I would like to know why mostly of dentists doesn't use an adhesive system to their sealants, because when asked they just answer with "because that’s not the protocol" but in fact they’re plenty of studies like by Feigal in the late 2000 reporting the elasticity of the bonding agents serving as a long-term stress-breaker for these sealants. Moreover McCafferty & O’Connell reported the statistical significant improvement in the retention of a bonded sealant at 12 months over conventional sealants, and there's at least 10 more studies showing the benefits of bonding sealants. Is it time to switch the paradigm about bonding our sealants?
When deciding on this, I think that it is more appropriate to examine the systematic reviews and meta-analyses obtained from the findings of these studies and to make decisions accordingly, rather than clinical studies. For example, “Bagherian, A., Shirazi, A. S., & Sadeghi, R. (2016). Adhesive systems under fissure sealants: yes or no?: A systematic review and meta-analysis. The Journal of the American Dental Association, 147(6), 446-456” article is a comprehensive meta-analysis that states that adhesive systems can be used under fissure sealants (odds ratio, 3.294; 95% confidence interval, 1.292-8.401; P = .013). On the other hand, I think the “no protocol yet” you hear from different researchers arise from the scarcity of studies in different styles, especially clinical studies. Even the meta-analysis I mentioned above came to a conclusion by compiling only 12 studies. Therefore, I think that adhesives can be used under fissure sealants, but it will take a while before this becomes a protocol. In this process, there is a need for a large number of studies, especially randomized controlled studies with larger sample sizes, on this subject. For example, the use of adhesives under fissure sealants in developmental enamel defects such as molar-incisor hypomineralization is recommended in systematic reviews and meta-analyses published in journals with high impact factor and guidelines.
Best regards,
Time, costs, behavior issues. Also, retention is good without bonding.
Now a days it is recommended to use adhesive system before resin based sealant material. As prevention of nanoleakage is a prime concern now.
Etching is not required, but bonding agent application is required
It depends on how deep is the fissure that need to be sealed.
adhesive systems is not necessary to enamel (not dentin involvement) because
- enamel is a material that mostly composed of Hydroxyapatite. Under etchng, microporosity is formed and this can be easily penetrated by fluid sealants
- while dentin ( hydrophilic--> fluid dentin in dentinal tubules) must be treated with adhesive system prior to the placement of restorative material of resin based which is hydrophobic
Adding an adhesive improves retention of the sealant especially when moisture control is compromised …this has been reported by many studies.
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