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Retention of Pit-and-Fissure Sealants With and Without A Seventh Generation Bonding Agent: A Clinical Study

Usha Mohan Das, MDS; Deepak Vishwanath, MDS; Ragnathan Venkatasubramanian, BDS; and Suma Gopal, BDS

Usha Mohan Das, MDS; Deepak Vishwanath, MDS; Ragnathan Venkatasubramanian, BDS; and Suma Gopal, BDS

Abstract
Objective: The objective of this study was to assess the effect of a seventh generation bonding agent on sealant retention after 3, 6, 9, and 12 months. Method and Materials: The sample group consisted of 35 school children (ages 7 to 9) with sound, caries-free permanent mandibular molars. Occlusal sealants were placed on the first mandibular molars using the split-mouth design. Pit-and-fissure sealants (Fissurit F, VOCO, Sunnyside, NY) were placed with and without the bonding agent (iBond^®, Heraeus-Kulzer, Armonk, NY). The results were evaluated at 3-, 6-, 9-, and 12-month intervals. The data obtained were analyzed using T-test and ANOVA statistical methods. Results: Results of statistical analysis showed that P < .05 in all cases. Conclusion: The study demonstrated that the use of a bonding agent prior to the application of pit-and-fissure sealant does not increase retention rate.

INTRODUCTION
The placement of sealants and their continued maintenance are scientifically sound and cost effective techniques for preventing pit-and-fissure caries in children. The preventive function of a pit-and-fissure sealant is achieved by the adherence of the material to the acid-etched enamel surface, thus physically occluding the pits and fissures from the rest of the oral environment. As long as the sealant remains intact, caries should not develop beneath it.¹ Thus, retention rates are of interest, as a sealant’s effectiveness is directly related to its retention, and completely sealed fissures should not develop caries.

Recent studies have shown improved results when an intermediate bonding layer is applied between enamel and sealant after etched enamel comes into contact with saliva: the use of a bonding agent under sealants on contaminated enamel increases bond strength, reduces microleakage, and enhances the flow of resins into fissures.^2-6

A recently introduced seventh generation bonding agent, iBond, performs etching, disinfecting, priming, and bonding in a single step. The benefits of this procedure are that it increases patient comfort, reduces chairside time, decreases contamination, and increases efficacy—which would be promising in preventing pit-and-fissure caries in pediatric patients.

This article reports data from a clinical study of sealant retention with and without bonding agents.

METHOD AND MATERIALS
The sample group consisted of 35 school children (ages 7 to 9), who had sound and unsealed permanent first mandibular molars, and who reported to the Department of Pedodontics and Preventive Dentistry, Vokkaligara Sangha Dental College and Hospital, Bangalore, India. Informed consent was obtained from the parents of all participants.

Occlusal sealants were placed on first mandibulars using a split-mouth design. The mandibular right first molar (tooth No. 46) was treated with a conventional method of acid-etching and sealed. The mandibular left first molar (tooth No. 36) was treated with bonding agent and sealed.

Application procedures followed accepted protocols. Caries-detecting dye was applied and rinsed off after 5 seconds. The tooth was polished using a slow-speed dry brush and isolated using a rubber dam. On tooth No. 46, 37% phosphoric acid gel was applied for 15 seconds, rinsed for 12 to 20 seconds, and dried. Pit-and-fissure sealant (Fissurit F) was applied and cured (Figure 1A View Figure). On tooth No. 36, iBond was applied and cured and then Fissurit F was applied and cured (Figure 1B View Figure).

Scoring
Criteria for sealant scoring are listed in Table 1. Data obtained were analyzed by employing T-test and ANOVA statistical methods.

RESULTS
Patients were evaluated for retention of pit-and-fissure sealant at 3-, 6-, 9-, and 12-month intervals in relation to marginal integrity (MI), marginal discoloration (MD), and anatomic form (AF) for teeth Nos. 36 and 46. Figure 2 (View Figure); Figure 3 (View Figure); Figure 4 (View Figure); Figure 5 (View Figure) provide a graphical representation of the results.

For tooth No. 36 (sealant without bonding agent), the MI rates were 94% at 3 and 6 months, and 91% at 9 and 12 months. The MD rates were 100% at all four intervals. The AF of the sealants was 94% at 3 and 6 months, and 91% at 9 and 12 months.

The clinically acceptable MI rates for tooth No. 46 (sealants with a bonding agent) were 83% at the end of 3, 6, 9, and 12 months. The rates for no color change in sealants with a bonding agent after 3 months were 83%. The AF of the sealants after the teeth sealed with a bonding agent at 3 months was 83%; subsequently after 6, 9, and 12 months the AF reported percentage was 83%. The results of the study are similar to the results obtained by Pinar et al.⁷

The authors observed that these results were statistically significant (P < .05) in all cases. Also, the scores of each individual for MI/MD/AF for different time periods were analyzed using ANOVA, and these results also revealed a significance value (P < .05), by which the authors conclude that the seal on tooth No. 46 is better than that on No. 36.

DISCUSSION
Pit-and-fissure sealants have become the most effective noninvasive treatment to prevent or arrest occlusal caries. The occlusal surface is at high risk for caries. This is especially true for newly erupted molars, where anatomic characteristics cause difficult access for cleaning procedures and incomplete maturation of enamel adds to caries susceptibility.^8,9 iBond contains UDMA, 4-META in an acetone/water solvent, and Gluma^® (Heraeus-Kulzer) desensitizer. The 4-META monomer is responsible for conditioning due to its acid function. UDMA is used as a cross-linking and film-forming monomer to add the required stability to the adhesive layer. As the acid component is neutralized during the etching process, demineralization is automatically limited and stopped after a short time. Acetone and water, used as solvents, ensure deep penetration of the monomers.

The present trend of using self-etching adhesives seems overstated in terms of its enormous benefit if applied to pit-and-fissure sealants. Literature shows conflicting findings concerning the need of a bonding agent prior to application of pit-and-fissure sealants.¹ Based on the results observed in this study, the use of a seventh generation bonding agent was not significantly effective in the retention of pit-and-fissure sealants, when compared to the conventional phosphoric acid-etching technique.

ACKNOWLEDGMENT
The authors would like to thank the staff and P.G.’s at the Department of Pedodontics and Preventive Dentistry.

REFERENCES
1. Ripa LW. The current status of pit and fissure sealants: a review. J Can Dent Assoc. 1985;51(5):367-380.

2. Hitt JC, Feigal RJ. Use of a bonding agent to reduce sealant sensitivity to moisture contamination: an in vitro study. Pediatr Dent. 1992;14(1):41-46.

3. Dukic W, Glavina D. Clinical evaluation of three fissure sealants: 24 month follow-up. Eur Arch Paediatr Dent. 2007;8(3): 163-170.

4. Burbridge L, Nugent Z, Deery C. A randomized controlled trial of the effectiveness of a one-step conditioning agent in fissure sealant placement: 12 month results. Eur Arch Paediatr Dent. 2007;8(1):49-54.

5. Burbridge L, Nugent Z, Deery C. A randomized controlled trial of the effectiveness of a one-step conditioning agent in fissure sealant placement: 6-month results. Int J Paediatr Dent. 2006;16(6):424-430.

6. Borem LM., Feigal RJ. Reducing microleakage of sealants under salivary contamination: digital image analysis evaluation. Quintessence Int. 1994;25(4):283-289.

7. Pinar A, Sepet E, Aren G, Bölükbas¸i N, Ulukapi H, Turan N. Clinical performance of sealants with and without bonding agent. Quintessence Int. 2005;36(5):355-360.

8. Feigal RJ, Musherure P, Gillespie B, Levy-Polack M, Quelhas I, Hebling J. Improved sealant retention with bonding agents: a clinical study of two-bottle and single-bottle systems. J Dent Res. 2000;79(11):1850-1856.

9. Hebling J, Feigal RJ. Use of one-bottle adhesive as an intermediate bonding layer to reduce sealant microleakage on saliva-contaminated enamel. Am J Dent. 2000;13(4):187-191.

Figure 1A Mandibular right first permanent molar with pit-and-fissure sealant placed.		Figure 1B Mandibular left first permanent molar with pit-and-fissure sealant placed with iBond.
Figure 2 Results at 3 months. *36 and 46: Permanent left and right first mandibular molar. *Scores: 0,1,2,3,4		Figure 3 Results at 6 months. *36 and 46: Permanent left and right first mandibular molar. *Scores: 0,1,2,3,4
Figure 4 Results at 9 months. *36 and 46: Permanent left and right first mandibular molar. *Scores: 0,1,2,3,4		Figure 5 Results at 12 months. *36 and 46: Permanent left and right first mandibular molar. *Scores: 0,1,2,3,4