Concorde Career College Sealants DH102: Clinic II Lisa Mayo, RDH, BSDH Concorde Career College

Reference CH36 Wilkins

Outline for Dental Sealants Definition Structure Properties Acid Etch Criteria Material Types Curing Methods Indications for Placement Contraindications Procedure Sealant Maintenance

Sealant Definition

Sealant Definition Organic polymer (resin) that flows into pit & fissures Mechanical retention (NBQ) Physical barrier to oral bacteria Can be placed over incipient decay to halt caries process (NBQ) Pit and fissures: allow for the accumulation of fermentable CHO and acidic agents/bacteria

Sealant Structure

Sealant Structure Components (NBQ) Monomer Bis-GMA: Majority made of bisphenol A-glycidylethylacrylate Initiator Benzoyl peroxide: Self-Cured Camphorquinone: Light-Cured Accelerator Amine

Sealant Structure Opaque filler 1% titanium dioxide or other colorant Reinforcing filler Silicate glass if used Do not usually need: wear resistance not required within pits/fissures Fluoride May be added for slow release Reaction Free radical

Sealant Properties

Sealant Properties Physical: wetting Low-viscosity sealants wet acid-etched tooth structure the best Mechanical (NBQ) Wear resistance is good To prevent loss – protect seals during dental polishing & air-abrasion Clinical efficacy (NBQ) Effectiveness is 100% if retained

Sealant Properties Color Clear, tinted, opaque Purpose: quick id for evaluation during maintenance assessment Effect: clear, tinted, opaque sealants do not differ in retention

NBQ If the dental hygienist was to seal a tooth with early caries, what would be the result? Decay would progress more rapidly The caries would arrest Nothing

NBQ If the dental hygienist was to seal a tooth with early caries, what would be the result? Decay would progress more rapidly The caries would arrest Nothing

Acid Etch

Acid Etch Purpose of acid etch (NBQ) Produce irregularities or micropores in the enamel Allows the liquid resin to penetrate into the micropores and create a bond or mechanical locking Phosphoric acid

Acid Etch ACTION Create micropores to increase the surface area and provide retention for the sealant Remove contamination from enamel surface Provide antibacterial action Allows for the sealant to “lock” into enamel surface

(Adapted with permission from Buonocore MG, Matsui A, Gwinnett AJ (Adapted with permission from Buonocore MG, Matsui A, Gwinnett AJ. Penetration of resin dental materials into enamel surfaces with reference to bonding. Arch Oral Biol. 1968 Jan;13(1):61–70.)

Sealant Criteria

Sealant Criteria Fluoride does not benefit pit and fissure cavity prevention like smooth surface Rsrch based evidence Protection from caries approaches 100% if sealant placed correctly and maintains

NBQ How effective is a properly placed dental sealant in the prevention of decay? 100% 75% 50% 25%

NBQ How effective is a properly placed dental sealant in the prevention of decay? 100% 75% 50% 25%

Sealant Criteria Criteria for ideal sealant Achieve prolonged bonding to enamel Biocompatible with oral tissues Simple application procedure Free-flowing, low-viscosity material capable of entering narrow fissures Low solubility in the oral environment

Material Types 5 Types Filled Unfilled Fluoride-Releasing Glass Ionomer Calcium Phosphate

Sealant Material Types 5 types of sealants Filled: ↑ bond strength & resistance to wear Fillers: glass or quartz particles High viscosity: not as “flowable” Flow into depth of a fissure varies Unfilled Clear Do not contain particles Less resistant to abrasion & wear May require occlusal adjustment when placed

Sealant Material Types 5 types of sealants (cont’d) Fluoride-releasing filled: enhance caries resistance Remin. of incipient caries Glass ionomer Salivary control not a critical factor Ideal for teeth when moisture control an issues Calcium phosphate Promotes remin.

NBQ A dry field is necessary for the long-term success of resin-based pit-and-fissure dental sealants; therefore, glass ionomer pit-and-fissure dental sealant material should be applied on the teeth of clients when moisture control is an issue. Both statements are TRUE Both statements are FALSE The first statement is TRUE; the second statement is FALSE The first statement is FALSE; the second statement is TRUE

NBQ A dry field is necessary for the long-term success of resin-based pit-and-fissure dental sealants; therefore, glass ionomer pit-and-fissure dental sealant material should be applied on the teeth of clients when moisture control is an issue. Both statements are TRUE Both statements are FALSE The first statement is TRUE; the second statement is FALSE The first statement is FALSE; the second statement is TRUE

Fluoride in Glass Ionomer: Mosby’s

Curing Methods Self-cured or autopolymerized Visible light-cured or photopolymerized

Self or Light Cured Self-cured or autopolymerized Preparation: the material is supplied in two parts When the two are mixed they quickly polymerize (harden) Disadvantages: mixing required; working time limited because polymerization begins when the material is mixed

Self or Light Cured Visible light-cured or photopolymerized Preparation: the material hardens when exposed to a special curing light Advantages: no mixing required; increased working time due to control over start of polymerization Disadvantages: extra costs and disinfection time required for curing light, protective shields, and/or glasses

Review What are the two methods of polymerization? Self-cured and autopolymerized UV polymerized and solar polymerized Visible-light polymerized and photopolymerized Photopolymerized and autopolymerized

Review What are the two methods of polymerization? Self-cured and autopolymerized UV polymerized and solar polymerized Visible-light polymerized and photopolymerized Photopolymerized and autopolymerized

Indications for Placement

Indications for Placement Patient at risk for dental caries Xerostomia Ortho Incipient caries Teeth: newly erupted within first couple months Occlusal contour: when pit/fissure deep and irregular Caries hx, incipient caries Dietary issues Smoker

Indications for Placement All guardians should be made aware the benefits of sealants All adults with exposed pits & fissures should be made aware the benefits

Contraindications

Contraindications Radiographic evidence of proximal caries If Dr fills tooth, occlusal will be filled as well Low caries risk Pit and fissures shallow and easily cleansed

Contraindications Behaviors will not allow a dry field in the mouth Carious lesions Interproximal caries (Class II or III or IV) Previously restored tooth Life expectancy of tooth is short

Question When is the optimal time for sealant placement? When tooth first erupts Few months after tooth erupts When tooth begins picking up stain When incipient decay is noted

Answer When is the optimal time for sealant placement? When tooth first erupts Few months after tooth erupts When tooth begins picking up stain When incipient decay is noted

Sealant Procedure

Sealant Procedures Treat each quadrant separately Use assistant if available (4-handed) Ensure moisture control Work efficiently & save time Follow manufacturer’s directions for each product Success of retention depends on you! Maintain a dry field Follow each step precisely

Sealant Procedure Steps in procedure: follow the outline in Table 36-1 in the text., page 546 Next slides outline WILKINS p.546

Sealant Procedure Preparation of the Tooth Remove debris and deposits Acid etch cannot penetrate through plaque and seal will not retain Polish, scale, air polisher Polish brush with pumice or coarse paste: our clinic uses Use explorer to ensure groove debris-free A/W & Suction: must be rinsed thoroughly or sealant will not retain if polish paste/pumice retained

Sealant Procedure Isolation #1 cause sealant non-retention = Saliva/moisture contamination Rubber dam or Isolite can be used for isolation Cotton-roll isolation Most commonly used Dry the tooth Prepare tooth for acid etch Eliminate moisture and contamination Use clean air: test A/W first to make sure no water expels from tip Air dry for at least 10 sec, preferred 20-30sec

Sealant Procedure Acid Etching Phosphoric acid: 15-50% available Liquid: low viscosity allows good flow into pit or fissure but may be difficult to control Liquid, gel, or semi-gel

Sealant Procedure Acid Etching Etch timing 30-60sec (manufacturer) Etch delivery Gel and semi-gel: we have in clinic Use a syringe, brush, or manufacturer-supplied single-use cannula

Sealant Procedure Acid Etching Completion of etching Rinse thoroughly; apply suction to prevent saliva from reaching the etched surface Dry, and examine the etched surface Repeat etching process if the surface does not appear white and chalky Dry for 20-30 seconds Maintain dry isolation ready for sealant application

Sealant Procedure Acid Etching Avoid contact with tissues: chemical burn Bad taste Cover all surfaces that will be sealed Rinse after completed etching Do not let pt swish Use high speed suction if can to avoid patient swallowing etch – can induce emesis Do not let patient close down on suction which could contaminate conditioned surface you just created

Review The acid etchant used for preparing a tooth for pit and fissure sealants is usually which ingredient? Hydrochloric acid Phosphoric acid Hydrogen peroxide Fluorescing acid Amylases

Review The acid etchant used for preparing a tooth for pit and fissure sealants is usually which ingredient? Hydrochloric acid Phosphoric acid Hydrogen peroxide Fluorescing acid Amylases

Sealant Procedure After etching dry tooth very well for at least 10-20 seconds If not completely dry, sealant will not retain Properly etched teeth will appear chalky white If change not seen will need to re-etch

Sealant Procedure Follow manufacturer’s instructions General instructions Avoid over-manipulation to prevent producing air bubbles Cover all pits and fissures but do not overfill to a high, flat surface Occlusals Buccal pits mand molars Lingual groove max molars #7/10 lingual pits After placement: leave in place for 10 seconds to allow for optimum penetration

Sealant Procedure Visible Light-Cured Sealants 90% of dentistry uses Resin seal applied to etched areas Tip of source is placed 2mm from the sealant Light must be delivered for polymerization to occur and for the prevention of sealant failure Once polymerization complete – sealant wiped with a wet cotton roll or pellet to remove any air-inhibited layer of nonploymerized resin Failure to do this = unpleasant taste to patient

Sealant Procedure Chemical/Self-Curing Sealant Only 10% of dentistry uses Catalyst and sealant mixed together and placed into prepped tooth Use brush or custom dispenser Working time mixing to setting = 1-3min

Sealant Procedure Curing Apply curing light: use eye protection Cover entire tooth surface to allow complete polymerization Check for voids: material can be added if surface has not been contaminated or wet Timing 20-30 seconds in accord with manufacturer’s instructions Longer curing time is related to increased retention

Sealant Procedure Examine sealant to determine strength of bond and absence of voids, under-extensions, over-extensions or undercuts Sealant surface should feel very smooth Floss to ensure material did not get caught interprox

Sealant Procedure Occlusion Articulating paper to locate high spots Adjust as required Occlusal wear: unfilled sealants wear down to correct height Filled sealants require occlusal adjustment with bur

NBQ The hygienist has just finished placing sealants on the following teeth: 3,14,19,30. Which of the following steps are NOT necessary after placing these sealants? Recommend the patient not eat or drink for the next 30 minutes Check the patients bite for occlusion interference Check the patient’s sealants for any voids or air bubbles Floss interproximally around the teeth she placed sealants on today

NBQ The hygienist has just finished placing sealants on the following teeth: 3,14,19,30. Which of the following steps are NOT necessary after placing these sealants? Recommend the patient not eat or drink for the next 30 minutes Check the patients bite for occlusion interference Check the patient’s sealants for any voids or air bubbles Floss interproximally around the teeth she placed sealants on today

Sealant Maintenance

Sealant Maintenance Reexamination at ea appt Retention Time: many years Factors affecting Technique of application Avoid air polishing at RC appts Bruxism Replacement of lost material

Review Which of the following is the major reason for sealant failure? Glycerin or fluoride was used in prophy paste to prepare the tooth Salivary contamination Phosphoric acid in a concentration of 30% to 50% Etching time only 1 to 2 minutes

Review Which of the following is the major reason for sealant failure? Glycerin or fluoride was used in prophy paste to prepare the tooth Salivary contamination Phosphoric acid in a concentration of 30% to 50% Etching time only 1 to 2 minutes

Factors to Teach the Patient Part of a total preventive program Not substitutes for oral hygiene at home Meticulous application required Expectations for sealant: length of time Need for maintenance of sealants and possible replacement

Good vs Bad of Sealants Good Bad Main desirable characteristic is the flowability Easy placement because it has low viscosity Bad Wear higher than resin’s Strength lower than resin’s Higher expansion and contraction to hot/col Polymerization shrinkage higher than resin’s

Dr. Christensen Video 11:28-17:00 18:00-20:22 31:35-33:00 44:43-52:05