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Glass ionomer cement shows no caries preventive advantage over resin-based fissure sealants Critical Summary Prepared by: Romesh Nalliah BDS 

OVERVIEW

  • Systematic Review Conclusion:

    There is no evidence that either GIC or resin-based fissure sealant is superior to the other in preventing dental caries.

  • Critical Summary Assessment:

    Clinician judgment should determine material selection for fissure sealants as there is no clear evidence in support of GIC or resin based materials as the superior material in preventing caries.

  • Evidence Quality Rating:

    Limited

  • Clinical Questions:

    Is there a difference in caries risk with either GIC or resin-based sealants?

  • Review Methods:

    This is an update to an earlier systematic review. The authors searched eight databases for articles published from January 15, 2008 to August 26, 2010 in addition to 11 databases from the original study, which included all trials up to January 15, 2008. The current systematic review added seven trials to the evaluation. Key inclusion criteria were studies in English and studies that compared GIC and resin fissure sealants. Key exclusion criteria were studies with no outcome measure related to caries and use of resin-modified GIC, rather than conventional GIC. The outcome assessed was the development of new caries. Each study was reviewed by two independent reviewers and disputes were resolved by discussion.

  • Main Results:

    A total of 16 trials met the inclusion criteria. The authors included 12 dichotomous datasets. Seven of those indicated that resin-based fissure sealants were significantly superior to GIC-based in preventing caries after 2 to 3 years. The other five datasets showed GIC-based sealants to be significantly better than resin-based at preventing caries after 3 to 5 years. Two groups of datasets (one including three studies and one including two studies) were considered homogenous enough to perform meta-analyses. Pooled relative risk of 2.62 (95 percent CI: 1.71 - 4.00) suggests a 2 to 3 times higher risk of caries for teeth sealed with conventional GIC than for those sealed with resin, after 3 years. The second meta-analysis showed no significant difference between GIC-based and resin-based fissure sealants in preventing caries after 4 years. The authors also carried out a cumulative relative risk analysis and found no statistically significant difference between the two materials in preventing caries after 5 years.

  • Conclusion:

    GIC- and resin-based fissure sealants displayed significant caries preventive effects. This systematic review found no evidence that one material was superior to the other in preventing dental caries.

  • Source of funding:

    No funding is reported

Commentary:

  • Importance and Context:

    Although there is strong evidence in support of the use of fissure sealants, there is no clear evidence as to which material is best to reduce caries.

  • Strengths and Weaknesses of the Systematic Review:

    Strengths of the current study included the use of nine databases, two independent reviewers and the use of dual, independent data extraction and quality assessment. The authors combined the results of clinically homogeneous studies into several meta-analyses, and they also performed sensitivity analysis to examine attrition bias. However, they used multiple datasets and analyzed intermediate points in time in addition to data at the end of the trial period. This may have introduced the risk of misleading results where there may have been short-term effectiveness in preventing caries but long-term failure. The authors presented a comprehensive list of details of included studies as well as a list of excluded studies, citing the reason for exclusion but providing no further details. There was no report of contacting experts. A limitation of the systematic review may be that the updated search was limited to English language publications whereas the original study included two Portuguese studies. The authors investigated publication bias and found it to be statistically insignificant. In fact, the authors considered selection, detection, performance and attrition bias.





  • Strengths and Weaknesses of the Evidence:

    A strength of the evidence was the existence of 16 accepted trials, which allowed two meta-analyses with a total sample of GIC fissure sealants of 1186 and the same number of resin fissure sealants. However, no accepted trial reported blinding of patients, operators or trial evaluators. There were two separate forest plots, one for 3- year and one for 4-year data. The authors were not clear about why these meta-analyses were not combined. They presented a cumulative meta-analysis that showed no statistically significant differences between groups . All forest plots had moderate-high levels of heterogeneity. Results should be taken with caution as all included studies were evaluated as being at high risk of bias.

  • Implications for Dental Practice:

    The current ADA clinical recommendations for use of pit and fissure sealants recommend resin as the material of choice.(1) However, this new systematic review provides new evidence that shows no significant difference between the caries preventive impact of GIC and resin sealant materials. Therefore, clinicians should use their own judgment when choosing a dental sealant material.

    1. Beauchamp J, Caufield PW, Crall JJ, et al. Evidence-Based Clinical Recommendations for the Use of Pit-and-Fissure Sealants: A Report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2008;139(3):257-68.

  • Critical Summary Publication Date: 4/12/2012

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association ©

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