Sealant Retention using Rubber Dam and Cotton Roll Isolation

Objectives: To evaluate the effectiveness of sealants placed with rubber dam and cotton roll isolation.

Method: Sealant retention in previously placed sealants in permanent first molars was evaluated in 503 children aged 6 to 8 years in 20 primary schools. These sealants in pit and fissure surfaces were placed using either rubber dam or cotton roll isolation. Sealants had been placed after cleaning with pumice and rubber cup and 20 second etching. Sealant retention was evaluated each year. Sealant retention was scored as complete retention, partial or complete loss of sealants. Restored and resealed teeth were also scored. Caries was scored in teeth in which the sealants were partially or completely lost.

Results: A total of 2538 sealants were applied, with 1752 sealants examined at the end of the fifth year. At the five-year examination, overall 58.3% sealants were completely retained, 7.4% partially lost and 34.3% completely lost, resealed or restored. Of those isolated with cotton roll 59.7% were completely retained, and with rubber dam 57.7% were completely retained. 12.2 % of tooth surfaces were carious, 11.3% with cotton roll isolation and 12.5% with rubber dam. Bivariate analysis showed no differences in sealant retention (p=0.44) and caries (p=0.49) between teeth isolated using rubber dam or cotton roll. Additionally, occlusal surfaces were 2.0 times more likely to retain a sealant than the buccal and palatal pits (p<0.0001), and maxillary teeth were 1.2 times more likely to retain their sealant than the mandibular teeth (p=0.10).

Conclusion: Isolation by cotton roll is just as effective as rubber dam for placing a sealant. Therefore a change in policy might be considered.