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Twenty-four month clinical evaluation of

fissure sealants on partially erupted
permanent first molars: Glass ionomer versus
resin-based sealant
Sibel A. Antonson, Donald E. Antonson, Sandra
Brener, Jude Crutchfield, Jose Larumbe, Christie
Michaud, A. Rüya Yazici, Patrick C. Hardigan,
Samira Alempour, David Evans and Rome
Ocanto
JADA 2012;143(2):115-122
10.14219/jada.archive.2012.0121

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Twenty-four month clinical evaluation
of fissure sealants on partially erupted
permanent first molars
Glass ionomer versus resin-based sealant
Sibel A. Antonson, DDS, PhD, MBA; Donald E. Antonson, DDS, MEd;
Sandra Brener, DDS, MS; Jude Crutchfield, DMD; Jose Larumbe, DDS, MS;
Christie Michaud, DMD; A. Rüya Yazici, DDS, PhD; Patrick C. Hardigan, PhD;
Samira Alempour, DMD; David Evans, DMD; Rome Ocanto, DDS
he dental profession has
T invested many resources to
emphasize prevention-
oriented treatment plans
and has reported a decline in caries
rates in both permanent and pri-
mary dentitions.1 Despite these
improvements, caries remains an
oral health problem. The risk of
caries’ developing is highest during
the first few years after tooth erup-
tion.1 Partially erupted molars
present a particularly difficult situ-
ation. As long as an erupting tooth
has no antagonist contact, plaque
accumulation and caries develop-
ment are promoted.2 The eruption
time for the first and second molars
is about 1.5 years, whereas the
eruption time for premolars is one
to two months.3 In addition, the
operculum covering the distal one-
half of these teeth during the erup-
tion process allows for the retention
of plaque and the initiation of the
carious process before complete
eruption has occurred.4 The location
of the permanent molars in the pos-
terior region of the child’s mouth
also complicates his or her ability to
properly clean these areas and
remove food debris. All of these fac-
tors contribute to the increased
occlusal pit-and-fissure caries rate
of permanent first molars.
The occlusal surface of molars is
responsible for 67 to 90 percent of
caries in children from 5 through 17
years of age.5,6 Therefore, re-
searchers have tried to develop effi-
Copyright © 2012 American Dental Association. All rights reserved.
COVER STORY
AB STRACT
Background. Glass ionomer sealants are an
alternative to resin-based sealants, especially for
✷
®
✷
J
A D
A
N
CON
IO
use in partially erupted permanent molars. The
T
A
authors conducted a study to compare the retention, N
I
U C
IN U
A G ED
marginal staining and cariostatic properties of a glass R T L E 1
IC
ionomer sealant with those of a resin-based sealant
during a 24-month period.
Methods. We included in this study 39 patients aged 5 through 9
years who had bilateral partially erupted first permanent molars. One
of us (S.B.) placed a resin-based sealant (Delton Plus FS+, Dentsply
Professional, York, Pa.) (group D) on a partially erupted first molar in
one quadrant of the maxilla or mandible and a glass ionomer sealant
(GC Fuji Triage White, GC America, Alsip, Ill.) (group T) in the other
quadrant. Two masked and calibrated investigators (S.A.A., J.C.) eval-
uated the sealants for retention, marginal staining and carious lesions
at three, six, 12 and 24 months. The authors used a multinomial
regression for statistical analysis (P < .05).
Results. The recall rate was 69.2 percent at 24 months. Two sealants
from group D and three from group T were lost completely. Complete
retention rates at 24 months were 40.7 and 44.4 percent for groups D
and T, respectively. The authors found no statistically significant differ-
ence in retention rates between groups at each recall examination
(P > .05). For marginal staining, sealants in the resin-based group
exhibited statistically higher marginal staining than did sealants in
the glass ionomer group (P < .05). Although the authors detected no
caries in teeth in group T, teeth in group D in which the sealant was
lost completely experienced demineralization.
Conclusions. Resin-based and glass ionomer sealants exhibited
similar retention rates at 24 months. However, marginal staining was
lower in the glass ionomer group, and the authors found no caries in
teeth in this group. Consequently, glass ionomer sealants may be a
better choice when salivary contamination is expected.
Clinical Implications. Sealing during tooth eruption presents a
particular challenge owing to difficulty in isolating the tooth. Glass
ionomers may be a better material for sealing partially erupted molars.
Key Words. Dental sealants; caries prevention; glass ionomer
sealants; resin-based sealants.
JADA 2012;143(2):115-122.
JADA 143(2) http://jada.ada.org February 2012 115
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COVER STORY
cient and effective treatments to prevent high-
risk children from developing caries, especially
soon after their first teeth erupt. One of the most
effective ways to prevent caries in pits and fis-
sures, as well as to arrest undiagnosed caries in
these areas, is to place sealants.7-11 Sealants pro-
vide a physical barrier that isolates the covered
surfaces of teeth from microorganisms and food
particle accumulation. Although the results of
previous clinical trials have provided evidence of
sealants’ demonstrating caries-preventive ef-
fects, a clinical question remains concerning the
choice of sealant type. Two types of sealant
materials are used predominantly: resin-based
sealants and glass ionomer sealants (either con-
ventional or resin-modified).12,13
The effectiveness of sealants in preventing
caries depends on long-term retention.13 A dental
sealant that can tolerate a moist environment
would be an improvement over currently recom-
mended resin-based sealants, because successful
isolation is a prerequisite for effectiveness. Fur-
thermore, a sealant with biochemical properties
that make the tooth more resistant to acid
attack is desirable. Ultimately, this may lead to
a decreased caries rate for permanent first
molars. Glass ionomers are moisture friendly
because they require the presence of a moist
environment to develop and maintain their
mechanical properties, and, unlike resin-based
sealants, they do not require intermediate steps
such as acid etching and application of a primer
and bonding agent. More importantly, the
fluoride-release potential of glass ionomers pro-
vides cariostatic action by producing an acid-
resistant surface of fluoride-modified hydroxyap-
atite; this, in turn, promotes remineralization of
enamel in teeth with early carious lesions.14
Conversely, resin-based materials are
hydrophobic and require an isolated environ-
ment for placement. In addition, when used to
seal a tooth surface, resin-based sealants do not
allow the penetration of calcium or phosphate
ions into the maturing enamel surface. In most
studies, investigators have observed lower
retention rates with glass ionomer sealants
compared with resin-based sealants.15-19 How-
ever, Mejàre and Mjör20 reported that even the
retention of small amounts of glass ionomer
sealants might be sufficient to prevent caries in
entire pits and fissures of teeth.
A low-viscosity, flowable, high-fluoride–
releasing glass ionomer sealant (GC Fuji Triage
White, GC America, Alsip, Ill.) has been on the
market for several years. The manufacturer
claims that this moisture-friendly glass ionomer
is ideal for sealing partially erupted molars, and
116 JADA 143(2) http://jada.ada.org February 2012
Copyright © 2012 American Dental Association. All rights reserved.
its self-bonding feature requires fewer steps in
less time compared with those for resin-based
sealants.21 On application, it forms a semiper-
meable skin that, along with its high fluoride
level, helps reduce acid attacks and bacterial
levels, while allowing the diffusion of calcium
and phosphate ions to strengthen the tooth.
In a review of the dental literature, we found
several studies in which researchers compared
the clinical performance of resin-based sealants
with that of glass ionomer sealants. However,
we found only one study in which investigators
used GC Fuji Triage, and they compared its
effectiveness with that of a resin-based sealant
on newly erupted molars.22 However, the study’s
duration was only one year and the sealed teeth
were free of mucosal tissue.22
The aim of our 24-month clinical study was to
compare the retention, marginal staining and car-
iostatic properties of a glass ionomer sealant with
those of a resin-based sealant (Delton Plus+,
Dentsply Professional, York, Pa.) on partially
erupted molars with operculum coverage. The
null hypothesis was that the clinical performance
of the two sealants would not be different.
METHODS
We included in this study 39 patients, aged 5
through 9 years, who had bilateral partially
erupted first molars that were free of restora-
tions, caries, hypoplasia, fracture or cracks. The
human ethics committee at Nova Southeastern
University, Fort Lauderdale, Fla., reviewed and
approved the protocol and consent form for this
study, and we obtained written informed con-
sent from the children’s parents or guardians.
We identified all participants according to an
assigned number. Four of us (S.A.A., D.E.A.,
J.C., J.L.) categorized partially erupted first
molars according to operculum coverage of at
least one-fourth and up to one-half of the
occlusal surface. We excluded from the study
teeth with an operculum that covered more
than one-half of the occlusal surface.
One of us (J.C.) examined the partially
erupted first molars with a calibrated laser fluo-
rescence device (DIAGNOdent Classic, KaVo
Dental, Biberach, Germany) for the absence of
occlusal caries. The clinician performed this
examination after removing plaque from the pits
and fissures and drying the tooth surface thor-
oughly. He placed the tip of the instrument per-
pendicular to the occlusal surface on the prese-
lected site, rotated it and recorded the maximum
reading (peak value). He took three measure-
ments at each site to verify the readings. The cli-
nician then correlated the peak value with the
 Downloaded from jada.ada.org on August 23, 2014
definitions on the scale, which correspond to the
absence or presence of a carious lesion. We
excluded from the study teeth for which the
DIAGNOdent reading was higher than 20.
Two experienced dentists (S.A.A., J.L.) using
calibrated technique performed all baseline
evaluations and debridement for each patient
and gave oral hygiene instructions to patients’
parents. They determined each patient’s saliva
quantity, pH and buffering capacity (Saliva-
Check Buffer, GC America) according to the
manufacturer’s directions. Three of us (C.M.,
S.A., D.E.) identified patients at high risk of
developing caries according to socioeconomic
background and included them in the study. We
excluded patients who were receiving medica-
tions, had developmental syndromes or both.
The clinician (S.B.) placed a resin-based
sealant (group D) on a partially erupted first
molar in one quadrant after applying an etch-
and-rinse adhesive system (Prime & Bond NT
light cured, Dentsply Caulk, Milford, Del.), and
she placed a glass ionomer sealant (group T) on
a partially erupted first molar in the other
quadrant (split-mouth model) after applying a
cavity conditioner. We used a coin toss to assign
sealants randomly to quadrants. The clinician
applied the sealants as follows:
Group D (resin-based sealant). After
brushing the teeth with water, the clinician acid
etched the occlusal surfaces with 34 percent
phosphoric acid (Delton EZ Etch, Dentsply Pro-
fessional) for 30 seconds, rinsed the teeth with
water for 10 seconds and dried them until a
frosted occlusal surface appeared. She applied
one coat of etch-and-rinse adhesive with a micro-
brush, gently air-dried the teeth and light cured
them for 20 seconds (VIP junior dental curing
light, Bisco, Schaumburg, Ill.). Using a flocked-
tip syringe, the clinician then applied the resin-
based sealant to the fissures, including under
the operculum, and spread the material care-
fully with a dental probe to prevent air entrap-
ment. She then used a microbrush to push the
material into the pits and fissures. The clinician
light cured the sealant material for 20 seconds
with a quartz-tungsten-halogen light. Light
output of the curing unit exceeded 550 milli-
watts per square centimeters before and after
the study, as verified with a radiometer.
Group T (glass ionomer). After brushing
the teeth with water, the dentist applied a bond
surface conditioner (Cavity Conditioner, GC
America) on the occlusal surfaces with a micro-
brush for 15 seconds, then rinsed the teeth with
water for 10 seconds and wiped off excess water
with gauze. A dental team member prepared the
Copyright © 2012 American Dental Association. All rights reserved.
COVER STORY
glass ionomer sealant according to the manufac-
turer’s directions; the clinician then applied it on
the occlusal surface of the tooth, including under
the operculum. She used a microbrush to push
the material into the pits and fissures and light
cured the material for 40 seconds. The clinician
removed the excess material with an explorer.
The clinician placed all sealants without
rubber dam isolation. She maintained moisture
control by means of cotton roll isolation pro-
cedures. Untreated first molars served as the con-
trol group. The clinician used an intraoral camera
(Gendex, KaVo Dental, Lake Zurich, Ill.) to obtain
photographs of the teeth before and after applica-
tion of the sealants. Immediately after sealant
application, a masked examiner (S.A.A.) verified
the integrity of margins and occlusion of teeth.
Recall examinations. Two calibrated inves-
tigators (S.A.A., J.C.) who were not involved
with the treatment procedures evaluated the
sealants with regard to retention, marginal
staining and development of carious lesions
with the use of a mirror, blunt explorer and air
stream. We used the following ratings to eval-
uate sealant retention:
dsealant completely retained;
dsealant partially lost;
dsealant completely lost.
We considered the presence of staining at the
margins of the sealants to be a potential sign of
microleakage. We used the following ratings to
evaluate marginal staining:
dno marginal staining;
dpartial marginal staining;
dcomplete marginal staining.
We conducted recall examinations at three,
six, 12 and 24 months. If the clinician (S.A.A.,
J.C.) found any demineralization during the
recall examination, she or he treated the tooth
according to the usual procedures. The clinician
also obtained intraoral photographs during the
recall examinations. In addition, the clinician
estimated retention and marginal staining visu-
ally, both during the intraoral examination and
on magnified intraoral photographs of the
sealants across time (Figures 1 and 2).
Statistical analysis. We used a multinom-
inal model with panel-adjusted standard errors
to analyze the differences in retention, marginal
staining and caries formation between the two
sealants across time at a 5 percent level of sig-
nificance. Analysis of panel data allowed us to
develop a multinomial model with both spatial
and temporal dimensions. (The spatial dimen-
sion pertains to the sealant and the temporal
dimension pertains to observations at three, six,
12 and 24 months.23)
JADA 143(2) http://jada.ada.org February 2012 117
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COVER STORY

attend the three-month

evaluation. One partici-
pant attended only the
three-month and
24-month recall
appointments.
Table 1 presents the
sealant retention rates.
The overall probability
of full retention de-
A B creased significantly
across time for both
sealant groups
(P = .001). The proba-
bility of partial reten-
tion increased across
time, and the proba-
bility of complete loss of
retention did not change
across time for both
sealant groups.
The study results
C D showed a statistically
Figure 1. A. Resin-based sealant (Delton FS+, Dentsply Professional, York, Pa.) at baseline. significant difference
B. Delton FS+ at six months. C. Delton FS+ at 12 months. D. Delton FS+ at 24 months. Arrow indi- between the two sealant
cates partial loss of retention. groups in terms of mar-
ginal staining at each of
the recall examinations
(P = .001), with sealants
in the glass ionomer
group exhibiting less
marginal staining
(Table 2). In addition,
we found a significant
difference between
sealants in the proba-
A B bility of marginal
staining’s occurring,
with the resin-based
sealant 22 percent more
likely to have exhibited
staining. The results
showed no significant
difference in marginal
staining in each sealant
group across time.
Three-month
recall. The three-month
C D recall rate was 94.9 per-
Figure 2. A. Glass ionomer sealant (GC Fuji Triage, GC America, Alsip, Ill.) at baseline. B. GC Fuji cent. The results
Triage at six months. C. GC Fuji Triage at 12 months. D. GC Fuji Triage at 24 months. showed no statistically
significant difference in
RESULTS retention rates between the two groups. With
We placed a total of 78 sealants in 39 patients respect to marginal staining, the results showed
at baseline. One participant with two sealants a statistically significant difference (P = .001)
who was seen at baseline did not return for the between the two sealant groups in partial
recall examinations, and one participant did not staining.

118 JADA 143(2) http://jada.ada.org February 2012

Copyright © 2012 American Dental Association. All rights reserved.
 Downloaded from jada.ada.org on August 23, 2014

COVER STORY

Six-month recall. TABLE 1

The recall rate at six Distribution of sealant retention rates.
months was 92.3 per-
cent. We found no sta- SEALANT NO. (%*) OF OCCLUSAL SURFACES WITH SEALANTS (N = 78†)
RETENTION
tistically significant Three Months Six Months 12 Months 24 Months
differences between Delton GC Fuji Delton GC Fuji Delton GC Fuji Delton GC Fuji
the two groups with FS+‡ Triage§ FS+ Triage FS+ Triage FS+ Triage
regard to sealant Complete 27 (73.0) 32 (86.5) 23 (63.9) 28 (77.8) 21 (61.8) 20 (58.8) 11 (40.7) 12 (44.4)
retention. Although Retention
none of the sealants Partial 9 (24.3) 3 (8.1) 11 (30.6) 7 (19.4) 11 (32.3) 9 (26.5) 14 (51.9) 12 (44.4)
in either group exhib- Loss

ited complete mar- Complete 1 (2.7) 2 (5.4) 2 (5.5) 1 (2.8) 2 (5.9) 5 (14.7) 2¶ (7.4) 3 (11.1)
Loss
ginal staining, the
results showed a sta- TOTAL 37 (100) 37 (100) 36 (100) 36 (100) 34 (100) 34 (100) 27 (100) 27 (100)
tistically significant * Reported percentages are the predicted probabilities from the panel-adjusted multinominal model.
difference (P = .001) † Some patients were lost to follow-up.
‡ Delton FS+ resin-based sealant is manufactured by Dentsply Professional, York, Pa.
between the two § GC Fuji Triage glass ionomer sealant is manufactured by GC America, Alsip, Ill.
groups in partial mar- ¶ Presence of demineralization.
ginal staining.
Twelve-month TABLE 2
recall. Five patients
with 10 sealants who
Distribution of marginal staining rates.
were seen at baseline MARGINAL NO. (%*) OF OCCLUSAL SURFACES WITH SEALANTS (N = 78†)
STAINING
did not return for the Three Months Six Months 12 Months 24 Months
12-month recall visit Delton GC Fuji Delton GC Fuji Delton GC Fuji Delton GC Fuji
(87.2 percent recall FS+‡ Triage§ FS+ Triage FS+ Triage FS+ Triage
rate). We found no No 28 (78.0) 35 (100) 22 (64.7) 33 (94.3) 23 (71.9) 28 (96.6) 22 (88.0) 24 (100)
statistically signifi- Marginal
Staining
cant difference in
retention rates Partial 8 (22.0) 0 (0.0) 12 (35.3) 2 (5.7) 9 (28.1) 1 (3.4) 1 (4.0) 0 (0.0)
Marginal
between the two Staining
groups. Regarding
Complete 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (8.0) 0 (0.0)
marginal staining, the Marginal
results showed a sta- Staining
tistically significant TOTAL 36 (100) 35 (100) 34 (100) 35 (100) 32 (100) 29 (100) 25 (100) 24 (100)
difference (P = .001) * Reported percentages are the predicted probabilities from the panel-adjusted multinominal model.
between the two † Some patients were lost to follow-up.
sealant groups in par- ‡ Delton FS+ resin-based sealant is manufactured by Dentsply Professional, York, Pa.
§ GC Fuji Triage glass ionomer sealant is manufactured by GC America, Alsip, Ill.
tial staining.
Twenty-four–
month recall. At the 24-month recall visit, 12 ferent from those in the glass ionomer group.
participants were absent, mainly because of
relocations. The overall recall rate was 69.2 per- DISCUSSION
cent. We observed no carious lesions in teeth in Since the 1970s, pit-and-fissure sealants have
group T (glass ionomer) throughout the 24- been an accepted caries-prevention treatment,
month study period. However, we did observe and they are considered an effective noninva-
demineralization in both teeth in group D (resin sive treatment to prevent or arrest occlusal
based) in which the sealant was lost completely. caries.24 Resin-based sealants have been in
The results showed no statistically significant common use, but glass ionomer sealants are an
difference between the two groups in terms of acceptable alternative owing to their high fluo-
sealant retention. For marginal staining, none ride release, moisture-friendly features and
of the sealants exhibited complete marginal need for reduced chair time.12,13 In addition,
staining at the three-month, six-month or 12- application of glass ionomer is less problematic
month recall visits. At the 24-month recall visit, because of its hydrophilic chemistry. Also, it
two resin-based sealants (group D) had experi- does not require acid-etching, which helps to
enced complete marginal staining, although the decrease the child’s anxiety resulting from the
results were not statistically significantly dif- phosphoric acid’s bad taste.

JADA 143(2) http://jada.ada.org February 2012 119

Copyright © 2012 American Dental Association. All rights reserved.
 Downloaded from jada.ada.org on August 23, 2014
COVER STORY
Retention rates. We observed similar reten-
tion rates for resin-based and glass ionomer
sealants in our study. Therefore, we accepted
the null hypothesis. This finding is not in agree-
ment with those of some clinical studies, in
which investigators reported higher retention
rates for resin-based sealants than for glass
ionomer sealants.15-20,22,25,26 Many investigators
reported retention rates of approximately 80 to
90 percent for the resin-based sealants, whereas
several reported retention rates of 10 to 20 per-
cent for the glass ionomer sealants.16,18-20 In addi-
tion, several investigators concluded that the
resin-based sealant was superior to the glass
ionomer sealant in preventing caries, which
might be related to the superior retention of the
resin-based sealants.16,18,25 These study findings
are inconsistent with our findings, which
showed no statistically significant difference in
caries development between the two sealant
groups.
A possible explanation for these contrary
findings could be related to our use of a bond
surface conditioner (Cavity Conditioner) with
the glass ionomer sealant. This product contains
polyacrylic acid, which produces a chelation
reaction with the calcium of the enamel, thus
providing a hybrid layer for the glass ionomer to
establish a more stable bonding surface. The
conditioner also acts as a wetting agent.
In our study, lower retention rates obtained
with resin-based sealants might be the result of
inadequate moisture control. It is known that
resin-based sealants require a completely dry
field to achieve adequate adhesion. In previous
studies,18,19,22,24-26 researchers did not consider the
effect of saliva contamination on resin-based
sealant retention, because they placed the
sealants on fully erupted teeth that were iso-
lated properly.
Prismless enamel on partially erupted teeth
might affect the etching efficacy of the acid in
resin-based sealants. This might explain why
we observed more marginal staining in molars
that received resin-based sealants. The mar-
ginal sealing ability of sealant materials also is
important for the success of treatment. Lack of
sealing allows marginal leakage that can ini-
tiate carious lesions underneath the sealant.
It is a common practice to apply pit-and-fissure
sealants without the use of bonding agents.13
However, in this study, we applied the resin-
based sealant with a bonding agent. We based
this decision primarily on the results of a study
conducted to identify the best method of ap-
plying fissure sealants on saliva-contaminated
surfaces. In this in vitro study, Antonson and
120 JADA 143(2) http://jada.ada.org February 2012
Copyright © 2012 American Dental Association. All rights reserved.
colleagues14 compared the retention of a glass
ionomer sealant (GC Fuji Triage) with that of a
resin-based sealant (Delton FS+ with Prime &
Bond NT and Delton FS+ alone) on saliva-
contaminated enamel surfaces. The glass
ionomer sealant and the resin-based sealant
placed with the bonding agent demonstrated
100 percent retention after each of three periods
of thermocycling and toothbrush abrasion. These
groups also demonstrated similar wear rates.
On the other hand, 21 percent of resin-based
sealants (Delton FS+) placed without a bonding
agent experienced a complete loss of retention
during the first simulated six-month period.
After this study, Antonson and colleagues14
measured the depth of penetration of each
sealant into saliva-contaminated fissures and
quantified the depth of penetration on the basis
of the anatomy of the fissure. The results
showed that the resin-based group (Delton FS+)
achieved a mean surface coverage of 65.6 per-
cent, whereas the glass ionomer group (GC Fuji
Triage) achieved a mean surface coverage of
83.2 percent under selected deep fissure areas.
Because surface coverage is a function of flow-
ability and adaptability of the sealants, the
investigators27 concluded that the glass ionomer
sealant was a more effective agent under saliva-
contaminated surfaces.
With regard to fissure anatomy, application of
the resin-based sealant resulted in 40.07 per-
cent of fissures being unfilled or partially filled,
whereas application of the glass ionomer
sealant resulted in 23.12 percent of fissures
being unfilled or partially filled. The study
results showed that Y-shaped fissures were
more difficult to penetrate for both of the
sealant materials. However, when the fissures
were contaminated with saliva, the effective-
ness of the glass ionomer sealant group was
double that of the resin-based sealant group, as
the glass ionomer material can penetrate more
effectively into the moist fissures.28 Although
these were in vitro studies,27,28 results of labora-
tory studies can be good predictors of the clin-
ical behavior of materials.
Microleakage. Al-Jobair29 evaluated the
microleakage of a glass ionomer sealant (GC
Fuji Triage) in saliva-contaminated pits and fis-
sures and compared it with the microleakage of
a resin-based sealant. The investigator reported
that the glass ionomer sealant was insensitive
to moisture contamination, as the study results
showed no difference in its leakage scores under
dry or wet contamination protocols. When com-
paring the glass ionomer sealant with the resin-
based sealant, Al-Jobair29 found that the former
 Downloaded from jada.ada.org on August 23, 2014
exhibited less leakage under wet contamination
conditions, whereas the latter exhibited less
leakage under dry conditions.
In another in vitro study, Ashwin and Arathi30
reported no difference in microleakage between a
glass ionomer sealant and a resin-based sealant,
indicating that the sealing ability of the glass
ionomer cement was similar to that of the conven-
tional unfilled resin. Moreover, the glass ionomer
has the additional benefit of fluoride release.30
The authors attributed the increased resistance
to microleakage in glass ionomer sealants, com-
pared with that in other studies, to the condi-
tioning before application, chemical adherence to
the tooth, protection with an enamel bonding
agent after application and absence of resin, thus
resulting in no polymerization shrinkage.
Caries. In our study, caries developed in two
patients in the resin-based sealant group, and
the caries was present in the teeth in which the
sealant was lost. This might have been due to
the different caries activity of these partici-
pants. However, we found no caries in teeth in
the glass ionomer group, which probably is
related to the material’s high fluoride release or
to the glass ionomer particles remaining in the
bottom of fissures. Barja-Fidalgo and
colleagues31 reported a similar result in their
clinical study in which they compared a high-
viscosity glass ionomer with a resin-based
sealant. Frencken and Wolke32 reported that
remnants of high-viscosity glass ionomer
materials are retained and block the deeper
parts of pits and fissures even after the sealant
appears to have disappeared clinically, thus con-
tinuing its caries-preventive effect.
In a clinical trial33 in which researchers com-
pared the caries-preventive effect of glass
ionomer sealants (placed according to the atrau-
matic restorative treatment procedure) with that
of resin-based sealants across time, they con-
cluded that the caries-preventive effect of high-
viscosity glass ionomer sealants was between 3.1
and 4.5 times higher than that of the resin-based
sealants across three to five years. Conversely,
some authors reported that glass ionomer and
resin-based sealants were equally effective in pre-
venting caries.26,33,34 However, there is no evidence
that either resin-based or glass ionomer sealant
material is superior to the other in preventing the
development of dentinal lesions in pits and fis-
sures across time.35 Therefore, long-term clinical
studies are warranted to confirm our results.
CONCLUSION
The results of our study show that glass
ionomer sealants may be preferable to resin-
Copyright © 2012 American Dental Association. All rights reserved.
COVER STORY
based sealants for sealing partially erupted per-
manent molars, as well as when salivary con-
tamination is expected. Although resin-based
and glass ionomer sealants exhibited similar
retention rates at 24 months, marginal staining
was lower in the glass ionomer group and we
found no caries in teeth in this group. ■
Dr. Sibel Antonson is a clinical associate professor, Department of
Restorative Dentistry, School of Dental Medicine, The State Univer-
sity of New York at Buffalo. She also is director of education and pro-
fessional services, Ivoclar Vivadent, Amherst, N.Y. Address reprint
requests to Dr. Antonson, The State University of New York at Buffalo,
215 Squire Hall, Buffalo, N.Y. 14214, e-mail “sibela@buffalo.edu”.
Dr. Donald Antonson is a professor, Department of Restorative
Dentistry, School of Dental Medicine, The State University of New
York at Buffalo.
Dr. Brener is an assistant professor, Department of Pediatric Den-
tistry, College of Dental Medicine, Nova Southeastern University,
Fort Lauderdale, Fla.
At the time this study was conducted, Dr. Crutchfield was a resi-
dent, Department of Pediatric Dentistry, Kornberg School of Den-
tistry, Temple University, Philadelphia. He now is in private practice
in Rocklin, Calif.
Dr. Larumbe is an assistant professor, Department of Pediatric
Dentistry, College of Dental Medicine, Nova Southeastern Univer-
sity, Fort Lauderdale, Fla.
At the time this study was conducted, Dr. Michaud was a dental stu-
dent, College of Dental Medicine, Nova Southeastern University, Fort
Lauderdale, Fla. She now is in private practice in Fort Myers, Fla.
Dr. Yazici is a professor, Department of Conservative Dentistry,
School of Dentistry, Hacettepe University, Ankara, Turkey.
Dr. Hardigan is a professor, Assessment, Evaluation and Faculty
Development, Nova Southeastern University, Fort Lauderdale, Fla.
Dr. Alempour is in private practice in Miami.
Dr. Evans is chief resident, Department of Pediatric Dentistry,
Kornberg School of Dentistry, Temple University, Philadelphia.
Dr. Ocanto is an assistant professor, Department of Pediatric Den-
tistry, College of Dental Medicine, Nova Southeastern University,
Fort Lauderdale, Fla.
Disclosure. None of the authors reported any disclosures.
Funding for this project was provided by Nova Southeastern Uni-
versity President’s Faculty Research and Development grant 335381
and GC America, Alsip, Ill.
The authors express their gratitude to Caridad Center staff in
Boynton Beach, Fla., and in particular Ms. Rosa Lores, for their ded-
icated contribution to this study.
1. National Center for Health Statistics. Health, United States,
2009 With Special Feature on Medical Technology. Hyattsville, Md.:
2010:306-307.
2. Shaw L. Modern thoughts on fissure sealants. Dent Update
2000;27(8):370-374.
3. Dennison JB, Straffon LH, Smith RC. Effectiveness of sealant
treatment over five years in an insured population. JADA 2000;
131(5):597-605.
4. Simonsen RJ. Retention and effectiveness of dental sealant after
15 years. JADA 1991;122(10):34-42.
5. Kaste LM, Selwitz RH, Oldakowski RJ, Brunelle JA, Winn DM,
Brown LJ. Coronal caries in the primary and permanent dentition of
children and adolescents 1-17 years of age: United States, 1988-1991.
J Dent Res 1996;75(special no.):631-641.
6. Brown LJ, Wall TP, Lazar V. Trends in total caries experience:
permanent and primary teeth. JADA 2000;131(2):223-231.
7. Ahovou-Saloranta A, Hiiri A, Nordblad A, Worthington H,
Mäkelä M. Pit and fissure sealants for preventing dental decay in
the permanent teeth of children and adolescents. Cochrane Database
Syst Rev 2004;(3):CD001830.
8. Oong EM, Griffin SO, Kohn WG, Gooch BF, Caufield PW. The
effect of dental sealants on bacteria levels in caries lesions: a review
of the evidence. JADA 2008;139(3):271-278.
9. Griffin SO, Oong E, Kohn W, Vidakovic B, Gooch BF; CDC
Dental Sealant Systematic Review Work Group, Bader J, Clarkson J,
JADA 143(2) http://jada.ada.org February 2012 121
 Downloaded from jada.ada.org on August 23, 2014
COVER STORY
Fontana MR, et al. The effectiveness of sealants in managing caries
lesions. J Dent Res 2008;87(2):169-174.
10. Zero DT, Fontana M, Martínez-Mier EA, et al. The biology, pre-
vention, diagnosis and treatment of dental caries: scientific advances
in the United States. JADA 2009;140(suppl 1):25S-34S.
11. Gooch BF, Griffin SO, Gray SK, et al; Centers for Disease Con-
trol and Prevention. Preventing dental caries through school-based
sealant programs: updated recommendations and reviews of evi-
dence. JADA 2009;140(11):1356-1365.
12. Pardi V, Pereira AC, Mialhe FL, Meneghim Mde C, Ambrosano
GM. A 5-year evaluation of two glass-ionomer cements used as a fis-
sure sealants. Community Dent Oral Epidemiol 2003;31(5):386-391.
13. Beauchamp J, Caufield PW, Crall JJ, et al; American Dental
Association Council on Scientific Affairs. Evidence-based clinical rec-
ommendations for the use of pit-and-fissure sealants: a report of the
American Dental Association Council on Scientific Affairs. JADA
2008;139(3):257-268.
14. Antonson SA, Wanuck J, Antonson DE. Surface protection for
newly erupting first molars. Compend Contin Educ Dent 2006;27(1):
46-52.
15. Karlzén-Reuterving G, van Dijken JW. A three-year follow-up of
glass ionomer cement and resin fissure sealants. ASDC J Dent Child
1995;62(2):108-110.
16. Raadal M, Utkilen AB, Nilsen OL. Fissure sealing with a light-
cured resin-reinforced glass-ionomer cement (Vitrebond) compared
with a resin sealant. Int J Paediatr Dent 1996;6(4):235-239.
17. Smales RJ, Wong KC. 2-year clinical performance of a resin-
modified glass ionomer sealant. Am J Dent 1999;12(2):59-61.
18. Poulsen S, Beiruti N, Sadat N. A comparison of retention and the
effect on caries of fissure sealing with a glass-ionomer and a resin-
based sealant. Community Dent Oral Epidemiol 2001;29(4):298-301.
19. Baseggio W, Naufel FS, Davidoff DC, Nahsan FP, Flury S,
Rodrigues JA. Caries-preventive efficacy and retention of a resin-
modified glass ionomer cement and a resin-based fissure sealant:
a 3-year split-mouth randomised clinical trial. Oral Health Prev
Dent 2010;8(3):261-268.
20. Mejàre I, Mjör IA. Glass ionomer and resin-based fissure
sealants: a clinical study. Scand J Dent Res 1990;98(4):345-350.
21. GC America. GC Fuji Triage. Glass ionomer sealant & surface
protectant. “www.gcamerica.com/products/operatory/GC_Fuji_
TRIAGE/features.php”. Accessed Jan. 4, 2012.
22. Subramaniam P, Konde S, Mandanna DK. Retention of a resin-
based sealant and a glass ionomer used as a fissure sealant: a com-
122 JADA 143(2) http://jada.ada.org February 2012
Copyright © 2012 American Dental Association. All rights reserved.
parative clinical study. J Indian Soc Pedod Prev Dent 2008;26(3):
114-120.
23. Beck N, Katz JN. What to do (and not to do) with time-series-
cross-section data. Am Political Sci Rev 1995;89:634-647.
24. Croll TP, Sundfeld RH, Berg JH. A pit-and-fissure clinical pro-
tocol. Compend Contin Educ Dent 2005;26(12):862-868.
25. Forss H, Halme E. Retention of a glass-ionomer cement and a
resin-based fissure sealant and effect on carious outcome after 7
years. Community Dent Oral Epidemiol 1998;26(1):21-25.
26. Forss H, Saarni UM, Seppä L. Comparison of glass-ionomer
and resin-based fissure sealants: a 2-year clinical trial. Community
Dent Oral Epidemiol 1994;22(1):21-24.
27. Antonson SA, Kilinc E, Antonson DE. Depth of penetration of
fissure sealants on contaminated enamel surface (abstract). J Dent
Res 2006;85(special issue B):1580.
28. Antonson SA, Kilinc E, Antonson DE. Depth of penetration of
fissure sealants based on fissure configuration (abstract). J Dent Res
2007;86(special issue A):2447.
29. Al-Jobair A. In vitro evaluation of microleakage in contami-
nated fissures sealed with GC Fuji Triage glass ionomer cement.
J King Saud Univ 2010;22(1):25-32.
30. Ashwin R, Arathi R. Comparative evaluation for microleakage
between Fuji-VII glass ionomer cement and light-cured unfilled
resin: a combined in vivo in vitro study. J Indian Soc Pedod Prev
Dent 2007;25(2):86-87.
31. Barja-Fidalgo F, Maroun S, de Oliveira BH. Effectiveness of a
glass ionomer cement used as a pit and fissure sealant in recently
erupted permanent first molars. J Dent Child 2009;76(1):34-40.
32. Frencken JE, Wolke J. Clinical and SEM assessment of ART
high-viscosity glass-ionomer sealants after 8-13 years in 4 teeth.
J Dent 2010;38(1):59-64.
33. Williams B, Laxton L, Holt RD, Winter GB. Fissure sealants:
a 4-year clinical trial comparing an experimental glass polyalkeno-
ate cement with a bis glycidyl methacrylate resin used as fissure
sealants. Br Dent J 1996;180(3):104-108.
34. Beiruti N, Frencken JE, van’t Hof MA, Taifour D, van Palen-
stein Helderman WH. Caries-preventive effect of a one-time applica-
tion of composite resin and glass ionomer sealants after 5 years.
Caries Res 2006;40(1):52-59.
35. Beiruti N, Frencken JE, van’t Hof MA, van Palenstein
Helderman WH. Caries preventive effect of resin-based and glass
ionomer sealants over time: a systematic review. Community Dent
Oral Epidemiol 2006;34(6):403-409.