Improved sealant retention with bonding agents: A clinical study of two-bottle and single-bottle systems

Recent in vitro work and a short clinical study suggest that adding a bondi ng agent layer between sealant and saliva-contaminated enamel allows for ad equate bond strength and retention of resin sealants and may improve succes s of all sealant applications. This five-year clinical study scored 617 occ lusal and 441 buccal/lingual molar sealants, with use of a split-mouth desi gn, with half receiving sealant alone and half bonding agent plus sealant. Treatment effects and potential risk factors for sealant failure were teste d by means of a Cox regression model. Three bonding agent groups were analy zed for treatment effect: Tenure primer, Scotchbond Multi-Purpose, and 3 si ngle-bottle dentin bonding agents as a third group. The single-bottle group was successful in reducing risk of sealant failure, with a hazard ratio (H R) of 0.53 (p = 0.014) for occlusal and 0.35 (p = 0.006) for buccal/lingual sealants. Scotchbond was detrimental to occlusal sealant success, with a H R of 2.96 (p = 0.0003). Tenure primer was neutral, showing HRs close to 1.0 . Variables that affected success differed between occlusal and buccal/ling ual sealants, suggesting that failures oc these two surfaces may be depende nt upon differing factors. Early eruption stage was a significant risk fact or for both sm-fazes (HR = 2.91, p = 0.00001, occlusal; and HR = 1.52, p = 0.015, buccal/lingual). Behavior (HR = 1.96, p = 0.0007), salivary problems (HR = 1.73, p = 0.002), and visually apparent variations in enamel (HR = 1 .51, p = 0.018) were significant risk factors for occlusal sealants only. I n addition to completing detailed analyses of risk factors for sealant surv ival, this study shows that single-bottle bonding agents protect sealant su rvival, yielding half the usual risk of failure for occlusal sealants and o ne-third the risk of failure for buccal/lingual sealants.