Meta-analysis of sealants versus fluoride varnishes for the prevention of occlusal surface caries in children’s first permanent molars

doi:10.7518/hxkq.2025.2024418

Abstract

Abstract:

Objective To assess the effectiveness of the comparison between pit and fissure sealants and fluoride varnishes, as well as various types of sealants, in preventing caries on the occlusal surface of children’s first permanent molars (FPM). Methods Conduct a comprehensive search of literature published between January 1, 1988, and May 30, 2024, in the following databases: China National Knowledge Infrastructure, Web of Science, Cochrane Library, Embase, PubMed, China Science Periodical Database and China Biology Medicine database. Meta-analysis and subgroup analyses were performed on the literature that met the inclusion criteria. Results A total of 5 618 pieces of literature were retrieved, resulting in the inclusion of 14 in the study. Meta-analysis showed that there was no statistically significant difference in the efficacy between varies pit and fissure sealants compared to fluoride varnishes, and between varies types of sealants in preventing caries on the occlusal surface of children’s first permanent molars within 24 months post-surgery (P>0.05). Conclusion Within 24 months, there was no significant difference in the effectiveness of using resin-based or glass iomomer pit and fissure sealants compared with fluoride varnishes in preventing occlusal caries in FPM in children; within 24 months, there was no significant difference in the effectiveness of using resin-based sealants compared with ART sealants in preventing occlusal caries in FPM in children. ART sealants are recommended over resin-based sealers for children who have no conditions for chair-side manipulation or who are poorly co-operative.

Key words: pit and fissure sealant, fluoride varnish, first permanent molar, caries prevention, Meta-analysis

CLC Number:

R781.1

Han Jingya, Zhang Yajun, Ji Mengzhen, Sun Jingfei, Jia Shuhan, Wang Zhifeng. Meta-analysis of sealants versus fluoride varnishes for the prevention of occlusal surface caries in children’s first permanent molars[J]. West China Journal of Stomatology, 2025, 43(3): 383-394.

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References 32

1	秦满, 夏斌. 儿童口腔医学[M]. 3版. 北京: 北京大学医学出版社, 2020: 43.
	Qin M, Xia B. Pediatric dentistry. 3rd ed. Beijing: Peking University Medical Press, 2020: 43.
2	Peres MA, Macpherson LMD, Weyant RJ, et al. Oral di-seases: a global public health challenge[J]. Lancet, 2019, 394(10194): 249-260.
3	GBD Epilepsy Collaborators. Global, regional, and national burden of epilepsy, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016[J]. Lancet Neurol, 2019, 18(4): 357-375.
4	Quan JK, Wang XZ, Sun XY, et al. Permanent teeth ca-ries status of 12- to 15-year-olds in China: findings from the 4th National Oral Health Survey[J]. Chin J Dent Res, 2018, 21(3): 181-193.
5	Wright JT, Tampi MP, Graham L, et al. Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: a systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry[J]. J Am Dent Assoc, 2016, 147(8): 631-645.e18.
6	Ahovuo-Saloranta A, Forss H, Walsh T, et al. Pit and fissure sealants for preventing dental decay in permanent teeth[J]. Cochrane Database Syst Rev, 2017, 7(7): CD001830.
7	Levy SM. Pit-and-fissure sealants are more effective than fluoride varnish in caries prevention on occlusal surfaces[J]. J Evid Based Dent Pract, 2012, 12(2): 74-76.
8	Baik A, Alamoudi N, El-Housseiny A, et al. Fluoride varnishes for preventing occlusal dental caries: a review[J]. Dent J (Basel), 2021, 9(6): 64.
9	Bravo M, Montero J, Bravo JJ, et al. Sealant and fluoride varnish in caries: a randomized trial[J]. J Dent Res, 2005, 84(12): 1138-1143.
10	Frencken JE, Pilot T, Songpaisan Y, et al. Atraumatic restorative treatment (ART): rationale, technique, and development[J]. J Public Health Dent, 1996, 56(3 Spec): 135-140, 161-163.
11	Beiruti N, Frencken JE, van’t Hof MA, et al. Caries-preventive effect of a one-time application of composite resin and glass ionomer sealants after 5 years[J]. Caries Res, 2006, 40(1): 52-59.
12	Bravo M, Llodra JC, Baca P, et al. Effectiveness of visible light fissure sealant (Delton) versus fluoride varnish (Duraphat): 24-month clinical trial[J]. Community Dent Oral Epidemiol, 1996, 24(1): 42-46.
13	Bravo M, Baca P, Llodra JC, et al. A 24-month study comparing sealant and fluoride varnish in caries reduction on different permanent first molar surfaces[J]. J Pu-blic Health Dent, 1997, 57(3): 184-186.
14	Liu BY, Lo EC, Chu CH, et al. Randomized trial on fluorides and sealants for fissure caries prevention[J]. J Dent Res, 2012, 91(8): 753-758.
15	Salem K, Shaahsavari F, Kazemnejad E, et al. Pit and fissure sealant versus fluoride varnish in prevention of occlusal caries. J Dentomaxillofac Radiol Pathol Surg, 2014, 3(1): 37-47.
16	唐莉红, 施乐, 袁爽, 等. 3种不同方法预防儿童恒牙龋的临床效果评价[J]. 上海口腔医学, 2014, 23(6): 736-739.
	Tang LH, Shi L, Yuan S, et al. Effectiveness of 3 diffe-rent methods in prevention of dental caries in permanent teeth among children[J]. Shanghai J Stomatol, 2014, 23(6): 736-739.
17	Chestnutt IG, Hutchings S, Playle R, et al. Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay[J]. Health Technol Assess, 2017, 21(21): 1-256.
18	Uchil SR, Suprabha BS, Shenoy R, et al. Clinical effectiveness of resin-modified glass ionomer-based fluoride varnish for preventing occlusal caries lesions in partially erupted permanent molars: a randomised active-control-led trial[J]. Int J Paediatr Dent, 2022, 32(3): 314-323.
19	季佩红, 许全林, 巴勇. 氟保护漆与玻璃离子水门汀窝沟封闭剂的防龋效果比较[J].上海口腔医学, 2007, 16(4): 374-376.
	Ji PH, Xu QL, Ba Y. Clinical evaluation of fluor protector and glass-ionomer cement used as pit and fissure sealant for preventing pit and fissure caries in children[J]. Shanghai J Stomatol, 2007, 16(4): 374-376.
20	de Oliveira DC, Cunha RF. Comparison of the caries-preventive effect of a glass ionomer sealant and fluoride varnish on newly erupted first permanent molars of children with and without dental caries experience[J]. Acta Odontol Scand, 2013, 71(3/4): 972-977.
21	Liu BY, Xiao Y, Chu CH, et al. Glass ionomer ART sea-lant and fluoride-releasing resin sealant in fissure caries prevention: results from a randomized clinical trial[J]. BMC Oral Health, 2014, 14: 54.
22	Chen X, Du MQ, Fan MW, et al. Caries-preventive effect of sealants produced with altered glass-ionomer materials, after 2 years[J]. Dent Mater, 2012, 28(5): 554-560.
23	Oba AA, Dülgergil T, Sönmez IS, et al. Comparison of caries prevention with glass ionomer and composite resin fissure sealants[J]. J Formos Med Assoc, 2009, 108(11): 844-848.
24	Zhang WW, Chen X, Fan MW, et al. Do light cured ART conventional high-viscosity glass-ionomer sealants perform better than resin-composite sealants: a 4-year randomized clinical trial[J]. Dent Mater, 2014, 30(5): 487-492.
25	Weintraub JA, Ramos-Gomez F, Jue B, et al. Fluoride varnish efficacy in preventing early childhood caries[J]. J Dent Res, 2006, 85(2): 172-176.
26	吴晨, 徐东升, 赵玉梅. Duraphat varnish对乳牙釉质氟含量的影响[J]. 上海口腔医学, 2011, 20(2): 159-163.
	Wu C, Xu DS, Zhao YM. The effect of Duraphat varnish on fluoride content of enamel in deciduous teeth[J]. Shanghai J Stomatol, 2011, 20(2): 159-163.
27	Zero DT, Fontana M, Martínez-Mier EA, et al. The bio-logy, prevention, diagnosis and treatment of dental ca-ries: scientific advances in the United States[J]. J Am Dent Assoc, 2009, 140(): 25S-34S.
28	Splieth CH, Christiansen J, Foster Page LA. Caries epidemiology and community dentistry: chances for future improvements in caries risk groups. Outcomes of the ORCA Saturday Afternoon Symposium, Greifswald, 2014. Part 1[J]. Caries Res, 2016, 50(1): 9-16.
29	ten Cate JM. Review on fluoride, with special emphasis on calcium fluoride mechanisms in caries prevention[J]. Eur J Oral Sci, 1997, 105(5 Pt 2): 461-465.
30	Li FF, Jiang PP, Yu FY, et al. Comparison between fissure sealant and fluoride varnish on caries prevention for first permanent molars: a systematic review and meta-analysis[J]. Sci Rep, 2020, 10(1): 2578.
31	林静, 姚华. 窝沟封闭术联合氟保护漆在预防5~8岁儿童龋齿中的效果评价[J]. 上海口腔医学, 2019, 28(4): 384-387.
	Lin J, Yao H. Effects of pit and fissure sealant combined with fluorine protective paint on prevention of children caries aged 5-8 years old[J]. Shanghai J Stomatol, 2019, 28(4): 384-387.
32	Splieth C, Forster M, Meyer G. Additional caries protection by sealing permanent first molars compared to fluoride varnish applications in children with low caries prevalence: 2-year results[J]. Eur J Paediatr Dent, 2001, 2(3): 133-138.

PICOS框架	纳入标准	排除标准
研究对象	FPM已萌出的儿童	动物实验、重复发表或类似的研究
干预	单独使用窝沟封闭剂或树脂基封闭剂预防儿童FPM咬合面龋	其他方法或治疗
对照	单独使用氟保护漆或ART封闭剂预防儿童FPM咬合面龋	其他方法或治疗
结局指标	龋病发病率（caries incidence，CI）、龋面均（decayed，mis-sing，and filled teeth surface，DMFS）增量、儿童CI及封闭剂完全脱落率	现有研究数据不完整且无法通过补充计算等合理手段获得必要的数据
研究设计	随机对照试验（randomized controlled trial，RCT）、临床对照试验，不限语言	文献综述、会议摘要、病例报告、体外试验，经联系仍无法获取全文者

领域	偏倚风险	判断依据
选择偏倚	随机序列产生	详细描述随机分配序列产生的方法，以便评估不同分配组是否具有可比性
选择偏倚	分配隐藏	详细描述隐藏随机分配方案的方法，明确分组前及分组期间是否已告知干预措施的分配方法
实施偏倚	对受试者、试验人员实施盲法（需分别评估各项主要结局或结局的种类）	描述所有对受试者和试验人员施盲的方法，并提供所有有效的相关信息
测量偏倚	对结局评估员施盲（需分别评估各项主要结局或结局的种类）	描述所有对结局评估员施盲的方法，并提供所有有效的相关信息
随访偏倚	结果数据不完整（需分别评估各项主要结局或结局的种类）	描述每个主要结局指标结果数据的完整性，包括失访、排除、纳入的有效数据及其相关情况；每个干预组的人数（与分配入组时的人数比较）
报告偏倚	选择性报告研究结果	阐明结局评估员检查选择性结果报告的相关情况
其他偏倚	其他偏倚来源	工具中未提及的与偏倚有重要关联的情况；如果系统评价的计划书中有预先设定的问题或条目，需一一回答

纳入研究	研究类型	样本量 /n	年龄 /岁	性别（男/女）	窝沟封闭剂/n	氟保护漆 /n	空白对照组/n	周期 /月	结局指标	备注
Bravo^[12]	RCT	362	6~8	185/177	树脂基窝沟封闭剂/75	77	94	24	CI
Bravo^[13]	RCT	362	7.28	185/177	树脂基窝沟封闭剂/100	98	116	24	DMFS增量
Liu^[14]	RCT	501	9.1	251/250	树脂基窝沟封闭剂/121	116	124	24	CI
Salem^[15]	RCT	400	6~7	218/134	树脂基窝沟封闭剂/200	200	无	24	CI DMFS增量
Tang^[16]	RCT	1 016	7~8	486/530	树脂基窝沟封闭剂/321	243	210	24	DMFS增量 DMFT增量
Chestnutt^[17]	RCT	1 015	6~7	472/543	树脂基窝沟封闭剂/514	501	无	36	CI
Uchil^[18]	RCT	74	6~8	-	玻璃离子窝沟封闭剂/36	36	无	12	CI
Ji^[19]	RCT	622	6~8	-	玻璃离子窝沟封闭剂/205	207	210	36	CI
Oliveira^[20]	RCT	60	6~8	-	玻璃离子窝沟封闭剂/151	148	无	18	CI	龋易感性人群的对比、分口试验

纳入研究	研究类型	样本量 /n	年龄 /岁	性别（男/女）	封闭剂类型	空白对照组/n	周期 /月	结局指标	备注
Liu^[21]	RCT	280	7.8	123/157	树脂基封闭剂和 ART封闭剂	无	24	CI	分口试验
Beiruti^[9]	RCT	103	7.8	46/57	树脂基封闭剂和 ART封闭剂	无	60	CI 封闭剂完全脱落率
Chen^[22]	RCT	407	8	-	树脂基封闭剂和 ART封闭剂	无	24	DMFT增量封闭剂完全脱落率	纳入标准DMFT≥2；分4组，只看ART封闭剂与树脂基封闭剂的比较
Oba^[23]	RCT	70	7~11	-	树脂基封闭剂和 ART封闭剂	无	36	CI 封闭剂完全脱落率	分口试验
Zhang^[24]	RCT	405	8	-	树脂基封闭剂和 ART封闭剂	无	48	DMFT增量封闭剂完全脱落率	纳入标准DMFT≥2；分4组，只看ART封闭剂与树脂基封闭剂的比较

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