ESTUDO CLÍNICO RANDOMIZADO PIT AND FISSURE SEALANTS: EFFECT OF MATERIALS, TECHNIQUES, AND DENTAL ERUPTION STAGE-METANALYSIS AND RANDOMIZED CLINICAL TRIAL

ABSTRACT The occlusal surfaces of posterior teeth are the most susceptible places to develop carious lesions. Thus, the application of sealant has been utilized to additional prevention of dental caries on the occlusal surface. This Dissertation has two articles, which is consistent with the alternative format approved by CCPG. Article 1: aimed to discuss, in Systematic Review and Metanalysis, the clinical evidence of the effectiveness of sealants and sealing techniques in the caries prevention in permanent teeth. The Pubmed, Embase and Scielo databases were consulted, from january-1984 to october-2015, with the keywords "clinical trial", "sealants" and "permanent tooth," totaling 179 articles. After screening and eligibility, twenty-two studies were included and classified into levels of evidence (1A, 7B and 14C). Ten articles with comparable parameter were subjected to metanalysis by the Review Manager 5.3 software (p≤0.05). Sealant promoted the caries prevention compared to no treatment. The resin sealants (RS) had a higher retention when compared to sealants of glass ionomer ciments (GIC), at 24 months. The sealing technique using an intermediate layer prior to RS favored the retention, after 24 months of analysis. Regarding the prevention of dental caries, was not statistically significant difference between the RS and GIC, after 12 months. However, at 24 months, the GIC favored the prevention of dental caries. Article 2: aimed to assess long-term impact of dental Eruption Stages (ES) on sealant retention on occlusal surfaces previously coated with intermediary bonding layer and to determine the level of caries prevention in randomized clinical trial (RCT) single-blind and split-mouth. Sixty-five school children were selected (aged 6-10 years), with four non-carious permanent first molar in different ES (OPOperculum Present; MEMarginal Edge; CECompletely Erupted). The teeth were randomized: FFluroshield; HHelioseal Clear Chroma; SFSingle Bond + F; EHExcite + H. Data were submitted to Cox Proportional Hazard model (survival analysis) and Likelihood ratio χ2 test (correlation) by softwer SAS 9.3, p≤0.05. There was direct correlation between the retention of the sealants and ES. However, for all ES, there was no significant difference between the sealing technique, with and without intermediate layer, in the retention of the material. The dental caries prevention on tooth occlusal surfaces was ≅ 99% and there was not differ between groups at 2 years follow-up. Based on both articles, it can be concluded that sealants are effective in the caries prevention in high risk patients. The metanalysis showed that while the resin sealants exhibit greater retention, conventional glass ionomer sealants show greater prevention of the dental caries. Bass evidence studies showed that the sealing technique with intermediate layer prior to RS favored the retention, after 24 months of follow-up. However, RCT showed that the intermediate layer did not favor theThe occlusal surfaces of posterior teeth are the most susceptible places to develop carious lesions. Thus, the application of sealant has been utilized to additional prevention of dental caries on the occlusal surface. This Dissertation has two articles, which is consistent with the alternative format approved by CCPG. Article 1: aimed to discuss, in Systematic Review and Metanalysis, the clinical evidence of the effectiveness of sealants and sealing techniques in the caries prevention in permanent teeth. The Pubmed, Embase and Scielo databases were consulted, from january-1984 to october-2015, with the keywords "clinical trial", "sealants" and "permanent tooth," totaling 179 articles. After screening and eligibility, twenty-two studies were included and classified into levels of evidence (1A, 7B and 14C). Ten articles with comparable parameter were subjected to metanalysis by the Review Manager 5.3 software (p≤0.05). Sealant promoted the caries prevention compared to no treatment. The resin sealants (RS) had a higher retention when compared to sealants of glass ionomer ciments (GIC), at 24 months. The sealing technique using an intermediate layer prior to RS favored the retention, after 24 months of analysis. Regarding the prevention of dental caries, was not statistically significant difference between the RS and GIC, after 12 months. However, at 24 months, the GIC favored the prevention of dental caries. Article 2: aimed to assess long-term impact of dental Eruption Stages (ES) on sealant retention on occlusal surfaces previously coated with intermediary bonding layer and to determine the level of caries prevention in randomized clinical trial (RCT) single-blind and split-mouth. Sixty-five school children were selected (aged 6-10 years), with four non-carious permanent first molar in different ES (OPOperculum Present; MEMarginal Edge; CECompletely Erupted). The teeth were randomized: FFluroshield; HHelioseal Clear Chroma; SFSingle Bond + F; EHExcite + H. Data were submitted to Cox Proportional Hazard model (survival analysis) and Likelihood ratio χ2 test (correlation) by softwer SAS 9.3, p≤0.05. There was direct correlation between the retention of the sealants and ES. However, for all ES, there was no significant difference between the sealing technique, with and without intermediate layer, in the retention of the material. The dental caries prevention on tooth occlusal surfaces was ≅ 99% and there was not differ between groups at 2 years follow-up. Based on both articles, it can be concluded that sealants are effective in the caries prevention in high risk patients. The metanalysis showed that while the resin sealants exhibit greater retention, conventional glass ionomer sealants show greater prevention of the dental caries. Bass evidence studies showed that the sealing technique with intermediate layer prior to RS favored the retention, after 24 months of follow-up. However, RCT showed that the intermediate layer did not favor the