Transcript Clinical Aspects of Dental Sealants: Materials and Application

Clinical Aspects of
Dental Sealants:
Materials and
Application
National Primary Oral Health Care Conference
Kevin J. Donly, DDS, MS
Professor and Chair
Department of Pediatric Dentistry
University of Texas Health Science Center
at San Antonio
70% of molars
(years 1950–1980)
develop occlusal caries
(Eklund and Ismail, J Publ Health Dent, 1986)
Lewis and Hargreaves (1975)
Investigated occlusal caries in permanent first
molars in a four year longitudinal study of 142 five
year old children (Fluoride < 0.1 ppm).
Age
6
7
8
% of 1st Permanent Molars Carious
64
80
93
CLINICAL STUDIES OF
Bis-GMA SEALANTS
Study
Roydhouse40
Buonocore9
Rock38
Horowitz et al.22
Courley19
Merrill et al.33
Going et al.18
Meurman & Heiminen34
Time
Sealant
Retained*
Caries
Reduction
mos
%
%
36
24
24
24
24
15
24
36
* Completely present, data for permanent teeth
87
80
73
78
55
69
80
29
99
99
67
57
55
88
Occlusal caries in children
have significantly decreased
Third National Health and Nutrition
Examination Survey
Changes in Caries Levels in U.S. Health
Surveys (Early 1970s to Early 1990s)
Changes
Changes in Occlusal
Occlusal Caries
CariesRates
Rates
(4 years
years after
after Eruption)
Eruption)
Percentage
Percentage of
of Teeth
Teeth with
with Occlusal
Occlusal
Caries
Caries
100
100
90
90
80
80
70
70
60
60
50
50
68
55
1s
1ts Mo
t Mo
lala
rsrs
2nd
2 ndMo
Mo
lala
rsrs
40
40
30
30
25
25
20
20
15
15
10
10
00
1971-74
1971-74
1988-94
1988-94
U.S. Health
Health Surveys
Surveys
Is There a Need for
Dental Sealants?
Occlusal vs. Aproximal Caries
in the USA
16%
Occlusal
Aproximal
84%
Burt, et.al. IDR 67, 1988, p.1422
15-Year Single Sealant
Application Recall
(Simonsen, JADA 122:34-42, 1991)
Retention of White Sealants by
Surface on Permanent First Molars
5 Years
10 Years
15 Years
Complete retention
82% (173)
56.7% (131)
27.6% (53)
Partial retention
Missing
10.9% (23)
20.8% (48)
34.5% (68)
0.5% (1)
6.9% (16)
10.9% (21)
6.6% (14)
15.6% (36)
26% (50)
100% (211)
100% (231)
100% (192)
Restored/ carious
Total
Sound vs. Carious or Restored
Surfaces on Permanent First
Molars at 15 Years
Group with
Sealant
Group without
Sealant
Sound surfaces
68.8% (88)
17.2% (22)
Carious or
restored surfaces
31.3% (40)
82.8% (106)
Total surfaces
100% (128)
100% (128)
Matched pair analysis (n = 128 surfaces, 16 subject pairs)
5-Year Study; Fluoridated
Community
o
Sound Surfaces
-
o
Non-sealed – 13% caries
Sealed – 8% caries
Incipient or Questionable Surfaces
-
Non-sealed – 52% caries
Sealed – 11% caries
(Heller et al, J Publ Health Dent, 1995)
Indications for Sealants
to Prevent Occlusal Caries
Workshop on Guidelines for
Sealant Use
o
o
o
o
o
Caries risk assessment of the individual and the tooth
are important as determinants of sealant need.
Caries risk on surfaces with pits and fissures may
continue into adulthood; therefore, post-eruptive age
alone should no-longer be used as a major criterion for
sealant decisions.
Sealants should be used to prevent caries in at-risk teeth
(preventive sealants).
Sealants should be used to treat teeth with questionable
caries or definite caries confined to the enamel pits and
fissures (therapeutic sealants).
Sealed teeth need to be evaluated periodically for
sealant integrity and retention.
(Siegal, J Publ Health Dent, 1995)
AAPD Recommendations
The dental literature supports:
1. Bonded resin sealants, placed by appropriately trained
dental personnel, are safe, effective and underused in
preventing pit and fissure caries on at risk surfaces.
Effectiveness is increased with good technique,
appropriate follow-up, and resealing as necessary.
2. Sealant benefit is increased by placement on surfaces
judged to be at high risk or surfaces that already exhibit
incipient carious lesions. Placing sealant over minimal
enamel caries has been shown to be effective at
inhibiting lesion progression. Appropriate follow-up care,
as with all dental treatment, is recommended.
3.
4.
Presently, the best evaluation of risk is done by
an experienced clinician using indicators of tooth
morphology, clinical diagnostics, past caries
history, past fluoride history and present oral
hygiene.
Caries risk and, therefore, potential sealant
benefit, may exist in any tooth with a pit or fissure
at any age, including primary teeth of children
and permanent teeth of children and adults.
Mertz-Fairhurst et al. Cariostatic and
Ultraconservative Sealed Restorations:
Nine-Year Results Among Children and
Adults. ASDC J Dent Child, 1995
vs.
Weerheijm et al. Sealing of Occlusal
Hidden Caries Lesions: An Alternative for
Curative Treatment? ASDC J Dent Child,
1992
Minimal Decay vs. Extensive
or Rampant Decay
 Importance of screening children in
School-Based Sealant Programs and
referring those to a Dental Home most in
need of comprehensive dental care.
Types of Sealants
 Self cure
 Light cure
 Unfilled resin
 Filled resin
 Color changing
 Self etching
 Fluoride releasing
Clinpro Sealant (3M ESPE)
Helioseal Clear Chroma (Ivoclar)
Self Etch Sealant and
Hydrophilic Sealant
Fluoride Releasing Sealants
o Glass Ionomer
o Fluoridated Resin
Lesion Initiation (Mean ± S.D.)
Control Sealant
Fluoride Sealant
GIC
(Hicks & Flaitz, Am J Dent, 1992)
138 ± 18µm
109 ± 21µm
83 ± 12µm
Acid Etch vs. Air Abrasion
 Kanellis et al., 2000 (J Pub Health Dent)
 Berry and Ward, 1995 (Quintessence Int)
How Long Should Primary
Enamel be Etched?
 Redford, Clarkson and Jensen, 1986
(Pediatr Dent)
Etch Depths (microns) in Primary
Enamel after Different Etching
Times with 37% Phosphoric Acid
Etch Times
Mean Depth
15s
30s
60s
120s
9
12
14
50
Bond Strength (kg/cm2) of Sealant
after Different Etching Times
Etch Times
15s 30s 60s 120s
Mean
S.D.
# of Samples
92
177
13
92 83
161 142
21 17
83
145
13
5. Sealant placement methods should include
careful cleaning of the pits and fissures
without removal of any appreciable enamel.
Some circumstances may indicate use of a
minimal enameloplasty technique.
6. A low-viscosity, hydrophilic material bonding
layer as part of or under the actual sealant
has been shown to enhance the long-term
retention and effectiveness.
Enameloplasty
Air abrasion
Minimally invasive burs
Bonding Agent Prior to
Sealant Placement
 Hitt and Feigal, 1992 (Pediatr Dent)
 Feigal et al., 1993 (JADA)
 Feigal et al., 2000 (J Dent Res)
PRIME & BOND 2.1
(Caulk/Dentsply)
Sealant Placement Technique
 At risk surface
 Tooth isolation
 Clean surface
 Etch with 35% phosphoric acid for 15–30





seconds
Bonding agent
Place sealant
Cure sealant
Check occlusion
Re-evaluate
ONE-STEP®
(Bisco)
7. Glass ionomer materials can be used as
transitional sealants, and may prove to be
effective as longer-term pit and fissure
sealants.
8. The profession must be alert to new
preventive methods effective against pit
and fissure caries. These may include
changes in dental materials or technology.
Glass Ionomer
Sealants
Bisphenol A
90–931 µg/30 ml saliva
Environmental Health Perspectives
March 1996
1.
50% uncured bisphenol A leaches within
3 hours (Ferracane, 1990).
2.
Saliva dose not equal to blood dose.
3.
Estrogenic effects in breast cancer cells,
not normal cell culture
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