From prevention to therapy: minimal intervention with sealants and resin restorative materials.

The breakthrough discovery of the acid-etch procedure by Buonocore in the mid-1950s laid the groundwork for the development of pit and fissure sealant as the best preventive agent for use against the development and progression of pit and fissure caries. The acid-etch technique is also the foundational technology behind the ability for clinical dentistry to adapt to a more conservative, minimally invasive, approach to restorative dentistry. The 1970s saw the acid etch technique developed the first foray into minimally invasive operative approaches, which was termed the Preventive Resin Restoration. With the development of the etching of porcelain, additional uses of the acid-etch technique (not discussed here) have led to other conservative procedures such as the porcelain veneer technique and the restorative uses of bonded, etched porcelain, and bonded fixed partial dentures.

Preventing dental caries through school-based sealant programs: updated recommendations and reviews of evidence.

BACKGROUND: School-based sealant programs (SBSPs) increase sealant use and reduce caries. Programs target schools that serve children from low-income families and focus on sealing newly erupted permanent molars. In 2004 and 2005, the Centers for Disease Control and Prevention (CDC), Atlanta, sponsored meetings of an expert work group to update recommendations for sealant use in SBSPs on the basis of available evidence regarding the effectiveness of sealants on sound and carious pit and fissure surfaces, caries assessment and selected sealant placement techniques, and the risk of caries' developing in sealed teeth among children who might be lost to follow-up. The work group also identified topics for which additional evidence review was needed. TYPES OF STUDIES REVIEWED: The work group used systematic reviews when available. Since 2005, staff members at CDC and subject-matter experts conducted several independent analyses of topics for which no reviews existed. These reviews include a systematic review of the effectiveness of sealants in managing caries. RESULTS: The evidence supports recommendations to seal sound surfaces and noncavitated lesions, to use visual assessment to detect surface cavitation, to use a toothbrush or handpiece prophylaxis to clean tooth surfaces, and to provide sealants to children even if follow-up cannot be ensured. CLINICAL IMPLICATIONS: These recommendations are consistent with the current state of the science and provide appropriate guidance for sealant use in SBSPs. This report also may increase practitioners' awareness of the SBSP as an important and effective public health approach that complements clinical care.

A revised classification for direct tooth-colored restorative materials.

Composite resins and glass-ionomer cements were introduced to dentistry in the 1960s and 1970s, respectively. Since then, there has been a series of modifications to both materials as well as the development other groups claiming intermediate characteristics between the two. The result is a confusion of materials leading to selection problems. While both materials are tooth-colored, there is a considerable difference in their properties, and it is important that each is used in the appropriate situation. Composite resin materials are esthetic and now show acceptable physical strength and wear resistance. However, they are hydrophobic, and therefore more difficult to handle in the oral environment, and cannot support ion migration. Also, the problems of gaining long-term adhesion to dentin have yet to be overcome. On the other hand, glass ionomers are water-based and therefore have the potential for ion migration, both inward and outward from the restoration, leading to a number of advantages. However, they lack the physical properties required for use in load-bearing areas. A logical classification designed to differentiate the materials was first published by McLean et al in 1994, but in the last 15 years, both types of material have undergone further research and modification. This paper is designed to bring the classification up to date so that the operator can make a suitable, evidence-based, choice when selecting a material for any given situation.

Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs.

This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs. The panel addressed the following clinical questions. Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews.

Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association Council on Scientific Affairs. The panel addressed the following clinical questions: Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus. glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? TYPES OF STUDIES REVIEWED: Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews. At the panel's request, the ADA Division of Science staff conducted additional searches for clinical studies related to specific topics. The Centers for Disease Control and Prevention also provided unpublished systematic reviews that since have been accepted for publication. RESULTS: The expert panel developed clinical recommendations for each clinical question. The panel concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions. CLINICAL IMPLICATIONS: These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. The evidence indicates that sealants can be used effectively to prevent the initiation and progression of dental caries.

Caries management by risk assessment: implementation guidelines.

ACT This consensus statement supports implementation of caries management by risk assessment in clinical practice by using the following principles: modification of the oral flora, patient education, remineralization, and minimal operative intervention. The statement includes a list of supporters.

Preventive resin restorations and sealants in light of current evidence.

Pit and fissure sealant should be treatment option provided to all children, particularly at the age immediately after eruption of the posterior teeth and especially, but not exclusively, the permanent teeth. Preventive resin restoration is minimally invasive procedure that should be the treatment of choice for small carious lesions in the posterior teeth. The Class I amalgam should not be placed as a first-time restorative material to treat incipient or small carious lesions under any circumstances. The amount of tooth structure removal necessary for Class I Black preparation, which requires sufficient depth of amalgam and extension for prevention, is an unacceptable treatment when minimally-invasive options are available.

Why we can't believe what we read.

It is argued that many claims made in the dental literature lack scientific grounding. Rather than become cynical, dentists are urged to use their own critical judgment and caution when reading the literature, especially articles and advertisements in the rapidly expanding area of dental materials. An example involving research on "condensable" resin-bonded composites is analyzed in detail, showing how an apparently credible claim can be lacking in support.

Pit and fissure sealant: review of the literature.

For this literature review of pit and fissure sealant, 1,465 references were selected by a search for "sealants" on PubMed. References were limited to dental journals and papers in the English language. The search comprised papers from 1971 to October 2001. Additional papers of historical significance prior to 1971 were added from memory and from reference lists published in early papers. This paper reviewed the literature on pit and fissure sealants under the following subheadings: (1) laboratory studies, (2) clinical technique and tooth preparation, (3) etching time, (4) auxiliary application of pit and fissure sealant, (5) retention and caries prevention, (6) fluoride used with sealants and fluoride-containing sealant, (7) glass ionomer materials as sealants, (8) options in sealant: filled vs unfilled; colored vs clear; autocure vs light-initiated, (9) sealant placed over caries in a therapeutic manner, (10) cost effectiveness of sealant application, (11) underuse of pit and fissure sealant, (12) the estrogenicity issue, (13) use of an intermediate bonding layer to improve retention, (14) new developments and projections, and (15) summary and conclusions. From a careful and thorough review of peer-reviewed publications on pit and fissure sealant, it is clear that sealants are safe, effective and underused (at least underused in the United States). Pit and fissure sealant is best applied to high-risk populations by trained auxiliaries using sealant that incorporates the benefit of an intermediate bonding layer, applied under the rubber dam or with some alternative short-term, but effective, isolation technique, onto an enamel surface that has been cleaned with an air polishing technique and etched with 35% phosphoric acid for 15 seconds. The dental profession awaits with enthusiasm, and some impatience, the incorporation of dentin-bonding technology into the development of a modern, more durable, resin-based sealant.