Sealants and preventive restorations: review of effectiveness and clinical changes for improvement.

Sealants are effective caries-preventive agents to the extent they remain bonded to teeth. Preventive resin restorations (PRR) have a proven record, but are susceptible to failure as the overlying sealant fails. Careful analyses of studies reveal a measurable failure rate of sealants (5-10% per year) that must be addressed. Even under the best of circumstances, sealants fail. Therefore, dentistry (as well as third-party systems) must accept that sealants need vigilant recall and proper preventive maintenance. In addition, it is clear that cost-effective use of sealants will involve selective application on teeth with the greatest caries risk. Caries risk analysis of the patient as well as the tooth is an essential step in the treatment planning process. To improve sealant success, new material advances are suggested. Data from studies using an intermediate layer of dentin bonding agent between etched enamel and sealant show dramatic reduction of failure for sealants, particularly in instances of molars judged difficult to seal due to early stage of eruption.