Transcript Pit and Fissure Sealants

Pit and Fissure Sealants
Pit and Fissure
Sealants in Preventive
Dentistry
Pit and Fissure Sealants
The focus of this presentation is on the role
that dental sealants play in preventive
dentistry, and two types of placement
techniques: the traditional method and
a “no-rinse” technique.
Pit and Fissure Sealants
Role of dental sealants in preventive
dentistry:
Used in combination with patient education,
effective personal oral hygiene, and the use of
fluorides, sealants are major factors in the
prevention of dental caries.
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Dental Sealants
 Sealants are “plastic coverings” for pits and fissures in
teeth that provide mechanical barrier against cariogenic
bacteria
 The procedure is esthetic, non-invasive, and costeffective for dental patients
 Sealants are applied by dental professionals, including:
 Dentists
 Registered Dental Hygienists
 Registered Dental Assistants
with Certification
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How to determine who should have a dental
sealant placed:
 Assess the caries risk of the patient and their individual
teeth
 Caries risk factors include:
 Accumulations of plaque
 Cariogenic diet
 History of caries in the patient or the patient’s family
 Low fluoride intake
 Pit and fissure anatomy
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Other Considerations:
 Teeth can be sealed if pits and fissures are caries free
 Teeth with deep grooves and pits will benefit from
sealants being placed as soon as possible after eruption
 If interproximal caries are present via radiographs
a sealant should not be placed
 Frank pit or fissure caries should not be sealed
Pit and Fissure Sealants
Situations where sealants would not be
recommended:
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Inability to isolate and maintain a dry field
Primary teeth close to exfoliation
Presence of decay
Any known allergies to the sealant material
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Glass ionomer vs.resin-based sealants:
 Fluoride releasing glass ionomer sealants are a
good choice for teeth that are:
 Partially erupted
 Difficult to isolate
 Glass ionomer sealants are moisture tolerant
 Excellent as a transitional sealant
Pit and Fissure Sealants
Glass ionomer vs. resin-based sealants
(cont.)
 Once the tooth is totally erupted, a resin-based
sealant should be placed
 Resin-based sealants provide higher bond
strengths and longer retention than glass ionomer
sealants
Pit and Fissure Sealants
Are sealants recommended for both children
and adults?
Susceptibility to decay can exist in any tooth with pits
and fissures
This includes the primary teeth of children, and the permanent
teeth of children and adults
The caries risk status of an individual can change over
a period of time during both adolescence and
adulthood
Therefore - sealants really aren’t “just for kids”.
Pit and Fissure Sealants
Long-term Success of Sealant Therapy
 Dependent on vigilant recall and repair if necessary
 Even partial loss of a sealant can lead to a surface
with a risk for caries similar to one never sealed
 Studies that incorporated routine recall and
maintenance report >80% success after a decade or
more
Pit and Fissure Sealants
Sealant Placement Techniques
Using a Resin-Based Material
 Traditional Technique
 “No-rinse” Technique
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Traditional Sealant Placement Procedure
Pit and Fissure Sealants
Select teeth to be sealed and isolate
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Clean the tooth surfaces with an air polisher or prophy
paste using a rubber prophy cup or brush
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Enamel cleaned of debris
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Etch the enamel (minimum of 15 seconds).
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Rinse and dry etched enamel
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Gently rinse etchant and look for a frosty white
appearance
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Apply sealant material
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Light cure for time period recommended via product
instructions. Colored sealant material turns from pink
to tooth colored after light-curing.
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Check sealant coverage using articulating paper.
Arrows indicate the points of contact.
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No-Rinse Sealant Placement Technique
Pit and Fissure Sealants
“No-Rinse” Sealant Placement
Technique:
3M ESPE Adper Prompt Self-Etch Adhesive and
3M ESPE Clinpro Sealant:
This technique uses a self-etching dental adhesive
to bond the sealant to the tooth
Pit and Fissure Sealants
Adper Prompt Self-Etch Adhesive
Indications For Use:
• Bonding light-cured composite
and compomer materials to
dentin and enamel
• Desensitization of exposed root
surfaces
• Bonding of light-cure resin
based pit and fissure sealants
Unidose L-Pop
delivery system
Two-vial delivery system
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Self-etch Adhesive Clinical Technique
 Thoroughly clean the teeth to remove plaque and debris
from the enamel surfaces and fissures
 Do not use any cleaning medium that may contain
fluoride or oils as it may affect the adhesion value
 Rinse thoroughly with water and dry
 Isolate the tooth (e.g. with cotton rolls, rubber dam)
 Dry the surface to be sealed
 Activate the L-Pop
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Self-Etch Adhesive: L-Pop Activation
 Squeeze the material from the red reservoir into the yellow
(middle) reservoir
 The middle reservoir will expand indicating proper transfer of
fluid
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 Fold back the red reservoir until it meets the flat face
of the yellow reservoir
 Keep the red reservoir tightly squeezed while bending the
package to prevent the material from flowing back
 Squeeze the liquid from the yellow reservoir into the blue
reservoir
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 Apply a churning or spinning motion to the applicator for five
seconds to mix the adhesive and fully coat the applicator tip
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A lightly yellow-tinted applicator tip indicates proper
activation. If a yellow color is not obtained unfold the
L-Pop, reactivate, and apply a spinning motion to the
applicator for 5 seconds to mix the adhesive.
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Adper Prompt Self-Etch Adhesive
Clear tip
indicates
improper
activation
Tip must be
yellow
indicating
proper
activation
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• Apply adhesive onto the surface to be sealed; scrub for 15 second
applying moderate finger pressure. Do not shorten this time.
• Proper bonding will not occur if the solution is simply applied and
dispersed.
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 Use a gentle stream of air to
thoroughly dry the adhesive to
a thin film (approximately 10
seconds)
 If the stream of air is too
forceful, the adhesive will be
blown off the tooth
 The surface will appear
glossy, but not moist
 The tooth surface will not
appear frosty as in the
“traditional” technique
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Apply a light-cured sealant
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Light-cure the sealant and adhesive together with a halogen,
LED or plasma light for the amount of time specified to cure the
sealant
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Check sealant coverage, occlusion, and wipe the surface
of the sealant material clean using a wet cotton-tipped
applicator; this removes the “smear” layer or tackiness of
the material used.
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Adper Prompt Self-Etch Adhesive and Clinpro
Sealant - Key Technique Tips:
 Activated L-Pop must be a deep golden yellow
 The L-Pop can be activated up to 10 minutes before the
procedure
 Saves time to activate before bringing patient back to
operatory
 Adhesive must be scrubbed on the surface for a minimum of
15 seconds
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Key Technique Tips (continued)
 Gentle, but thorough, drying step is critical
• Purpose: evaporate the solvent (water)
• Dry an inch or so away from the tooth surface
• Adhesive will have a “waving” motion the first 10 seconds
of drying
• When “the wave” stops . . . water is evaporated
• Tooth will not have a “frosty” appearance
 Co-cure adhesive and sealant together for 20 seconds
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Benefits of Technique:
• No rinsing involved (means no bitter taste, which can increase
salivary flow and affect isolation)
• Adper Prompts are simple to use and will etch any uncut
enamel surface
• Sealant is actually being bonded to the tooth (same concept as
bonding a composite)
• Less micro-leakage compared to the traditional technique:
• Means less chance of recurrent decay/better retention
• Decreased challenge of patient management
• Saves time compared to the traditional technique
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Conclusions about the use of dental
sealants:
 One of the best preventive measures we can offer
patients
 Cost effective, simple and fast
 When properly placed and maintained:
 Sealants have proven longevity
 Will aid in the prevention of caries
 Patients appreciate the preventive efforts
Pit and Fissure Sealants
Acknowledgements:
The instructional staff wish to gratefully acknowledge the
following for their contributions to this project –
3M-ESPE
Vicki L. Svoboda – 3M Dental Division
Columbia Dentoform
The California Association of Dental Assisting Teachers, Inc.
© 3M-ESPE/CADAT 2010