• Jo E. FrenckenEmail author


Research over the last five or so decades has provided ample knowledge regarding risk and protective factors that influence the caries process. One of the protective factors concerns turning potentially vulnerable tooth surfaces into non-vulnerable ones. This procedure is known as sealing pits and fissures systems. The seal changes a rough tooth surface into a smooth one from which the biofilm can be removed relatively easy.

This chapter presents and discusses clinical aspects of sealants. Outcomes from evidence-based studies have been used as much as possible. Aspects that have been given attention include: indications for sealing pits and fissures, (dis)advantages of common materials used for sealing, description of sealant application step by step, their effectiveness over time and to what extent sealants manage micro-cavities.


Atraumatic restorative treatment ART Sealant Glass-ionomer sealant Resin sealant Micro-cavity sealing over 



I would like to thank all colleagues who, through their research, have assisted me in writing this chapter.


  1. 1.
    van Loveren C, Duggal MS. The role of diet in caries prevention. Int Dent J. 2001;51(6 Suppl 1):399–406.PubMedCrossRefGoogle Scholar
  2. 2.
    Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. Minimal intervention dentistry for managing dental caries – a review: report of a FDI task group. Int Dent J. 2012;62(5):223–43.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Marinho VC, Worthington HV, Walsh T, Chong LY. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2015;(6):CD002280.Google Scholar
  4. 4.
    Ekstrand KR, Christiansen ME. Outcomes of a non-operative caries treatment programme for children and adolescents. Caries Res. 2005;39(6):455–67.PubMedCrossRefGoogle Scholar
  5. 5.
    Disney JA, Graves RC, Stamm JW, Bohannan HM, Abernathy JR, Zack DD. The University of North Carolina Caries Risk Assessment study: further developments in caries risk prediction. Community Dent Oral Epidemiol. 1992;20(2):64–75.PubMedCrossRefGoogle Scholar
  6. 6.
    de Amorim RG, Leal SC, Mulder J, Creugers NH, Frencken JE. Amalgam and ART restorations in children: a controlled clinical trial. Clin Oral Investig. 2014;18(1):117–24.PubMedCrossRefGoogle Scholar
  7. 7.
    Chen X, Du MQ, Fan MW, Mulder J, Huysmans MC, Frencken JE. Caries-preventive effect of sealants produced with altered glass-ionomer materials, after 2 years. Dent Mater. 2012;28(5):554–60.PubMedCrossRefGoogle Scholar
  8. 8.
    Beiruti N, Frencken JE, van ’t Hof MA, van Palenstein Helderman WH. Caries-preventive effect of resin-based and glass ionomer sealants over time: a systematic review. Community Dent Oral Epidemiol. 2006;34(6):403–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Hesse D, Bonifácio CC, Guglielmi CeA, Franca C, Mendes FM, Raggio DP. Low-cost glass ionomer cement as ART sealant in permanent molars: a randomized clinical trial. Braz Oral Res. 2015;29:1–6.Google Scholar
  10. 10.
    Yengopal V, Mickenautsch S. Resin-modified glass-ionomer cements versus resin-based materials as fissure sealants: a meta-analysis of clinical trials. Eur Arch Paediatr Dent. 2010;11(1):18–25.PubMedCrossRefGoogle Scholar
  11. 11.
    Kühnisch J, Mansmann U, Heinrich-Weltzien R, Hickel R. Longevity of materials for pit and fissure sealing – results from a meta-analysis. Dent Mater. 2012;28(3):298–303.PubMedCrossRefGoogle Scholar
  12. 12.
    van ’t Hof MA, Frencken JE, van Palenstein Helderman WH, Holmgren CJ. The atraumatic restorative treatment (ART) approach for managing dental caries: a meta-analysis. Int Dent J. 2006;56(6):345–51.PubMedCrossRefGoogle Scholar
  13. 13.
    Dowling AH, Fleming GJ. Are encapsulated anterior glass-ionomer restoratives better than their hand-mixed equivalents? J Dent. 2009;37(2):133–40.PubMedCrossRefGoogle Scholar
  14. 14.
    Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, et al. Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev. 2013;(3):CD001830.Google Scholar
  15. 15.
    Yengopal V, Mickenautsch S, Bezerra AC, Leal SC. Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: a meta analysis. J Oral Sci. 2009;51(3):373–82.PubMedCrossRefGoogle Scholar
  16. 16.
    Beiruti N, Frencken JE, van’t Hof MA, Taifour D, van Palenstein Helderman WH. Caries-preventive effect of a one-time application of composite resin and glass ionomer sealants after 5 years. Caries Res. 2006;40(1):52–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Frencken JE, Holmgren CJ. Atraumatic restorative treatment for dental caries. Nijmegen: STI book b.v.; 1999.Google Scholar
  18. 18.
    Mickenautsch S, Yengopal V. Retention loss of resin based fissure sealants – a valid predictor for clinical outcome? Open Dent J. 2013;7:102–8.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Mickenautsch S, Yengopal V. Validity of sealant retention as surrogate for caries prevention – a systematic review. PLoS One. 2013;8(10):e77103.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Ngo H, Seow WK. Dental sealants. In: Limeback H, editor. Comprehensive preventive dentistry. Ames: Wiley-Blackwell; 2012. p. 292.Google Scholar
  21. 21.
    Antonson SA, Antonson DE, Brener S, Crutchfield J, Larumbe J, Michaud C, et al. Twenty-four month clinical evaluation of fissure sealants on partially erupted permanent first molars: glass ionomer versus resin-based sealant. J Am Dent Assoc. 2012;143(2):115–22.PubMedCrossRefGoogle Scholar
  22. 22.
    Taifour D, Frencken JE, van’t Hof MA, Beiruti N, Truin GJ. Effects of glass ionomer sealants in newly erupted first molars after 5 years: a pilot study. Community Dent Oral Epidemiol. 2003;31(4):314–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Frencken JE, Leal SC, Navarro MF. Twenty-five-year atraumatic restorative treatment (ART) approach: a comprehensive overview. Clin Oral Investig. 2012;16(5):1337–46.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Simonsen RJ. Glass ionomer as fissure sealant – a critical review. J Public Health Dent. 1996;56(3 Spec No):146–9; discussion 61–3.Google Scholar
  25. 25.
    Hilgert LA, Leal SC, Mulder J, Creugers NH, Frencken JE. Caries-preventive effect of supervised toothbrushing and sealants. J Dent Res. 2015;94(9):1218–24.PubMedCrossRefGoogle Scholar
  26. 26.
    Zhang W, Chen X, Fan MW, Mulder J, Huysmans MC, Frencken JE. Do light cured ART conventional high-viscosity glass-ionomer sealants perform better than resin-composite sealants: a 4-year randomized clinical trial. Dent Mater. 2014;30(5):487–92.PubMedCrossRefGoogle Scholar
  27. 27.
    Liu BY, Xiao Y, Chu CH, Lo EC. Glass ionomer ART sealant and fluoride-releasing resin sealant in fissure caries prevention – results from a randomized clinical trial. BMC Oral Health. 2014;14:54.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Deery C. Strong evidence for the effectiveness of resin based sealants. Evid Based Dent. 2013;14(3):69–70.PubMedCrossRefGoogle Scholar
  29. 29.
    Mejàre I, Mjör IA. Glass ionomer and resin-based fissure sealants: a clinical study. Scand J Dent Res. 1990;98(4):345–50.PubMedGoogle Scholar
  30. 30.
    Torppa-Saarinen E, Seppä L. Short-term retention of glass-ionomer fissure sealants. Proc Finn Dent Soc. 1990;86(2):83–8.PubMedGoogle Scholar
  31. 31.
    Frencken JE, Wolke J. Clinical and SEM assessment of ART high-viscosity glass-ionomer sealants after 8–13 years in 4 teeth. J Dent. 2010;38(1):59–64.PubMedCrossRefGoogle Scholar
  32. 32.
    Smith NK, Morris KT, Wells M, Tantbirojn D, Versluis A. Rationale for caries inhibition of debonded glass ionomer sealants: an in vitro study. Pediatr Dent. 2014;36(7):464–7.PubMedGoogle Scholar
  33. 33.
    Kidd EA. How ‘clean’ must a cavity be before restoration? Caries Res. 2004;38(3):305–13.PubMedCrossRefGoogle Scholar
  34. 34.
    Griffin SO, Oong E, Kohn W, Vidakovic B, Gooch BF, Bader J, et al. The effectiveness of sealants in managing caries lesions. J Dent Res. 2008;87(2):169–74.PubMedCrossRefGoogle Scholar
  35. 35.
    Oong EM, Griffin SO, Kohn WG, Gooch BF, Caufield PW. The effect of dental sealants on bacteria levels in caries lesions: a review of the evidence. J Am Dent Assoc. 2008;139(3):271–8; quiz 357–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Mertz-Fairhurst EJ, Schuster GS, Fairhurst CW. Arresting caries by sealants: results of a clinical study. J Am Dent Assoc. 1986;112(2):194–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Frencken JE, Makoni F, Sithole WD, Hackenitz E. Three-year survival of one-surface ART restorations and glass-ionomer sealants in a school oral health programme in Zimbabwe. Caries Res. 1998;32(2):119–26.PubMedCrossRefGoogle Scholar
  38. 38.
    Holmgren C, Gaucher C, Decerle N, Doméjean S. Minimal intervention dentistry II: part 3. Management of non-cavitated (initial) occlusal caries lesions – non-invasive approaches through remineralisation and therapeutic sealants. Br Dent J. 2014;216(5):237–43.PubMedCrossRefGoogle Scholar
  39. 39.
    Mertz-Fairhurst EJ, Curtis JW, Ergle JW, Rueggeberg FA, Adair SM. Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc. 1998;129(1):55–66.PubMedCrossRefGoogle Scholar
  40. 40.
    Hesse D, Bonifácio CC, Mendes FM, Braga MM, Imparato JC, Raggio DP. Sealing versus partial caries removal in primary molars: a randomized clinical trial. BMC Oral Health. 2014;14:58.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Bakhshandeh A, Qvist V, Ekstrand KR. Sealing occlusal caries lesions in adults referred for restorative treatment: 2–3 years of follow-up. Clin Oral Investig. 2012;16(2):521–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Hevinga MA, Opdam NJ, Frencken JE, Bronkhorst EM, Truin GJ. Can caries fissures be sealed as adequately as sound fissures? J Dent Res. 2008;87(5):495–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Fleisch AF, Sheffield PE, Chinn C, Edelstein BL, Landrigan PJ. Bisphenol A and related compounds in dental materials. Pediatrics. 2010;126(4):760–8.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Kingman A, Hyman J, Masten SA, Jayaram B, Smith C, Eichmiller F, et al. Bisphenol A and other compounds in human saliva and urine associated with the placement of composite restorations. J Am Dent Assoc. 2012;143(12):1292–302.PubMedCrossRefGoogle Scholar
  45. 45.
    Ak AT, Alpoz AR, Bayraktar O, Ertugrul F. Monomer release from resin based dental materials cured with LED and halogen lights. Eur J Dent. 2010;4(1):34–40.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Eng DS, Lee JM, Gebremariam A, Meeker JD, Peterson K, Padmanabhan V. Bisphenol A and chronic disease risk factors in US children. Pediatrics. 2013;132(3):e637–45.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Jedeon K, De la Dure-Molla M, Brookes SJ, Loiodice S, Marciano C, Kirkham J, et al. Enamel defects reflect perinatal exposure to bisphenol A. Am J Pathol. 2013;183(1):108–18.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Yeo M, Berglund K, Hanna M, Guo JU, Kittur J, Torres MD, et al. Bisphenol A delays the perinatal chloride shift in cortical neurons by epigenetic effects on the Kcc2 promoter. Proc Natl Acad Sci U S A. 2013;110(11):4315–20.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    FDI World Dental Federation. FDI policy statement on bisphenol-A in dental restorative and preventive materials. Adopted by the FDI General Assembly: 30 August 2013 – Istanbul, Turkey. Int Dent J. 2013;63(6):284.Google Scholar
  50. 50.
    Barja-Fidalgo F, Maroun S, de Oliveira BH. Effectiveness of a glass ionomer cement used as a pit and fissure sealant in recently erupted permanent first molars. J Dent Child (Chic). 2009;76(1):34–40.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Oral Function and Prosthetic DentistryRadboud University Medical CentreNijmegenThe Netherlands

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