Evaluation of Clinical Success of Fissure Sealant, Patients’ Preference and Gingival Damage Following Different Isolation Methods in Children: A Randomised Split-mouth Clinical Trial

Abstract

Effective tooth isolation is a key factor affecting the retention and, in turn, the clinical success of fissure sealants. Hence, the aim of this study was to evaluate the clinical success of fissure sealants, patients’ preferences and gingival damage following cotton roll isolation, rubber dam isolation and Mr. Thirsty isolation system in children. In this in vivo, split-mouth randomised clinical trial, participants aged 6–11 years requiring sealants on the first permanent molars were enrolled according to the inclusion and exclusion criteria. Each participant received sealants on three random first permanent molars using three isolation techniques. The method of choosing which tooth to seal using which isolation system was randomly carried out using a computer allocation system. The time required for sealant placement was recorded for each technique. Following sealant placement, participants were given an interview-based questionnaire to evaluate their preference regarding the isolation techniques. The evaluation of clinical success using USPHS criteria was recorded at baseline and followed up for 3, 6 and 9 months. These data were analysed using IBM SPSS version 25 for Windows statistical software. Kruskal–Wallis test was used for intergroup comparison, and for quantitative data between three groups, analyses were done using the Chi-square test with multiple comparison tests. For all statistical analyses, probability levels of P < 0.05 were considered statistically significant and P < 0.001 as highly significant. A total of 93 teeth were clinically evaluated at the end of 9 months; of these, significantly higher retention rates were seen in the rubber dam group, where 71% had completely retained sealants and 29% had a partial loss of sealants. The mean chair side times were 1.94 ± 0.31, 3.28 ± 0.32 and 2.44 ± 0.32 for cotton roll, rubber dam and Mr. Thirsty isolation, respectively. Approximately 60% of participants preferred cotton roll isolation over rubber dam and Mr. Thirsty isolation system. (P = 0.02). Cotton roll isolation was the most preferred technique; however, sealant retention was reported to be the best using rubber dam isolation. Mr. Thirsty can be used as a viable alternative in patients where cotton rolls and a rubber dam are contraindicated.