Sealants revisted: an update of the effectiveness of pit-and-fissure sealants

The first sealant clinical trials used cyanoacrylate-based materials. These were replaced by dimethacrylate-based products which were marketed. A major difference between marketed sealants is their method of polymerization. First-generation sealants were initiated by ultraviolet light, second-generation sealants are autopolymerized, and third-generation sealants use visible light. Over time, clinical retention was found to be greater for second generation as compared with first-generation sealants. Five to 7 years after initial application the pits and fissures of approximately one third of teeth treated with first-generation sealants were fully protected as compared with two thirds of the teeth treated with second-generation sealants. First-generation, ultraviolet light initiated, sealants are no longer marketed. Clinical reports indicate that retention is similar for second- and third-generation systems, but longer clinical evaluations are necessary. A recent innovation is the addition of fluoride to sealants. Fluoride release to the saliva from a fluoride sealant system is rapid, but clinical studies are needed to determine if the fluoride addition improves caries inhibition.