Griffin Susan O, Gray Shellie Kolavic, Malvitz Dolores M, Gooch Barbara F
Division of Oral Health, Centers for Disease Control and Prevention, Chamblee, GA 30341, USA.
J Am Dent Assoc. 2009 Apr;140(4):415-23. doi: 10.14219/jada.archive.2009.0190.
The authors examined the risk of caries development in teeth with partially or fully lost sealant (formerly sealed [FS] teeth) relative to the risk in teeth that never have received sealants (never-sealed [NS] teeth).
The authors searched the population of studies used in five reviews of sealant effectiveness as established in split-mouth design studies involving resin-based sealants with no reapplication of lost sealant. They required included studies to contain sufficient data to estimate the risk of caries in FS teeth relative to that in NS teeth (relative risk [RR] = % FS development caries% NS development caries) and its 95 percent confidence interval (CI). To estimate the mean RR by year since sealant placement, they used a weighted bivariate model and tested for heterogeneity using the quantity I(2).
The weighted mean RR was 0.998 (95 percent CI, 0.817-1.220) one year after placement (four studies, 345 tooth pairs) and 0.936 (95 percent CI, 0.896-0.978) at four years (five studies, 1,423 tooth pairs).
Teeth with fully or partially lost sealant were not at a higher risk of developing caries than were teeth that had never been sealed.
Inability to provide a retention-check examination to all children participating in school sealant programs because of loss to follow-up should not disqualify a child from receiving sealants.
作者研究了与从未接受过窝沟封闭的牙齿（未封闭牙齿）相比，窝沟封闭剂部分或完全脱落的牙齿（原封闭牙齿）发生龋齿的风险。
作者在五项窝沟封闭剂有效性综述中所使用的研究人群中进行检索，这些研究是在涉及树脂基窝沟封闭剂且未对脱落的窝沟封闭剂进行重新应用的半口设计研究中确立的。他们要求纳入的研究包含足够的数据，以估计原封闭牙齿相对于未封闭牙齿发生龋齿的风险（相对风险[RR]=原封闭牙齿发生龋齿的百分比/未封闭牙齿发生龋齿的百分比）及其95%置信区间（CI）。为了按窝沟封闭剂放置后的年份估计平均RR，他们使用了加权双变量模型，并使用I(2)量检验异质性。
放置后1年的加权平均RR为0.998（95%CI，0.817 - 1.220）（4项研究，345对牙齿），4年时为0.936（95%CI，0.896 - 0.978）（5项研究，1423对牙齿）。
窝沟封闭剂完全或部分脱落的牙齿发生龋齿的风险并不高于从未封闭过的牙齿。
由于失访而无法对所有参与学校窝沟封闭项目的儿童进行保留检查，不应使儿童失去接受窝沟封闭的资格。
