Search Strategy
Systematic Reviews
Systematic reviews of randomized clinical trials are the highest level of scientific evidence to support clinical recommendations. Staff of the American Dental Association (ADA) Division of Science searched MEDLINE for all systematic reviews published in English on pit-and-fissure sealants through Oct. 4, 2006. They used the "Find Systematic Reviews" tool of the PubMed Clinical Queries search engine. Search terms, identified elsewhere in this document as the "standard search terms," were as follows: "Sealants, Dental" OR "Dental Sealants" OR "Pit Fissure Sealants" OR "Fissure Sealants, Pit" OR "Sealants, Pit Fissure" OR "Fissure Sealants" OR "Sealants, Fissure" OR "Sealants, Tooth" OR "Tooth Sealants" OR "Resin Cements" OR "Glass Ionomer Cements".
The ADA staff members identified 77 articles. They screened titles and abstracts and consulted the full texts of selected publications. Inclusion criteria were as follows:
- Publications that address one or more of the identified clinical questions
- Publications that had a documented search strategy to systematically identify the evidence
- Publications written in English
The ADA staff members screened references cited in selected systematic reviews to identify additional systematic reviews not identified through the search strategy. Thus, they identified 10 systematic reviews. One member of the expert panel identified an additional systematic review that had been published since the literature search was conducted. Members of the expert panel had the opportunity to identify any additional systematic reviews that should be considered. Representatives of the panel from the U.S. Centers for Disease Control and Prevention (CDC) shared with the panel a prepublication copy of additional systematic reviews recently completed by CDC. (Those manuscripts since have been published.) The panelists considered a total of 12 systematic reviews.
Newly Published Studies
ADA Division of Science staff conducted a search for articles published between Dec. 1, 2002 and Sept. 15, 2006, by using MEDLINE to identify any newly published studies using the standard search terms described above. They selected search dates on the basis of the search strategies of the most current systematic reviews that address each of the clinical questions:
- Under what conditions should sealants be placed to prevent caries? (The literature searches for this systematic review included studies published through June 2005.)
- Does placing sealants over early (noncavitated) lesions prevent progression of the lesions? (The literature search for this systematic review included studies published through June 2005.)
- Are there conditions that favor the placement of resin-based versus glass ionomer cement sealants in retention or caries prevention? (The literature search for this systematic review included studies published through December 2002.)
- Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? (The literature search for this systematic review included studies published through December 2004).
This literature search for clinical studies identified 2,130 articles. ADA Division of Science staff members screened titles and abstracts and consulted the full texts of selected publications.
Inclusion criteria were as follows:
- Clinical studies that addressed one of the identified clinical questions
- Studies published within the inclusion dates listed above
- Publications written in English
The staff members identified 16 clinical studies. Members of the expert panel had the opportunity to identify additional clinical studies that should be considered for inclusion. The panelists chose to analyze individually seven clinical studies from the 2001 systematic review conducted by Tinanoff and Douglass. They selected these publications because they addressed one of the clinical questions. The panelists also identified seven additional clinical studies for consideration. Four of those studies, published in 1997 or later, evaluated the use of adhesives or bonding agents in sealant placement. The panel excluded studies on adhesive or bonding agents that are no longer marketed in the United States. While developing these clinical recommendations, the panelists learned of an additional study that was accepted for publication (now published). The lead author of that study provided the accepted manuscript for the panel's consideration.
Two- or Four-handed Sealant Placement Technique
The panelists determined that the systematic reviews and newly identified studies were insufficient to determine whether use of a four-handed versus a two-handed technique improves sealant retention or caries prevention. Staff of the ADA Division of Science conducted a literature search using MEDLINE for clinical studies that directly compared sealant outcomes resulting from two- or four-handed sealant placement technique, examining literature from January 1975 through January 2007 using the following search terms: ("Dental Sealants" OR "Pit Fissure Sealants" OR "Fissure Sealants, Pit" OR "Sealants, Pit Fissure" OR "Fissure Sealants" OR "Sealants, Fissure" OR "Sealants, Tooth" OR "Tooth Sealants" OR "Resin Cements" OR "Glass Ionomer Cements") AND ("two-hand" OR "two hand" OR "2 hand" OR "2-hand" OR "four-hand" OR "four hand" OR "4 hand" OR "4-hand" OR "dentists" OR "hygienist" OR "assistant" OR "Dental team" OR "Auxiliary team" OR "Auxiliary"). The search identified 412 articles. ADA Division of Science staff screened titles and abstracts, and they reviewed the full texts of selected publications. Inclusion criteria were as follows:
- Clinical studies of two- and/or four-handed dentistry
- Publications written in English
The staff members identified no clinical studies on this topic.
Members of the expert panel presented an unpublished manuscript (now published) that examined individual studies included in three recent systematic reviews on sealant effectiveness. CDC completed a multivariate analyses of factors, including use of two-handed or four-handed method, associated with sealant retention. The included studies evaluated the retention of second- or third-generation resin-based sealant materials and provided data on whether sealant was applied with a two-handed or a four-handed method.
Enamel Preparation Techniques
The panelists determined that the systematic reviews and newly identified studies were insufficient to determine whether enamel preparation, including air abrasion or enameloplasty, would improve sealant retention or caries prevention. ADA Division of Science staff conducted an additional literature search to identify clinical studies published since 1975.
The ADA staff members searched the literature from January 1975 through January 2007 using MEDLINE for selected studies evaluating enamel preparation techniques using the following search terms: ("Dental Sealants" OR "Pit Fissure Sealants" OR "Fissure Sealants, Pit" OR "Sealants, Pit Fissure" OR "Fissure Sealants" OR "Sealants, Fissure" OR "Sealants, Tooth" OR "Tooth Sealants" OR "Resin Cements" OR "Glass Ionomer Cements") AND ("enamel preparation" OR "air abrasion" OR "fissureotomy" OR "enamelplasty" OR "enameloplasty" OR "fissurotomy"). The search identified 605 articles. ADA Division of Science staff screened titles and abstracts and consulted and the full texts of selected publications. Inclusion criteria were as follows:
- Clinical studies of enamel preparation techniques
- Publications written in English
The staff members identified four additional reports on this topic. Members of the expert panel were aware of three additional reports that were considered for these clinical recommendations.