The Research Behind Embrace WetBond Pit & Fissure Sealant

Disclosure: This article is sponsored content from Pulpdent as part of our sponsored partner program.

Dental caries remains one of the most prevalent chronic diseases in both children and adults, affecting 97% of the population worldwide.^1,2 Caries rates have declined since the 1970s in the United States, but disparities remain among some population groups:^3-6

• 23% of children aged two to five years have had dental caries in their primary teeth, with 10% going untreated.³
• 57 % of adolescents aged 12 to 19 years have had dental caries in their permanent teeth, with 17% going untreated.⁴
• Nearly 90% of adults aged 20 to 64 have had dental caries in their permanent teeth, with 25% (one in four adults) going untreated.⁵
• 96% of adults 65 or older have had dental caries in their permanent teeth, with nearly 17% (one in six older adults) going untreated.⁶

These numbers significantly increase for those with low income and in certain population groups.^3-6

Though the caries disease process is multifactorial, it is largely preventable. With the invention of pit and fissure sealant over six decades ago, dental clinicians have a powerful tool to significantly reduce the incidence of caries, not only in children but also in adults.²

However, pit and fissure sealants remain vastly underutilized.⁷ Research has shown that the leading reason for sealant underutilization is the difficulty of placement due to challenges in achieving a dry field. Bisphenol A-glycidyl methacrylate (Bis-GMA) or bisphenol-A (BPA), which is contained in many sealant materials, is hydrophobic and makes these sealants intolerant to moisture. If a dry field is not achieved prior to sealant placement, moisture negatively affects sealant retention and increases failure rates. This leads to drawbacks and limitations in clinical use.^8-11

To overcome the challenges that may lead to the underutilization of sealants, using hydrophilic sealant materials that can be placed in a wet field while maintaining their physical properties can provide the potential to improve patient outcomes in the prevention of dental caries.¹¹

Despite their underutilization, sealants are efficacious in preventing dental caries.¹²

A Snapshot of Sealant Efficacy

The American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry (AAPD) issued clinical practice guidelines based on a systematic review of the literature to establish recommendations regarding the use of sealants.¹²

The ADA/AAPD guideline panel’s findings from nine randomized controlled trials showed a 76% caries reduction after two to three years in permanent molars with the use of pit-and-fissure sealants in children and adolescents with sound occlusal surfaces compared with the nonuse of sealants. Data from three randomized controlled trials found a 73% caries reduction with the use of sealants compared with fluoride varnish treatment in children and adolescents in permanent teeth with sound occlusal surfaces after two to three years of follow-up.¹²

The guideline panel recommends the use of sealants as an effective way to prevent dental caries in primary and permanent occlusal surfaces in children and adolescents. Additionally, the guideline panel recommends sealants as a secondary prevention approach to inhibit the progression of noncavitated (incipient) occlusal lesions.^2,12

The guideline panel’s systematic review did not include studies on adults; however, they suggest that this recommendation can be extended to adults.¹²

Factors to Consider When Choosing a Sealant Material

The ADA/AAPD guideline panel does not provide specific recommendations on one type of sealant material over the other. However, the panel does suggest that clinicians should consider factors such as the likelihood of experiencing a lack of retention based on patient factors and the clinical scenario. For example, if it is difficult to keep a dry field when placing a sealant, the panel suggests a hydrophilic material that can be placed in a wet field.^2,12

Other factors for clinicians to consider when choosing sealant material include ease of placement, retention rate, marginal integrity, and whether the material is fluoride-releasing. Because dentistry is an evidence-based profession, research showing efficacy on these factors should be considered when choosing a sealant material.

A Look at Embrace WetBond Pit & Fissure Sealant Material

Embrace WetBond Pit & Fissure Sealant is a moisture-tolerant, ionic resin-based material. Embrace WetBond’s hydrophilic resin chemistry does not contain moisture-sensitive materials, such as BisGMA or BPA. This allows it to micromechanically and chemically bond to a relatively wet surface with smooth margins and a superior marginal seal without compromising retention and tooth integration.^8,13

Embrace WetBond is not only moisture-tolerant it is also activated in the presence of a small amount of moisture due to the incorporation of multifunctional acrylate monomers into advanced acid-integrating chemistry.¹⁴ In other words, WetBond technology allows the sealant to bond to a moist tooth and is activated this way, so there’s no need to keep a completely dry field, and no bonding agents are required.^8,14 Although Embrace WetBond can be placed on a dry tooth, it integrates even better if the tooth is slightly moist.⁹

Embrace WetBond Pit & Fissure Sealant has been well-researched, including the efficacy of its marginal integrity, durability, retention rate, and bond strength.*

*None of the following referenced studies were financially supported by Pulpdent, and none reported any conflict of interest.  

Marginal Integrity

Discoloration at a restoration’s margin is due to marginal breakdown, which may cause the penetration of biofilm and oral fluids, leading to microleakage and secondary caries.⁸ With less microleakage, a sealant can be retained longer while having a cariostatic effect.¹⁰ This makes marginal integrity one of the main factors in determining the longevity and efficacy of a sealant material.⁸

A study by Beheta and colleagues revealed that after 12 months, Embrace WetBond exhibited the least marginal discoloration, with 93.3% of the sealant surfaces remaining intact and nondiscolored compared to two other sealant materials. The other two sealant materials showed 80% and 76.7% of nondiscolored surfaces in this study.⁸

The authors attributed the lack of marginal discoloration in comparison to the other sealant materials to the greater water sorption of the hydrophilic compound hydroxyethyl methacrylate found in Embrace WetBond, which enables better bonding to the tooth structure in the presence of moisture.⁸

The formation of marginal and microgaps can also decrease marginal integrity. Marginal and microgaps are caused by the diverse thermal expansion of resin material and tooth structures. The oral cavity is frequently exposed to heat and pH changes, which result in thermal stress and microleakage. This makes the efficacy of a sealant material’s marginal sealing ability clinically relevant.¹⁰

Research by Joshi and colleagues looked at two sealant materials’ marginal sealing abilities by assessing microleakage at the interface between the tooth substance and the sealant. It was found that Embrace WetBond had the least microleakage compared to the other sealant material assessed.¹⁰

Durability

As time progresses, sealant material can begin deteriorating due to masticatory forces. Beheti and colleagues revealed that Embrace WetBond showed less overall wear and deterioration compared to two other sealant materials.⁸

This was attributed to Embrace WetBond’s low viscosity due to less filler material, making it more penetrable into pit and fissure areas compared to bis-GMA-containing sealants. This finding was also attributed to greater tensile strength compared to other resin materials, along with the formation of longer resin tags and good marginal adaptation.⁸

Retention and Bond Strength

The primary measure of efficacy for sealants is retention, as their caries prevention abilities lie in their ability to form a barrier that prevents nutrients in the oral cavity from reaching the microorganisms present in fissures of occlusal surfaces.¹⁴ Compared to smooth surfaces, occlusal surfaces are eight times more susceptible to caries.⁸ In children, occlusal caries risk is increased in the first four years following tooth eruption, and 88% of carious lesions are in pits and fissures.^8,14 If a sealant remains bonded to a tooth and offers a good seal, then the occurrence of caries is expected to decrease.¹⁴

Beheta and colleagues found that Embrace WetBond “demonstrated the utmost retention” after 12 months compared with two other sealant materials. Embrace WetBond’s retention rate remained 100% when evaluated two, four, six, eight, and 10 months after placement. At month 12, one sealant was not retained, leading to Embrace WetBond showing a 96.7% retention rate. The other two sealant materials demonstrated a loss of sealants by month four, with a total retention rate of 76.7% and 80% at month 12.⁸

It should be noted that in the aforementioned study, teeth were not etched as the manufacturer recommends, and a bonding agent was not used before sealants were placed using Embrace WetBond. However, etching and a bonding agent were used for the two other sealant materials. Yet, Embrace WetBond still showed the highest retention rate.⁸

A study by Alsabek and colleagues analyzed the retention rates of Embrace WetBond compared to a glass ionomer sealant material at three and six months. After three months, Embrace WetBond showed 95% full retention with no sealant suffering a total loss. Meanwhile, the glass ionomer sealant material showed 87.5% full retention, including 7.5% total loss.¹¹

After six months, Embrace WetBond showed 85% full retention, with a partial loss of 5% and a total loss of 10%. In contrast, the glass ionomer material showed 62.5% full retention, with a partial loss of 17.5% and a total loss of 20%. The authors concluded that Embrace WetBond showed superiority in retention over the glass ionomer sealant.¹¹

Other Sealant Material Considerations

Beyond marginal integrity, durability, retention, and bond strength, additional considerations when choosing a sealant material include ease of placement and added benefits such as fluoride-releasing abilities.

Ease of Placement

Moisture contamination is a significant factor in decreased sealant retention and loss when using sealant materials containing hydrophobic Bis-GMA or BPA.^8,9,13,14 Salivary or moisture contamination affects retention by changing surface characteristics because of organic adherent films covering the etched surface and the inhibition of close contact of the sealant material to the tooth surface.⁹

Though necessary with certain sealant materials, maintaining a dry field while placing sealants can be challenging. Ease of placement is greatly increased if a sealant material is moisture-tolerant and, at the same time, shows clinical efficacy.

Being less technically sensitive compared to materials that require a dry field during placement can be especially helpful when isolation is difficult to achieve. Resin-based sealant materials that are moisture-tolerant are “highly beneficial in treating children because it is often difficult to maintain a dry field, and the fact that the material works well in a slightly moist field is a great benefit to the practitioner. The ability to bond in the presence of moisture simplifies the sealant procedure and makes it less technique-sensitive.”¹³

Additionally, ease of placement extends to patients with disabilities, semi-erupted molars, or those who are less than cooperative. In these cases, Beheti and colleagues conclude, “Embrace is the sealant of choice.”⁸

Fluoride Releasing

The fluoride-releasing nature and benefits of a sealant material come from its ability to provide ion transfer, making the material dynamic, not passive, in the oral environment.¹¹ Generally, glass ionomers are known for their fluoride-releasing abilities. However, glass ionomers have drawbacks, such as their limited survival rate due to their hydrophobic characteristics and low wear resistance to occlusal forces.^11,13

In contrast, Embrace WetBond is a material that provides ion transfer and releases fluoride while maintaining the beneficial physical properties that come with being resin-based. Together, the properties of a resin-based material that is fluoride-releasing offer the potential to improve patient outcomes through remineralization support, higher retention rates, and effective sealant results.¹¹

Embrace WetBond has been shown to possess the same remineralization effect as a glass ionomer. Alsabek and colleagues found when placed on incipient occlusal carious lesions, then removed and assessed after six months, Embrace WetBond and a glass ionomer showed no significant difference in remineralization.¹¹

The study determined that “occlusal caries lesions, which are restrictive to enamel and in need of surgical intervention, can be arrested clinically by sealing the lesion with both a hydrophilic resin sealant and glass ionomer sealant materials.”¹¹

In Closing

Dental clinicians have many choices when it comes to which sealant material to use. Factors to consider when choosing a sealant material include marginal integrity, durability, retention rate, and bond strength. Ease of placement is another consideration, especially if keeping a dry field is difficult, as a lack of retention may occur when using a hydrophobic, non-moisture-tolerant material.^8,9,13,14 Fluoride-releasing ability is also an added benefit of a sealant material, as remineralization support may improve patient outcomes.¹¹

Evidence-based research can help weigh the efficacy of factors to consider when choosing a sealant material. Studies have shown that Embrace WetBond exhibits higher retention rates and greater bond strength, marginal integrity, tensile strength, and durability compared to other sealant materials.^8,10-12,14 Its moisture-tolerant nature also makes it less technically sensitive to place.^8,13 Further, it’s been concluded that Embrace WetBond supports remineralization as well as a glass ionomer.¹¹

Despite dental caries remaining one of the most prevalent chronic diseases, preventive measures can be taken, including the placement of pit and fissure sealants. Though underutilized, sealants are effective in reducing the incidence of caries. Additionally, sealants are an effective method of non-invasively arresting incipient lesions.¹²

To connect with a Pulpdent area representative for an Embrace WetBond Pit & Fissure Sealant sample or virtual/in-person demonstration, visit: https://www.pulpdent.com/embrace-info/

References

1. Dental Caries (Tooth Decay). (2022, November). NIH: National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/research/data-statistics/dental-caries
2. Caries Risk Assessment and Management. (2023, July 18). American Dental Association. https://www.ada.org/resources/ada-library/oral-health-topics/caries-risk-assessment-and-management
3. Dental Caries (Tooth Decay) in Children Ages 2 to 11 Years. (2022, November). NIH: National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/research/data-statistics/dental-caries/children
4. Dental Caries (Tooth Decay) in Adolescents (Ages 12 to 19 Years). (2022, November). NIH: National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/research/data-statistics/dental-caries/adolescents
5. Dental Caries (Tooth Decay) in Adults (Ages 20 to 64 Years). (2022, November). NIH: National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/research/data-statistics/dental-caries/adults
6. Dental Caries (Tooth Decay) in Seniors (Aged 65 and Older). (2022, November). NIH: National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/research/data-statistics/dental-caries/seniors
7. Dental Sealants Facts. (2024, May 15). Centers for Disease Control and Prevention. https://www.cdc.gov/oral-health/data-research/facts-stats/fast-facts-dental-sealants.html
8. Baheti, A.S., Bhayya, D.P., Gupta, S., et al. Assessment of Clinical Success of Three Sealants: Embrace-Wetbond, Clinpro, and Helioseal-F in Permanent Molars: An In Vivo Study. Journal of South Asian Association of Pediatric Dentistry. 2020; 3(1): 7-13. https://www.jsaapd.com/doi/JSAAPD/pdf/10.5005/jp-journals-10077-3035
9. Panigrahi, A., Srilatha, K.T., Panigrahi, R.G., et al. Microtensile Bond Strength of Embrace Wetbond Hydrophilic Sealant in Different Moisture Contamination: An In-Vitro Study. Journal of Clinical and Diagnostic Research. 2015; 9(7): ZC23-ZC25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573031/
10. Joshi, K.H., Avula, S.K., Sahu, D., et al. Assessment of Embrace-WetBond and Fissurit F Pit and Fissure Sealants’ Marginal Sealing Abilities. Journal of Pharmacy and Bioallied Sciences. 2023; 15(Suppl 2): S1227-S1229. https://doi.org/10.4103/jpbs.jpbs_152_23
11. Alsabek, L., Al-Nerabieah, Z., Bshara, N., Comisi, J.C. Retention and Remineralization Effect of Moisture Tolerant Resin-Based Sealant and Glass Ionomer Sealant on Non-Cavitated Pit and Fissure Caries: Randomized Controlled Clinical Trial. Journal of Dentistry. 2019; 86: 69-74. https://doi.org/10.1016/j.jdent.2019.05.027
12. Wright, J.T., Crall, J.J., Fontana, M., et al. Evidence-Based Clinical Practice Guideline for the Use of Pit-and-Fissure Sealants: A Report of the American Dental Association and American Academy of Pediatric Dentistry. Journal of the American Dental Association. 2016; 147(8): 672-682.e12. https://jada.ada.org/article/S0002-8177(16)30473-1/fulltext
13. Bhat, P.K., Konde, S., Raj, S.N., Kumar, N.C. Moisture-Tolerant Resin-Based Sealant: A Boon. Contemporary Clinical Dentistry. 2013; 4(3): 343-348. https://doi.org/10.4103/0976-237X.118394
14. Priscilla, S., Gs, P. Mohandoss, S. Kavitha, M. Moisture Tolerant Pit and Fissure Sealant: A Literature Review. International Journal of Pediatric Dentistry. 2022; 15(2): 233-239. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10338934/