Sealing of occlusal carious lesions: a randomized clinical trial

There is a significant decrease in the number of viable microorganisms under sealants and restorations and a consequent decrease in caries progression when bacteria are separated from the oral environment. The aim of this randomized controlled clinical trial was to evaluate the efficacy of two treatments strategies: 1) sealing of carious lesions and 2) operative restorative treatment of occlusal carious lesions in permanent teeth. The sample consisted of 52 carious posterior teeth (premolars and molars) from 47 patients aged 8 - 43 years. In all lesions restorative treatment was necessary according to the following current strategies: presence of cavity and impossibility to perform biofilm control. The maximum depth of lesions was halfway through the dentine assessed by bitewing radiograph. The teeth were randomly assigned to test group – sealant treatment or control group - conventional restorative treatment. Baseline caries experience (DMFT) and gingival bleeding index (GBI) was assessed. Bitewing radiographs were performed after 12 months to evaluate the integrity of the restorations and the radiolucent zone (ZR) beneath the sealants/restorations. Outcomes were defined as clinical performance of sealant and restoration and the prevalence of regression, inactivation and progression of carious lesion by radiographic examinations. Presence of tertiary dentine was also evaluated. The data were submitted to Fisher`s exact test. A total of 26 sealants and 26 restorations were performed. There were no differences between the two groups regarding baseline characteristics – age, gender, DMFT and GBI. After one year, 49 evaluations had been performed, showing 95.8% and 100% of success rates in test and control group respectively (p>0.05). There was one therapeutic failure (total loss in the sealant group) observed during the study. No difference in the radiographic evaluation (progression, inactivation, regression and tertiary dentin deposition) was observed between the groups (p>0.05). No teeth showed caries progression; regression was observed in only one case (sealant group) and tertiary dentin was founded in 12.5% of the sample (5 sealants and 1 restoration). Sealants can be used as a therapeutic treatment for incipient carious lesions in permanent teeth, since they prevent the progression of carious lesions, while preserving tooth structure when compared to conventional restorative treatment.