What is the clinical effectiveness of pit and fissure sealants on ICDAS 3 and 4 lesions in adults in inhibiting long-term caries lesions?

Study setting(s) - Dental Clinic of the Institute of Health Sciences of the Autonomous University of the State of Hidalgo

Recruitment - Clinical and radiographic examination of the patient to verify caries lesions in the first or second permanent molars with ICDAS codes 3 and 4. Each patient will be informed of their participation and will be provided with a written brochure detailing the steps to follow and the reasons for discontinuing participation. A specially designed clinical history will then be taken to record personal and demographic data, as well as the patient's clinical history. A diagnosis of dental caries severity will be made based on the International Caries Detection and Diagnosis System (ICDAS). Explain the treatment application method and its benefits. Obtain patient agreement and sign the informed consent form Request follow-up sessions after 6, 12, 18, 24, 30, and 36 months for follow-up

Participation Record Each patient will be informed of their participation and will be provided with a written brochure detailing the steps to follow and the reasons for discontinuing participation. A specially designed clinical history will then be taken to record personal and demographic data, as well as the patient's clinical history. A diagnosis of dental caries severity will be made based on the International Caries Detection and Diagnosis System (ICDAS), and sealants will be placed.

Medical History The medical history is divided into four sections to obtain important patient information. 1. Identification form. This form collects the patient's personal and demographic information. Name, address and phone number, sex, date of birth, and age (Document 1. Medical History, Appendix section). 2. General medical information. This form collects a history of medical conditions, taking into account central nervous system diseases, endocrine diseases, cardiac diseases, genitourinary system diseases, infectious diseases, allergies, surgical procedures, drug treatment, previous trauma, and toxic habits (alcohol, tobacco, and drugs) (Document 1. Medical History, Appendix section), as these may determine exclusion criteria for participation in the study. 3. Dental information. An assessment of dental caries risk factors is performed, including dietary and hygiene habits, previous treatments, dental and gingival pathology, and perception of saliva quantity as well as a socioeconomic assessment to determine the patient's caries risk assessing factors that could influence the follow-up and success of sealants. 4. Clinical evaluation. An odontogram is completed to diagnose teeth with caries lesions and their severity. The dental organs with restorations and those missing are also recorded

Intervention

Sealant Application 1. Complete isolation will be performed with a rubber dam and atraumatic clamp (Soft Clamp, Kerr) for both molars to be treated. Prophylaxis will be performed on the occlusal surfaces of the molars with in two groups of patients with ICDAS 3 and 4 lesions using a low-speed handpiece with a prophylaxis brush and water, and then dried with oil-free air. 2. As a next step, the occlusal enamel will be etched with 37% orthophosphoric acid (Total Etch Ivoclar Vivadent) for 15 seconds, then rinsed with water for 30 seconds and dried with oil-free air for 10 seconds. 3. A resin-based SFF (Equia Forte Coat) will be placed and polymerized with a light-curing lamp for 20 seconds, 0.5 cm away from the tooth. 5. If any porosity is detected, additional material will be applied. 6. Postoperative instructions and dental recommendations regarding hygiene and nutrition will be provided. 7. Treatments will be performed by a single operator.

1. Same intervention will be performed on 30 patients diagnosed with ICDAS 3 and 30 patients diagnosed with ICDAS 4

Finally, they will be given a card recording your six-monthly attendance, as well as the results of the measurements taken on the day of your appointment.

1. Systemically healthy adult male or female, aged 18 to 25 years.

2. Presence of first and/or second permanent molars with ICDAS 3 and 4 caries lesions.

The exclusion criteria will be as follows:

1. Patients with molars that receive excessive or no load due to malocclusion.

2. Patients undergoing orthodontic treatment.

3. Patients with enamel defects (hypoplasia, fluorosis, hypocalcification).

4. Patients with periodontal disease.

5. Patients on medication (antihistamines, antidepressants, anxiolytics, and sedatives).

6. Presence of symptoms of pulp disease in first and second molars.