Complete clinical retention of sealant materials should not be contemplated as cut-off for clinical success

Valid surrogate endpoints that are clinically meaningful require compliance with the Prentice criterion: (i) the surrogate needs to correlate with its true clinical endpoint and (ii) the surrogate/clinical endpoint correlation needs to be independent from the treatment type applied. This means that for sealant retention to be a valid surrogate for caries prevention the material retention-loss risk should be directly associated with the caries risk and that such association holds true regardless whether the sealant was placed e.g. with composite resin or glass-ionomer. Our findings show a direct association for resin (but with only a low adjusted R2 = 0.28) but not for glass-ionomer sealants and that the ratio of retention-loss risk to the risk of caries on sealed tooth surfaces was not sealant material independent.