Cochrane · intervention · CD001830

Pit and fissure sealants for preventing dental decay in permanent teeth

Ahovuo‐Saloranta, A, Forss, H, Walsh, T, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library

Oral Health Dental caries5 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

11

current version

GRADE rated

3

No studies

2

Included studies

38

as reported

No studies 2 · 18.2%Ungraded 6 · 54.5%Very low 2 · 18.2%Low 0 · 0%Moderate 1 · 9.1%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Children and adolescents from the general population, aged up to 20 years	38 studies with 7924 randomised participants; children aged 5 to 16 years; recruited from schools or dental clinics; studies conducted in 20 countries
Intervention	Resin/composite-based, glass ionomer-based, or new types (ormocer-based) fissure sealants placed on occlusal surfaces of permanent premolar or molar teeth to prevent caries; applied on sound surfaces or enamel lesions; direct application or after mechanical preparation of the surface	Resin/composite-based sealants (n=15 studies); glass ionomer-based sealants (n=18, incl. resin-modified); ormocer-based sealant (n=1)
Comparison	No sealant, or a different type of sealant material	No sealant (n=18); different sealant material (n=24)
Outcomes	Incidence of caries expressed as caries or no caries on occlusal surfaces of permanent premolar or molar teeth; caries defined as caries into dentine; adverse events and safety of sealants	Incidence of caries on occlusal surfaces (n=38); retention of sealants (n=38); adverse events (n=4, none observed)
Study designs	Randomised controlled trials with at least 12 months follow-up; both parallel-group and split-mouth study designs; unit of randomisation could be individual, group, tooth or tooth-pair	Split-mouth and parallel-group studies (38 total)
Timing	At least 12 months follow-up	Follow-up periods: 12 months (n=7); 24 months (n=16); 36 months (n=9); 48-54 months (n=5); 60 months (n=3); 72-84 months (n=2); 108 months (n=1)

Search date: 2016-08. Databases: Cochrane Oral Health's Trials Register; CENTRAL; MEDLINE Ovid; Embase Ovid; ClinicalTrials.gov; WHO ICTRP

Questions and results

Current version only

Resin-based fissure sealant (2nd/3rd/4th generation) vs No sealant (control/no treatment)

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB5 (current) · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Caries on occlusal surfaces of permanent molars (48-54 months) 48-54 months same question in other reviews	OR 0.21 [0.16, 0.28]	4 studies	Ungraded
Caries on occlusal surfaces of permanent molars (12 months) 12 months same question in other reviews	OR 0.17 [0.10, 0.30]	7 studies	Ungraded
Adverse effects same question in other reviews	Two trials measured adverse effects. None were reported.	2 studies	Ungraded
Caries on occlusal surfaces of permanent molars (36 months) 36 months same question in other reviews	OR 0.17 [0.11, 0.27]	7 studies	Ungraded
Dentine caries in permanent molars (24 months) 24 months same question in other reviews	OR 0.12 [0.08, 0.19] 160 per 1000 (16%); 400 per 1000 (40%); 700 per 1000 (70%) vs 52 per 1000 (31 to 74); 63 per 1000 (38 to 96); 189 per…	7 studies · 1322 participants	Moderate Downgraded: indirectness

Glass ionomer-based sealant vs No sealant (control/no treatment)

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB5 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Adverse effects same question in other reviews	Adverse effects not measured.	NR	No studies
Dentine caries in permanent molars (24 months) 24 months same question in other reviews	Inconclusive results: two studies slightly favoured glass ionomers (Liu 2014b OR 0.46 (0.23-0.91); Tagliaferro 2011) evaluating 426 children; one study (Songpaisan 1995) found no difference (MD DFS -0.18 (-0.39 to…	3 studies · 830 participants	Very low Downgraded: risk of bias, inconsistency, indirectness

Glass ionomer-based sealant vs Resin-based sealant

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB5 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Adverse effects same question in other reviews	One trial measured adverse effects. None reported.	1 study	Ungraded
Dentine caries in permanent molars 12-72 months same question in other reviews	Inconsistent effect (differences in products, comparisons, outcomes, outcome reporting times, background fluoride and age groups); 21 trials (3883 participants randomised); very low quality	21 studies · 3883 participants	Very low Downgraded: inconsistency, indirectness

New types of fissure sealant (e.g. ormocer-based) vs No sealant (control)

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB5 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	No studies comparing new types of fissure sealants with no sealant were included.	NR	No studies

Ormocer-based sealant vs Low-viscosity glass ionomer sealant

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB5 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dentine caries in permanent molars 24 months same question in other reviews	Guler 2013 (N=50) compared ormocer-based sealant versus low-viscosity glass ionomer; not separately meta-analysed	1 study · 50 participants	Ungraded

Resin-based fissure sealant (2nd/3rd/4th generation) vs No sealant (control/no treatment)

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB4 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Caries on occlusal surfaces of permanent molars (12 months) 12 months	OR 0.16 [0.08, 0.30]	6 studies	Ungraded
Dentine caries in permanent molars (24 months) 24 months	OR 0.12 [0.07, 0.19] 400 per 1000 (40%); 700 per 1000 (70%) vs 63 per 1000 (38 to 96); 190 per 1000 (122 to 272)	6 studies · 1066 participants	Moderate Downgraded: indirectness
Caries on occlusal surfaces of permanent molars (36 months) 36 months	OR 0.17 [0.11, 0.27]	7 studies	Ungraded
Caries on occlusal surfaces of permanent molars (48-54 months) 48-54 months	OR 0.21 [0.16, 0.28]	4 studies	Ungraded

Glass ionomer-based sealant vs No sealant (control/no treatment)

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB4 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dentine caries in permanent molars (DFS increment, 24 months) 24 months	MD -0.18 [-0.39, 0.03] -0.18 [-0.39, 0.03] DFS increment (mean difference)	1 study · 404 participants	Very low Downgraded: risk of bias, imprecision, indirectness

Glass ionomer-based sealant vs Resin-based sealant

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB4 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dentine caries in permanent molars 12-84 months	Inconsistent effect (differences in comparisons, outcomes, outcome reporting times and background fluoride exposure); 15 trials (2939 participants randomised); very low quality	15 studies · 2939 participants	Very low Downgraded: inconsistency, indirectness

Resin-modified glass ionomer (RMGI) sealant vs Resin-based sealant

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB4 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dentine caries in permanent molars 12-36 months	Inconsistent effect (different products, outcomes, outcome reporting times and age groups); 3 trials (418 participants randomised); very low quality	3 studies · 418 participants	Very low Downgraded: inconsistency, indirectness

Polyacid-modified resin composite (compomer) vs Resin-based sealant

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB4 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dentine caries in permanent molars (24 months) 24 months	OR 0.65 [0.29, 1.48]	2 studies · 68 participants	Very low Downgraded: risk of bias, imprecision, indirectness

Resin-based fissure sealant (2nd/3rd/4th generation) vs No sealant (control/no treatment)

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB3 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Caries on occlusal surfaces of permanent molars (36 months) 36 months	RR 0.30 [0.22, 0.40]	3 studies	Ungraded
Caries on occlusal surfaces of permanent molars (12 months) 12 months	RR 0.13 [0.09, 0.20]	3 studies	Ungraded
Caries on occlusal surfaces of permanent molars (48-54 months) 48-54 months	RR 0.40 [0.31, 0.51]	3 studies	Ungraded
Dentine caries in permanent molars (24 months) 24 months	RR 0.22 [0.15, 0.34]	3 studies	Ungraded

Glass ionomer-based sealant vs No sealant (control/no treatment)

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB3 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dentine caries in permanent molars (DFS increment, 24 months) 24 months	MD 0.18 [-0.034, 0.39]	1 study · 404 participants	Ungraded

Glass ionomer-based sealant vs Resin-based sealant

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB3 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dentine caries in permanent molars 24 months-7 years	Divergent across 8 studies (e.g. Poulsen RR 3.39, Kervanto-Seppala RR 3.86 favour resin; Arrow RR 0.19, Beiruti RR 0.28 favour glass ionomer; Forss RR 1.44 no difference); no meta-analysis	8 studies	Ungraded

Polyacid-modified resin composite (compomer) vs Resin-based sealant

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB3 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dentine caries in permanent molars (24 months) 24 months	OR 0.61 [0.23, 1.66]	2 studies	Ungraded

Resin-based fissure sealant (2nd/3rd/4th generation) vs No sealant (control/no treatment)

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB2 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Dentine caries in permanent molars (24 months) 24 months	RR 0.24 [0.20, 0.30]	3 studies	Ungraded
Caries on occlusal surfaces of permanent molars (36 months) 36 months	RR 0.30 [0.26, 0.35]	3 studies	Ungraded
Caries on occlusal surfaces of permanent molars (12 months) 12 months	RR 0.14 [0.09, 0.19]	3 studies	Ungraded
Caries on occlusal surfaces of permanent molars (48-54 months) 48-54 months	RR 0.43 [0.37, 0.50]	2 studies	Ungraded

Glass ionomer-based sealant vs No sealant (control/no treatment)

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB2 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dentine caries in permanent molars (DFS increment, 24 months) 24 months	MD 0.18 [-0.034, 0.39]	1 study · 404 participants	Ungraded

Glass ionomer-based sealant vs Resin-based sealant

Population: Children and adolescents (general population, aged under 20 years)

CD001830.PUB2 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dentine caries in permanent molars 24-84 months	Conflicting: Poulsen 2001 RR 3.39 (1.98-5.79) and Songpaisan 1995 MD -0.47 (-0.63 to -0.31) favour resin; Arrow 1995 RR 0.19 (0.09-0.43) favours glass ionomer; no meta-analysis	3 studies	Ungraded

Fissure sealant (resin-based or glass ionomer) vs No sealant (control)

Population: Children and adolescents (general population, aged under 20 years)

CD001830 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Caries increment on occlusal surfaces of permanent molars (planned primary outcome)	no estimate extracted	NR	No studies

One type of fissure sealant vs Another type of fissure sealant

Population: Children and adolescents (general population, aged under 20 years)

CD001830 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Caries increment on occlusal surfaces of permanent molars (planned primary outcome)	no estimate extracted	NR	No studies