pit and fissure sealants in preventive dentistry pit and fissure sealants

Pit and FissureSealants in

Preventive Dentistry

Pit and Fissure Sealants

The focus of this presentation is on the rolethat dental sealants play in preventivedentistry, and two types of placement techniques: the traditional method and a “no-rinse” technique.


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.


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 cost-effective for dental patients

Sealants are applied by dental professionals, including:DentistsRegistered Dental HygienistsRegistered Dental Assistants with Certification


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 plaqueCariogenic dietHistory of caries in the patient or the patient’s family

Low fluoride intakePit and fissure anatomy


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


Situations where sealants would not be recommended:

Inability to isolate and maintain a dry field

Primary teeth close to exfoliation Presence of decay Any known allergies to the sealant

material


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


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


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”.


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


Sealant Placement Techniques

Using a Resin-Based Material

Traditional Technique

“No-rinse” Technique


Traditional Sealant Placement Procedure


Select teeth to be sealed and isolate


Clean the tooth surfaces with an air polisher or prophy paste using a rubber prophy cup or brush


Enamel cleaned of debris


Etch the enamel (minimum of 15 seconds).


Rinse and dry etched enamel


Gently rinse etchant and look for a frosty white appearance


Apply sealant material


Light cure for time period recommended via productinstructions. Colored sealant material turns from pinkto tooth colored after light-curing.


Check sealant coverage using articulating paper. Arrows indicate the points of contact.


No-Rinse Sealant Placement Technique


“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


Adper Prompt Self-Etch Adhesive

Indications For Use:

• Bonding light-cured compositeand compomer materials to dentin and enamel• Desensitization of exposed rootsurfaces• Bonding of light-cure resinbased pit and fissure sealants

Unidose L-Pop delivery system

Two-vial delivery system


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


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


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


Apply a churning or spinning motion to the applicator for five seconds to mix the adhesive and fully coat the applicator tip


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.


Clear tip indicates improper activation

Tip must be yellow indicating

proper activation

Adper Prompt Self-Etch Adhesive


• 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.


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


Apply a light-cured sealant


Light-cure the sealant and adhesive together with a halogen,

LED or plasma light for the amount of time specified to cure the

sealant


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.


Adper Prompt Self-Etch Adhesive and Clinpro Sealant - Key Technique Tips:

Activated L-Pop must be a deep golden yellowThe L-Pop can be activated up to 10 minutes

before the procedureSaves time to activate before bringing patient

back to operatory Adhesive must be scrubbed on the surface for a

minimum of 15 seconds


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


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


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



Acknowledgements:

The instructional staff wish to gratefully acknowledge the following for their contributions to this project –

3M-ESPEVicki L. Svoboda – 3M Dental DivisionColumbia DentoformThe California Association of Dental Assisting Teachers, Inc.

© 3M-ESPE/CADAT 2010

pit and fissure sealants in preventive dentistry pit and fissure sealants

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