Transcript Pit and Fissure Sealants

Pit and Fissure Sealants
D Caroline Mohamed
Pit and fissure sealants

A thin plastic coating placed in the pit and
fissures of the teeth to act as a physical barrier
to decay
Why pit & fissure sealants needed

Bacteria produces acid
which causes decay
 “demineralization”
Pit and fissure sealants

Over 85% of children (5-17 years old) in US
have caries in the pits and fissures
 Fluoride is least effective on pit and fissures
 Only 18% of school-aged children in US have
sealants
Effectiveness of sealants

15 year study – 68%
of sealed teeth were
caries free vs 17% of
unsealed control
group
Other Preventive Programs





Community water
fluoridation
School water
fluoridation
Fluoridated toothpaste
Fluoride mouthrinse
In-office treatment


50-60% (18-40%)
40%
 15-30%
 31%
 26%
Preventive Programs as Related to
Sealants



Tooth brushing and flossing - mechanical
plaque removal
Fluoride – chemical prevention
Dental visits – mechanical plaque removal
and chemical prevention
Preventive Programs as Related to
Sealants - continued
Diet
 Minimize exposure to cariogenic foods and
liquids that have little or no nutritional
value
 Minimize solid and sticky foods
 Minimize slowly dissolving foods
History of Sealants




Acrylic polymers introduced to dentistry –
1937
Composites - 1960
“Occlusal Sealing” – 1965
Glass ionomers – 1972
Retention of Sealants – 4 year study
Fluoride releasing
sealant
 91% retention
(77% complete
& 14% partial)
 10% caries rate
Non-fluoride
releasing sealant
 95% retention
(89% complete &
6% partial)
 10% caries rate
Retention of Sealants – 2 year study
Fluoride releasing sealant
 >90% retention
 No caries
Sealant retention
Sealant Failure



Debris and/or saliva contamination
Air inclusion during manipulation – voids
Manipulating self-cured sealants late in the
setting reaction
Loss of Sealant

A contaminated site from faulty technique
will likely result in complete or partial loss
of the sealant within 6-12 months.
Cost Factors





Dental Sealants = $25 - $49 per tooth
Amalgam = $75 to $145 per filling
Composite = $150 to $200 for a single surface
white composite filling
Medical reimbursement
Insurance reimbursement
Preventive Resin Restoration

The preparation
of fissures by use
of air abrasion,
bur or laser
followed by
filling the prep
with a flowable
composite.
Incipient Caries


Studies have shown that sealants can be
placed over incipient caries which arrests
the caries process
Most dentists choose to use air abrasion, a
bur, or a laser to remove the caries before
the sealant is placed
Tooth morphology

Pits and fissures
Tooth morphology
Tooth morphology
Tooth morphology

Why fissures are
caries susceptible
Selection of teeth
Considerations
 Patient age
 Oral hygiene
 Caries risk
 Diet
 Fluoride history
 Tooth type
 Morphology
Selection of teeth - continued






Frequency of pit & fissure caries
Lower molars – 50%
Upper molars 35-40%
Upper and lower second premolars
Upper laterals and upper first premolars
Upper centrals and lower first premolars
Indications






Deep fissures
Incomplete or ill formed pits
Newly erupted teeth
High caries rate
Children
Molars
Contraindications






Shallow fissures
Well coalesced pits
Fluoride rich enamel
Low caries rate
Occlusal or proximal caries
Adults
Partially erupted teeth?

To seal or not
to seal?
 Operculum
(gum flap) –
leaks
crevicular
fluid
Sealant Kits

Cavity Indicators
 Drying and/or bonding agent (optional)
 Acid etch
 Sealant material
Acid Etch

Gel
 Liquid
 3M Innovation:
Adper™ Prompt™ LPop™ Self-Etch
Adhesive
Acid etch



Phosphoric acid 35%-40%-50%
Dissolves organic portion of
enamel
“micromechanical retention”
Acid etch - continued

Creates more
surface area for
better adhesion
 Also high
energy surface
Acid etch - Precautions

Avoid contact with
adjacent teeth or soft
tissues
 Can use mylar strips
or matrix bands
Acid etch –Precautions cont.





Active ingredient – phosphoric acid
Avoid contact with skin, eyes, and clothing.
If skin contact – flush with water
If eye contact – flush immediately with water
and seek medical attention
If ingestion- do not induce vomiting. Give
large amounts of water or milk. Take an
antacid. Call a physician.
Acid etch – storage and handling
protocol
Protection – protective eyewear, gloves and
clothing
 Toxicity – mild irritation for skin or ingestion
but damage to eye exposure if chronic
exposure.
 Storage - Store at room temperature.
 Handling – Use gloves, protective eyewear and
PPE.

Acid etch - continued
Will an etched tooth be
more prone to decay?
 Remineralization
begins after 24 hours
Drying agent (PrimaDry)

Acid etching and
Primadry (alcohol
based) allows enamel
to be easily “wetted”
PrimaDry – precautions
Active ingredient – ethyl alcohol
 If skin contact – wash with soap and water
 If eye contact – flush with lots of water
Ingestion- give large amounts of water or milk.

PrimaDry – storage and handling
protocol
Protection – protective eyewear, gloves and
clothing
 Toxicity – mild irritation for skin or ingestion
but severe irritation for eye exposure
 Storage - Store at room temperature. Keep out
of heat and/or direct sunlight.
 Handling – Use gloves and protective eyewear.

Sealant composition

A type of
specialized plastic
(resin) or glass
ionomer material
 Matrix
 Filler
Sealant Types
Resin Sealants
 (Bis-GMA) Bisphenol
A-glycidyl
methacrylate resins
 Urethane-based resin
Glass Ionomer Sealants
 Anticariogenic
 More viscous, less
retention, more brittle
and less resistant to
occlusal wear
Sealant Types

Filled sealants
 Unfilled sealants
Accepted Sealant Materials
ADA Council on Scientific Affairs












3M ESPE – Clinpro Sealant
Confi-Dental Products Company
Dental Technologies
Dentsply International - FluroShield
Ivoclar Vivadent, Inc. - Helioseal
Kuraray America Inc. – Teethmate F-1
PracticeWares Dental Supply
Pulpdent Corporation
Southern Dental Industries
Tru-Tain Prime Dental
Ultradent Products, Inc. - Ultraseal
Zenith/DMG Dental Manufacturing
Types of curing for sealants
Chemical cured – “autopolymerization”
 Base and catalyst
Monomer & Initiator + Diluted monomer & 5% Organic
Amine Accelerator = Sealant
Visible light cured – “photopolymerization”
 Pre-mixed
Dimethacrylate + Diluent + Activator + Light = Sealant
Chemical cure sealant materials
Advantages
 No cure light or risk of eye damage
 Can apply sealants to several teeth
Disadvantages
 Variation in setting time (appx 2 min)
 Voids from mixing material
 Changes in viscosity over time
Light cured sealant materials
Advantages
 Short setting time (appx 20 seconds)
 No mixing required
 Won’t set-up – longer working time
 Does not get thick
Disadvantages
 Potential eye damage due to light cure
 Additional cost of cure light
 Cure time increased with number of teeth sealed
 Difficult to manipulate cure light for posterior teeth
Sealant Shades

Clear
 Tinted
 Opaque
Clinpro™ Sealant goes
on pink for easy-to-see
application, and cures to
a natural white.
 low viscosity, fluoridereleasing sealant

Sealant Material – precautions
Active ingredient – Bis-GMA
 Skin contact – wash with soap and water
 Eye contact – flush with lots of water & call
physician if needed
 Ingestion- in large amounts induce vomiting

Sealant Material – storage and
handling protocol
Protection – protective eyewear, gloves and
clothing
 Toxicity – mild irritation for skin and eye. Low
possiblility of sensitization upon prolonged
exposure for the skin.
 Storage - Refrigerate when not in use.
 Handling – Use gloves, protective eyewear and
PPE.

Concepts of bonding



Mechanical bonding – interlocking
Chemical bonding – use of adhesive
Physical bonding – attraction of atomic
charges
Requirements for Adhesion





Clean surface
Good wetting by adhesive
Good adaptation to the substrate
Good interface
Good curing
Strength and Viscosity
Characteristics
Viscosity
 The thicker the sealant the
less likely to penetrate to
depth of fissure
Wear of Sealants
 Considerations for wear –
less filler, more wear and visa
versa
Curing units

Conventional cure light with halogen bulb =
20 seconds cure for each surface

Plasma arc or laser = 5-10 seconds
Assemble armamentarium
Assemble sealant kit

Check the operation of
the syringe on gauze
Armamentarium
Curing units

CAUTION – Avoid looking directly at the
light
Give patient instructions
Verbal instructions
 I will be placing a
dental sealant on your
teeth – it’s like a thin
plastic coating on top
of the tooth and will
help prevent cavities
 If you have any
problems then raise
your left hand
Give patient instructions
Verbal instructions
 This won’t hurt but
you will need to keep
open for a long time
and it doesn’t taste
very good.
Wear personal protective
equipment - operator





Gloves
Mask
Safety glasses/visor
Protective clothing
Closed toed shoes
Wear personal protective
equipment - patient

Safety glasses
 Pt. glasses should
be tinted when
using a curing light
(operator/assistant
should have tinted
glasses on shields)
Position patient
Mandibular
Maxillary
Check prescription and teeth

Occlusal surfaces
 Buccal and lingual pits
on first molars
 Lingual pits on upper
anterior teeth
Suspicious lesions?
Explorer – “a stick”
 Caries indicator dye
 DIAGNOdent

Prepare the tooth

Bristle brush or rubber
cup and plain pumice
 Dentist can use bur,
air abrasion or laser
 Sharp explorer to
clean out debris
 Rinse
Prepare the Tooth - continued

air abrasion, bur,
prophy jet or laser
Position the patient
Check occlusion

Avoid placing
acid etch and
sealant on
marked areas
from
articulator
paper
Isolate tooth/teeth
Treat quadrants
separately
 To control isolation
 To prevent
contamination by
moisture
Isolate tooth/teeth

Rubber dam
 Cotton rolls
 Cotton roll holders
 Dri-angle
Dry tooth
Test air/water syringe
before applying blast
of air
Apply acid etch





15-20 seconds
Use blue micro tip or
brush tip
Apply only in pit and
fissures
For liquid – dab but do
not rub
Re-etch 10 seconds if
saliva contamination
Apply acid etch - continued

3M Innovation:
Adper™
Prompt™ LPop™ Self-Etch
Adhesive
 Etch, prime and
bond
Apply acid etch

Etch pit and fissures
 Extend 1-2 mm beyond
pit and fissures
 Avoid cusp tips
Acid etch - continued
Etch longer
 Deciduous teeth
 Saliva contamination
 Air abrasion or prophy
jet used
 Highly mineralized
teeth
Do not use explorer
Rinse tooth/teeth

Use HVE and a/w
syringe
 Proper – usually
20 seconds rinse
 Avoid saliva
contamination
 Re-isolate
Dry tooth/teeth

Should appear chalky
or frosty white if
etched
 If not, re-etch for
another 10 seconds if
not contaminated
with saliva
Apply drying agent (PrimaDry)

Use brush tip
 Apply and leave for 5
seconds
 Gently blow air to dry
 DON’T RINSE
Apply bond agent

A bond agent will
improve retention
Apply sealant material

Most posterior tooth first
 Extend 1-2 mm beyond pit
and fissures
 Gently work into pits and
fissures
 Avoid lifting off tooth
 Don’t overfill
 “pop” bubbles in sealant
with explorer or brush tip
before curing
Light cure for 20 seconds

20 seconds each tooth
 Don’t touch tip of cure
light to sealant
material
 Don’t let saliva
contaminate the
field…..yet
Note: sealant will appear
shiny/wet
Light cure for 20 seconds – air
inhibition theory

Top layer of sealant
will remain uncured
 sealant will appear
shiny/wet
Check sealed teeth

Use explorer
 Tooth should be
smooth but not soft
 Re-apply sealant, if
necessary
(Remove uncured
sealant with wet
cotton roll)
Remove isolation materials

Moisten Dri-angle
 Rinse the patient’s
mouth
Check occlusion & contact(s)

Articulating paper
 Dental floss
 Ask patient how it
feels
 Dentist can adjust with
bullet-shaped finishing
bur or polishing stone
Give patient instructions



The sealant is hard so you don’t have any
restrictions on eating
If it feels “high” after you go home – you
can come in to get it adjusted
We will keep checking the sealant at
subsequent appointments
(if using unfilled corposite sealant the bite
will self adjust in 2-3 days)
Documentation
9/1/05 Medical history updated – no changes.
Parent consented to sealants on #19 OB and
#30 OB. Cotton rolls and dri-angle
isolation. Ultraseal etch, primer and light
cured sealant used. Patient tolerated
procedure well. Informed parent that
sealant will be checked at recall
appointments.
Infection control

Disinfect unit

Disinfect sealant
syringes

Throw away brush
tips used in patient’s
mouth
 Sharp tips need to be
placed with sharps
container
Common Problems
Re-etch
 Improperly etched surface – doesn’t appear
frosty and chalky white
 Dentin etching – need to dissolve smear
layer
 Contamination of application site – saliva
 Non-adherence of sealant material
Failure of sealants
Main cause – moisture
contamination
 Maxillary and
mandibular 2nd molars
 Early loss means less
retention of the resin

Sealing over caries

For incipient caries –
risk of progression is
very small
Risks associated with sealants





No carcinogens or toxic materials
Have xenoestrogens – concentrations too low
Potential chemical burns from phosphoric acid
Occlusal trauma
Danger from cure light
Sealant maintenance

Loss of all or part of
the sealant

Staining at edges

Discoloration
underneath sealant
Repair of sealant
Reapply if totally lost
Repair partial loss
 Roughen with
diamond stone
 Re-etch 20 seconds
 Reapply sealant
Finished!