The Use of Pit and FissureSealants—A Literature Review

The Use of Pit and FissureSealants—A Literature Review

ReemNaaman, Azza A. El-Housseiny, and NajlaaAlamoudi

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Abstract

This paper reviews the literature and discusses the latest updates on the use of pit and fissuresealants. It demonstrates the effectiveness of pit and fissuresealants in preventingcaries and the management of earlycariouslesions. It compares the use of different sealantmaterials and theirindications. It describes the applicationtechnique for sealants. It also reviews the cost-effectiveness of sealantsas a preventivestrategy. From this review and after the discussion of recentlypublishedstudies on pit and fissuresealants, it is evident that sealants are effective in cariesprevention and in preventing the progression of incipientlesions. It is thereforerecommended that pit and fissuresealant be applied to high-caries-riskchildren for optimumcost-effectiveness. It is a highlysensitivetechnique that needsoptimumisolation, cleaning of the toothsurface, etching, and the application of a thinbondinglayer for maximumbenefit. Recall and repair, whenneeded, are important to maximize the effectiveness of suchsealantuse.

Keywords: pit and fissuresealants, cariesprevention, resin-basedsealants

Introduction

Dentalcaries is a multifactorialdiseasecaused by alteration in the composition of the bacterialbiofilm, leading to an imbalancebetween the demineralization and remineralizationprocesses and manifested by the formation of carieslesions in primary and permanentdentitions [1]. The National Health and NutritionExamination Survey (NHANES) 2011–2012 datashowed that 37% of children, aged 2–8 years old, werediagnosed with dentalcaries in primaryteeth, and 21% of children, aged 6–11, and 58% of children, aged 12–19, werediagnosed with dentalcaries in theirpermanentteeth. Whencomparing this data to the earliersurvey of 1999–2004, an overalldecline in the prevalence of caries in primaryteeth and a slightdecrease in the cariespercentage in permanentteethwasnoticed [2,3]. However, this decreasewas not found to be uniformacross different agegroups or consistent with sociodemographicstatus and different toothsurface sites. Instead, it wasfound that the greatestdecrease in carieswasamongsmoothsurfacesratherthanpits and fissures [4,5]. Pit and fissurecaries accounts for about 90% of the caries of permanentposteriorteeth and 44% of caries in the primaryteeth in children and adolescents [6]. The use of cariespreventiveapproaches, suchascommunitywaterfluoridation, topicalfluoridetherapy, plaquecontrol, and dietarysugarcontrol, hasbeengenerallyseen to be the cause of the overalldecline of cariesprevalence, which in turnhashad a greatereffect on smoothsurfacecariouslesionreduction. The plaqueretentivenature of pits and fissures make themdifficult to clean, therebycausingthem to be more susceptible to cariesthansmoothsurfaces and possibly not to be protected by fluorideadministration [7].

 

More effectivemeasures are necessary to protectpits and fissures; theseinclude the use of pit and fissuresealants. Sealantapplication is a preventiveconservativeapproachinvolving the introduction of sealantsinto the pits and fissures of cariesproneteeth; this sealantthenbonds to the toothmicromechanically, providing a physicalbarrier that keepsbacteriaaway from theirsource of nutrients [8]. Despite the overallincreases in sealantuse, they are stillconsidered to be underused worldwide although the efficacy and caries-preventiveeffect of pit and fissuresealantshasbeen well documented in the literature.

Data from NHANES in 2011–2012, whencompared to that from a previoussurvey in 1999–2004, showed an increase in the use of sealants in permanentteeth. About 31% of children, aged 6–8 years old, 49% of children, aged 9–11, and 43% of adolescents, aged 12–19, had at least one sealedpermanenttooth [2,3,6].

In Europe, sealantprevalence in adolescentswasfound to be about 58.8% in Portugal and 8% in Greece [9,10]. In the Middle East, in Saudi Arabia, it wasfound that only 9% had a minimum of one permanentmolarsealed [11].

The aim of this paperwas to review the literatureregarding the latest updates on the use of pit and fissuresealants on primary and permanentmolars in children and adolescents.

Sealant vs. No Sealant

The role of fissuresealants in cariesprevention is well established in the literature. There is also a moderatequality of evidence that sealantsreduce the incidence of caries by 76% on sound occlusalsurfaces, compared to the non-use of sealantsduring the two to threeyear follow-up period [28].

A recent update of a Cochrane review evaluated the cariespreventiveeffect of sealants in children and adolescents, compared with a no sealantcontrolgroup. Thirtyeighttrials with a total of 7924 participants, agedbetween 5 and 16 years old, wereincluded. Fifteentrialscomparedresin-basedsealantswhenapplied to the first permanentmolars with no sealant and showed a moderatequality of evidence that resinsealantsreducedcariesincrement by between 11 percent and 51 percent in a two year follow-up period. If cariesincrementwas 40 percent in controlteethsurfaces, the application of sealantreduced the cariesincrement to 6.25 percent. At longer follow-up periods of 48 to 54 months, the cariespreventiveeffect of sealantswasretainedbut the quality of evidencewaslow [34]. This is in agreement with the results of the previouslypublished review [35].

Whencomparing the cariespreventiveeffect of glass-ionomerbasedsealants with the use of no sealant, no conclusioncould be drawn on whether GI sealantpreventedcaries, compared to no sealant, at a two year follow-up, due to the verylowquality of evidence [34,36].

Sealant vs. FluorideVarnish

Severalpublishedstudiescomparedpit and fissuresealants’ effectiveness to that of fluoridevarnish in cariesprevention on occlusalsurfaces. A recent update of a Cochrane review concluded that there is only a lowquality of evidence that pit and fissuresealantshave a superioroutcome, whencompared to fluoridevarnishapplication, in the prevention of occlusalcaries. This conclusion is similar to that found in the previous review in 2010 [37]. Two out of threestudiesincluded in the last updated review showed a significantlybetterperformance of sealants, compared to fluoridevarnish, while the thirdstudyreported that the benefits of sealantwere not statisticallysignificant, compared to fluoridevarnish. Two of the includedstudieswereassessedashaving a highoverallrisk of bias and the thirdashaving an unclearoverallrisk of bias [38]. The recentevidence-basedguidelines of the American Dental Association (ADA), in collaboration with the American Academy of PediatricDentistry (AAPD), recommend the use of sealants in preference to no sealant or fluoridevarnish, although the quality of evidence for this recommendationwasfound to be low [5,28]. In fact, this runscounter to the results from a recentrandomizedclinicaltrial that compared the clinicaleffectiveness for cariesprevention of fluoridevarnish and fissuresealants at a threeyear follow-up among a 6 to 7 years old population. Afterthreeyears of follow-up, 17.5% of the fluoridevarnishgroup and 19.6% of the fissuresealantgroupdevelopedcaries in theirdentin. The differencebetween the two groupswas not statisticallysignificant [39].

Isolation

Adequatemoistureisolationduringresinsealantplacement is the mostcriticalstep in sealantapplication. If the etchedenamelgetsexposed to salivaryproteins for aslittleas 0.5 s, it can be contaminated [36]. If this occurs, re-etching is required. The use of a rubberdam is the idealway to achieveoptimummoisturecontrol. The use of cottonrolls and a salivaejector is also a validoption [59]. The use of moisturecontrolsystems, suchas the Isolite® system (InnerliteIncorporation, Santa Barbara, CA, USA) provides less time for the procedure and offerscomparablesealantretentionrates to cottonrollisolation or the use of a rubberdam [60].

A systematic review hassuggested that four-handeddelivery, compared to two-handeddelivery, increasessealantretention by 9% whenotherfactors, suchas the surfacecleaningmethod, werecontrolled [61]. The use of the four-handedtechniquefacilitatessealantplacement and is alsoassociated with improvedretention [32].

AcidEtching and Rinsing

The phosphoricacidconcentration that wasoriginallyused for etching by Buonocore in 1955 was 85%, but it wasthenreduced in hisearlyclinicalstudies to 50% [18]. Nowadays, 35% and 37% are the commonlyusedconcentrations. Acid-etching times havealsobeenreduced from 60 s down to 20 s [62].

Earlyrecommendations for primaryteethenameletching time were double the accepted time for permanentenamel, namely, 120 s for primaryenamel and 60 s for permanentenamel. The early in vitrostudiesshowed that 120 s are necessary for an adequateetchingpattern in primaryteethenamel to eliminate the identification of prismlessenamel. This findingwasfound not to be clinicallysignificant for sealantretention, asdemonstrated by Simonsen et al. in 1978. Hisstudyincluded 56 childrenbetween the ages of 3–8 years with 373 deciduous first and secondmolars that weresealed and examinedsixmonthspost-application; 178 teethwereetched for 60 s and 195 teethwereetched for 120 s. The retentionrate for the 60 s etchedteethwas 100%, and for the 120 s etchedteeth, it was 99% [8,23]. Moreover, the shorteretching time decreases the chance of salivacontamination, particularly in pre-cooperativechildren.

An in-vitrostudyevaluated the etchingdepth and bondingstrength of 130 exfoliatedprimaryteethafter the following four different etching times: 15, 30, 60, and 120 s. Despite the greaterincrease in depthafter 120 s etching time, the meanbondstrengthsobtained for the fouretching times were not significantly different [63]. Anotherstudyshowed that the length of etching time haslittleeffect on sealantretention. No significantdifference in fissuresealants’ retention on primary or permanentmolarswasfoundafter a one-year follow-up with different etching times of 15, 30, 45, and 60 s [64].

A rinsing time of 30 s and drying the tooth for 15 s should be sufficient to remove all acidetchantresidues and achieve the characteristicchalkywhiteenamelfrostyappearance [20,22].

BondingAgents

The idea of using a bondingagentunder the sealantcame from Feigal et al. in 1993 whentheyusedhydrophilicbondingmaterials to aid the bondstrengthwhen the sealant is applied in a moist environment [65].

Therehavealreadybeeneightgenerations of bondingagents [66,67,68], the latest and eighth one beingintroduced in 2010. It is characterized by the incorporation of nano-fillersinto the adhesivecomposition to improve the mechanicalproperties of the adhesivesystem. However, the mostrecenttype in adhesivedentistry is called the universal adhesive or the multi-modeadhesive. It was first introduced in 2011. This kind of adhesivesystem can be usedas an etch and rinseadhesive, a self-etchadhesive or to do self-etch on dentin and etch-and-rinse on enamel; this particulartechnique is calledselectiveenameletching. Itscompositiondiffers from the otheradhesivesystems that allowchemical and micromechanicalbonding [67]. Severalstudiesevaluated the use of a bondingagentbeforesealantapplication. A randomizedcontrolledtrialcomparedfourthgeneration (three-step-etch-and-rinse) and fifthgeneration (two-step-etch-and-rinse) adhesiveswhenusedundersealants. Theyfound that the two-stepadhesivesreduced the risk of sealantloss by half (Hazardratio = 0.53) whenapplied on occlusalsurfaces. On the otherhand, the three-stepadhesiveshad a detrimentaleffect on the sealantretentionrate, which can be explained by the composition of the adhesive, as it is water-based, and waterhas a deleteriouseffect on sealantbonding. The two-stepadhesive is acetone- or ethanol-based, whichmay be more effective in bonding to etchedenamel [69].

 

With regard to self-etchadhesives, a recentclinicaltrialevaluated the sealantretentionrate and cariespreventiveefficacy over a three-yearperiod. Theycomparedthreeadhesivegenerations, namely, fourthgeneration (three-step-etch-and-rinse), fifthgeneration (two-step-etch-and-rinse), and sixthgeneration (one-step, two-component-self-etch) with the conventionaltechnique, which is etching with no adhesiveapplicationas a control. Therewas a significantdifferencebetween the retentionrates of sealantscombined with the variousadhesivesystemsused (p < 0.05). The highestretentionrates of sealants on the first permanentmolars at a 36-monthrecallwerecombined with the fourth and fifthgenerationadhesivesystems and were 80.01% and 74.27%, respectively. In contrast, the lowestretentionrateswerecombined with the sixthgenerationadhesivesystem (42.84%) and with the conventionalacid-etchtechnique (62.86%). Theyalsofound that the fissurecariesincidencerate in first permanentmolars that hadbeensealedafter using the sixthgenerationadhesivesystemwas 34.28%, whichwassignificantlyhigherthanwhenotheradhesivesystemshadbeenused [70]. This was in agreement with a previouslypublishedstudy that reported a significantlybetterretentionrate with the etch-and-rinseadhesivesystem (fifthgeneration) compared to the self-etchadhesivesystem (sixthgeneration) at a 12-month follow-up [71]. Anotherstudy, on the otherhand, evaluated the retentionrate of fissuresealants in primarymolars using a sixthgeneration (one-step, two-component-self-etch) adhesivecompared to the conventionalphosphoricacid-etchingtechnique with no bondingagentapplication. Theyfound no statisticallysignificantdifference in sealantretention in the two groupsafter a one-year follow-up period [72].

A recentsystematic review compared the retentionrate of sealants, combined with self-etchadhesivesystems(sixth or seventhgeneration), with that of etch-and-rinseadhesivesystems (fourth and fifthgenerations). Fivestudieswereinvolved: threestudiesshowed that etch-and-rinseadhesivesystemshadsignificantlybetterretentionthanself-etchadhesivesystems. The other two includedstudiesshowed no significantdifferencebetween the two adhesivesystems. Feigal and Quelhas in 2003, for example, reportedsimilarretentionrates of 61% at 24 months. However, the sample in this studywassmall (18 molarsonly) [73]. The systematic review concluded that the retention of occlusalfissuresealants is higherwhenapplied with the etch-and-rinseadhesivesystemthan with the self-etchadhesivesystem [74].

Finally, a recentsystematic review by Bagherian et al. evaluated the fissuresealantretentionrate with or without the use of an adhesivesystem and alsocompared the retentionrate of sealantswhen using etch-and-rinseadhesivesystems (fourth or fifthgenerations) versus the rateachievedwhenself-etchingadhesivesystems (sixth or seventhgenerations) wereused. Theyfound that the adhesivesystemhas a positiveeffect on the retention of the fissuresealant. The adhesivecomponentsmayincrease the penetrationintoenamelporosities and thusincreasebondstrength. It wasalsofound that etch-and-rinseadhesivesystems are superior to self-etchadhesivesystems in terms of sealantretention [75]. However, in a recent, randomizedcontrolledtrial, Khare et al. evaluated the integrity of fissuresealants by comparing the use of fifth, seventh, or Universal bondingsystems with a no bondingprotocol at 3-, 6- and 12-monthfollow-ups. At the 12-month follow-up, fifthgenerationbonding and universal bondingprotocolsperformedbetterthanseventhgeneration or no-bondingprotocols, but the differencebetween the groupswas not statisticallysignificant [76].

In summary, the above-mentionedstudiesindicated that the use of adhesivesystemsprior to fissuresealantapplicationhad a positiveeffect on increasingpenetration and improving the retentionrate. It alsoappears that the use of bonding-agents that involve a separateacid-etchingstep (fourth and fifthgenerations) providesbettersealantretentionthanself-etchingadhesives (sixth and seventhgenerations). Etch- and-rinseadhesivesystemsproducebetterpenetration of the enamelsurfacethanself-etchadhesivesystems, and this mayresult in a betterbondstrength.

An evidence-based 2008 report from the American Dental Association and the American Academy of PediatricDentistry supports the use of adhesivesystemsbeforesealantapplication for bettersealantretention [32,58].

SealingPrimaryTeeth

On the basis of cariesriskassessment, primaryteeth can be judged to be at riskdue to fissureanatomy or patientcariesriskfactors, and wouldthereforebenefit from sealantapplication [55]. Therefore, pit and fissuresealants are indicated in primaryteeth, if suchteethhavedeepretentive or stainedpits and fissures with signs of decalcification or if the childhascaries or restorations in the contralateralprimarymolar or anyotherprimaryteeth [44]. Sealingshould be consideredparticularly for children and youngpeople with medical, physical, or intellectualimpairment [59].

Pit-and-fissuresealantswerefound to be retained on primarymolars at a rate of 74 to 96.3% at one year and 70.6–76.5% at 2.8 years [58]. However, the focus of mostsealantstudies is the occlusalsurfaces of permanentmolars and there is stillinsufficientevidence to support the use of fissuresealants in primarymolars [32]. Rathnam and Madan maintain that it is difficult to conductclinicalstudies on primaryteethdue to severalconfoundingfactors, suchasage, cooperation, and the behavior of the childwhenpresentedwithin an unfamiliarset-up, suchas in the dentalclinic [77]. To simplify the clinicalprocedure and make fissuresealantapplication more acceptable to youngchildren, a shorteretching time may be used to decrease the chance of salivacontamination. As mentionedearlier, severalstudiesshowed that the length of etching time has a minimaleffect on sealantretention [64]. Anothermeasure that can be used with youngchildren in an attempt to shorten the procedure time is to useself-etchingbondingagentsas an alternative to the conventionalacidetchingtechnique. Severalstudieshaveshown an insignificantlylowersealantretentionrate in primaryteethwhenself-etchingbondingagentshavebeenused, compared to conventionalacidetching [72,78]. Moreover, studieshaveshown that using a GI sealantmay be a good interimoptionwhensalivarycontamination is expectedbecause it has a highertoleration to moisturecompared to resin-basedsealants [31]. However, studies on the use of GI sealants in primaryteeth are verylimited [79] and considerably more research is thereforeneeded in this area [42].

Esterogenicity

Bisphenol-A (BPA) is the precursorchemicalcomponent of bisphenol-adimethacrylate (Bis-DMA) and bisphenol-aglycidyldimethacrylate (Bis-GMA), which are the mostcommonmonomersused in resin composite restorations and resin-basedsealants. It is known for itsestrogenicproperty with potentialreproductive and developmentalhumantoxicity [96,97]. BPA is not present in monomersas a raw materialbutas BPA derivatives that can sometimes be hydrolyzed and found in saliva [34].

It hasbeenreported in a systematic review that highlevels of BPA werefound in salivasamples that hadbeencollectedimmediately or one hourafterresin-basedsealantplacement. High levels of BPA werealsodetected in urinesamples [98]. However, a report by the American Dental Association and the American Academy of PediatricDentistry did not support the occurrence of adverseeffectsaftersealantplacement and described the BPA effectas a smalltransienteffect [5,28].

Somestudieshavereportedtechniques, suchas the immediatecleaning of the sealedsurface, or the removal of the oxygen inhibitionlayer of the unreactedmonomer, which is present on the outerlayer of the sealantsurface to reduce the amount of unreactedmonomer. This can be done using a pumice or a rotatingrubber cup [98], to reduce the potential BPA exposure.

Conclusions

Pit and fissuresealant is an effectivemeans of preventingpit and fissurecaries in primary and permanentteeth. Dentistsshouldtherefore be encouraged to applypit and fissuresealants in combination with otherpreventivemeasures in patients at a highrisk of caries. Selection of sealantmaterial is dependent on the patient’sage, child’sbehavior, and the time of teetheruption. Teeth that present with earlynon-cavitatedcariouslesionswouldalsobenefit from sealantapplication to preventanycariesprogression. Sealantplacement is a sensitiveprocedure that should be performed in a moisture-controlled environment. Maintenance is essential and the reapplication of sealants, whenrequired, is important to maximize the effectiveness of the treatment.

Abbreviations

AAPD	American Academy of PediatricDentistry
ADA	American Dental Association
ARBS	autopolymerizingresinbasedsealants
BIS GMA	bisphenol-a-glycidyldimethacrylate
BPA	bisphenol-A
FRBS	fluoridereleasingresinbasedsealants
FS	fissuresealant
GI	glassionomer
LRBS	lightpolymerizingresinbasedsealants
NHANES	National health and nutritionexaminationsurvey
RBS	resinbasedsealants
RMGI	resinmodifiedglassionomer
SE	self-etchadhesives
SES	socioeconomicstatus
TE	total-etchconcept
USA	United States of America
UV	ultraviolet

Author Contributions

Literaturesearch and studiesselectionwereconducted by ReemNaaman, Azza A. El-Housseiny and NajlaaAlamoudi. ReemNaaman: provided the research idea and wrote the manuscript. Azza A. El-Housseiny: Participated in the design and mademanuscriptrevisions. NajlaaAlamoudi: Madecontributions to manuscriptrevisions. All authorshaveread and approved the final manuscript.

Conflicts of Interest

The authorsdeclare no conflict of interest.

Articleinformation

Dent J (Basel). 2017 Dec; 5(4): 34.

Published online 2017 Dec 11. doi: 10.3390/dj5040034

PMCID: PMC5806970

PMID: 29563440

ReemNaaman,1Azza A. El-Housseiny,1,2 and NajlaaAlamoudi1,*

1PediatricDentistryDepartment, Faculty of Dentistry, King Abdulaziz University, 21589 Jeddah, Saudi Arabia; [email protected] or as.ude.uak.uts@namuonr (R.N.); as.ude.uak@yniessohlaa or moc.liamtoh@inissuha or [email protected] (A.A.E.-H.)

2PediatricDentistryDepartment, Faculty of Dentistry, Alexandria University, 21526 Alexandria, Egypt

*Correspondence: moc.liamg@1102iduomalan or as.ude.uak@iduomalan; Tel.: +966-21-640-1000 (ext. 20388)

Received 2017 Oct 19; Accepted 2017 Dec 6.

Copyright © 2017 by the authors.

Licensee MDPI, Basel, Switzerland. This article is an open accessarticledistributedunder the terms and conditions of the Creative CommonsAttribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

This articlehasbeencited byotherarticles in PMC.

Articles from Dentistry Journal are providedherecourtesy of Multidisciplinary Digital Publishing Institute (MDPI

 

 

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Перевод

 

· Использование герметиков для ямок и трещин - обзор литературы

 

· Рим Нааман, Азза А. Эль-Хуссейни и НаджлаАламуди

 

· Дополнительная информация о статье

 

· Аннотация

 

В этой статье содержится обзор литературы и обсуждаются последние обновления по использованию герметиков для ямок и фиссур. Она демонстрирует эффективность герметиков для ямок и фиссур в предотвращении кариеса и лечении ранних кариозных поражений. В ней сравнивается использование различных герметиков и их показания. Описана техника нанесения герметиков. Также рассматривается экономическая эффективность герметиков в качестве профилактической стратегии. Из этого обзора и после обсуждения недавно опубликованных исследований герметиков для ямок и фиссур становится очевидно, что герметики эффективны в профилактике кариеса и в предотвращении прогрессирования зарождающихся повреждений. Поэтому рекомендуется применять герметик для ямок и фиссур у детей с высоким риском кариеса для оптимальной экономической эффективности. Это высокочувствительный метод, требующий оптимальной изоляции, очистки поверхности зуба, протравливания и нанесения тонкого связующего слоя для получения максимального эффекта.

 

Ключевые слова: герметики для ямок и фиссур, профилактика кариеса, герметики на основе смол.

 

1. Введение

Кариес зубов - многофакторное заболевание, вызванное изменением состава бактериальной биопленки, приводящее к дисбалансу между процессами деминерализации и реминерализации и проявляющееся в образовании кариесных поражений в первичных и постоянных зубных рядах [1]. Данные Национального обследования здоровья и питания (NHANES) за 2011–2012 годы показали, что у 37% детей в возрасте от 2 до 8 лет был диагностирован кариес молочных зубов, а у 21% детей в возрасте 6-11 лет и 58 лет. У% детей в возрасте 12–19 лет был диагностирован кариес постоянных зубов. При сравнении этих данных с более ранним обследованием 1999–2004 гг. Было отмечено общее снижение распространенности кариеса молочных зубов и небольшое снижение процента кариеса постоянных зубов [2,3]. Однако это снижение не было одинаковым для разных возрастных групп или соответствовало социально-демографическому статусу и разным участкам поверхности зубов. Вместо этого было обнаружено, что наибольшее снижение кариеса наблюдалось на гладких поверхностях, а не на ямках и трещинах [4,5]. Кариес ямок и фиссур составляет около 90% кариеса постоянных боковых зубов и 44% кариеса молочных зубов у детей и подростков [6]. Использование подходов к профилактике кариеса, таких как фторирование воды по месту жительства, местная фторидная терапия, контроль зубного налета и контроль сахара в рационе, в целом считается причиной общего снижения распространенности кариеса, что, в свою очередь, оказало большее влияние на уменьшение кариозных поражений гладкой поверхности. Ямки и трещины, удерживающие бляшки, затрудняют их очистку, в результате чего они более подвержены кариесу, чем гладкие поверхности, и, возможно, не защищены от введения фторида [7].

 

Необходимы более эффективные меры по защите ямок и трещин; к ним относятся использование герметиков для ямок и трещин. Применение герметика - это профилактический консервативный подход, предполагающий введение герметиков в ямки и фиссуры зубов, подверженных кариесу; этот герметик затем микромеханически связывается с зубом, создавая физический барьер, который удерживает бактерии от источника питательных веществ [8]. Несмотря на общий рост использования герметиков, они по-прежнему считаются недостаточно используемыми во всем мире, хотя эффективность и предотвращающий кариес эффект герметиков для ямок и фиссур хорошо задокументированы в литературе.

 

Данные NHANES за 2011–2012 гг. По сравнению с данными предыдущего исследования 1999–2004 гг. Показали рост использования герметиков в постоянных зубах. Около 31% детей в возрасте 6–8 лет, 49% детей в возрасте 9–11 лет и 43% подростков в возрасте 12–19 лет имели хотя бы один запломбированный постоянный зуб [2,3,6]

 

В Европе распространенность герметика среди подростков составляет около 58,8% в Португалии и 8% в Греции [9,10]. На Ближнем Востоке, в Саудовской Аравии, было обнаружено, что только у 9% был запломбирован как минимум один постоянный моляр [11].

 

Целью данной статьи был обзор литературы, касающейся последних обновлений по использованию герметиков для ямок и фиссур на первичных и постоянных молярах у детей и подростков.

 

2. История разработки герметика для трещин.

 

В прошлом было предпринято несколько попыток защитить ямки и трещины от кариеса; Использовались такие подходы, как ликвидация трещин эмали. Это включало расширение фиссур или так называемую фиссуротомию, чтобы преобразовать глубокие фиссуры в очищаемые [12]. Другой метод заключался в обработке ямок и трещин аммиачной селитрой серебра [13]. Однако ни один из этих подходов не имел большого успеха. Более инвазивный подход был предложен Hyatt в 1923 году, и он включал подготовку полости класса I, которая включала все глубокие ямки и фиссуры, и установку профилактической реставрации. Фактически, этот подход оставался методом выбора до 1970-х годов [14]. В 1955 году Буонокоре опубликовал свое классическое исследование, в котором задокументировал метод приклеивания акриловой смолы к ранее протравленной зубной эмали. Он описал технику кислотного травления с использованием 85% фосфорной кислоты в течение 30 секунд в качестве инструмента для увеличения адгезии материалов на основе самоотверждающейсяметилметакрилатной смолы к зубной эмали. Это исследование действительно стало началом революции в стоматологической клинической практике [15]. В середине 1960-х Куэто создал первый герметизирующий материал, метилцианоакрилат, но он не поступил в продажу. Однако этот материал со временем подвергался бактериальному распаду в полости рта [16]. Позже Боуэн изобрел вязкую смолу, названную бисфенол-a-глицидилдиметакрилатом, которая стала известна как BIS-GMA [17]. Было обнаружено, что этот класс устойчив к разрушению и успешно обеспечивает связь с протравленной эмалью. Буонокоре сделал дальнейшие успехи и опубликовал свою первую статью о герметике для ямок и трещин, описывая его успешное использование смолы BIS-GMA с использованием ультрафиолетового света в 1970 году [18].

 

3. Материалы для герметизации ямок и трещин

 

Герметики подразделяются на три вида герметиков. В настоящее время преобладающими типами герметиков на рынке являются герметики на основе смол и герметики на основе стеклоиономерного цемента [19].

Классификация герметизирующих материалов.

3.1. Герметики на основе смол (RBS)

 

Герметики на основе смол (RBS) делятся на четыре поколения, определяемые методом полимеризации. Первое поколение RBS было полимеризовано под действием ультрафиолетовых лучей на инициаторы в материале, которые инициируют полимеризацию; этот тип, однако, больше не используется [20]. Nuva-Seal® (LD. Caulk Co.: Milford, DE, USA) - герметик, впервые представленный на рынке, и пример герметика на основе смолы, полимеризуемого под действием источника ультрафиолетового света. Второе поколение - герметики на основе автополимеризующихся смол (ARBS) или герметики химического отверждения; третичный амин (активатор) добавляется к одному компоненту и смешивается с другим компонентом. В результате реакции между этими двумя компонентами образуются свободные радикалы, которые инициируют полимеризацию полимерного герметика [20]. Такие автополимеризующиеся герметики на основе смол в настоящее время в значительной степени заменены третьим поколением, которое включает герметики на основе полимеров, полимеризуемых в видимом свете (LRBS). В этом типе герметика видимый свет активирует фотоинициаторы, которые присутствуют в герметизирующем материале и чувствительны к видимому свету в диапазоне длин волн около 470 нм (синяя область) [21]. При сравнении полимеризации в видимом свете и предыдущего поколения, автополимеризующийся герметик на основе смолы, LRBS, схватывается за более короткое время, а именно 10–20 с, по сравнению со временем схватывания ARBS 1-2 мин. Время работы больше, и материал не затвердевает, пока не подвергнется полимеризации. За счет исключения стадии перемешивания в герметик попадает меньше пузырьков воздуха [22]. Четвертое поколение - герметики на основе фторсодержащих смол (FRBS). Герметик на основе фторидных смол - это продукт, полученный в результате добавления высвобождающих фтор частиц к LRBS в попытке подавить кариес. Однако согласно литературным данным FRBS не может рассматриваться как резервуар с фтором, обеспечивающий долгосрочное высвобождение фторида, и, как таковой, этот вид герметика не дает дополнительных клинических преимуществ LRBS [23,24,25].

 

RBS также можно классифицировать по их вязкости (с наполнителем и без наполнения). Добавление частиц наполнителя к материалу герметика фиссур, по-видимому, оказывает лишь небольшое влияние на клинические результаты. Хотя наполненные герметики обладают более высокой износостойкостью, их способность проникать в трещины невысока. Заполненные герметики обычно требуют коррекции окклюзии, что излишне удлиняет процедуру. С другой стороны, герметики из ненаполненной смолы имеют более низкую вязкость и обеспечивают большее проникновение в трещины и лучшее удерживание [23,26].

 

Герметики также можно классифицировать по степени прозрачности (непрозрачные и прозрачные) [23]. Непрозрачный материал может быть белого цвета или цвета зуба, а прозрачные герметики могут быть прозрачными, розовыми или янтарными. Белые непрозрачн<