International Journal of Paediatric Dentistry 2000; 10: 90-98

Fluoride pit and fissure sealants: a review

TONIA L. MORPHIS*^ K. JACK TOUMBA* & NICK A. LYGIDAKIS^
* Department of Child Dental Health, Leeds Dental Institute, Leeds, UK, 1; Paediatric
Dentistry Center IKA, Community Health System, Nikea Health Authority, Athens, Greece

Summary. There are two methods of fluoride incorporation into fissure sealants. In the
first method, fluoride is added to the unpolymerized resin in the form of a soluble
fluoride salt that releases fluoride ions by dissolution, following sealant application. In
the second method, an organic fluoride compound is chemically bound to the resin and
the fluoride is released by exchange with other ions (anion exchange system). This report
reviews the literature on the effectiveness of all the fluoride-releasing sealantscommercial and experimental-that have been prepared using either the former or the
latter method of fluoride incorporation. There is evidence for equal retention rates to
conventional sealants and for ex vivo fluoride release and reduced enamel
demineralization. However, further research is necessary to ensure the clinical
longevity of fluoride sealant retention and to establish the objective of greater caries
inhibition through the fluoride released in saliva and enamel.

Introduction

The addition of fluoride to fissure sealatits was

considered more than 25 years ago [1] and efforts to
combine the two continue today [2,3]. Kadoma et al.
[4] stated that the properties a fluoride containing
sealant should have in order to replace a conventional one, are: (a) better or at least comparable
retention rates with the conventional sealant, (b)
constant fluoride release for a prolonged period of
time and (c) function as a reservoir of fluoride ion to
provide fluoride to enamel and promote fluorapatite
formation in enamel. The aim of this paper is to
review and discuss the literature on the effectiveness
of fluoride releasing sealants-commercial and
experimental - that have been prepared using either
one of two methods offluorideincorporation. Glassionomer cements prepared to be used as fissure
sealants are excluded from this review.
Methods of fluoride incorporation in fissure sealants

Two methods of fluoride incorporation into pit and

fissure sealants are used. In the first, fluoride is
Correspondence: Dr N. A. Lygidakis, 2 Papadiamantopoulou
St., Athens 11528, Greece. E-mail: lygidakis@internet.gz

90

added to unpolymerized resin in the form of a

soluble fluoride salt. After the sealant is applied to
the tooth, the salt dissolves and fluoride ions are
released. In the second method an organic fluoride
compound is chemically bound to the resin. The
fluoride is released by exchange with other ions [5,6].
According to the National Institute of Dental
Research [7] the former method has been questioned, because fluoride release resulting from the
dissolution of a soluble salt might weaken the
sealant in situ and thereby might reduce its
usefulness as a preventive agent. In the latter
method (anion exchange systems), however, fluoride
constitutes only a small amount of the total
structure, and is replaced rather than lost. Thus,
there should not be any significant decrease in the
strength of the sealant [7].
Method 1: soluble fluoride salts added to
unpolymerized resins (see Tables 1 and 2)

Lee et al. [1] were the first to formulate a

polyurethane fluoride-containing sealant material
that would release fluoride on the enamel surface for
an extended period of 24 h-30 days. A number of
evaluation tests were carried out ex vivo on several
fluoride salts: NaF, acidulated NaF and Na2PO3F.
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Flouride pit and fissure sealants

91

Table 1. Ex vivo studies on fluoride pit and fissure sealants containing soluble fluoride salts
Authors

Formulation

Studied properties

Findings

NaaPOjF, NaF or
NaF plus KH2PO4
added to polyurethane

-enamel acid solubility

-fluoride uptake in enamel
-fluoride release

Polyurethane + Na2 PO3F reduced enamel acid

solubility, increased fluoride uptake in enamel
and released fluoride up to 1 month

Swartz et al.
(1976) [8]

2-5% NaF added to

a BIS-GMA resin

-enamel acid solubility

-fluoride uptake in enamel
-physical properties
-fluoride release

-reduced enamel acid solubility, increased enamel

fluoride uptake
-physical properties remained the same
-great fluoride release during the first 1-2 days

El-Mehdawi
etal.(\9%5)
[9]

0-05%, 0-2%, 2%
NaF added to
Nuva-Seal

fluoride release

-decreased fluoride release over the 3-week study period

-increased fluoride release with the highest salt concentration

Cooley et al.
(1990) [10]

FluroShield
vs. Helioseal

fissure penetration
-microleakage
-fluoride release

-no significant difference in fissure penetration

-FluroShield allowed microleakage
-fluoride release with FluroShield over the 7-day study
period ('burst effect' during the first 2 days)

Jensen et al.
(1990) [11]

FluroShield
vs. PrismaShield

Fluoride effect on size and

depth of artificial caries
lesions.

Lesion depth 3-fold higher with the conventional sealant

(PrismaShield).

Hicks & Flaitz

(1992) [12]

FluroShield
vs. PrismaShield
and Ketac-Fil

Caries initiation and

progression in the enamelrestorative interface site in
Class V restorations.

FluroShield and Ketac-Fil showed less lesions

than PrismaShield

Park et al.
(1993) [13]

FluroShield
vs. PrismaShield
and Delton

-shear bond strength

-scanning electron microscopy
-microleakage

-significantly higher shear bond strength in

FluroShield and PrismaShield than in Delton
-better adaptation to the etched enamel with
FluroShield and PrismaShield than with Delton
-no significant difference in microleakage among
the 3 FSs

Loyola Rodriguez
and Garcia-Godoy
(1996) [2]

FluroShield
vs. HelioSeal
and Teethmate-F

antibacterial ability against

strains of Mutans streptococci

inhibition of S. mutans and S. sobrinus only from

Teethmate-F

FluroShield
vs. Baseline

fluoride release

-fluoride release twice as great for FluroShield

than for baseline
- 2 5 % of the total fluoride release occurred in the
first 2 weeks

Lee et al.
(1971) [1]

Rock et at.
(1996) [3]

Although the greatest fluoride uptake into powdered enamel was observed in the acidulated NaF
solutions, Na2PO3F was selected because F~ release
rate in water was more rapid and enamel demineralization was less than with other fluoride salts
tested. In the in vivo part ofthe same study the ultra
violet-cured fluoride releasing polyurethane sealant
was eflective in reducing the incidence of carious
lesions in molar teeth of albino rats [1].
Swartz et al. [8] conducted an ex vivo study to test
the feasibility of imparting anticariogenic properties
to ultraviolet polymerized pit and fissure sealants

(Nuva-Seal [LD Chaulk Co., Milford, DE], Epoxylite 9075 [Lee Pharmaceuticals, El Monte, CA] and
two experimental formulations) by adding 2-5%
NaF. They found that reductions in enamel
solubility were achieved by the addition of NaF in
the range of 2-5% in three ofthe sealants, although
Nuva-Seal required the addition of 5% of NaF
before maximum efl"ect was attained. The results
also indicated that, under the test conditions, the
physical properties of the resins (tensile strength,
water absorption, hardness and resistance to toothbrush abrasion) were not grossly impaired by the

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Tonia L. Morphis, K. Jack Toumba & Nick A. Lygidakis

Table 2. Clinical studies on both types fluoride pit and fissure sealants
Number of
sealants

Study period
(years)

Complete retention
(%)

FluroShield vs.
PrismaShield

294

86,9 FluroShield
80 0 PrismaShield

FluroShield

344

70

do-Rego & de-Araujo

(1996) [14]

FluroShield vs.
Delton Plus

153

91,35 FluroShield
93,14 Delton Plus*

Lygidakis & Oulis

(1999) [15]

FluroShield vs.
Delton

446

76 5 FluroShield
88,8 Delton

Morphis & Toumba

(1998) [16]

Delton Plus vs.

Delton and
fluoride-glass
formulation

104

67 74 Delton Plus
70 Delton
61,29 fluoride-glass
formulation

Kuba et al.
(1992) [30]

MF-MMA and
phosphate ester
monomer
(method 2)

70

96

Authors

FS formulation

Jensen et al.
(1990) [5]
Rock et al.
(1996) [3]

*Satisfactory retention, according to the criteria of Ryge [17]

addition of fluoride salts nor was enamel-resin bond

strength or microleakage. However, the greatest
amount of fluoride was released during the first day
or two, after which the amount rapidly diminished.
Based on the previous study, El-Mehdawi et al.
[9] studied, ex vivo, the ability of an ultraviolet
polymerized fissure sealant (Nuva-Seal) to release
fiuoride throughout a 3-week period by adding
several concentrations of NaF to the sealant. The
released fluoride ions were determined using a
specific fluoride ion electrode. It was concluded
that Nuva-Seal did have the ability to release
fluoride over a 3-week period when 005, 0-5 or
2-0% NaF was added to it. The quantity of fluoride
ions increased when the concentration of the
fluoride salt in the sealant increased [9].
More recently, a commercially available sealant
with fluoride was marketed that purportedly releases fiuoride [10]. This product (FluroShield; LD
Chaulk/Dentsplay, Milford, USA) is a visible lightcured resin containing 2% NaF and 50% by weight
inorganic filler. Cooley et al. [10] compared in an ex
vivo study, FluroShield with a nonfluoride sealant
(HelioSeal; Vivadent Inc., Tonawanda, USA) in
order to evaluate its abiUty to penetrate fissures,
resist microleakage and release fluoride. They found
no significant difi"erence between the two sealants in

ability to penetrate fissures, but FluroShield was

found to have significantly more leakage. All
specimens of the FluroShield released fiuoride over
the 7-day test period; there was a 'burst efiect' in
which larger amounts of fiuoride were released on
the first and the second day and then the release
tapered ofi'. Fluoride release decreased by approximately one-half for each of the first 3 days.
Jensen et al. [11] conducted an ex vivo study in 10
pairs of human extracted molars, in order to
compare the size and depth of artificial caries
lesions when using FluroShield or its nonfluoride
containing analogue PrismaShield (LD Chaulk/
Densply). Lesion depth was found to be over 3-fold
higher in specimens that contained the conventional
sealant compared with specimens that contained the
fluoride-releasing sealant. However, because the
data was obtained from a laboratory model, the
results could not directly predict clinical caries
reduction through the use of FluroShield.
Hicks & Flaitz [12] in another ex vivo study used
40 sectioned human extracted premolar teeth in
order to determine the efiects of FluroShield on
initiation and progression of caries-like lesions
around class V restorations, in comparison to
PrismaShield and a GIC material, Ketac-Fil
(Espe-Premier, Norristown, USA). Surface lesion

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Flouride pit and fissure sealants

depths were significantly reduced in both FluroShield and Ketac-Fil groups when compared with
PrismaShield; the GIC material provided the greatest caries protection to the enamel-restorative
interface and had the least number of wall lesions,
while the conventional sealant group had the
greatest number of wall lesions.
In a clinical study, Jensen et al. [5] evaluated the
retention and salivary fiuoride release of FluroShield compared to its nonfiuoride-containing
analogue PrismaShield (Chaulk/Densply, Mildford,
DE, USA, 19963). One hundred and forty-seven
pairs of sound permanent molars in 82 children
aged 6-9 years of age were sealed using the two
sealant types and samples of whole unstimulated
saliva, as well as site-specific saliva samples were
collected from 20 randomly selected subjects and
analysed for fiuoride content. There was no
significant difi"erence in retention between the two
sealants at 6 and at 12 months. Complete retention
for FluroShield-sealed molars was 86 9% and for
PrismaShield-sealed molars it was 800%, at 12
months. However, fiuoride release was significantly
increased, when compared to the baseline values,
only at the 30 min postsealant sampling interval [5].
Park et al. [13] compared FluroShield, PrismaShield and Delton Pit and Fissure Sealant (Johnson
and Johnson, New Brunswick, USA) to each other
through shear bond, scanning electron microscope
(SE]VI) and microleakage evaluation. No significant
difi'erences in microleakage were noted among the
three sealants, while SEM analysis revealed that
both Prismashield and FluroShield adapted to the
etched enamel surface in a more complete fashion
than the unfilled sealant Delton. Prismashield and
FluroShield exhibited significantly higher mean
shear bond strength values than Delton.
In one of the most recent studies, Loyola
Rodriguez & Garcia-Godoy [2] estimated the
antibacterial activity (by using agar plates infected
with several strains of Streptococcus mutans and S.
sobrinus) and the fiuoride release, of FluroShield,
Helioseal and a new fiuoride containing sealant
Teethmate-FTM (Kuraray Co., Osaka, Japan,
batch no. 0761). Teethmate-F was the only
material that showed inhibition activity against
all strains of Mutans streptococci tested; there was
no significant difi'erence in the inhibition between
strains of 5. mutans and S. sobrinus. Also
Teethmate-F exhibited higher fiuoride release than
FluroShield during the 7-day study period. These

93

materials showed their highest concentration of

fiuoride release during 2 days after setting. Release
then decreased to approximately 50% (below 0-1
p.p.m. F~) at 7 days [2].
Rock et al. [3] had similar results to those of
Loyola Rodriguez & Garcia-Godoy [2], regarding
fiuoride release, ex vivo, from FluroShield in
comparison to a GIC material Baseline (De Trey,
Dentsply, Weybridge, UK). Approximately onequarter of the total fiuoride release took place in the
first 2 weeks, after which time the rate gradually
slowed down. Rock et al. found 70% complete
retention of FluroShield applied to contralateral
caries-free first permanent molars in 86 children
aged 7-8 years, after 3 years follow-up. do-Rego &
de Araujo [14] found that 91-35% of FluroShield
sealants and 93-14% of Delton Plus (Johnson and
Johnson Dental) sealants were intact-the difi'erence
being statistically insignificant-after 2 years followup. However their technique was more rigorous
because the authors performed minimal enamel
reduction (invasive technique) under complete
isolation with rubber dam.
More recently, Lygidakis & Oulis [15] evaluated
the retention rate and the caries increment difi'erences between FluroShield and Delton. The sealants
were applied in a half-mouth design to all four
caries-free first permanent molars of 112 children
aged 7-8 years. At 4 years follow-up the complete
retention for FluroShield was 76-5% and for Delton
88-8%, the difi'erence being statistically significant.
However, it is important to note that sealant loss
and caries increments were similar in both groups.
In one of the latest clinical studies Morphis &
Toumba [16] evaluated the retention rates of three
difi'erent sealants: a conventional sealant Delton, its
recently marketed fiuoride containing analogue
Delton Plus, and an experimental fiuoride-containing sealant which was prepared by adding fiuorideglass powder to Delton. The sealants were applied
to 104 permanent molars in a randomized way in
children aged 616 years. Results showed no
significant difi'erence in retention among the three
sealants after a year of follow-up.
Method 2: organic fluoride compounds chemically
bound to the resin (anion exchange systems) (see

Tables 2 and 3)
In order to avoid the problem of possible dissolution of fiuoride salts incorporated into sealant

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Tonia L. Morphis, K. Jack Toumba & Nick A. Lygidakis

Table 3. Ex vivo studies on fluoride pit and fissure sealants using anion exchange systems
FS formulation

Studied properties

Findings

Rawls & Querens

(1980) [19]

acrylic monomer plus

t-BAEMA/HF
(fluoride monomer)

hydrophilicity

-hydrophobic resin matrix

-hydrophilic F ~ exchange sites
resulting in deteriorated physical
properties

Querens et al.
(1981) [20]

acrylic monomer plus

t-BAEMA/HF
(fluoride monomer)

-colour stability
-toxicity
-mutagenicity

-poor colour stability

-toxic and mutagenic one of the
components (GMA)

Querens & Rawls

(1982) [21]

FR-16
(16% t-BAEMA/HF)

toxicity
-mutagenicity

-low toxicity level

-non mutagenic

Rawls & Zimmerman

(1983) [18]

acrylic monomer plus

t-BAEMA/HF
(fluoride monomer)

-remineralization
properties in artificial
carious lesions

-promotion of remineralization
-inhibition of demineralization

Zimmerman et al.
(1984) [22]

Delton with 3% added

t-BAEMA/HF
vs. Delton

-fluoride release
-colour stability
-hardness

fluoride FS revealed:
-acceptable fluoride release for 9 months
-colour stability and hardness not
significantly altered

Kadoma et al.
(1982) [25]

MF-MMA copolymer

fluoride release

-constant rate of fluoride release

-adjustable fluoride release by varying
copolymer composition

Kojima et al.
(1982) [26]

MF-MMA copolymer
incorporated into a
conventional FS (MMA
+ MF-MMA) vs.
conventional FS

adhesive tensile
strength

adhesive tensile strength minimally

affected by the addition of MF-MMA

Kadoma et al.
(1983) [4]

MF-MMA copolymer

-fluoride release
-fluorapatite formation
in enamel

constant fluoride release for 84 days

acquired fluoride by enamel present as
fluorapatite

Tanaka et al.
(1983, 1987) [27, 28]

MF-MMA copolymer
added to conventional
experimental FS
vs. experimental FS

-enamel fluoride uptake

4 weeks after FS
application in
premolars

fluoride FS revealed:
statistically significant enamel
fluoride uptake

FS containing MF-MMA
copolymer plus phosphate
ester monomer

fluoride release

very small amount of fluoride released at

least for the 4-month study-period with
gradual decrease with time

Authors

Yoshida et al.
(1988) [29]

materials Rawls & Zimmerman [18] incorporated

fluoride ions as a mobile charge in an acrylic anionexchange resin. In these resins the fluoride containing monomer was t-butyl-amino-ethylmethacrylate
hydrogen fluoride (t-BAEJVIA: HF), which copolymerized readily with other acrylic monomers. Thus
the organic portion of the fluoride salt was
covalently bound into the insoluble polymer network structure of the resin. An ion from saliva
diffused into the resin, exchanged with fluoride ion,
which then diffused out and was released [18].

The possibility of making fluoride-releasing sealants with organic resin was explored at an early
stage and became one of the major focuses of effort
[19]. The initial results demonstrated that the material
was too hydrophilic so that the physical properties
deteriorated. In addition, colour stability was poor
and one of the components, glycidyl methacrylate
(GMA), proved to be both toxic and mutagenic [20].
Reformulation of this 'flrst generation' resin was
accomplished by replacing GMA with EGDMA
(ethylene glycol dimethacrylate). The properties were

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Flouride pit and fissure sealants

much improved and the 'second generation' resin was

neither toxic nor mutagenic [21].
As a first step towards this end it was determined
that the fluoride monomer could be dissolved in a
commercial sealant (Delton) without significantly
changing its rate and degree of polymerization; a
potential for 1-year fluoride release (0-03 mg/g/day)
with 10% polymer loading was found ex vivo, while
physical properties remained similar to the sealant
alone [22]. Based on these results new formulations
('third generation resins') were devised by the same
authors that were less hydrophilic [23]. Evaluation
of these materials is currently in progress.
Kadoma et al. [24] conducted other studies with
the aim of developing fluoride-releasing sealant
materials. Copolymers were obtained by the copolymerization of methacryloyl fluoride (MF) with
methyl methacrylate (MMA), which proved to be of
potential value as long lasting topical fluoride
materials. The fluoride in the copolymers was
present as acid fluoride covalently bonded to
carbonyl groups, and fluoride ions were slowly
released by hydrolysis in aqueous solution [25]. The
rate of release was adjustable by varying the
copolymer composition [25].
On the basis of the above results, a MF-MMA
copolymer with appropriate composition was incorporated into a powder of a modified commercial
sealant [26]. The adhesive tensile strength of the
sealant to etched enamel was found to be minimally
aifected by the addition of the copolymer [26].
Release of fluoride from the same sealant placed
in a phosphate buflfer solution showed that the rate
of decrease of fluoride content was almost constant
for 84 days. It was also found that human enamel
fluoride uptake significantly increased with time [4].
Similar results were obtained, in vivo, 4 weeks after
experimental sealant application to caries-free premolars that were scheduled to be extracted for
orthodontic reasons [27,28].
Yoshida et al. [29] studied a sealant containing
MF-MMA copolymer and phosphate ester monomer. Very small amounts of fluoride were released
from the sealant over a 4-month period, ex vivo, with
gradual decrease over time. Kuba et al. [30]
conducted an in vivo study, using the same material
on 35 partially erupted molars in 24 subjects, aged
5-13 years. The molars had either sound structure or
chalky, demineralized enamel margins next to the
fissures. An air polishing device (Quick Jet; Dentcraft Inc., USA) was used as a prophylaxis agent; a

95

rotating fine needle point at low speed and GK-101

solution was also used for sound teeth, while an
ultrasonic root canal filing device (Enack; Osada
Co., Tokyo, Japan) and GK-101 solution was used
additionally for teeth with early caries. The authors
attempted to apply the visible light-cured fluoride
releasing material without acid etching. Complete
retention of the fissure sealants was 96%, but the
observation period was only 12 months [30].
Discussion
Two common methods of fluoride incorporation
into fissure sealant materials exist: (a) the 'anion
exchange system' (organic fluoride compound chemically bound to the resin) and (b) the addition of a
fluoride salt to unpolymerized resin. Research of the
anion exchange system-sealants is in progress but to
date no commercial product is available. FluroShield and Delton Plus are examples of the second
type of fluoride fissure sealants that contain sodium
fluoride and release fluoride ions as the salt
dissolves. In addition, Helioseal-F is another
fluoride sealant that contains fluoride in the form
of 20% fluorosilicate glass [31].
To replace a conventional sealant, a fluoride
sealant should have better or at least comparable
retention rates with it [32]. Two out of the three
studies mentioned above [5,16] have showed no
significant difl'erence in retention between the two
types of sealants. However, the study period in both
was only 12 months. According to Dennison et al.
[33] this is not a study design problem because the
most critical period for sealant failure is at baseline
and during the 6 months following application.
However, a longer follow-up period would give
more confidence about the results. The longest
recent trial [15] on the retention of fluoride fissure
sealants was 48 months. This showed a lower full
retention rate for a fluoride sealant (FluroShield)
compared to a conventional one (Delton) despite
the fact that total sealant loss and caries increment
was similar in both groups. It should be mentioned,
however, that all the children examined participated
in a regular biannual programme, including topical
fluoride gel (NaF) application. The latter has been
associated with surface deterioration and weight
loss of filled sealants, and this finding may explain
the decreased full retention of FluroShield [34].
According to Ripa [35] in order to have a
cariostatic efl"ect a fluoride device should be retained

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Tonia L. Morphis, K. Jack Toumba & Nick A. Lygidakis

in the mouth and release a constant amount of

fluoride for at least 6 months. Most of the above
mentioned studies investigated the fluoride release
offluorideflssuresealants for only a week [2,10] and
only one study investigated fluoride release for 6
months [3]. The problem with the release of fluoride
in all these studies was that there was a 'burst effect'
in which great amounts of fluoride were released
during the first days and then, especially after the
second week, the release slowed down. The longest
study showed detectable but very low levels of
fluoride throughout the experimental period of 6
months [3]. Results from the only in vivo study on
fluoride release showed that the levels of fluoride in
whole saliva, as well as saliva sampled from the
immediate environment of the sealed tooth, returned to baseline levels within 24 h [5].
The mechanism of fluoride release from fluoride
flssure sealants remains speculative. For example,
release might occur from the insoluble sealant
material as a result of porosity. It might also occur
because the fluoride ion or the fluoride-glass is not
tightly bound to the polymerized resin molecules.
Release in fluoride-glass containing sealants [16]
may also be due to fluoride-glass grains depositing
on the surface of the resin. Fluoride may have
been released in several ex vivo systems that have
been studied from the unpolymerized air-inhibited
layer on the surface of the specimens [9,10].
Unpolymerized resin probably would not be of
benefit to the enamel, in the clinical situation
because it contacts the enamel only minimally and
also would be worn away almost immediately after
sealant placement.
Under laboratory conditions most of the measurements [2,3,9,10] have been made in distilled
water and not saliva, and fluoride release occurs
only in one direction, from the sealant-specimen
into water. In the mouth, it is probable that some of
the fluoride release is available for ionic substitution
of the mineral phase of the enamel. Release of
fluoride from fluoride materials into artiflcial human saliva [36] has been shown to be signiflcantly
less than into water [37]. It has been suggested that
components from human saliva form a coating on
the surface of the material that impedes fluoride
release [38]. Thus, in addition to determining the
fluoride ion release from sealants ex vivo, long-term
in vivo studies are necessary in order to evaluate the
factors of concentration, rate and duration of
fluoride release.

Another important although difficult question is

how much fluoride release is required from a fissure
sealant in order to be clinically effective and for how
long would the effect last? No in vivo studies have
determined the minimal amounts of fluoride that
should be released from a fluoride material in saliva
and plaque fluid in order to enhance remineralization. Jensen et al. [11] showed in an artificial caries
study that FluroShield reduced the amount of
enamel demineralization adjacent to it significantly
more than PrismaShield that contains no fluoride.
Hicks & Flaitz [12] came to the same conclusions
regarding the depth of artificial caries lesions.
Summary and conclusions

Despite the above evidence for equal retention rates,

ex vivo fluoride release and reduced enamel demineralization, any statement for additional benefits of
fluoride over nonfluoride fissure sealants should be
made with caution. It is obvious that further longterm clinical trials are necessary to determine that
the clinical longevity of the sealant retention is not
adversely affected by the presence of fluoride and
that the objective of greater caries inhibition through
the fluoride released in saliva and incorporated in
enamel can be achieved in the clinical situation.
Excellent clinical caries reductions are achieved by
correct use of inert sealants and firm evidence that
the properties of a resin will not be compromised by
fluoride incorporation is presently lacking.
Resume. II existe deux methodes d'incorporation de
fluor dans les produits de scellement de sillon. Dans
la premiere methode, le fluor est ajoute a la resine
non polymerisee sous la forme d'un sel de fluor
soluble qui libere les ions fluorures par dissolution,
apres l'application du scellement de sillon. Dans la
seconde methode, un composant fluore organique
est lie chimiquement a la resine et le fluor est libere
par echange avec d'autres ions ('systeme d'echange
d'anion'). Une revue de litterature est effectuee sur
l'efficacite de tous les produits de scellement de
sillon liberant du fluor-commerciaux et experimentaux-qui ont ete prepares en utilisant l'une ou
l'autre des methodes d'incorporation. II y a a
l'evidence, des taux de retention egaux pour les
produits conventionnels de scellement de sillons,
une liberation ex vivo du fluor, et une demineralisation amelaire reduite. Cependant, des recherches
futures sont necessaires pour assurer une longevite

2000 IAPD and BSPD, International Journal of Paediatric Dentistry 10: 90-98

Flouride pit and fissure sealants

clinique de la retention du scellement des sillons

fluore et pour obtenir une plus grande inhibition des
caries par le fluor libere dans la salive et I'email.
Zusammenfassung. Es gibt 2 Methoden um Fluoride
den Fissurenversiegler beizugefugen bei der ersten
Methode wird den unpolymerisierten Kunststofif,
Iosbares Fluoride-Salz beigefugt, dieses befreit
Fluorid- lonen bei der Auflosung, nach dem Auffragen des Versieglers. Bei der zweiten Methode wird
ein organisches Fluorid chemisch mit dem Kunstoff
verbunden und das Fluorid wird durch einen
lonenaustasch wirksam (Inion Exchange System).
Ein Literatubersicht iiber den 2 erwahnten Methoden. Es ist erwiesen, dass die Retentionraten dieser
Versiegler gleich ist wie bei den konventialen
Versiegler, trotzdem sind bezuglich der Langzeitretention, der Fluoridmangel im Speichel und dem
Schmelz weitere Untersuchungen notig.
Resumen. Hay dos metodos de incorporacion de fliior
a los selladores de fisuras. En el primer metodo, el
fluor se aflade a la resina no polimerizada en la forma
de una sal soluble de fluor que libera iones fliior por
disolucion, tras la aplicacion del sellador. En el
segundo metodo, un compuesto organico de fliior se
une quimicamente a la resina y el fliior se libera por
intercambio con otros iones (sistema de intercambio
ionico). Se hace una revision de la literatura sobre al
efectividad de todos los selladores liberadores de
fliiorcomerciales y experimentales-que han sido
preparados usando tanto el metodo anterior como el
ultimo metodo de incorporacion de fliior Hay
evidencia de porcentajes de retencion iguales a los
selladores convencionales, de la liberacion de fliior en
vivo y de la reduccion en la desmineralizacion del
esmalte. Sin embargo son necessarias investigaciones
posteriores para asegurar la longevidad clinica de la
retencion del sellador con fliior y demostrar el
objetivo de una mayor inhibion de la caries mediante
el fliior liberado en la saliva y el esmalte.

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