In vitro analysis of material micro-leakage in pit and fissure sealants.

A preferable choice of material offers superior resistance against micro-leakage for clinical applications in preventing dental caries in pits and fissures is of interest. A total of 45 extracted human premolars were cleaned, stored in a saline solution, and randomly divided into three groups, each intended for treatment with one of the sealants: Fuzi VII, ClinPro, and Embrace Wetbond. The application of the sealants followed the manufacturers' instructions strictly. The teeth were subjected to thermal cycling to simulate oral conditions. Marginal micro-leakage was then assessed by dye penetration method using a 0.5% methylene blue dye. Teeth were sectioned, and dye penetration was measured under a stereomicroscope. The results showed that all the tested materials exhibited some degree of micro-leakage. Within the limitations of this In vitro study, it was concluded that Embrace Wetbond exhibited superior performance in terms of minimizing marginal micro-leakage among the tested pit and fissure sealants.

Detection of pit and fissure sealant microleakage using quantitative light-induced fluorescence technology: an in vitro study.

This in vitro study aimed to evaluate the feasibility of quantitative light-induced fluorescence (QLF) technology for detecting the presence and severity of microleakage of pit and fissure sealants. The areas of interest (AOIs) were 160 pits and fissures of 40 extracted permanent teeth. Fluorescent images were acquired using a QLF device, and the maximum fluorescence loss ΔFmax of each AOI was analyzed. After staining and cross-sectioning of the teeth, histological dye penetration was scored on a scale of 0 to 3. The relationship between ΔFmax and microleakage depth was analyzed, and the areas under the curve (AUCs) were calculated. The │ΔFmax│ increased as microleakage depth increased. The ΔFmax values of microleakage areas showed a strong significant correlation with the histological scores of dye penetration (r = - 0.72, P = 0.001). AUC analysis showed a high diagnostic accuracy for microleakage depth (AUC = 0.83-0.91). The highest AUC of 0.91 was found when differentiating the outer half microleakage of the sealant (histological score 0 vs. 1-3). QLF technology is effective in assessing the presence and severity of microleakage, suggesting its potential for noninvasive detection and monitoring of sealant microleakage in clinical settings.

Clinical Evaluation of the Retention of Four Different Pit and Fissure Sealants on the First Permanent Molars - An Original Research.

Objective: In this study, the retention rates of four different pit and fissure sealant materials on the first permanent molars were clinically assessed and compared. Materials and Methods: A total of 120 kids aged 7 to 10 participated in a randomized controlled experiment. On their first permanent teeth, the subjects each got one of the four sealant materials (A, B, C, or D). Over the course of 24 months, the retention rates were evaluated every 6 months. The Chi-square test and Kaplan-Meier survival analysis were used for statistical analysis. Results: At 6, 12, 18, and 24 months, the following retention rates were observed overall: A (85%, 78%, 65%, 52%), B (90%, 82%, 70%, 60%), C (78%, 70%, 55%, 42%), and D (95%, 88%, 75%, 62%). At each time point, the sealant materials showed significant variations in retention rates (P 0.05). While sealants A and C showed lower retention rates, sealant D showed the best retention rates, followed by sealant B. Conclusion: This study shows that different materials have different retention rates for pit and fissure sealants on first permanent molars. Higher retention rates for sealants D and B suggest that they may be superior than sealants A and C. These results highlight how crucial it is to choose the right sealant materials to guarantee long-term retention and effectiveness in avoiding dental cavities.

Clinical effectiveness of pit and fissure sealants in primary and permanent teeth of children and adolescents: an umbrella review.

PURPOSE: This umbrella review aimed to critically appraise the evidence published in systematic reviews (SRs) on the clinical effectiveness of sealants compared with each other/the non-use in primary/permanent teeth of children and adolescents with at least 12-month follow-up. METHODS: A systematic literature search on 4 electronic databases was conducted up to January 18th, 2023. Following handsearching, two review authors independently screened retrieved articles, extracted data, and assessed the risk of bias (RoB) using the risk of bias in systematic reviews (ROBIS) tool. Based on a citation matrix, the overlap was interpreted by the corrected covered area (CCA). RESULTS: Of 239 retrieved records, 7 SRs met the eligibility criteria with a moderate overlap among them (CCA = 7.4%). For primary molars, in 1120 1.5- to 8-year-old children, data on the clinical effectiveness of sealants were inconclusive. For permanent molars, 3 SRs found a significant caries risk reduction for sealants versus non-use (≤ 36-month follow-up). There was insufficient evidence to proof superiority of sealants over fluoride varnish for caries prevention (3 SRs), and to rank sealant materials according to the best clinical effectiveness in permanent molars. One study was rated at low and 6 at high RoB, which did not allow for a valid quantitative synthesis. CONCLUSION: Considering the limitations of this umbrella review, sealants are more effective for caries prevention in children's permanent molars compared to no treatment. Future well-implemented RCTs are needed to draw reliable conclusions on the clinical effectiveness of sealants in primary and permanent teeth of children and adolescents.

Comparative Analysis of Techniques for Pit and Fissure Sealant Application to Reduce Microleakage.

Introduction In modern dentistry, the focus is more on preventing caries than on treating it, which helps preserve the tooth structure. Pit and fissure sealants (PFS) are the most effective methods for providing a mechanical barrier and avoiding the accumulation of dental plaque in deep pits and fissures, thereby preventing occlusal caries. The present study was conducted to compare the efficiency of dentin bonding agents (DBA) with or without fissurotomy in reducing microleakage before PFS placement. Materials and methods A total of 48 freshly extracted premolars were randomly divided into four groups as follows: Group 1, the conventional technique of PFS (Clinpro, 3M ESPE sealant); Group 2, fissurotomy performed before PFS placement; Group 3, Scotchbond Universal Adhesive (3M ESPE DBA) applied before PFS placement; and Group 4, fissurotomy along with DBA was used before PFS placement. The teeth were subjected to thermocycling followed by dye penetration using a 1% solution of methylene blue for 24 hours. All teeth were then assessed for microleakage by a qualitative method using a stereomicroscope at 40X and depth of dye penetration by image analysis. The Kruskal-Wallis test followed by Dunn's test was used for intergroup comparisons of microleakage scores, and ANOVA followed by Tukey's test was used for intergroup comparisons of the depth of dye penetration. These analyses were conducted using statistical software (SPSS version 22, Chicago, IL, USA). Results Statistically significant differences were observed between the groups in terms of the microleakage scores and depth of dye penetration (p<0.05). The group 4 showed a minimum microleakage score (0.50±0.52), and maximum scores were observed in Group 1 (2.16±0.71). Group 2 showed insignificant differences with groups 3 and 4 for depth of dye penetration (p>0.05). Statistically significant differences were observed between groups 1 and 2, groups 1 and 4, and groups 3 and 4 for the microleakage score (p<0.05). Conclusion Fissurotomy with or without DBA significantly reduced microleakage before the PFS placement. Prior use of fourth-generation DBA significantly reduced microleakage compared with PFS placement without the use of DBA.

Influence of incorporation of nanostructured silver vanadate decorated with silver nanoparticles on roughness, microhardness, and color change of pit and fissure sealants.

Objective: The aim of this study was to evaluate the roughness, hardness, and color change of pit and fissure sealants of two commercial brands (Fluroshield ™ and Ultraseal XT ™) incorporated with nanostructured silver vanadate nanomaterial decorated with silver nanoparticles (ß-AgVO3) in concentrations (0% - control, 2.5% and 5%). Material and methods: Two commercial brands Fluroshield TM and Ultraseal XT ™ were used to make the samples with dimensions of 6 × 6 × 4 mm. The control group was made according to the manufacturer's instructions and in the groups with the addition of ß-AgVO3, the nanomaterial was added proportionally by mass at percentages of 2.5% and 5%. Roughness properties were evaluated using a 3D Laser Confocal Microscope (n = 10), Knoop microhardness by Microdurometer (n = 10), and color change by Portable Color Spectrophotometer on the CIEDE2000 system (n = 10). Data were evaluated by one-way ANOVA with Bonferroni adjustment and Tukey's mean comparison test at a 5% significance level. Results: Ultraseal XT ™ sealant roughness showed a significant difference between concentrations with the highest mean for the 5% group (P = 0.010). Regarding the hardness, both sealants showed no significant difference between the groups. Fluroshield ™ sealant showed a significant difference in ΔE00 between the control-2.5% 24.93 (3.49) and control-5% 28.41 (2.58). Conclusion: It may be concluded that the incorporation of ß-AgVO3 influenced the increase in roughness for Ultraseal XT ™ pit and fissure sealant, did not interfere with the microhardness of both sealants, and promoted a change in the color of Fluroshield ™ sealant within clinically acceptable limits.

Research interest on dental sealant in dentistry based on the 100 most cited articles: bibliometric analysis

Abstract The aim of this study was to identify and analyze the characteristics of the 100 most cited articles about dental sealants (DS) in dentistry. In September 2023, a search was performed in the Web of Science Core Collection (WoS-CC) database. The following information was extracted from each article: number and density of citations, year of publication, authorship, journal, impact factor, keywords, study design, theme, continent, country, and institution. The citations of the WoS-CC were compared with those of the Scopus and Google Scholar databases. The VOSviewer software was used to generate collaborative networks. The number of citations ranged from 33 to 205. The articles were published between 1961 and 2016. Buonocore MG (7%) was the most prominent author among the most cited. The Journal of the American Dental Association was the most frequent journal (25%) and Journal of Dental Research (7.6) had the highest impact factor. Most studies had interventional (41%) and laboratory (31%) designs, mainly addressing DS effectiveness in the prevention and control of dental caries (86%). There was a predominance of publications from North America (46%) and the USA was the country with the highest number of articles (44%). The most frequent institutions were the Centers for Disease Control and Prevention (USA) and the University of Rochester (USA) (6% each). "Retention" was the most frequent keyword. In conclusion, the 100 most cited articles were mostly interventional and laboratory studies, addressing the retention and efficacy of DS. Most of the articles were concentrated in North America and Europe, demonstrating a little collaboration from other continents.

Use of Sealants in Permanent Molars by Brazilian Dentist: A Comparative Study of Public versus Private

Abstract Objective: To compare the use of sealants in permanent molars between public and private dentists in Brazil. Material and Methods: This was a cross-sectional and analytical web survey study. The convenience sample consisted of dentists in Brazil who answered a pre-tested online form released via social media between July and October 2021. Descriptive analysis was performed using absolute and relative frequencies (%) and associations using the Chi-square test (p<0.05). Results: Brazilian professionals participated in the study (n=2,244). Comparing the professionals from the public service with those from the private service, the former had a higher positive perception of the use of sealants as a preventive (92.4% vs. 81.1%, p<0.00l) and therapeutic procedure (90.7% vs. 82.4%, p=0.00l), higher percentage of non-invasive (91.7% vs. 83.8%, p<0.00l) and invasive (22.8% vs. 12.0%, p< 0.001) techniques. Professionals from the private service reported more frequently that they did not use sealants than those from the public service (14.0% vs. 4.8%, p<0.00l). Resin sealant (97.7% vs. 94.9%, p=0.0l5) and Flow resin (62.0% vs. 54.3%, p=0.013) were the most used by professionals in the private service. The use of glass ionomer cement was not associated with the type of service (75.1% vs. 77.2%, p=0.172), nor was the use of adhesives (0.6% vs. 1.4%, p=0.195) or resin with Giomer technology (1.9% vs. 2.2%, p=0.856) (p>0.05). Conclusion: The percentage of use of sealants among dentists in Brazil is high, especially among professionals in the public service, and the most used materials were resinous sealants and glass ionomer cement.

The role of income and frequency of dental visits in the relationship between dental sealant use and resin fillings after extended coverage: a retrospective cohort study.

BACKGROUND: Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship. METHODS: This retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA). RESULTS: The ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency. CONCLUSIONS: Income and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.

Evaluation of the effectiveness of prophylactic sealing of pits and fissures of permanent teeth with fissure sealants - umbrella review.

BACKGROUND: Tooth decay is an infectious disease which, in its initial phase, leads to the formation of cavities in the teeth through decalcification of the enamel and local tissue destruction. In addition to proper oral hygiene, prophylactic sealing of fissures and cavities with a sealant is a method of preventing the development of caries. The aim of this study is to summarise the effectiveness of fissure sealing of permanent teeth with fissure sealants compared to other preventive methods or no intervention. METHOD: An umbrella review was carried out to achieve the purpose of our study. Searches were performed in Medline (via PubMed), Embase (via OVID), and Cochrane Library databases. Quality assessment of the included studies was performed using the AMSTAR2 tool. In addition, a manual search for recommendations/clinical practice guidelines on dental prophylaxis was performed. RESULTS: 204 publications were identified, of which 15 met the inclusion criteria. Based on the results of 3 systematic reviews, there was a statistically significant reduced odds of caries occurrence or development with prophylactic sealing of permanent teeth compared with no intervention - depending on the review and follow-up period odds ratio (OR) ranged from 0.06 [95%CI: (0.01-0.32)] to 0.28 [95%CI: (0.20-0.38)]. In the eight systematic reviews that analysed different sealants, there were no statistically significant differences between the types of materials used for prophylactic tooth sealing. For systematic reviews comparing the efficacy of fissure sealants with fluoride varnish, three reported no statistically significant difference in the efficacy of caries incidence, with only one systematic review based on 1 RCT finding a statistically significant difference in favour of fissure sealants. CONCLUSION: Compared to the no intervention, dental sealing is an effective method for the prevention of dental caries. However, it is not possible to conclude conclusively which type of sealant and which of the available prophylactic methods is more effective in preventing caries.

An economic evaluation of pit and fissure sealants and fluoride varnishes in preventing dental caries: a systematic review.

The aim was to systematically evaluate the cost-effectiveness of pit and fissure sealants (PFSs) compared with that of fluoride varnishes (FVs) in dental caries prevention. We searched four electronic databases including the Cochrane Oral Health Group's Trials Register (till 03 June 2022), Web of Science (from 1945 to 03 June 2022), PubMed (from 1996 to 03 June 2022), and EMBASE via Ovid (from 1980 to 03 June 2022) to identify the cost and effectiveness of PFSs and FVs in decreasing dental caries incidence. Two researchers independently screened search results, extracted data from the included studies, and conducted the risk of bias assessments. The main characteristics of the included studies were extracted and analyzed. The initial search produced 874 articles. After removing duplicates and full-text review, 19 studies were included. In this study: nine studies were on PFSs comparison with control; five on PFSs comparison with FVs; and five on FVs comparison with control. Regarding the type of economic evaluation (EE), 13 studies conducted cost-effectiveness analysis, five conducted cost-utility analyses, and one conducted both cost-effectiveness analysis and cost-utility analyses. The cost-effectiveness evaluation of PFSs and FVs in the available studies was limited. The prevalence of dental caries, payers' willingness to pay, length of follow-ups, delivery settings, retention rate of PFS, and application intervals of FV can affect the economic evaluation of these two methods for dental caries prevention. Therefore, more studies in the future are need to draw clear conclusions about which method is more cost-effective for the two preventive interventions in future.

Factors that Affect the Shear Bond Strength of Pit and Fissure Sealants to Tooth Structure: A Systematic Review.

INTRODUCTION: Pit and fissure sealants are effective in preventing caries disease, however, they may present flaws that damage the physical barrier leading to treatment failure. OBJECTIVE: To answer the question ''Do pit and fissure sealants present good adhering to the dental structure when analyzed by their resistance to shear/microshear?". METHODS: This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and was recorded in Open Science Framework. Embase, PubMed, SCOPUS, and Web of Science databases were used for the search strategy. The articles were selected according to the eligibility criteria. The risk of bias was performed with the adaptation of the quasi-experimental studies tool by Joanna Briggs Institute (JBI). RESULTS: 1245 studies were found in the databases when applying the search strategy, after removal of duplicates 881 were evaluated and 44 were selected. After applying the JBI tool, 30 studies presented low risk and 15 moderate risk of bias. Meta-analysis was not possible to performed due to the heterogeneity of the studies. CONCLUSION: The adhesion is dependent on the application protocol, and among the protocols evaluated, conditioning with 37% phosphoric acid for 60 seconds and contamination of the substrate, as these can affect sealant adhesion.

Dental hygiene student perceptions of a school-based sealant program: A qualitative review.

PURPOSE/OBJECTIVES: The purpose of this 2021 study was to explore experiences acquired from a school-based sealant program (SBSP), to improve understanding of the relationship between SBSP and dental hygiene (DH) student outcomes, and to inform institutions of the value of educational experiences aiming to reduce disparities in access to dental care. METHODS: University of Missouri Kansas City School of Dentistry Senior DH students complete a community engaged course which includes participation in community projects and clinical activities targeting Kansas City's urban and surrounding rural environments. The SBSP is a component of this course. This investigation utilized a qualitative methodology to examine SBSP experiences through the experience of the primary investigator, on-site dentist, and DH students involved in the program. RESULTS: Data analysis resulted in consensus of five synthesized conceptual models and twenty-three emergent themes. The conceptual models include: competence, roles and responsibilities, social justice, value added, and lessons learned. CONCLUSION: Based on triangulated results, SBSPs improve access to care for children, save dental costs, and provide essential experiences for DH students.

Evaluation of the marginal integrity of various pit and fissure sealants.

PURPOSE: To evaluate the marginal integrity of various pit and fissure sealants subjected to different application methods. METHODS: A total of 253 non-carious human third molars extracted and randomly divided into two groups according to the preparation method employed: invasive or non-invasive. Eight fissure sealant materials were tested: nano-filled flowable composite (Filtek Ultimate Flow), nanohybrid flowable composite (GrandioSo Flow), micro-hybrid flowable composite (Majesty Flow), resin-based unfilled fissure sealant (ClinPro Sealant), resin-based filled fissure sealant (Fissurit FX), resin-based highly filled fissure sealant (GrandioSeal), giomer-based fissure sealant (BeautiSealant), and glass ionomer-based fissure sealant (Fuji Triage). Samples were subjected to two-year cyclic thermo-mechanical and brushing simulations. Two observers quantitatively evaluated the restoration margins and classified them as either "permanent restoration edge", or if a gap larger than 250 µm was evident, "gapping at the restoration edge". The extent of the gap was recorded as a percentage relative to the total length of the restoration edge. RESULTS: The baseline marginal adaptation had no significant effect on the marginal adaptation (P > 0.05). However, the preparation method and type of fissure sealant material had a significant impact on the marginal adaptation (P < 0.05). CONCLUSION: On the basis of quantitative analysis, the highest marginal integrity was observed for flowable composites, whereas the lowest was observed for glass ionomer-based fissure sealant.

Application Study of Novel Eggshell/Ag Combined with Pit and Fissure Sealants.

Objective: The study aims to enhance the anti-caries performance of pit and fissure sealants through the synthesis of novel silver nanocomposites, and to evaluate their mechanical properties and biological safety in vitro and in vivo. Methods: The antibacterial properties of synthetic eggshell/Ag were detected by bacterial inhibition zone, minimum bacteriostatic concentration, fluorescence staining and scanning electron microscopy. The synthetic products were then combined with pit and fissure sealants to prepare specimens, and their effects on mechanical properties, antibacterial properties and cytotoxicity were evaluated. Furthermore, an oral mucosal contact model of golden hamsters was established according to the ISO10933 standard to evaluate local stimulation and systemic effects. Results: The novel nanocomposite eggshell/Ag was confirmed to exhibit strong broad-spectrum antibacterial activity, and that the eggshell/Ag-modified pit and fissure sealant had strong antibacterial properties against common dental caries bacterial biofilms, without any significant change in mechanical properties. The gradient dilution extract showed acceptable cytotoxicity, and in the golden hamster oral contact model, there were no visible abnormalities in local mucosal tissues, blood indices, or liver and kidney histopathology. Conclusions: These findings suggest that eggshell/Ag combined with pit and fissure sealants has strong antibacterial activity and excellent biosafety in vitro and in vivo, making it a promising candidate for clinical applications.

Real-world effectiveness of national pit and fissure sealants program in Taiwan.

OBJECTIVES: This study investigated the effectiveness of a national population-based pit and fissure sealants (PFS) program in Taiwan. METHODS: Part 1 (effectiveness of national PFS program) involved children who had participated in the PFS program from 2015 to 2019. After propensity score matching, 670,840 children were selected for analysis until the end of 2019. During follow-up, the permanent first molars of the participants were assessed for caries-related treatments by employing multilevel Cox proportional hazards models. In Part 2 (effectiveness of retained sealants), which involved 1,561 children, sealant retention was evaluated 3 years after placement. A structured questionnaire was employed to collect information on family and individual factors. The endpoints were the same as in Part 1. RESULTS: In Part 1, the adjusted hazard ratios (HRs) for caries-related treatments among participants in the PFS program were 0.90 (95% confidence interval [CI] = 0.89, 0.91) for dental restoration, 0.42 (95% CI = 0.38, 0.46) for initiation of endodontic treatment, 0.46 (95% CI = 0.41, 0.52) for completion of endodontic treatment, and 0.25 (95% CI = 0.18, 0.34, all Ps < 0.0001) for extraction. In Part 2, the adjusted HR for dental restoration of teeth with retained sealants was 0.70 (95% CI = 0.58, 0.85), significantly lower than that for teeth without retained sealants (P = 0.0002). CONCLUSIONS: Participation in the national PFS program was associated with a significant reduction of at least 10% in the risk of caries-related treatments, and an additional 30% risk reduction may have been attributed to sealant retention. CLINICAL SIGNIFICANCE: In a real-world setting, schoolchildren in the national PFS program were associated with a significant reduction of at least 10% in the likelihood of caries-related treatments. The program provided moderate protection against caries for the study population and could be improved by increasing the sealant retention rate.

What preventive strategies do dentists prescribe for dental caries prevention? - A KAP survey.

Background: Dentists play an important role in caries prevention by delivering preventive care, educating patients, and buying related products; it is critical to recognize what they know and believe about caries prevention, as well as how they use caries prevention interventions. Materials and Methods: A descriptive cross-sectional study was conducted in South India between January 2021 and February 2021 to determine the dentists' knowledge, attitude, and practice of prescribing preventive strategies and remineralizing agents for caries prevention. A questionnaire including 11 self-administered, prestructured questions was made and distributed through electronic media. Chi-square test was done. The test significance value was taken as 0.05. Results: A total of 252 dental practitioners participated in the study. The majority of general dentists and specialists followed all the measures such as pit and fissure sealants, fluoride application, counseling patients about oral hygiene maintenance, and regular recall after 6 months to 1 year (P > 0.05). Fluoridated remineralization strategy was found to be the most prescribed (69%) strategy for caries prevention. A significant number of dentists think fluoridated mineralization strategies will remain prevalent (P < 0.05). Younger dentists find practicing preventive dentistry more feasible compared to dentists with greater years of experience (P < 0.05). Conclusion: Dentists across the country are well aware, have sufficient knowledge, and prescribe preventive strategies such as fluoride application, pit and fissure sealants, regular oral health checkups, and counsel the patients about the importance of oral health but there is a lack of implementation of these preventive strategies in everyday practice.

Testing a Deliberative Democracy Engagement Intervention to Increase Guideline-Concordance Among Oral Health Providers: Results from the DISGO Cluster-Randomized, Stepped-Wedge Trial.

Background: Dental caries affects billions worldwide and in the U.S. is among the most prevalent noncommunicable diseases in both children and adults. Early in the caries process, it can be arrested by dental sealants, which are non-invasive and thus tooth sparing, however, few dentists have adopted this approach. Deliberative engagement processes enable participants to engage with diverse perspectives on a policy issue and develop and share with policy makers informed opinions about the policy issue. We examined the effects of a deliberative engagement process on the ability of oral health providers to endorse implementation interventions and to apply dental sealants. Methods: Using a stepped wedge design, 16 dental clinics were cluster randomized, and 680 providers and staff were exposed to a deliberative engagement process that included an introductory session, workbook, facilitated small group deliberative forum, and post-forum survey. Forum participants were assigned to forums to ensure diverse role representation. Mechanisms of action examined included sharing voice and diversity of opinion. Three months after each clinic's forum, the clinic manager was interviewed about implementation interventions deployed. There were 98 clinic-months in the non-intervention period and 101 clinic-months in the intervention period. Results: Compared with providers and staff in small clinics, providers and staff in medium and large clinics more strongly agreed that their clinic should adopt two of the three proposed implementation interventions targeting the first barrier and one of the two proposed implementation interventions targeting the second barrier. Compared with the non-intervention period, in the intervention period providers did not place more sealants on occlusal non-cavitated carious lesions. Survey respondents reported sharing both promotive and prohibitive voice. From the beginning to the end of the forums, most forum participants did not change their opinions about the possible implementation interventions. At the end of the forums, there was no significant within-group variability in implementation interventions endorsed. Conclusions: Deliberative engagement intervention may help clinic leadership identify implementation interventions when there is a challenging problem, a network of semi-autonomous clinics, and autonomous providers within those clinics. It remains to be determined whether there is a range of perspectives within clinics. Trial Registration: This project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 12/18/2020. https://clinicaltrials.gov/ct2/show/NCT04682730.

Bonding Technologies in Young Permanent Molars: A Case Series.

Introduction: Dental caries has been the most common disease affecting the human population. Once cavitated, the disease requires restoration. Dental adhesives used to bond composite resins to tooth structure have evolved over the last several decades. Composites were developed to meet the requirements of durable esthetics restorative material. The process of bonding occurred due to micromechanical interlocking between hydroxyapatite of enamel and resin. Over a period of time, bonding to enamel has become a reliable procedure. However, bonding to dentin has proven to be less predictable. In order to overcome the challenges, dental adhesive systems have evolved through several generations with changes in chemistry, mechanism, number of bottles, application techniques, and clinical effectiveness. Case details: The "self-etch" system is especially attractive to pediatric dentistry because of its "fewer steps" and "lesser time." One product launched as a self-etching self-adhesive flowable composite Constic (DMG, Germany), a new three- in -one flowable composite that combines etching gel, bonding agent, and flowable composite in one single product which has multiple benefits over conventional products. Such a material can be of true advantage as it allows for single-step application, less technique sensitivity, and reduced chair time. In light of this knowledge, this paper will focus on two commonly performed procedures in the general practitioner's office, that is, the placement of small class I composite resin restorations and the placement of pit and fissure sealants on permanent molars in pediatric patients. Clinical significance: The advantage of this material is less technique sensitivity and reduced chair time. How to cite this article: Pruthi T, Pandit IK, Gugnani N, et al. Bonding Technologies in Young Permanent Molars: A Case Series. Int J Clin Pediatr Dent 2023;16(1):159-161.

Cost-Effectiveness of Pit and Fissure Sealing at Schools for Caries Prevention in China: A Markov Modeling Analysis.

The World Health Organization states that the application of pit and fissure sealants (PFSs) is an effective way to prevent dental caries. Estimates of potential health and economic impacts of PFS upon school-age children provide crucial evidence to support the extension of PFS coverage to all target populations. The China Children's Oral Disease Comprehensive Intervention Project was launched in 2009 to provide free oral health examinations, PFS application, and oral health education for children aged 7 to 9 years. However, the national-level health and economic impacts of the program are unclear. To provide higher quality evidence at the national level in China, we developed a multi-perspective, multistate Markov model to estimate the cost and effect of PFS application to prevent dental caries. The total cost of the PFS project was 2.087 billion CNY, which can prevent 16.06 million PFMs from caries lesions. Compared with no intervention, PFS application was cost-effective from payer and society perspectives (BCR = 1.22 from the payer's perspective, BCR = 1.91 from the societal perspective). The incremental cost-effectiveness ratio from both perspectives was negative (-61.46 CNY from the payer's perspective, and -125.75 CNY from the societal perspective), indicating that PFS was cost-effective and cost-saving. Expanding the coverage of PFS application in school can be a more cost-effective strategy for caries prevention in China.