Kervanto-Seppälä Sari, Lavonius Eeva, Pietilä Ilpo, Pitkäniemi Janne, Meurman Jukka H, Kerosuo Eero
Institute of Dentistry, University of Helsinki, Helsinki, Finland.
Int J Paediatr Dent. 2008 Jan;18(1):56-61. doi: 10.1111/j.1365-263X.2007.00855.x.
The aim of this study was to compare the caries-preventive effect of two types of sealant modalities and to evaluate whether the caries-preventive effect is related to sealant retention. A hypothesis was tested in which a glass ionomer sealant, once applied to the occlusal surface, was able to protect the fissure from caries even if the sealant appeared lost at visual inspection.
A 3-year randomized split-mouth trial evaluating two sealant modalities was performed at a public health centre in Finland. A chemically curing glass ionomer cement (GIC) and light-curing resin-based (RB) sealant material were applied randomly to the permanent second molars. Sealant application as a routine treatment procedure was carried out to 599 children in the age group of 12-16 years. Caries rate of the sealed teeth and sealant retention with both materials were analysed by a modified McNemar's test. The effectiveness, rate difference, and relative risk with both sealant materials were measured.
The difference in caries rate between the two modalities was highly significant. When compared to the GIC sealant method, the effectiveness of RB sealant method was 74.1% and the rate difference 3.2% (95% CI 1.44%, 4.98%). The relative risk for RB-sealed surfaces vs. GIC-sealed surfaces of having detectable dentin caries was 0.26 (95% CI 0.12, 0.57). The retention rate of sealants was higher with RB than GIC (P < 0.001). The effectiveness of the retention rate for RB sealants was 94.8% and the rate difference 87.2% (95% CI 83.86%, 90.50%). The relative risk during the 3-year study period of having a defective or lost RB sealant was 0.052 (95% CI 0.036, 0.075) when compared to having a defective or lost GIC sealant.
It is concluded that in preventing dentin caries a RB sealant programme including resealing when necessary was more effective than a single application of GIC. The original hypothesis was thus falsified.
本研究旨在比较两种类型的窝沟封闭剂的防龋效果，并评估防龋效果是否与封闭剂的保留情况有关。我们检验了一个假设，即玻璃离子窝沟封闭剂一旦应用于咬合面，即使在视觉检查中看起来封闭剂已脱落，也能够保护窝沟免受龋齿侵害。
在芬兰的一个公共卫生中心进行了一项为期3年的随机半口试验，评估两种窝沟封闭剂。将化学固化玻璃离子水门汀（GIC）和光固化树脂基（RB）封闭剂材料随机应用于恒牙第二磨牙。对599名年龄在12至16岁的儿童进行了窝沟封闭剂作为常规治疗程序的应用。采用改良的McNemar检验分析两种材料封闭牙齿的龋病发生率和封闭剂保留情况。测量了两种封闭剂材料的有效性、率差和相对风险。
两种方式之间的龋病发生率差异非常显著。与GIC封闭剂方法相比，RB封闭剂方法的有效性为74.1%，率差为3.2%（95%可信区间1.44%，4.98%）。RB封闭面与GIC封闭面发生可检测到的牙本质龋的相对风险为0.26（95%可信区间0.12，0.57）。RB封闭剂的保留率高于GIC（P < 0.001）。RB封闭剂保留率的有效性为94.8%，率差为87.2%（95%可信区间83.86%，90.50%）。与有缺陷或脱落的GIC封闭剂相比，在3年研究期间RB封闭剂有缺陷或脱落的相对风险为0.052（95%可信区间0.036，0.075）。
得出的结论是，在预防牙本质龋方面，包括必要时重新封闭的RB封闭剂方案比单次应用GIC更有效。因此，原假设被证伪。
