Background: Placing pit and fissure sealants, an effective measure to prevent caries, is a technique-sensitive procedure that is impacted by moisture control. In vitro and in vivo evidence suggests that use of an adhesive may improve sealant retention.
Clinical question: (1) Does placing resin-based sealants on permanent first molars with an ethanol-based etch-andrinse primer and adhesive system compared with placing sealants without an adhesive improve the 1-year retention rate? (2) Does patient behavior impact sealant retention rates?
Summary of methods and results: A split-mouth randomized controlled trial (RCT) was conducted with first permanent molars of 112 healthy children aged from 5 to 16 years. Molars in matching arches were randomized to receive either a bonded sealant (study group) or a conventional sealant (control group). Behavior was evaluated at the end of treatment for both groups, and complete retention was assessed 12 months posttreatment by blinded examiners. The authors concluded that the addition of an ethanol-based bonding agent significantly increased complete retention of sealants at 12 months, particularly on palatal fissures of permanent maxillary first molar teeth.
Critical appraisal: Overall, this RCT is of moderate quality. Strengths include: a clearly focused question was addressed, arches were randomly allocated, and a clinically relevant outcome was measured. Weaknesses include: a lack of clarity regarding statistician blinding, demographics of the study and control groups, and whether both groups were treated similarly. Intention-to-treat analysis was not performed.
Practical implications: Based on the evidence available through this study, the use of an adhesive may be considered for palatal surfaces, especially in the maxilla. Use on other surfaces remains questionable and may be considered on a case-by-case basis.