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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 4  |  Issue : 4  |  Page : 343-347

Effect of preconditioning on retention of glass ionomer pit and fissure sealant: An in vivo 9-month study


1 Department of Operative Dentistry, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, Egypt
2 Department of Pedodontics and Oral Health, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, Egypt

Date of Submission18-Feb-2021
Date of Acceptance22-Apr-2021
Date of Web Publication06-Oct-2021

Correspondence Address:
Samaa A Zaghloul
Department of Operative Dentistry, Faculty of Dental Medicine for Girls, Al-Azhar University, Youssef Abbas Street, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsm.jnsm_20_21

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  Abstract 


Purpose: Caries prevention using fissure sealants is directly proportional to their retention. This in vivo study evaluated the effect of preconditioning on retention of glass ionomer (GI) fissure sealant, in maxillary and mandibular primary and permanent teeth. Subjects and Methods: Two hundred and forty teeth in 30 children of 6-8 years age range were involved. In all participants, the second primary and the first permanent molars in each quadrant were investigated following split-mouth design; so that, selected teeth in the right side had their pits and fissures conditioned before GI sealant application (Group A: n = 120 teeth). In the left side, however, the same sealant was applied without preconditioning (Group B: n = 120). According to Simonsen's sealant retention criteria, clinical assessment was performed at 3, 6, and 9 months. Data were gained then statistically analyzed using Chi-square test. Results: A significant difference (P ≤ 0.05) was evident between both groups at the three assessment intervals, with better sealant retention in preconditioned group. Although no significant difference appeared between primary and permanent teeth, maxillary teeth were significantly better in sealant retention than mandibular ones. Conclusions: Preconditioning enhanced GI sealant retention, more durable caries prevention can be thus provided easily with low cost.

Keywords: Caries prevention, glass ionomer conditioners, pit and fissure sealants, sealant retention, sealing primary and permanent teeth


How to cite this article:
Zaghloul SA, El-Sayed SR, Mohamed EA. Effect of preconditioning on retention of glass ionomer pit and fissure sealant: An in vivo 9-month study. J Nat Sci Med 2021;4:343-7

How to cite this URL:
Zaghloul SA, El-Sayed SR, Mohamed EA. Effect of preconditioning on retention of glass ionomer pit and fissure sealant: An in vivo 9-month study. J Nat Sci Med [serial online] 2021 [cited 2021 Dec 1];4:343-7. Available from: https://www.jnsmonline.org/text.asp?2021/4/4/343/327597




  Introduction Top


Due to complex anatomy, pit and fissure caries is still a mess despite the rapid progress in dental prophylaxis protocols.[1],[2] Pits and fissures with complex morphology are highly retentive areas for food and bacteria. In addition, they represent physical barriers against salivary flow cleansing and remineralizing agents.[3] Several morphologies are known for pits and fissures anatomy; U and V are easily accessed and cleansed, while I and K patterns are too sophisticated requiring more difficult interventions to inhibit caries process.[4]

Many approaches had been allocated for pit and fissure caries management. These approaches start from general caries prophylaxis measures, including dietary control of cariogenic carbohydrates, enhancing oral hygiene measures, and increasing fluoride intake either topically or in diet and water, till reaching more specific ways as in fissurotomy; in which retentive fissures are transformed into nonretentive ones when slightly opened with a bur, fluoride varnishes, and pit and fissure sealants application.[5]

In 1967, Cueto and Bunocore had first utilized the pit and fissure sealing concept. When pits and fissures are sealed, a physical barrier will prevent the ingress of food and bacteria, therefore, caries is expected to be inhibited.[6] This desired caries inhibition is achieved through pit and fissure sealing; only if a good adaptation and retention between the sealant and the pit and fissure walls are present.[7],[8]

Common sealants include: Filled and unfilled resin sealants, flowable composite, and glass ionomer cement (GIC).[9] Chemical adhesion to tooth structure without prior bonding and fluoride discharge are the major merits of GIC. GIC also shows less sensitivity to moisture contamination compared to resin sealants. The last advantage facilitates its placement, especially in children.[10],[11]

Several studies suggested that conditioning tooth surface with mild acids before GIC application can remove surface contaminants and thus bring about more sealant retention and adhesion.[12],[13] Therefore, this study investigated the effect of preconditioning on retention of a GI pit and fissure sealant clinically, at 3-, 6-, and 9-month intervals.


  Subjects and Methods Top


Ethics

CONSORT guidelines were followed. An approval from the Committee of Ethics (PD-P-020-008), Faculty of Dental Medicine for Girls, Al- Azhar University, Cairo, Egypt, was gained. In addition, informed consents were signed by the participants' parents before holding this randomized controlled study. CONSORT guidelines were followed. An approval from the Committee of Ethics (PD-P-020-008), gained on 12/22/2020 from the Committee of Ethics at Faculty of Dental Medicine for Girls, Al- Azhar University, Cairo, Egypt. In addition, informed consents were signed by the participants' parents before holding this randomized controlled study.

Case selection

Using the statistical sample calculator http://WWW.Surveysystem.com [with confidence level= 0.95, confidence interval= 21,91 and P. value= 0.05], the resultant sample size was 240. Two hundred and forty teeth in 30 children of both sexes, with 6-8 years age range, from the patients of the pediatric outdoor clinic of Faculty of Dental Medicine for Girls, Al- Azhar University, were enrolled in this study, if met the following inclusion criteria: cooperative children with no carious cavities, sealants, or restorations present in teeth selected for this study. Medically compromised children (as those with mental, respiratory, or physical illnesses) were excluded.[14]

Grouping of cases

In each participant, the second primary molars and the first permanent molars in the four quadrants were used for the study, following the split-mouth design; so that, maxillary and mandibular selected teeth in the right side were designated to receive 26% polyacrylic acid conditioner (RIVA conditioner, SDI, Sao Paulo, SP, Brazil) before GI sealant (RIVA Protect, SDI, Sao Paulo, SP, Brazil) application (Group A: n = 120 teeth), while their left-side counterparts were decided to have the same sealant without prior conditioner application (Group B: n = 120 teeth).

Teeth isolation and materials application

After teeth polishing, selected teeth were isolated using rubber dam and suitable clamps. In Group A, RIVA conditioner was applied followed by water washing then air drying. RIVA protect sealant capsules were then mixed for 10 s in an amalgamator (Astronmix, Dabi Atlante/Ribeirao Preto, SP, Brazil) and applied using dispensing gun then light cured for 20 s. In Group B, however, the same sealant was applied without preconditioning. In both groups, following materials application, rubber dam assembly was removed, the occlusion was checked using articulating paper, and high spots were eliminated. Participants' parents were informed about recall visits after 3-, 6-, and 9-month intervals.

Clinical assessment at the recall visits

Sealant retention assessment was fulfilled using mouth mirrors according to Simonsen's criteria:[14]

  • Completely retained: If no ledges were present, even if after sealant wear some peripheral fissures were uncovered
  • Partially retained: If a portion of previously sealed pit/fissure was evident
  • Missing: If no any sealant was detectable.


Data of all groups being assessed at 3-, 6-, and 9-month intervals were collected and statistically analyzed.

Statistical analysis

Statistical analysis was performed using a commercially available software program (SPSS 18; SPSS, Chicago, IL, USA).

Values were expressed in numbers and percentages. Among groups and within intervals, Chi-square test was performed. The level of significance was set at P ≤ 0.05.


  Results Top


Comparing preconditioned versus nonpreconditioned groups

At the three assessment intervals (3, 6, and 9 months), teeth in Group A (preconditioned group) showed higher complete sealant retention percentages than Group B (nonpreconditioned group). The difference between groups was statistically significant (P ≤ 0.05) [Table 1] and [Figure 1].
Figure 1: Bar chart illustrating criteria of sealant retention in preconditioned (A) & non- preconditioned (B) groups at different assessment intervals

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Table 1: Comparison of criteria of sealant retention, n (%) in preconditioned versus nonpreconditioned groups at different assessment intervals (Chi-square test)

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Comparing sealant retention in primary versus permanent teeth

At the three assessment intervals, permanent teeth showed higher complete sealant retention than primary teeth, and the difference, however, did not represent a statistical significance (P ≥ 0.05) [Table 2] and [Figure 2].
Figure 2: Bar chart illustrating criteria of sealant retention in primary versus permanent teeth at different assessment intervals

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Table 2: Comparison of criteria of sealant retention, n (%) in primary versus permanent teeth at different assessment intervals (Chi-square test)

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Comparing sealant retention in maxillary and mandibular teeth

At the three assessment intervals, maxillary teeth showed higher complete sealant retention percentages than mandibular teeth. The difference between groups was statistically significant (P ≤ 0.05) [Table 3] and [Figure 3].
Figure 3: Bar chart illustrating criteria of sealant retention in maxillary versus mandibular teeth at different assessment intervals

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Table 3: Comparison of criteria of sealant retention, n (%) in maxillary versus mandibular teeth at different assessment intervals (Chi-square test)

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  Discussion Top


Caries prevention has become one of the most recent and important objectives in dentistry.[15] Preventing occlusal caries through pit and fissure sealants can be maximal only if there was perfect retention of the sealant to the retentive pit/fissure.[16],[17] In this study, GI sealant was utilized because of its advantages including being adhesive and anticariogenic through fluoride charging, added to its low sensitivity to moisture and low cost compared to resin sealant, being suitable for low income and high caries incident populations.[18],[19] Several studies had shown no statistically significant difference compared to resin sealants regarding caries prevention although resin sealants showed higher retention rates.[20],[21],[22],[23] Preconditioning with acids such as polyacrylic acid was suggested to increase retention rates of GI fissure sealants.[24],[25]

The sitting study investigated the effect of preconditioning on retention of GI pit and fissure sealants as compared to no preconditioning. Results showed that complete retention of GI sealant in preconditioned group was greater than in nonpreconditioned one, in the three assessment intervals. Such results could be attributed to smear layer eradication and micropores formation in enamel, therefore, increasing surface area available for micromechanical retention in addition to chemical adhesion.[12]

These results came in accordance with Mazaheri et al.,[12] who proved that preconditioning cavities with 20% acrylic acid resulted in better chemical and micromechanical retention of GIC in primary teeth. Birkenfeld and Schulman[26] also stated that GI formed a morphologic unit with enamel and resulted in decreased microleakage, when preconditioning was attempted. In their scanning electron microscope study, Castro and Feigal[27] as well as Yilmaz et al.[28] recorded a lowered microleakage and better contact at enamel/GIC interface after preconditioning step.

On contradiction, Hoshika et al.[29] obtained nonsignificant difference between preconditioned and nonpreconditioned dentin regarding microtensile bond strength to GIC. It is worth mentioning that they also evaluated the dentin/GIC junction using transmission electron microscopy and showed that most of the failure was of cohesive type, which may be the cause for the nonsignificant difference when dentin was preconditioned or not in their study.

On comparing sealant retention in permanent versus primary teeth, no significant difference was recorded despite permanent teeth showed better sealant retention at the three assessment intervals, getting along with Bhushan and Goswami[14] who attributed such finding to proper rubber dam moisture control. A significant difference, however, resulted when maxillary teeth were compared to mandibular ones, with better sealant retention in maxillary teeth. The reason could be good stress dissipation away from the sealant; along the three furcated maxillary roots, compared to only two roots in mandibular molars with the sealant being in longer fissures, receiving, therefore, more occlusal load.[11]


  Conclusions Top


Preconditioning appeared to be capable of enhancing GI pit and fissure sealant retention, thus providing prolonged and cost-effective anticaries protection in both primary and permanent teeth.

Although polyacrylic acid preconditioning proved near the same efficacy in both dentitions, with evidently better retention in maxillary teeth, further studies are needed to evaluate the effect of different morphologic and histologic features of both dentitions on clinical outcomes of different pit and fissure sealants using various preconditioning protocols at longer assessment intervals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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[PUBMED]  [Full text]  
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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