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A comparison of the effects of toothbrushing and handpiece prophylaxis on retention of sealants

Kolavic Gray S, Griffin SO, Malvitz DM, Gooch BF . Journal of the American Dental Association. 2009;140(1):38-46

BACKGROUND: Tooth surface cleaning before acid etching is considered to be an important step in the retention of resin-based pit-and-fissure sealants. METHODS: The authors reviewed and summarized instructions for cleaning tooth surfaces from five manufacturers of 10 unfilled resin-based sealants marketed in the United States. The authors also searched electronic databases for studies that directly compared the effects of different surface-cleaning methods on sealant retention and for systematic reviews of the effectiveness of sealants. They explored the association between surface-cleaning methods and sealant retention in the studies included in the systematic reviews. They calculated the summary weighted retention rates for studies that used either a handpiece or toothbrush prophylaxis. RESULTS: All of the sealant manufacturers' instructions for use (IFU) recommended cleaning the tooth before acid etching. None of the IFU directly stated that a handpiece was required to perform the cleaning, but five IFU implied the use of handpiece prophylaxis. None of the IFU recommended surface-altering procedures in caries-free teeth. Direct evidence from two clinical trials showed no difference in complete sealant retention between surfaces cleaned mechanically with pumice or prophylaxis paste and those cleaned with air-water syringe or dry toothbrushing. Indirect evidence from 10 studies found that weighted summary retention by year after sealant placement in studies that used toothbrush prophylaxis was greater than or equivalent to values for studies that used handpiece prophylaxis. CONCLUSIONS: Levels of sealant retention after surface cleaning with toothbrush prophylaxis were at least as high as those associated with hand-piece prophylaxis. CLINICAL IMPLICATIONS: This finding may translate into lower resource costs for sealant placement. [References: 86]

How to clean the tooth surface before sealant application

Sergio Uribe DDS; Paul Farsai DMD; Kate Vig BDS, MS, FDS, Dorth .


Systematic Review Conclusion

Sealant retention after tooth surface cleaning with toothbrush prophylaxis was similar to that associated with handpiece prophylaxis.

Critical Summary Assessment

A review considering the best available evidence compared two surface-cleaning methods and found no difference in long term (five-year) sealant retention. Higher rates of retention were evident in the toothbrush prophylaxis groups at the end of the first year after sealant placement.

Evidence Quality Rating

Limited Evidence

This summary is published in the Journal of the American Dental Association and can be accessed at:

Critical Summary Publication Date:


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 © 2019