title: Improved sealant retention with bonding agents: a clinical study of two-bottle and single-bottle systems.
abstract: Recent in vitro work and a short clinical study suggest that adding a bonding agent layer between sealant and saliva-contaminated enamel allows for adequate bond strength and retention of resin sealants and may improve success of all sealant applications. This five-year clinical study scored 617 occlusal and 441 buccal/lingual molar sealants, with use of a split-mouth design, with half receiving sealant alone and half bonding agent plus sealant. Treatment effects and potential risk factors for sealant failure were tested by means of a Cox regression model. Three bonding agent groups were analyzed for treatment effect: Tenure primer, Scotchbond Multi-Purpose, and 3 single-bottle dentin bonding agents as a third group. The single-bottle group was successful in reducing risk of sealant failure, with a hazard ratio (HR) of 0.53 (p = 0.014) for occlusal and 0.35 (p = 0.006) for buccal/lingual sealants. Scotchbond was detrimental to occlusal sealant success, with a HR of 2.96 (p = 0.0003). Tenure primer was neutral, showing HRs close to 1.0. Variables that affected success differed between occlusal and buccal/lingual sealants, suggesting that failures on these two surfaces may be dependent upon differing factors. Early eruption stage was a significant risk factor for both surfaces (HR = 2.91, p = 0.00001, occlusal; and HR = 1.52, p = 0.015, buccal/lingual). Behavior (HR = 1.96, p = 0.0007), salivary problems (HR = 1.73, p = 0.002), and visually apparent variations in enamel (HR = 1.51, p = 0.018) were significant risk factors for occlusal sealants only. In addition to completing detailed analyses of risk factors for sealant survival, this study shows that single-bottle bonding agents protect sealant survival, yielding half the usual risk of failure for occlusal sealants and one-third the risk of failure for buccal/lingual sealants.
authors.affiliation: Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor 48109-1078, USA. feig@umich.edu
authors.forename: R J
authors.initials: RJ
authors.lastname: Feigal
authors.forename: P
authors.initials: P
authors.lastname: Musherure
authors.forename: B
authors.initials: B
authors.lastname: Gillespie
authors.forename: M
authors.initials: M
authors.lastname: Levy-Polack
authors.forename: I
authors.initials: I
authors.lastname: Quelhas
authors.forename: J
authors.initials: J
authors.lastname: Hebling
mesh_terms: D002648:Child; D001840:Dental Bonding; D019232:Dental Restoration Failure; D003793:Dental Restoration, Permanent / Q000379:methods*; D017220:Dentin-Bonding Agents; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008689:Methacrylates; D008963:Molar; D010895:Pit and Fissure Sealants; D016016:Proportional Hazards Models; D019279:Resin Cements; D012463:Saliva; D016019:Survival Analysis
chemical_list: D017220:Dentin-Bonding Agents; D008689:Methacrylates; D010895:Pit and Fissure Sealants; D019279:Resin Cements; C084018:Scotchbond Multi-Purpose; C074811:Tenure adhesive