Ammann 2013.

Study characteristics
Methods	Design: parallel‐group RCT Recruitment period: not stated Administration setting: private dental clinic Country: Germany Funding source: Dentsply DeTrey, Konstanz, Germany
Participants	Number of participants randomised: 72 (rubber dam: 34; cotton rolls: 38) Randomisation unit: participant Age: 5.9 to 16.9 years, mean age 11.1 years Sex: 23 boys, 49 girls Inclusion criteria: aged 6 to 16 years given indication for fissure sealing Exclusion criteria: participation in other studies evaluating parameters of stress not totally erupted teeth to seal lack of compliance no agreement from the guardians presence of fixed orthodontic appliances signs of opacity and brown discolouration of the tooth to be sealed psychotropic medication or cardiovascular drugs already sealed teeth present disease (cold) allergic reactions to used materials Number of participants evaluated: 72 (rubber dam: 34; cotton rolls: 38) Withdrawals/loss to follow‐up: no withdrawals
Interventions	Number of groups: 2 Intervention: rubber dam: "A suitable rubber dam clamp (Ivoryò; Sigma Dental Systems, Handewitt, Germany) was selected and applied. Afterwards, the rubber dam was placed over the clamp. Several teeth were included in the rubber dam in cases involving premolars, whereas for molars only the treated tooth was isolated" Control: cotton rolls: "The cotton rolls were positioned on the buccal and lingual region of the tooth to be sealed and were fixed by the operator's index finger and middle finger. Additionally, a saliva ejector was placed on the lingual side" Restorative treatment: pit and fissure sealants on premolars/molars
Outcomes	Outcomes: treatment time Time points: immediately after restorative procedure
Notes	Adverse events: not stated No details on sample size or power calculation were provided
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "72 subjects successfully took part in the study and were divided into two parallel groups by a dental assistant by drawing sealed lots (test n = 34; control n = 38)" Comment: method stated and appropriate
Allocation concealment (selection bias)	Unclear risk	Not stated Comment: insufficient information reported to make a judgement
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: the operators and the participants could not be blinded
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated Comment: insufficient information reported to make a judgement
Incomplete outcome data (attrition bias) All outcomes	Low risk	No withdrawals
Selective reporting (reporting bias)	High risk	Quote: "The time needed to finish the fissure sealing treatment was 12.4% (108 s [seconds]) less when using rubber dam (P < 0.05)" Comment: insufficient information reported to use the data in the analysis
Other bias	Low risk	Comparable groups at baseline (age, gender, type of teeth treated)