Non-Cochrane · intervention · PM32055001
Comparison between Fissure Sealant and Fluoride Varnish on Caries Prevention for First Permanent Molars: a Systematic Review and Meta-analysis.
Li Feifei, Jiang Peipei, Yu Fanyuan, et al. · Scientific reports · 2020 · PubMed · doi:10.1038/s41598-020-59564-5
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
8
current version
GRADE rated
0
No studies
0
Included studies
7
linked below
No studies 0 · 0%Ungraded 8 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%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 | Generally healthy children aged 6 to 9 years with at least one fully erupted FPM with deep fissures or early enamel caries (ICDAS 0-3) | Children aged 6 to 9 years with FPMs (8 RCTs; 3289 participants; 6878 FPMs) |
| Intervention | Fluoride varnish applied biannually per manufacturer protocol | Fluoride varnish 22,600 ppm biannual in most trials; Ji 2007 used 7,700 ppm |
| Comparison | Fissure sealant (resin-based or glass ionomer/GIC sealant) per standard protocol | Fissure sealant: resin-based (Liu 2012, Bravo 1996/1997, Raadal 1984, Chestnutt 2017, Salem 2014), RMGIC (Tagliaferro 2011), GIC (Ji 2007) |
| Outcomes | Primary: caries incidence (CI), the proportion of children/FPMs/occlusal surfaces developing dentin caries (ICDAS 4-6). Secondary: increment of occlusal DMFS at end of follow-up | Caries incidence of enrolled children (2 RCTs), of FPMs (6 RCTs), of occlusal surfaces (4 RCTs); occlusal DMFS increment (3 RCTs) |
| Study designs | RCTs only (quasi-RCTs, controlled clinical trials, cohort studies and case reports excluded) | 8 RCTs (7 parallel-group, 1 split-mouth [Raadal 1984]) |
| Timing | Not specified (biannual application; outcomes at end of follow-up) | Follow-up 23 to 36 months (pooled at 2 to 3 years) |
Search date: February 2018. Databases: Cochrane CENTRAL (2018); MEDLINE via OVID (1948 to February 2018); PubMed (1960 to February 2018); Embase (1984 to February 2018); CNKI (2018); hand-search of selected dental journals; WHO International Clinical Trials Registry Platform; reference lists
Questions and results
Fluoride varnish applied biannually vs Fissure sealant (resin-based or glass ionomer)
Population: Generally healthy children aged 6 to 9 years with at least one fully erupted first permanent molar with deep fissures or early enamel caries (ICDAS 0-3)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries incidence of first permanent molars (FPMs) 2 to 3 years · Sensitivity analysis excluding Bravo 1996 (high risk of bias) After excluding the high-risk-of-bias study (Bravo 1996), fluoride varnish and fissure sealant did not differ in caries incidence of FPMs and heterogeneity fell to 0% (RR 1.05, 95% CI 0.91 to 1.22; 5 RCTs; ungraded). Source: Results 'CI of FPMs'; Fig. S2A · same question in other reviews | RR 1.05 [0.91, 1.22] | 5 studies | Ungraded |
Caries incidence (proportion of enrolled children developing dentin caries, ICDAS 4-6) 2 to 3 years Fluoride varnish and fissure sealant did not differ significantly in the proportion of children developing caries at 2 to 3 years (RR 1.12, 95% CI 0.60 to 2.09; 2 RCTs; ungraded). Source: Results 'CI of enrolled children'; Fig. 3A · same question in other reviews | RR 1.12 [0.60, 2.09] | 2 studies · 1072 participants | Ungraded |
Caries incidence of first permanent molars (FPMs) 2 to 3 years Fluoride varnish and fissure sealant did not differ significantly in caries incidence of first permanent molars at 2 to 3 years (RR 1.29, 95% CI 0.95 to 1.75; 6 RCTs; ungraded). Source: Results 'CI of FPMs'; Fig. 3B · same question in other reviews | RR 1.29 [0.95, 1.75] | 6 studies · 6878 participants | Ungraded |
Caries incidence of occlusal surfaces of first permanent molars 2 to 3 years · Sensitivity analysis excluding Bravo 1996 (high risk of bias) After excluding Bravo 1996, occlusal caries incidence slightly favored fluoride varnish but was not significant, with heterogeneity falling to 0% (RR 0.98, 95% CI 0.82 to 1.16; 3 RCTs; ungraded). Source: Results 'CI of FPMs occlusal surfaces'; Fig. S2B · same question in other reviews | RR 0.98 [0.82, 1.16] | 3 studies | Ungraded |
Caries incidence of occlusal surfaces of first permanent molars 2 to 3 years Fluoride varnish and fissure sealant did not differ significantly in caries incidence of FPM occlusal surfaces at 2 to 3 years (RR 1.33, 95% CI 0.83 to 2.11; 4 RCTs; ungraded). Source: Results 'CI of FPMs occlusal surfaces'; Fig. 3C · same question in other reviews | RR 1.33 [0.83, 2.11] | 4 studies · 6551 participants | Ungraded |
Increment of occlusal DMFS (decayed, missing, filled surfaces) of FPMs 2 to 3 years Fluoride varnish and fissure sealant did not differ significantly in occlusal DMFS increment of FPMs (MD 0.13, 95% CI -0.09 to 0.34; 3 RCTs; ungraded). Source: Results 'occlusal DMFS increment of FPMs'; Fig. 4 · same question in other reviews | MD 0.13 [-0.09, 0.34] | 3 studies · 1787 participants | Ungraded |
Increment of occlusal DMFS (decayed, missing, filled surfaces) of FPMs 2 to 3 years · Sensitivity analysis excluding Bravo 1997 (high risk of bias) Excluding Bravo 1997, occlusal DMFS increment still did not differ between fluoride varnish and fissure sealant (MD 0.04, 95% CI -0.15 to 0.23; 2 RCTs; ungraded). Source: Results 'occlusal DMFS increment of FPMs'; Fig. S2C · same question in other reviews | MD 0.04 [-0.15, 0.23] | 2 studies | Ungraded |
Caries incidence of first permanent molars (FPMs) 2 to 3 years · Sensitivity analysis excluding split-mouth design (Raadal 1984) Excluding the split-mouth trial (Raadal 1984) did not change the finding of no significant difference in caries incidence of FPMs (RR 1.29, 95% CI 0.88 to 1.87; 5 RCTs; ungraded). Source: Results 'Analysis without split mouth design'; Fig. S1 · same question in other reviews | RR 1.29 [0.88, 1.87] | 5 studies | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | No | Yes | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | Yes | no |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: Yes | RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 7
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Bravo 1996 Effectiveness of visible light fissure sealant (Delton) versus fluoride varnish (Duraphat): 24‐month clinical trial DOI:10.1111/j.1600-0528.1996.tb00811.x | 1 other review | not stated | not extracted yet | not extracted yet |
| Bravo 1997 A 24‐month Study Comparing Sealant and Fluoride Varnish in Caries Reduction on Different Permanent First Molar Surfaces DOI:10.1111/j.1752-7325.1997.tb02972.x | 1 other review | Increment of occlusal DMFS (decayed, missing, filled surfaces) of FPMs | not extracted yet | not extracted yet |
| Liu 2012 Randomized Trial on Fluorides and Sealants for Fissure Caries Prevention DOI:10.1177/0022034512452278 | 1 other review | not stated | not extracted yet | not extracted yet |
| Chestnutt 2017 Fissure Seal or Fluoride Varnish? A Randomized Trial of Relative Effectiveness DOI:10.1177/0022034517702094 | this review only | not stated | not extracted yet | not extracted yet |
| Raadal 1984 Fissure sealing of permanent first molars in children receiving a high standard of proaphylactic care DOI:10.1111/j.1600-0528.1984.tb01414.x | this review only | Caries incidence of first permanent molars (FPMs) | not extracted yet | not extracted yet |
| Salem 2014 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Tagliaferro 2011 matched by author and year (probable) | this review only | Increment of occlusal DMFS (decayed, missing, filled surfaces) of FPMs | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).
| Review | Shared studies | Jaccard |
|---|---|---|
| Pit and Fissure Sealant versus Fluoride Varnish for the Prevention of Dental Caries in School Children: A Systematic Review and… (2022) | 3 | 0.27 |