Selante de fóssulas e fissuras para o controle de lesões de cárie oclusal: um ensaio clínico controlado randomizado

Abstract

Systematic reviews and meta-analysis based on controlled and randomized clinical trials (RCT) have been showed that resin sealant has a good clinical performance when applied in sound surfaces or in non-cavitated lesions. Others clinical studies have shown that sealing of caries lesions, including those that are localized in the middle third of dentin, can reduce the bacterial growth in the infected dentin leading to stop the carious process and inducing mineral gain. Few RCT have been conducted to establish the resin sealant longevity and its clinical performance when applied to caries lesions which present breaks into enamel and dentin surface. This RCT evaluated the resin sealant longevity applied in occlusal surface of permanent molar that present caries lesions with microcavities (up to 0.5mm diameter) and compared to conventional restorative treatment (composite resin) from young patients aged 10 to 25 years for a period of up to 22 months. Dental materials were evaluation according FDI criteria. Bivariate analysis and survival curves were used to evaluate the results (p <0.05). Fifty one patients and 61 teeth received the allocates intervention. From these, forty patients (51 teeth) were evaluated. Of those, 25 teeth received sealant (49%), and 26 resin composite treatment (56%-control group). The sealant group showed more failures than composite resin restorations. Eight of 25 teeth with sealant (32%) presented fracture or total or partial material loss. None tooth with composite resin restoration showed failure (P= 0.003). Sealant annual failure rate was 18.9%. Sealant also presented a lower survival probability in patients with active caries lesion at evaluation time (P = 0.005), and showed inferior performance compared to resin composite when marginal adaptation was evaluated (p = 0.046). Therefore, the resin sealant showed inferior performance when compared to composite resin restoration for caries lesion presenting microcavities with dentin extension.