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An evaluation of sealant restorations after 2 years Gray G. B. Br Dent J 1999; 186: 569–575

Comment

There is nothing more fundamental to dental practice than the management of dental caries. In the past, enormous volumes of tooth tissue were removed to manage caries in pits and fissures, with irreversible long-term damage to tooth structure. New techniques, developed on the back of new materials, now allow much more conservative treatment. With any new technique though, there is the worry that a good idea in theory, simply may not work in the real world. In dentistry, the process of establishing the efficacy of a new treatment is often drawn out, because the time scale before success can be judged may be many years. Although the preventive resin restoration was first described more than 20 years ago there has been continued evolution of the techniques and materials involved. Despite the fact that it would, intuitively, appear to be a major step forward, there is little hard evidence to support its efficacy.

Comparison of a new technique with an established treatments in randomised controlled clinical trials (RCT) are the gold standards for establishing efficacy, but are difficult to run where outcomes can only be established after many years. This may be why RCTs are rare in dentistry. However, other approaches, such as the one reported here, can still provide invaluable evidence to the clinician, and should not be ignored just because they are not RCTs.

The trial reported here shows quite clearly that preventive resin restorations should not suffer from major failures within 2 years of placement. The advantages of the technique over conventional amalgam restorations are so clear cut that an RCT (while always desirable) may not always be necessary for clinical decision making, provided the restorations last a reasonable time and that failure is not associated with tooth destruction. However, the suggestion here that there may be a link between materials used and the retention of overlying sealant, although interesting, can only really be clarified with an RCT.

Field trials like this provide a bench mark against which any practitioner can, and should, audit his or her treatment outcomes, but hospital based field trials can only tell part of the story. The value of any technique intended for widespread use can only be fully established by trials in a practice setting. Sealant restorations can last for 2 years without major failures, but we now need to know how much longer they can last, whether a similar level of success can be established in a practice environment, if not, why not, and what can be done to effect greater success? Many of these questions can only be answered with a scientific input from dental practice.