DIAGNOdent – Air Polishers – Sealants

DIAGNOdent – Air Polishers – Sealants
DIAGNOdent AirPolish Sealant Aug 17, 2012 DIAGNOdent – Air Polishers – Sealants Aug 17, 2012 Darlene A. Armstrong, Ed.D. (c) , M.A., RDH, RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

DIAGNOdent AirPolish Sealant
Aug 17, 2012 Block preparation Decide on partner for block – set in axiUm Before block - Review health history, radiographs, complete CER in axiUm Practice sealant on typodont At block – review health history, radiographs, determine appropriate teeth for sealants Inform hygiene faculty, then attending DDS evaluates Post in axiUm, get approval, then patient consent Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 Sealant & Air Polisher Block and Competencies 2012 Sealant evaluation process Block information Newly erupted Soon after eruption Occlusal contour Deep or irregular pit/fissure Caries History Other teeth Caries Detection DIAGNODent or other Visual & radiographic Contraindications Proximal caries Self-cleansing pits with low caries risk Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 DIAGNOdent Use with sealant block Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 Intact occlusal surface is present – Contralateral tooth surface carious or restored. Antimere* teeth – caries susceptibility is similar *(opposite side) one of the symmetric parts of a bilateral organism An incipient lesion exists in the pit and fissure Incipient caries: beginning caries, caries limited to the enamel Wilkins ibid. pg 570 Probable Indications are: Well isolated fossa Isolated from fossa w/ restoration Confined Fully erupted fossa, T. Milledge, DDS. Dept. of Pediatric Dentistry, LLUSD The fossa selected for sealant placement is well isolated from another fossa with a restoration The area selected is confined to a fully erupted fossa, even thought the distal fossa is impossible to deal due to inadequate eruption An intact occlusal surface is present where the contralateral tooth surface is carious or restored. This is because antimere* teeth are usually similarly susceptible to caries An incipient lesion exists in the pit and fissure Definition from Stedman’s medical dictionary for the Health Professions and Nursing 5th ed. Antimere- 1.segment of an animal body formed by planes cutting the axis of the body at right angles – 2 one of the symmetric parts of a bilateral organism – 3. The right or left half of the body Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

DIAGNOSTIC CONSIDERATIONS
DIAGNOdent AirPolish Sealant DIAGNOSTIC CONSIDERATIONS Aug 17, 2012 Evaluate proximal surfaces Caries restore Evaluate pits and fissures Questionable enameloplasty or PRR Sound – caries free, coalesced do not treat Sound deep pits sealant Sound – other occl. Caries sealant Sound – prev. occl. decay sealant T. Milledge, DDS. Dept. of Pediatric Dentistry, LLUSD Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Detection vs. Diagnosis
DIAGNOdent AirPolish Sealant Aug 17, 2012 Detection vs. Diagnosis Detection Identification of signs and symptoms (for sealants – determine presence or absence of cavitation) Diagnosis Art or act of identifying disease from signs and symptoms (active, speed progressing, etc.) Dental hygienists detect disease Nyvad, 2004 Fontana, et. Al, 2010 Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Detection of Dental Caries
DIAGNOdent AirPolish Sealant Aug 17, 2012 Detection of Dental Caries Traditional Visual Color change Cavitation Tactile Explorer use for fissures is Radiographic Occlusal caries require treatment at this stage Explorer use is OK for clearing pits and fissures of debris – for gently feeling for margins of fissure and evaluating sealant integrity. Forceful use of sharp explorer for detecting carious lesions is highly discouraged. - ICDAS does not include the use of a sharp explorer or probe under force for caries detection. -- (Fontana, et al, 2010) Loesche, et al, 1979; Kühnisch. et al 2004 Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Detection of Dental Caries
DIAGNOdent AirPolish Sealant Aug 17, 2012 Detection of Dental Caries Newer Technology Transilluminator Fiber optic trans- illumination (FOTI) Quant. Light-induced fluorescence Electrical caries monitor Tranæus, Shi, & Angmar-Månsson, 2005 DIFOTI, Kavo Microlux/DL, Addent Inspecktor Pro, Omni-pharma Newer technology has reported higher sensitivity, not specificity (low specificity) – higher rate of noncavitated lesions classified as carious. D-Carie, NEKS Tech, now Dentsply Modern Hygienist, Feb 2008, pg 39, Detection Toolkit Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 DIAGNOdent DIAGNOdent PPT Open DIAGNOdent PowerPoint DIAGNOdent clinical guidelines.pdf – 24 page complete info DIAGNOdent operating instructions.pdf – 2 page concise directions for use Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Air Polishers Cavitron NSK
DIAGNOdent AirPolish Sealant Aug 17, 2012 Guide to use and maintenance Air Polishers Cavitron NSK Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 Air Polisher Air Powder Polishing Remove stain Remove debris from deep grooves Before assessing for sealants Before beginning sealant procedures Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Air Polishing: Protocols and Details
DIAGNOdent AirPolish Sealant Aug 17, 2012 Air Polishing: Protocols and Details Air Polishing PPT Open Air Polishing PowerPoint Prophy Mate Neo Maintenance.pdf or Prophy Mate Neo color Prophy Mate Neo Flash brochure Prophy Mate Neo Manual scanned into pdf Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

PIT AND FISSURE SEALANTS
DIAGNOdent AirPolish Sealant PIT AND FISSURE SEALANTS Aug 17, 2012 Why, How, When, etc. Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 Healthy People 2020 Trend Dental caries in children age 2-5 have increased. Sealant use increasing in school-aged children High disparity – lack of access to care 2020 Goals- Reach new goals Goals for 2010 not reached for any oral health A few areas moved away from objectives Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 DEFINITION and ACTION Organic polymer (resin) Flows into the pit or fissure Bonds to the enamel surface Mechanical retention. Physical barrier “Seals off” pit or fissure Prevent collection oral bacteria and nutrients Reduces acid conditions  dental caries. Fill pit or fissure as deep as possible. Remains in the depth of the micropores Provides continue protection. A pit and fissure sealant is a organic polymer (resin) that flows into the pit or fissure and bonds to the enamel surface mainly by mechanical retention. Provide physical barrier to ‘seal off’ pit or fissure Prevent oral bacteria and their nutrients from collecting in the pits to create the acid conditions necessary for the initiation of dental caries. Fill pit or fissure as deep as possible. When sealant material is worn….the sealant in the depth of the micropore can remain and provide continue protection. Wilkins, E. Clinical practice of the dental hygienist, 9th ed; pgs Wilkins, E. Clinical practice of the dental hygienist, 9th ed; pgs Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 DEFINITION and ACTION Acid etchant – Enamel surface prepared Phosphoric acid Irregularities or micropores produced Allow liquid resin to penetrate Creates a bond Mechanical locking A pit and fissure sealant is a organic polymer (resin) that flows into the pit or fissure and bonds to the enamel surface mainly by mechanical retention. Provide physical barrier to ‘seal off’ pit or fissure Prevent oral bacteria and their nutrients from collecting in the pits to create the acid conditions necessary for the initiation of dental caries. Fill pit or fissure as deep as possible. When sealant material is worn….the sealant in the depth of the micropore can remain and provide continue protection. Wilkins, E. Clinical practice of the dental hygienist, 9th ed; pgs Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 SAMPLES Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 PURPOSE OF SEALANTS Prevention and control of dental caries Pits and fissures Primary and Permanent teeth. Protect caries-susceptible tooth surfaces benefited least by fluoride Placed As soon as possible After the tooth erupts Isolation can be obtained (kept dry) Guidelines for Pediatric Restorative Dentistry, May AAPD Reference Manual , pg. 55 Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 SAMPLE Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

INDICATION FOR SEALANTS
DIAGNOdent AirPolish Sealant Aug 17, 2012 INDICATION FOR SEALANTS Non-carious Primary or permanent molars Permanent premolars Deep pits and/or Deep fissures Maxillary incisors Cingulum Deep lingual pits and/or Deep fissures Guidelines for Pediatric Restorative Dentistry, May AAPD Reference Manual , pg. 55 Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 MOLARS – with deep pits Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

MAXILLARY INCISORS –lingual pits/fissures
DIAGNOdent AirPolish Sealant Aug 17, 2012 MAXILLARY INCISORS –lingual pits/fissures Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

THE BEST TIME TO PLACE Aug 17, 2012 Children Primary molars ~ age 3-4 First permanent molars ~ age 6-7 Second permanent molars ~ age 11-13 Premolars ~ age 9-11 Simonson R. J. Pit and fissure sealant in individual patient care programs. J Dent Educ ; 48 pgs These ages are based on sealing as soon as tooth has erupted enough to seal successfully Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

THE BEST TIME TO PLACE (cont.)
DIAGNOdent AirPolish Sealant THE BEST TIME TO PLACE (cont.) Aug 17, 2012 Adult Evidence of existing or impending caries Susceptibility due to: Excessive intake of sugar Following drug-or radiation –induced xerostomia Deep pits or fissures. ALWAYS – determine need – use evidence T. Milledge, DDS. Dept. of Pediatric Dentistry, LLUSD Sealants should be placed on the teeth of adults if there is EVIDENCE of existing or impending caries SUSCEPTIBILITY, as would occur following excessive intake of sugar, as a result of drug-or radiation-induced xerostomia or with deep pits and fissures In ALL CASES it is the DISEASE SUSCEPTIBILITY of the TOOTH that should be addressed, NOT the AGE of the PATIENT or the INSURANCE COVERAGE. See Caries Risk Assessment NOT AGE of the PATIENT or the INSURANCE COVERAGE Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 COMPOSITION AND TYPES Most clinical sealants - Bis-GMA* (bisphenol A- glycidyl methylacrylate). *plastic material or a liquid resin polymer whose base is a reaction product The techniques of application vary slightly Wilkins, E. Clinical practice of the dental hygienist, 9th ed; pgs 571 Current research shows the amount of Bis-GMA risk is low from dental materials. Dimensions of DH = “None of the dental sealants that carry the American Dental Association (ADA) Seal in 2007 released detectable BPA. In a recent position and statement paper, the ADA states that there is no cause for concern about potential exposure to BPA from composites or sealants at this time, but the ADA ‘supports additional research into how much BPA people are actually exposed to and at what levels of exposure health effects start to occur;” – J. Tuthill, RDH, MA from article Dim DH July v.6 i. 7 p 36-37 Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

METHODS OF POLYMERIZATION
DIAGNOdent AirPolish Sealant Aug 17, 2012 METHODS OF POLYMERIZATION a chemical reaction and is self-curing Autopolymerization – ? Advantage ~ Disadvantage ~ Photopolymerization - ? Advantages ~ Disadvantages ~ Wilkins, E. Clinical practice of the dental hygienist, 9th ed; pgs 571 no special equipment required mixing required, time limited visible light reaction no mixing required, increased working time extra costs and disinfection time required for curing light, protective shields/glasses Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 FILLED vs. UNFILLED Filled Purpose: Increase abrasion resistance Increase bond, Increase strength, Decrease wear. Fillers: glass, quartz, silica, and other filling material Effect: Viscosity increased, Flow varies May not reach narrow - deep May need to adjust occlusion Wilkins, E. Clinical practice of the dental hygienist, 9th ed; pgs 571 Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

UNFILLED vs. FLUORIDE RELEASING (cont.)
DIAGNOdent AirPolish Sealant UNFILLED vs. FLUORIDE RELEASING (cont.) Aug 17, 2012 Fluoride releasing Purpose: Enhance caries resistance Action: Remineralization of incipient caries at base of pit or fissure Fluoride reservoir Long term release of fluoride Unfilled abrasion, resistance, bond strength and wear Flows into narrow pits Do not need to adjust Wears down with occlusion Wilkins, E. Clinical practice of the dental hygienist, 9th ed; pg 571 UltraSeal XT plus and hydro are filled [similar to microfill resins] – hydro – can be placed in moist areas – is fluoride-releasing Fluorescent [use black light] to check for sealant margins Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 COLOR CLASSIFICATION Available: Clear Tinted Color changing Opaque Purpose: Quick identification for evaluation Effect: Do not differ in retention Wilkins, E. Clinical practice of the dental hygienist, 9th ed; pgs 571 UltraSeal XT plus available in 4 colors; UltraSeal XT hydro available in 2 colors Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 LOST SEALANT Replace area lost – step by step process Consult Tooth preparation Removal Re-etching Wilkins, ibid pg 577 Consult manufacturer’s instructions Tooth preparation: same as for original application Removal of sections of retained sealant is not usually necessary Re-etching of the tooth surface is always essential Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

FAILURE OF SEALANTS Aug 17, 2012 #1 cause of failure moisture control (operator technique/patient cooperation) Operculum 54% reapplication Tissue at distal marginal ridge 26% reapplication Behavior of patient Nelson, B. Chair Pediatric Dentistry, LLUSD, 2003 dental operculum the hood of gingival tissue overlying the crown of an erupting tooth. Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 Ultradent - Ultraseal XT+ & Ultraseal XT hydro Fuji – Triage 3M ESPE – Clinpro – color change 3M ESPE – Concise - white Pulpdent – Aegis & Embrace Shofu – Clear Check SLP (Sealant & Liquid Polisher) Ultradent: Ultraseal XT+ has undetectable level of Bisphenol-A (BPA) – Ultradent products do not use Bisphenol-A dimethacryalate in any of their resin products including pit and fissure sealants. Both products are flowable filled sealants similar to filler loadings of microfills eg Silus and Durafil. See Dr. Fischer’s PDF regarding misleading “Granada” study. Shofu – Clear check SLP Only Sealant indicated for use with caries detection devices. ClearCheck SLP removes the worry of caries hidden below a dental sealant. An exclusive super clear fluoride releasing and solvent free formula approved for use with Caries Detecting Devices High fluoride release Works in a moist field Extremely high compressive strength Cures with all dental lights others are also available Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 Glass ionomer sealant – this one requires special dispenser Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

DIAGNOdent AirPolish Sealant TECHNIQUE FOR ULTRASEAL XT+
Aug 17, 2012 SEALANT PLACEMENT TECHNIQUE FOR ULTRASEAL XT+ Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Explain procedures- Prepare patient
DIAGNOdent AirPolish Sealant Explain procedures- Prepare patient Aug 17, 2012 Explain evaluation process Thoroughly rinse teeth Many instructions show using rubber dam. This provides ideal setting especially if assistant is not available. In most practices, we use dry angles, and cotton rolls to provide moisture isolation. Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

EVALUATE TEETH Aug 17, 2012 Newly erupted Soon after eruption Occlusal contour Deep or irregular pit/fissure Caries History Other teeth Caries Detection DIAGNODent or other Visual & radiographic Contraindications Proximal caries Self-cleansing pits with low caries risk Teeth Newly erupted: as soon after eruption as possible Occlusal contour: when pit or fissure is deep and irregular Caries history: other teeth restored or have carious lesions Evaluate with DIAGNODent or other caries detection method Contraindications Radiographic evidence of proximal dental caries. Pit and fissures are well coalesced and self-cleansing; low caries risk. Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 Assemble equipment Etchant –cannula tip Primadry – sponge tip Caries assessment items Mirror, explorer, suction tips, air/water syringe tips Air polisher or pumice and prophy brush/cup Dry angles, cotton rolls Etchant – sealant products Curing light Articulating paper, handpiece, greenie, curette Sealant – brush tip – dark syringe to protect from light Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Complete debridement Aug 17, 2012 Clean pits and fissures Clean out stain and debris Use: Instruments Scaler or Curette O’Hehir Debridement curet (PDTdental) Air polisher or air abrasive [prophy jet plus or prophy mate] Prophy brush – pumice (no fluoride) – research varies Fissurotomy with high speed bur (DDS) Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 ISOLATE & DRY Isolate teeth Cotton rolls, Dry angles, or Rubber dam OR Wait to isolate after etchant Dry tooth Do not dry untreated teeth Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 ETCH 15 to 30 seconds Gel: brush on surface Liquid: cover surface, keep wet – add more liquid Do not rub Use less etchant than shown here Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 RINSE & DRY Rinse thoroughly No blue etchant remaining Gel: 60 seconds Liquid: 30 seconds Re-isolate Add cotton rolls Dry for 20 seconds Check for chalky appearance If not chalky, re-etch Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

ULTRASEAL - Primadry Aug 17, 2012 Ultraseal XT+ products Etchant –cannula tip Primadry – sponge tip Apply primadry (ethyl alcohol) for 5 seconds Do not rinse off If needed, dry well with air Improves flow into fissures Sealant – brush tip – dark syringe to protect from light Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 SEALANT & CURE Apply sealant with brush tip syringe Work it into all pits and fissures. Cover area No bubbles Thin gloss, not a lava pool Remove excess material Use micro brush Light cure for seconds Use safety glasses &/or shield [curing light can damage retina] Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

EVALUATE SEALANT INTEGRITY
DIAGNOdent AirPolish Sealant EVALUATE SEALANT INTEGRITY Aug 17, 2012 Check for voids and air bubbles Add small amount of sealant, if necessary Use explorer to evaluate edges Floss must be able to pass interproximally Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 EVALUATE OCCLUSION Use articulating paper Unfilled sealant – If patient notices differences in occlusion. Filled sealant material – must evaluate [Ultraseal is filled] Adjust sealants only Remove “high spots” Use curette OR Use low speed handpiece w/ green stone or greenie abrasive Use articulating paper~ filled sealant material only Adjust occlusion if sealant interferes with occlusion ~ low speed handpiece only Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 ENAMELOPLASTY Dentist performs procedure Minimal preparation of pit and fissure with small areas of caries in dentin Only pit and fissures with caries of clinical significance are prepared Removal of additional tooth structure to aid retention is not necessary Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

MAINTENANCE OF SEALANTS
DIAGNOdent AirPolish Sealant Aug 17, 2012 MAINTENANCE OF SEALANTS Reexamination At each maintenance or At least every 6 months, Each sealant examined for deficiency Retention Retention Time: “Sealants can be retained for years.” “Although surface sealant may be lost, pit and fissures retain sealant in microspaces and provide protection.” Simonsen, R.J.: Retention and Effectiveness of Dental Sealant After 15 Years, J. Am. Dent. Assoc. 122, 34, October, 1991 Reexamination At each maintenance or at least every 6 months, each sealant should be examined for deficiency Retention Retention Time: Sealants can be retained for years. Although surface sealant may be lost, pit and fissures retain sealant in microspaces and provide protection.. Wilkins, E. Clinical practice of the dental hygienist, 9th ed; pgs 577 Buonocore, M.G.: Pit and Fissure Sealing, Dent. Clin. North Am., 19, 367, April, 1975 Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 SEALANT RETENTION Retention Factors: During Placement: Precision of technique. Exclusion of moisture during placement Avoidance of contamination during placement Care of Existing Restorations. Avoid air powder polisher on intact existing sealants Sealant wear increases with time of exposure to … abrasion Wilkins, E. Clinical practice of the dental hygienist, 9th ed; pgs 577 Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

PATIENT EDUCATION Aug 17, 2012 Sealants Preventive measure One piece of the picture Sealant Is … Why … (expectations) Application overview… Why moisture control is important… Follow-up Need for regular examination Check at each recall Replace when indicated Wilkins, ibid, pg 577 sh/SelleDientesContraCariesDental ic=S&ArtID=1312#body Part of total preventive program Not a substitute for other preventive measures. What a sealant is and why application procedure steps must be meticulous What can be expected from a sealant Need for examination of the sealant at frequent, scheduled appointments, and need for replacement when indicated. Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 Have Fun! Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

Aug 17, 2012 Resources Wilkins’ Clinical Practice of Dental Hygienist Photographs Darlene/Daniel Armstrong Materials from manufacturers Review dental materials class information on sealants. Aug 17, 2012 LLU-AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Darlene Armstrong,Ed.D.(c), M.A., RDHAP

DIAGNOdent – Air Polishers – Sealants

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