Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
J Evid Based Dent Pract. 2024 Sep;24(3):102010. doi: 10.1016/j.jebdp.2024.102010. Epub 2024 May 22.
To compile the evidence from systematic reviews (SRs) about the use of sealants for preventing and arresting pit and fissure occlusal caries in primary and permanent teeth.
A search was performed in six databases and gray literature up to May 2023. Systematic reviews (SRs) that included randomized trials (RCTs) and nonrandomized clinical trials (n-RCTs) aiming to answer the PICO-based focused question "are pit and fissure sealants (I) more effective than other interventions, control or no treatment (C) in preventing and arresting occlusal caries (O) in primary and permanent teeth (P)?", were included. The methodological quality was assessed using the AMSTAR-2. The overlap between reviews was calculated (corrected covered, CCA).
Among the 25 included SRs, 18 underwent meta-analysis. Eighteen SRs considered sealing enamel caries lesions, one considered sealing dentine caries, and six considered both. Seventeen SRs were devoted to preventive sealing (RCT only, n = 12; RCT and n-RCT, n = 5), while eight were devoted to prevention and arrest of dental caries (RCT only, n = 5; RCT and n-RCT, n = 3). Nine SRs showed positive results for the primary dentition, and the most frequent periods of follow-up were at least 6 (n = 5) and 12 months (n = 4). According to our meta-analysis, a significant association between resin-based sealants (RBS) and dental caries prevention was detected at 6 months (n = 1) and over longer follow-up periods (n = 4), and the DMFT and dmft indices decreased (n = 2). RBS was better than fluoride varnish at preventing dentine caries (n = 1). A lower caries incidence rate was observed in the resin-modified glass ionomer group at 6 months (n = 1). Overall, the sealants were superior (n = 11), similar (n = 21), or inferior (n = 1) to the other treatments. The AMSTAR-2 scores for studies on preventive sealing were critically low (n = 8), low (n = 6), moderate (n = 1) and high (n = 2) for studies on preventive sealing and critically low (n = 5), low (n = 2) and high (n = 1) for studies on the prevention and arrest of caries lesions. The overlap was low (CCA = 3%).
This overview suggests that pit and fissure sealants are not inferior to other interventions in preventing and arresting dental caries lesions in primary and permanent teeth.
系统综述评估使用窝沟封闭剂预防和阻断恒牙和乳牙窝沟龋的证据。
截至 2023 年 5 月，在六个数据库和灰色文献中进行了检索。纳入了包括随机对照试验（RCT）和非随机临床试验（n-RCT）在内的系统综述，旨在回答基于 PICO 的焦点问题：“窝沟封闭剂（I）在预防和阻断恒牙和乳牙窝沟龋方面是否比其他干预措施、对照或不治疗（C）更有效？”。使用 AMSTAR-2 评估方法学质量。计算了综述之间的重叠（校正覆盖，CCA）。
在 25 项纳入的系统综述中，有 18 项进行了荟萃分析。18 项系统综述考虑了封闭釉质龋损，1 项考虑了封闭牙本质龋损，6 项同时考虑了两者。17 项系统综述专门用于预防性封闭（仅 RCT，n=12；RCT 和 n-RCT，n=5），而 8 项专门用于预防和阻断龋病（仅 RCT，n=5；RCT 和 n-RCT，n=3）。9 项系统综述显示乳牙有阳性结果，最常见的随访期至少为 6 个月（n=5）和 12 个月（n=4）。根据我们的荟萃分析，在 6 个月（n=1）和较长的随访期（n=4）时，发现树脂基封闭剂（RBS）与龋齿预防之间存在显著关联，DMFT 和 dmft 指数降低（n=2）。RBS 在预防牙本质龋方面优于氟化物漆（n=1）。在 6 个月时，树脂改性玻璃离子组的龋齿发生率较低（n=1）。总体而言，封闭剂优于（n=11）、相似（n=21）或劣于（n=1）其他治疗方法。预防性封闭研究的 AMSTAR-2 评分较低（n=8）、低（n=6）、中等（n=1）和高（n=2），而预防和阻断龋病的研究的 AMSTAR-2 评分较低（n=5）、低（n=2）和高（n=1）。重叠率较低（CCA=3%）。
本综述表明，窝沟封闭剂在预防和阻断恒牙和乳牙窝沟龋方面并不逊于其他干预措施。
