Sealing of Non-Cavitated Lesions

Independent of attempts to extend the longevity of the sealants, the sealing of pit and fissures can generally be recommended. Because the emergence of caries has changed in the last decades, not only teeth in eruption should be sealed [10]. The application of a sealing material should be based on personal, tooth-, and surface- risk, which can change during the patient’s life [10]. Risk-based sealing seems to be an ideal approach for patients with a differing caries risk, while routinely sealing of primary molars has been shown to be effective in patients with equal caries risk [53]. However, no superior technique exists to forecast tooth decay [54]; only caries experience can function as a prognostic tool to forecast tooth decay [55]. In addition to the use of sealing materials for primary prevention for the avoidance of caries occurrence, a secondary prevention in areas already affected by caries should also be considered [10].

Arresting the caries and eliminating viable microorganism under the sealing material is the purpose of this application [10]. As soon as a cavity is identified, conventional restorative methods must be implemented. In case of an intact enamel layer—a so-called non-cavitated lesion [56]—the application of a sealing material should be considered [57]. This method arrests the progression of this hidden caries and therefore conserves the tooth structure by means of delaying and minimizing operative procedures [58,59]. A systematic review on this topic reported that sealing with resin-based materials arrested the progression of carious lesions [59–62]; however, sealing with glass ionomer cement did not arrest caries progression [63]. These results are based on the intact and tight closure of the sealing material which did not occur when glass ionomer cement was used [57]. Further studies have shown positive effects of sealing non-cavitated lesions as long as the sealant is intact [59,60]. Fissure sealing was also successful in arresting caries in cases where the caries had already penetrated the dentin. However, the prerequisite was a tight connection between sealing material and tooth surface [64]. The use of sealing materials in carious deciduous teeth was also successful in so far as this technique was not inferior to the invasive techniques [59,61,62].

A decision aide for the application of fissure sealants is given in Figure 2.

Figure 2. Treatment options depending on the ICDAS (International Caries Detection and Assessment System) codes.

Follow-Up Treatment

Because the long-term success of pit and fissure sealing depends on the intact mechanical barrier of the material, regular control is essential. This applies to the application of sealing materials in the context of primary prevention and even more in the context of secondary prevention. Therefore, strict compliance from the patient and/or the patient’s parents as well as access to regular recall appointments is a sine qua non [61,65]. Otherwise, saliva and food remnants can penetrate the leaked sealing material sustaining bacterial and biofilm growth with the result of caries development or progression beneath the sealing material [61].

Apart from the aforementioned negative effects if the sealing material is leaking, studies have examined possible side effects. Patients participating in clinical trials on sealing materials did not show any adverse events [26,27,66]. Nevertheless, reports exist about possible oestrogen-like effects of resin-based materials containing bisphenol A, such as bis-GMA or bis-DMA. Bisphenol A was detected in the saliva of patients for up to three hours after the application of resin-based sealing material [67–69]. Nevertheless, studies have concluded that patients are not at risk for oestrogen-like effects after the application of pit and fissure sealings [20,70].

Conclusions

In summary, clinical recommendations for the use of pit and fissure sealants are beneficial. The main recommendations are that sealing pit and fissures of primary and permanent teeth is safe and effective both in preventing and in arresting caries. However, the long-term success is dependent on regular checkups and the renewal of the sealing if required.

Author Contributions: Writing-Original Draft Preparation: B.C. Writing-Review & Editing: K.B.; A.M.

Conflicts of Interest: The authors declare no conflicts of interest.

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