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ISSN 0970 - 4388

Retention of a resin-based sealant and a glass ionomer used as a fissure

sealant: A comparative clinical study

Sealing occlusal pits and fissures with resin-based sealants is a proven method of preventing occlusal caries. Retention of the
sealant is very essential for its efficiency. This study evaluated the retention of glass ionomer used as a fissure sealant when
compared to a self-cure resin-based sealant.
One hundred and seven children between the ages of 69 years, with all four newly erupted permanent first molars were selected.
Two permanent first molars on one side of the mouth were sealed with Delton, a resin-based sealant, and the contralateral two
permanent first molars were sealed with Fuji VII glass ionomer cement. Evaluation of sealant retention was performed at regular
intervals over 12 months, using Simonsens criteria. At the end of the study period, the retention of the resin sealant was seen
to be superior to that of the glass ionomer sealant.
Keywords: Glass ionomer cement, pit and fissure, resin, sealant

Methods of caries prevention should pay special attention to

surfaces with pits and fissures because they have always been
the earliest and most common sites to be affected by caries.
Occlusal caries is most prevalent in children as a result of the
morphology of pit and fissure surfaces: they are stagnation
areas, where plaque formed is anatomically protected from
even a single toothbrush filament by the dimensions of the
fissure.[1] Probably, the most caries-susceptible period of a first
permanent molar is the long eruption phase. At this period,
the enamel immatured, the child and parents often do not
know that a new tooth is erupting, and it is usually difficult
for the child to clean the erupting tooth surfaces.[2] Preventive
measures such as control of bacterial plaque and topical
applications of fluoride solutions have little effect on such
surfaces.[3] More effective measures are therefore necessary,
such as the application of occlusal sealants.[4]

fluoride and adhere to the enamel.[6] The new glass ionomer

Fuji VII (GC Corporation, Tokyo, Japan) which has a high
fluoride release has been introduced for caries stabilization
and protection of susceptible tooth surfaces. This study was
taken up to compare the retention of a self-cure resin-based
pit and fissure sealants with a glass ionomer cement.

Materials and Methods

Children aged between 69 years were examined in their
respective schools after obtaining consent from the concerned
school authorities. Dental examination was performed in
natural daylight using sterile and disposable mouth mirrors
with good reflecting surfaces and dental explorers.
Healthy cooperative children with all four newly erupted
caries-free and untreated permanent first molars were
selected for inclusion in the study. The inclusion criteria
specified that the occlusal surfaces had to be fully visible
and free of mucosal tissue. The children with hypoplastic
permanent first molars, developmental anomalies were
excluded from the study.

Since their introduction in Dentistry many commercial

preparations are available. These sealants differ according to
the base material used, the method of polymerization, and
whether or not they contain fluoride. Although the majority of
sealants available in the market have the same basic chemical
composition hence, it is important to know the effectiveness
and retention capacity of each sealants.[4] The ability of a
sealant to release fluoride, in addition to occluding pits and
fissures, would be a distinct advantage over the conventional
resin-based sealants.[5]

Out of 120 children who fulfilled the inclusion criteria,

the parents of 107 children gave their written consent for
participation in the study. Ethical clearance to conduct the
study was obtained from the institutional review board.
The children were brought to the Department of Pedodontics
and Preventive Dentistry for pit and fissure sealant
application. A single operator carried out oral prophylases
procedures for each child, followed by prophylaxis using a
slurry of pumice and a rotating brush to ensure the removal
of debris from the fissures.[7] The occlusal surfaces of the
first permanent molars were thoroughly flushed with water
to remove the traces of isolation of permanent first molars

Ionomeric cements have been suggested to be ideal material

for sealing pits and fissures due to their ability to release
Professor and Head, 2Former Associate Professor, 3Former PG
Student, Department of Pedodontics and Preventive Dentistry,
The Oxford Dental College, Hospital and Research Centre,
Bommanahalli, Hosur Road, Bangalore-560068, Karnataka, India

J Indian Soc Pedod Prevent Dent - September 2008



Retention of sealants

was achieved using cotton rolls and a saliva ejector held by

an assistant.[8]

of retention between the two sealants was highly significant.

Nine of the resin-sealed teeth (4.4%) and 11 of the glass
ionomersealed teeth (5.3%) showed missing sealant.

The self-cure opaque resin-based sealant, Delton (Dentsply

International, York, PA) was applied following the manufacturers
instructions on 16 and 46. The occlusal surface was dried and
the liquid etchant provided (35% phosphoric acid) was applied
with a disposable nylon brush into the pits and fissures and
extended up the cuspal inclines.[8] Each tooth was etched
for 60 s and then rinsed thoroughly for 30 s using an oilfree air-water syringe. The cotton rolls were substituted,
taking care not to contaminate the etched surfaces, which
were then thoroughly blow-dried. Etching was confirmed
by a dull frosty-white appearance of the enamel. If salivary
contamination occurred, the surface was again cleaned, dried,
and re-etched.[8]

Both sealants showed highest loss at the sixth month of

evaluation. Thirty-eight percent of resin sealant (79 teeth)
was completely retained as compared to only 13.1% of
glass ionomer sealant (27 teeth). This difference was highly
significant. Partial sealant retention was seen in 104 teeth
(50.5%) sealed with resin sealant as compared to 101 teeth
(49.0%) sealed with glass ionomer sealant. Twenty-three teeth
(11.2%) showed missing resin sealant and 78 teeth (37.9%)
showed missing glass ionomer sealant, a difference was
statistically significant.
A significant difference was also seen in the retention of
the two sealants at the ninth month of evaluation. Twenty
percent of resin sealant (43 teeth) was completely retained
as compared to only 2.9% of glass ionomer sealant (6 teeth).
Forty-nine percent (102 teeth) of resin sealant was partially
retained, while glass ionomer sealant was partially retained
on 76 teeth (36.9%),. Twenty-nine percent (61 teeth) showed
missing resin sealant and 60.2% (124 teeth) showed missing
glass ionomer sealant.

The two sealant components were mixed together thoroughly

for 10 second and disposable applicator tubes inserted into
applicator handles were used to draw up a measured amount
of sealant. This amount of sealant, which was suitable for an
occlusal surface, was gradually dispensed along the fissures.
A probe was used to remove air bubbles and ensure sealant
flow into all pits and fissures. An explorer was used to check
for complete application of pits and fissures.

Comparison of the two sealants at the end of 1 year showed

complete retention of 14% of resin sealant as compared to
only 0.9% of glass ionomer sealant (2 teeth). This difference
was highly significant. Partial sealant retention was seen in
39.3% (81 teeth) that had resin sealant applied, as compared
to only 27.7% (57 teeth) that had glass ionomer sealant
treatment. This difference was also significant. Forty-six
percent (95 teeth) showed missing resin sealant and a
significantly higher number of teeth, 147 (71.4%), exibited
missing glass ionomer sealant.

The pink-colored glass ionomer was applied as a sealant on

26 and 36. The occlusal surfaces were gently cleaned with
GC Dentin Conditioner for 20 s, rinsed for 20 s, and then
dried by blotting with a cotton pellet. The surfaces were not
desiccated and appeared moist and glistening. The cement
was mixed as per the manufacturers instructions and applied
to the occlusal surface using a plastic filling instrument. A
disposable nylon brush was used to spread it properus on to
the pits and fissures. The sealant was protected with a coat
of petroleum jelly.

Comparison of sealant retention on upper and lower first

permanent molars [Table 2 and Figure 2]
Resin sealant
At the third month, 57.28% (59 teeth) of resin sealant was
completely retained on upper teeth as compared to 59.22%

The patients were instructed not to eat or drink anything for

30 min, they were recalled for assessment of sealant retention
at intervals of 3, 6, 9, and 12 months.
Intra-examiner variability was minimized by reexamining on
10% of patients. Retention of the sealants at the specified time
intervals was evaluated using Simonsens criteria.[9] The data
obtained was tabulated and subjected to statistical analysis
using the Chi-square test and the Fisher exact test.





Comparison of retention of the two sealants [Table 1 and
Figure 1]
At the third month of evaluation, 58% of resin sealant was
completely retained, as compared to only 27.2% of glass
ionomer sealant. On 77 teeth (37.4%), resin sealant was
partially retained and on 139 teeth (67.5%) glass ionomer
sealant was partially retained. The difference in the degree

Figure 1: Retention of resin sealant and glass ionomer


J Indian Soc Pedod Prevent Dent - September 2008


Retention of sealants
Table 1: Retention of resin sealant and glass ionomer sealant
Evaluation period

3rd month

6th month

9th month

12th month



Resin sealant
Number of teeth

Glass ionomer sealant

(n=206 )


Number of teeth


P value


P<0.05* is significant; P<0.001** is highly significant

teeth as compared to 5.83% of sealant (six teeth) on lower

teeth. This difference was significant. Thirty percent of partial
retention was seen in 31 upper teeth which was significantly
different from 44% on 45 lower teeth. The glass ionomer
sealant was missing from 72 upper teeth (70%) and 52 lower
teeth (50%); this was a significant difference. At the twelfth
month, none of the glass ionomer sealant was completely
retained on upper teeth as compared to only 1.94% of sealant
(two teeth) on lower teeth. The glass ionomer sealant was
partially retained on 25 upper teeth (24.27%) and on 32 lower
teeth (31.07%). Seventy-six percent (78 teeth) of upper teeth
and 67% of lower teeth showed a missing sealant.

(61 teeth) of sealant on lower teeth. Partial retention of resin

sealant was seen on 39 upper teeth (37.86%) and on 38 lower
teeth (36.89%). The resin sealant was missing on 4% of upper
teeth (5 teeth) and 3.88% of lower teeth (4 teeth). At the sixth
month, 31.07% of sealant (32 teeth) was completely retained
on upper teeth as compared to 45.63% of sealant (47 teeth)
on lower teeth. This difference was significant. Sealant was
partially retained on 60 upper teeth (58.25%) and on 44
lower teeth (42.72%). This difference was also significant. The
sealant was missing on 11 upper teeth (10%) and 12 lower
teeth (11.65%). At the ninth month, 14 upper teeth (13.59%)
showed complete sealant retention as compared to 29 lower
teeth (28.15%). This difference was significant. The sealant
was partially retained on 56 upper teeth (54.36%) and on 46
lower teeth (44.66%). Thirty-two percent (33 teeth) of upper
teeth and 27.18% (28 teeth) of lower teeth showed missing
sealant. At the twelfth month, 7.76% of resin sealant (8 teeth)
was completely retained on upper teeth as compared to
21.36% of sealant (22 teeth) on lower teeth. This difference
was significant. Sealant was partially retained on 44 upper
teeth (42.72%) and on 37 lower teeth (35.92%). The resin
sealant was missing from 49% of upper teeth (51 teeth) and
from 42.71% of lower teeth (44 teeth).

Dental sealants have been proved to be highly effective in
the prevention of pit and fissure caries. The caries-preventive
property of sealants is based on the establishment of a seal
which prevents nutrients from reaching the microflora in the
fissure. The preventive effects of the sealant are maintained
only as long as it remains completely intact and bonded in
place.[10] Adequate retention of sealant requires the sealed
tooth to have a maximum surface area with deep, irregular
pits and fissures, and to be clean and dry at the time of the

Glass ionomer sealant

At the third month, 25.24% of sealant (26 teeth) was
completely retained on upper teeth as compared to 29.13%
(30 teeth) on lower teeth. It was partially retained on 70
upper teeth (67.96%) and on 69 (66.99%) lower teeth. Sealant
was missing from seven upper teeth (6%) and four lower
teeth (3.88%). At the sixth month, 8.74% of glass ionomer
sealant (nine teeth) was completely retained on upper teeth
as compared to 17.47% of sealant (18 teeth) on lower teeth.
This difference was significant. The sealant was partially
retained on 44 upper teeth (42.72%) and on 57 lower teeth
(55.33%). Forty-eight percent (50 teeth) of upper teeth and
27.18% of lower teeth (28 teeyh) showed missing sealant.
This difference was significant. At the ninth month, none of
the glass ionomer sealant was completely retained on upper
J Indian Soc Pedod Prevent Dent - September 2008

Most of the sealants available in the market are resin based.

However, placement of a resin is very technique-sensitive and
is influenced by several factors, such as patient cooperation,
operator variability, and contamination of the operating field.
A major drawback of sealing fissures with resins is that the
clinical procedure is extremely sensitive to moisture, which
makes it difficult to etch partially erupted molars.[12]
Isolation by rubber dam or cotton rolls are equally effective
in retention rates.[8,13] In this study, cotton rolls were used, a
technique that has been referred to as partial isolation.[4] It
has been stated that absolute isolation is not necessary for
the application of sealants as long as extreme care is taken


Retention of sealants
Table 2: Comparison of sealant retention on upper and lower teeth
Evaluation period


3rd month


6th month

9th month

12th month

Resin sealant

P value

Upper teeth

Lower teeth

59 (57.28)
39 (37.86)
5 (4.85)
32 (31.07)
60 (58.25)
11 (10.67)
14 (13.59)
56 (54.36)
8 (7.76)
44 (42.72)
51 (49.51)

38 (36.89)
47 (45.63)
44 (42.72)
12 (11.65)
29 (28.15)
46 (44.66)
28 (27.18)
22 (21.36)
37 (35.92)
44 (42.71)


Glass ionomer sealant

Upper teeth

Lower teeth

26 (25.24)
70 (67.96)
7 (6.79)
9 (8.74)
44 (42.72)
50 (48.54)
31 (30.09)
72 (69.90)
25 (24.27)
78 (75.73)

30 (29.13)
69 (66.99)
4 (3.88)
18 (17.47)
57 (55.33)
28 (27.18)
6 (5.83)
45 (43.69)
52 (50.49)
2 (1.94)
32 (31.07)
69 (66.99)

P value


*P<0.05* is significant; Figures in parentheses are in percentage


tooth structure.[15] These advantages of glass ionomer cement

make it a suitable sealant for community care programs.


Most of the studies on sealants have used the half-mouth

design, in which the teeth on one side of the mouth were
treated, while the contralateral teeth remained unsealed.[16]
Unsealed homologous paired teeth cannot, to be used as
controls. An alternative is to compare the retention of at
least two sealants in the same mouth, eliminating the need
for untreated control teeth.[17] Such studies should use a
split-mouth design that does not withhold treatment benefit
from the patient.

U=Upper tooth
L=Lower tooth





3 month 6 month 9 month 12 month





3 month 6 month 9 month 12 month

Figure 2: Comparison of sealant retention on upper and lower


The addition of color to a sealant greatly improves perception

at application and on recall examination; it also simplifies
record keeping by use of clinical photographs, as compared
with patients who have clear resin sealants placed. These
tinted sealants are easily visible and chairside time is saved
at follow-up.[17] Also, parents are reassured when they can
see the sealants on their childs teeth.[17] As the sealant is
clearly visible to the child, it is of benefit to encourage the
child to look periodically for any sealant loss. This constant
reminder of the presence of a preventive agent will help
in the motivational aspects of the preventive program.[17]
White was found to be the most esthetically acceptable
color for patients.[18] However, the chief criticism of opaque
sealants is the inability to visually detect progression of caries
underneath them.

to avoid salivary contamination of the etched surface.[4]

Etching roughens the tooth surface and produces a
honeycomb-like structure so that tags of sealant can penetrate
deeply into the enamel and form an effective mechanical
bond, thus retaining the sealant. The disadvantages of resin
sealants lie in their hydrophobic nature. Resins do not form
hydrolytically stable bonds, so their retention on tooth
structure depends on the durability of the mechanical bond.
A 1520 s etch, for either primary or permanent dentition,
should be adequate for sealant retention.[8]
Many researchers confirm that the Glassionomers are
seperately be preferable for sealing newly erupted teeth.[12]
Glass ionomer sealants offer similar caries-preventive effects
as resin-based sealants, with easier manipulation and without
the use of acid etching. The glass ionomer may be valuable
as a sealant in cases of difficult operating conditions i.e.
difficulty with moisture control in partially erupted teeth
or in children with management problems or in very young
children.[12] The ease of application, reduction in operating
time, and the adherence of these materials to moist teeth
favors their placement.[14] They are biocompatible and have
a coefficient of thermal expansion slightly lower than that of

Reported evidence of sealants needing replacement or repair

in contemporary studies averages between 5 and 10% per
year.[19] Clinical evidence suggests that sealant loss (retention
failure) occurs in two phases: there is an initial loss due to
faulty technique (such as moisture contamination), followed
by a second loss associated with material wear under the
forces of occlusion.[20]
In our study, at the end of 1 year, the resin sealant showed
14.6% complete retention, 39.3% partial retention, and 46%

J Indian Soc Pedod Prevent Dent - September 2008


Retention of sealants

could be inadequate adhesion of the cement to the enamel

surface.[28] In addition, the cement may have been exposed to
saliva before it had completely set, which would predispose
to surface degradation and early loss of sealant.[28] The
topography of the occlusal surfaces may be an obstacle
for good adhesion. Surface irregularities may result in
entrapment of air voids, hence reducing the strength of the
adhesive joint.[28]

missing sealant, i.e., the resin sealant was missing from nearly
half the treated teeth. The highest rate of sealant loss was
seen at the sixth month, with only 38% of sealant completely
retained and 51% partially retained. This was in accordance
with Whitehurst and Soni, who found that the greatest
sealant loss occurred during the first 6 months. They also
reported only 18% of first and second molars were completely
sealed after 1 year.[3] Also, Stephen et al. reported that only
12 out of nearly 400 teeth remained completely sealed after
1 year in a study performed under field conditions.[3]

Other possible explanations for the poor retention of

glass ionomer sealant include inability to obtain adequate
cooperation for isolation in the younger children, difficulty
in application on partially erupted teeth, excessive salivation,
and mucosal tissue covering the occlusal surface, which
would make sealant application more cumbersome. The low
wear resistance of glass ionomer materials to occlusal forces
may contribute for cement disintegration, by thinning the
sealant and eventually erosion of material.

A high retention rate of 7685% after 10 months was observed

by Shashikiran et al., which could be attributed to their use of
rubber dam isolation and sealant reapplication.[21] Lygidakis
et al. observed a retention rate of 89% after 4 years following
mechanical preparation of pits and fissures.[22]
Considering possible reasons for failure of resin sealant,
Anson et al. listed poor placement technique (inadequate
moisture control, not sealing all pits/fissures, inadequate
etching, inadequate rinsing and drying, and insufficient
curing time); material wear; nonsealant failure (extraction
of tooth, proximal caries, and exfoliation); and finally, failure
due to a combination of these factors.[20] Other variables
which influence sealant retention include the position of
the tooth in the mouth, the skill of the operator, and the
age of the patient.[23] The presence of prismless enamel on
newly erupted teeth confers a morphological difference in
the etching pattern and a smaller surface area for bonding,
which can influence the clinical performance of sealants.[24]

In vitro studies on the influence of various pretreatment

procedures on adhesion between glass ionomer and enamel
indicate that adhesion can be considerably improved by
conditioning the enamel surface before application of
cement.[28] Some manufacturers recommend that the enamel
surface be cleaned with a diluted polyacrylic acid solution
prior to sealant application. This procedure, however, might
compromise the wettability and penetration of the sealant
into enamel producing a low retention rate.[10] Also, as the
setting reaction of glass ionomer sealant is fast, the ability of
the sealant to penetrate into fissures, and hence its adhesive
strength, may decrease if the instructions are not followed
properly.[29] Increase in the proportion of powder results in
a more viscous cement which also sets faster, thus reducing
the ability of the cement to flow readily and to adhere to
the surface.[28]

Taylor and Gwinnett reported that pumice particles lodged

in the fissures are not removed after rinsing.[24] However;
the effect of pumice prophylaxis on retention of sealants
was not of any significant effect.[25] Also, a disadvantage
of autopolymerizing resins is that they should be in place
before setting of the resin begins, since this phase is marked
by a significant increase in viscosity which inhibits resin
penetration and thereby retention.

The considerably lower retention rate obtained with the

glass ionomer compared with the resin-based sealant is in
agreement with previous studies. Songpaisan and coworkers
in a field trial, found retention of resin sealant to be 92% after
6 months, while retention of glass ionomer sealant was a low
28%.[27] Poulsen et al. found that 3 years after application, the
glass ionomer sealant (Fuji III) was lost in almost 90% of teeth
compared to only 10% loss of the resin sealant Delton.[30]

In present study, the sixth month of evaluation revealed

the highest rate of loss of glass ionomer sealant, with only
13.1% completely retained, 49% partially retained, and 37.9%
missing. The twelfth month evaluation showed very low
retention, with only 0.9% showing complete retention, 27.7%
showing partial retention, and 71.4% showing missing sealant,
i.e., the glass ionomer sealant was missing from more than
half the treated teeth.

Maintenance of sealants is vital for long-term success.

However, there is evidence that teeth sealed very early after
eruption require more frequent reapplication of the fissure
sealant than teeth sealed later.[31] When resins are attached
to enamel by acid-etching techniques they provide stronger
mechanical bonds than the molecular bonds of glass ionomer
cements. For this reason, glass ionomers, when used as
fissure sealants, are not successful when placed in fissures
that have no orifice. Although the cement may be applied to
such a fissure, it will soon be lost through erosion / abrasion.
By contrast, when glass ionomer was used as sealant in patent
fissures (exceeding 100 m in width).[32]

According to Boksman and colleagues (1987), the routine

clinical use of a glass ionomer sealant was unreliable because
of poor retention. They observed a total loss of 94% after 6
months.[26] McKenna and Grundy, however, reported a 93%
retention rate after 6 months and 82.5% after 1 year.[27]
One main reason for the loss of the glass ionomer sealants
J Indian Soc Pedod Prevent Dent - September 2008



Retention of sealants


The caries-preventive effect of glass ionomer sealant depends

on both retention of sealant and release of fluoride from the
sealant. It has been suggested that fluoride released by the
glass ionomer sealant material and taken up by the adjacent
enamel can prevent the development of caries even after
visible loss of sealant material. Even where glass ionomer
sealants appear clinically to have been totally lost, there
remain small particles of material attached to the enamel
of the occlusal fissures.[33] Scanning electron microscopy
of fissures has shown the cement to remain in the deeper
recesses, acting as a plug. The bioavailability of the leachable
fluoride ion, which diffuses into surrounding enamel
during the retention period, would increase the resistance
of enamel to demineralization.[14] The establishment of a
fluoride reservoir might be expected to contribute to caries
prevention and to make the effectiveness of glass ionomer
materials as sealants less dependent on the long-term
retention of the material. Williams et al. suggested that glass
ionomers used as sealants should be regarded as slow-release
fluoride reservoirs and be called fluoride depot cements.

The following conclusions were drawn from the study:

The retention of the resin sealant was superior to that
of the glass ionomer cement at the end of 1 year.
The retention of sealants on mandibular teeth was
superior to that on maxillary teeth.



This study revealed higher sealant retention rates for the

mandibular teeth. This is in agreement with other studies
that have compared resin-based sealants and glass ionomer
sealants.[10,29] This could be because of direct visualization
during application, gravity-aided flow of the sealant, and
the presence of well-defined pits and fissures contribute to
superior retention.[27] Also, the effect of occlusal stress on the
sealant of the maxillary molar appeared at an earlier stage of
eruption compared with that of the mandibular molar. The
decrease in retention rates found in 89-year-old children
may be related to the occlusal stress that occurs during
eruption. In the earlier stages of mandibular eruption, the
maxillary teeth contact only mandibular cusps not reaching
the sealant.[29]



Recently, concerns have been raised about the possibility

that estrogenic chemicals, especially bisphenol-A (BPA) and
bisphenol-A dimethacrylate (BPADMA) resin-based sealants.
Thus, glass ionomer sealants can be considered as a viable


Dental sealants are a proven tool in caries prevention.[8]

Whether the prevention of caries is due to obturation of the
fissures or to the local presence of fluoride, or due to both,
it would appear that long-term retention of glass ionomer
fissure sealants is not a prerequisite for caries prevention
and such treatment should perhaps be regarded more as a
form of very prolonged fluoride application rather than as a
sealing of fissures.



In children with high risk of caries and partially erupted

molars, the use of a glass ionomer as a fissure sealant should
be encouraged rather than the traditional approach of waiting
until the tooth fully erupts. The use of glass ionomers as
interim sealants is highly beneficial in newly erupted teeth
when the risk of caries is highest.



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J Indian Soc Pedod Prevent Dent - September 2008

Reprint request to:

Dr. Priya Subramaniam,
Department of Pedodontics and Preventive Dentistry,
The Oxford Dental College,
Hospital and Research Centre,
Bommana Halli, Hosur Road,
Bangalore-560068, Karnataka, India.