a program which manages recently erupted permanent molars by means of prevention and treatment of occlusal dental caries. A preventive resin restoration is a conservative treatment that involves limited excavation to remove carious tissue, restoration of the excavated area with a composite resin, and application of a sealant over the surface of the restoration and the remaining sound, contiguous pits and fissures. Subjects were 57 children aged between 8 and 14 years, at the last examination and who had teeth treated with either SR or PRR. They had been participating in a school-based fluoride mouthrinse program from the age of 5 years, which was combined with a targeted sealant-sealant was selectively applied on the fissure detected as sticky using an explorer-in elementary school. Sixty six teeth-64 first and 2 second permanent molars-were evaluated. Carious lesions that did not exceed a width of 2 mm in a pit or fissure of these teeth were detected. Accordingly, SR or PRR were applied on them. An excavation performed with a small round bur (# 1/2) was indicated for SR, while excavation using a bigger bur was indicated for PRR. After these lesions were treated with either SR or PRR, they were assessed twice a year. The mean period of observation was 3.4 years, with a range of 1 to 7.5 years. Out of 45 teeth to which we applied SR, 9 teeth developed secondary caries. In the case of PRR 3 teeth out of 21 teeth developed secondary caries. The cumulative survival rate for subject teeth after 7.5 years was 71.9±8.0 (SE)% as detected by Kaplan-Meier survival functions; thus, the cumulative incidence of secondary caries was 28.1%. There was no significant difference between the cumulative survival rate for SR (71.0 ± 9.1%; after 7.5 years) and that for PRR (75.2 ± 14.8%; after 5.5 years) as determined by generalized Wilcoxon analysis. And stepwise multivariate logistic regression analysis indicated that the school grade at which carious lesion was detected first had a significant impact on the development of secondary caries after SR or PRR application. A cavity detected at the 1st and 2nd grade was at a larger risk (odds ratio=4.56) than that was detected at higher grades. Similar findings have been reported earlier. It is, therefore, recommended that these treatment methods, which are indicated for small and discrete pit or fissure caries, be adopted in dental clinics practicing preventive measures of dental caries, including fluoride use. It is also suggested that the condition of sealant or resin restoration be observed periodically, in order to maintain it properly.
