The smooth, curved angle of the ART applier instrument was used for burnishing the surface which was finally, covered with a new layer of petroleum jelly.
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Carbon paper and rotary instruments were used in bite adjustment. The trial was approved by the Research Ethics Committee of Wuhan University, reference number and was registered at the Dutch Trial Registration Centre, reference number Evaluation criteria for assessing sealant retention through the visual clinical examination. Pit and fissures partly visible.
Sharp fracture edge creating plaque retention site. Crumbled fracture edge not creating plaque retention site. If code 4 is recorded then pits and fissures are re-observed after the tooth surface is blown dry with compressed air. Code 4 can be then replaced by code 5 or 6. The tray was positioned over the syringed sealed tooth and, after its removal, was rinsed under tap water.
The epoxy resin tooth specimens were mounted on aluminium stubs, using double-sided adhesive tape, in such a way that the area to be studied faced upwards. Photographs of mandibular molars were taken, with the children seated on a chair, while the maxillary molars were photographed with the children lying on a table. Each photograph was judged for acceptability and quality and if not acceptable the photograph was retaken.
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The photographs were cropped to show only the sealed tooth and then randomly ordered to ensure that the identity of the material was not known to the evaluator. Prior to the examination, children brushed their teeth at a sink on the school compound.
Visual clinical examination was performed by two calibrated and experienced independent evaluators at 0. The evaluators used the criteria presented in Table 2. The first molars were divided arbitrarily into three sections mesial-central-distal in mandibular teeth and into two sections central and distal in maxillary teeth. An intra-oral light with a disposable mirror attached Mirrorlight, Kudos, Hong Kong was used to illuminate the examination site.
Any remaining visible plaque or debris was removed with the aid of an explorer or cotton stick.
The sealed tooth surfaces were dried with a cotton stick. Trained recorders assisted the evaluators. If sealant material was judged to have disappeared completely from a section or from the total tooth surface, the re-exposed pit and fissures were dried with an air syringe and judged again to see if remnants were visible in the deeper parts of the pit and fissure system Table 2. The kappa coefficient values for the inter-examiner consistency related to the visual clinical assessment of sealant retention of the sealant trial were 0.
The central section on the clinical picture contains a sealant that partially covers the fissures. Whether remnants are present in the re-exposed part of the central section and in the distal section is difficult to see. Assessing these sites from the SEM image is also difficult because of the various different structures visible that may show arrested enamel carious lesions on the clinical picture. The level of sealant retention in the occlusal surfaces was assessed using the criteria described in Table 2.
The colour photographs were placed in an MS Word document, three on one page. The colour photograph and SEM images were viewed on a Concordance of opinion was reached by discussion. The kappa coefficient values for the inter-examiner consistency for the assessment of sealant retention on mesial, central and distal sections from colour photographs and SEM images combined were 1.
Because of the very low numbers of teeth scored retention codes 1 and 2, these scores were combined in the analyses. The sampling procedure resulted in and sampled teeth from 59 and 98 children at years 2 and 3, respectively. The number of tooth sections was and at years 2 and 3, respectively. Clinical retention code 4 against retention scores assessed from images of colour picture and SEM code by sealant group for the three sections mesial-central-distal of the occlusal surface at evaluation year 2.
Clinical retention code 4 against retention scores assessed from images of colour picture and SEM code by sealant group for the three sections mesial-central-distal of the occlusal surface at evaluation year 3.
Clinical retention code 4 against retention scores assessed from images of colour picture and SEM code by sealant group for the three sections mesial-central-distal of the occlusal surface at evaluation years 2 and 3 combined. The number of surface sections with a retention code 5 or 6 from the clinical examination at evaluation years 2 and 3 was 3 and 21, respectively.
Of these, only one code 5 or 6 from the clinical examination was confirmed as a code 6 by the colour photograph and SEM image assessment. As no previous study had been performed on this topic, it was not possible to determine the optimum sample size. Despite the fact that the sample number was restricted by the cost of producing the SEM images within the budget, its size of well over teeth per evaluation year, with some having more than one section available for assessment, is considered large enough for answering the research question.
According to protocol, the SEM image was considered the reference standard. However, a number of images were technically unusable for which we did not receive a reason from the technician of the University of Geoscience, who handled the SEM machine on her own. For some we thought that the biofilm was removed from deeper pits and fissures insufficiently, showing foreign bodies.
Furthermore, it turned out to be difficult to detect remnants of sealant material with a sufficient level of certainty on a number of SEM images. It was difficult at times to distinguish the surface of an enamel carious lesion from parts of sealant material. For those reasons, the SEM images could not be used solely as the reference standard. As retention of sealant material is adequately assessed from colour photographs than through visible clinical examination [ 15 ], we decided to modify the assessment procedure.
Tooth sections were assessed from colour photographs immediately followed by the corresponding SEM image. This procedure has the added advantage that any doubtful decision from colour picture could be re-assessed for its correctness. One can argue that, as the combined assessment was not applied on all teeth, the methodology holds a certain level of evaluation bias.
That may be correct but considering the low number of unusable SEM images, the strength of using two assessment methods increasing the chance for finding the truth in the majority of cases and the low frequency of remnants observed, we think that through the modified assessment process, an adequate estimate of the real situation was obtained. The null hypothesis was accepted. No significant difference was found among the sealant groups with respect to the presence of material remnants in pits and fissures from which the sealant had been judged to have completely disappeared according to the visual clinical examination.
In fact, the occurrence of remnants at both evaluation years was very low. This finding appears to be different from those described in earlier publications. This may suggest that the assumption is unfounded that glass-ionomer remnants left behind in the deeper parts of pits and fissures, making them less deep and easier to clean with brush and toothpaste, is a reason for the absence of a difference in the prevalence of cavitated dentine carious lesions over time between glass-ionomer- and resin-based sealants [ 4 , 5 , 6 ].
Reasons that explain this phenomenon may well be related to the level of biofilm control as part of the maintenance programme accompanying the sealants trials referred to. However, this assumption was not a topic of the present study. Another remarkable finding was the high number of observed retention code 4 scores from assessing resin sealants through visual clinical examination that were scored retention codes 1 and 2 on colour photographs and SEM images at evaluation year 2.
This finding was not observed in the other sealant groups. We are unaware regarding factors that may have caused this result. Whatever the reason may be, the result implies that the survival of fully and partially retained resin sealants at evaluation year 2 is likely to be higher than reported [ 11 ]. We thank the children and parents for their participation and for providing permission to be included in the study.
We are grateful to the heads and staff of the primary schools for their kind reception and enthusiastic collaboration. We thank the dental assistants and final-year dental students for their pleasant cooperation and valuable contribution to the clinical examination. We thank Xu Xiao Qian for skillfully taking the photographs and Mrs.
None of the authors have any financial or personal conflict of interest to declare. All procedures performed were in accordance with the ethical standards of the University of Wuhan and with the Helsinki declaration and its later amendments or comparable ethical standards. Parents or guardians of all included children had received and signed the informed consent form, which explained the nature of the investigation.
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