The effectiveness of fissure sealants: How effective are fissure sealants in preventing occlusal caries in children and adolescents?

Data sources Sources were Medline, the Cochrane Library, reference lists of identified articles and selected textbooks.Study selection Selected studies were randomised clinical trials (RCT), quasi-RCT or controlled clinical trials that compared fissure sealing with no treatment or another preventive treatment, in children of up to 14 years of age at the beginning of study, with clearly described diagnostic criteria, and with at least 2 years follow-up. Studies reported in Danish, English, French, German, Italian, Norwegian, Spanish or Swedish were considered.Data extraction and synthesis Inclusion decisions and grading of the studies was done independently by two of the authors. The main outcome was caries increment and the measure of treatment effect was either relative risk (RR) reduction or prevented faction. A pooled estimate was calculated for studies using resin-based materials.Results Thirteen studies were included, eight of which used resin-based material and were selected for meta-analysis. The pooled estimate of effect for a single application of resin-based sealant on first permanent molars showed the RR of developing caries in sealed teeth relative to controls was 0.67 (95% confidence interval, 0.55–0.83), a reduction in RR of 33%. For repeated applications, the reduction in RR varied from 69 to 93%.Conclusions The review provides limited evidence that fissure sealing of first permanent molars with resin-based materials has a caries-preventive effect. The evidence is incomplete for second permanent molars, premolars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations of both low and high caries risk.