Comparison of Retention among Proximal Sealant and Adhesive System in Mandibular Permanent First Molars of 12 Year Old School Children in Chennai: A Split Mouth Randomized Trial

AIM OF THE STUDY: To assess and compare the retention properties of a proximal sealant made of polyurethane dimethacrylate versus a resin based adhesive system for sealing proximal surfaces of permanent mandibular first molars in 12 year old children. OBJECTIVES: 1. To identify sound enamel and early enamel lesions using International Caries Detection and Assessment System II criteria (ICDAS II, 2005) among the study population. 2. To evaluate and compare the retention of proximal sealants (a polyurethane dimethacrylate patch) and a resin based adhesive system placed on permanent mandibular first molars in 12 year old children over 6 months based on United States Public Health Service - Modified Ryge Criteria for Direct Clinical Evaluation of Restorations proposed by Cvar and Ryge, 1980. 3. To evaluate and compare additional factors such as colour match, marginal discolouration, secondary caries, anatomic form, marginal adaptation and surface texture of proximal sealants and adhesive systems on permanent mandibular first molars in 12 year old children over 6 months using the same criteria. METHODOLOGY: A split-mouth randomized trial was conducted among 50 school children, whose parents gave consent and fulfilled the inclusion criteria. Prior to the start of the study Pre operative and post-operative bitewing radiographs were taken bilaterally prior to the start of the study and at the end of the sixth month respectively. Separators were placed for those children who did not have physiological spacing. The interventions were delivered on the left and right sides after randomization as per the manufacturer’s instructions. All the children were instructed individually regarding the oral hygiene practices to be followed during the study period. The interventions were assessed for retention primarily and other criteria like colour match, marginal discolouration, marginal adaptation, anatomic form, caries formation (using bitewing radiographs), post-operative sensitivity and surface roughness at the end of the first, third and sixth months using United States Public Health Service (USPHS) criteria. The data was compiled and analyzed using SPSS software and results were generated. RESULTS: The study results showed that retention was better in the resin based adhesive system when compared to the polyurethane dimethacrylate adhesive patch at the end of six months (p = 0.026). The assessment of all the other outcome variables, like colour match, marginal discolouration, marginal adaptation, anatomic form and surface roughness between both the interventions showed that the difference was not statistically significant. At the end of six months, the assessment of post-operative bitewing radiographs showed that there was no caries progression in any of the intervention. CONCLUSION: This study throws light on two potential proximal sealants namely, the resin based adhesive system and a newly devised polyurethane dimethacrylate patch which have the ability to protect and seal the approximal surfaces of permanent mandibular first molars from caries in 12 year old school children. The study results reveal that the resin based adhesive system was better than the adhesive patch in terms of retention over a period of six months.