1. Sealants, Preventive Resins and Posterior Composites
Department of Pediatric Dentistry
University of Isfahan medical sciences 2009

2. Sealants Indications Recently erupted teeth Tooth can be isolated
No, or only minimal pit and fissure staining
No, or only minimal “catches” in the grooves
No evidence of radiographic caries

3. Sealants Material in Y/O Clinic Ultraseal XT ® plus™
Manufacturer: Ultradent
Advantages
High strength
Filled resin sealant (approximately 60% )
Low shrinkage
Clinically and radiographically opaque
Fluoride releasing
May be used for sealants and microrestorative (PRR’s)

4. Sealants Technique - Prior to etching the tooth:
Isolate tooth (i.e. rubber dam, dry-angle, cotton roll)
Pumice tooth with non-fluoridated pumice
Wash and dry.
Drag grooves with explorer to remove any remaining pumice.
If necessary, wash, dry, and re-isolate.

5. Sealants Etching: - 35% PA
Deliver to the tooth using the blue tip, or using a microbrush
Etch the grooves and cuspal inclines
Etch for 15 seconds
Wash for 10 seconds
Evaluate “frosted” enamel

6. Sealants
Apply “PrimaDry” for 5 seconds using the brush tip or microtip brush.
99% ethyl alcohol
Acts as a drying agent and increases bond strength
Gently dry

7. Sealant
Apply sealant using the spiral brush tip, or using a microbrush.
Sealant should flow into grooves and up cuspal inclines.
Cure for 20 seconds

8. Sealant Evaluate quality of sealant: Marginal integrity?
Pits or voids in sealant?
Overhangs?
Heavy occlusion?

9. Sealants Areas of concern
Retention rates on buccal pits and grooves of mandibular molars and distolinqual grooves of maxillary molars
Sealants need periodic maintenance
Moisture contamination secondary to incomplete eruption and difficulty in isolation - predicted 30% failure rate within 5 years in these areas.
Marginal integrity and wear.

10. Preventive Resins Restorations
Indications
Tooth can be isolated.
No, or only minimal pit and fissure staining
Minimal “catches” in the grooves, or areas with distinct incipient enamel caries.
No evidence of radiographic caries.

11. Preventive Resin Restorations
Type A
Caries is incipient and limited to enamel
No radiographic caries
Type B
Caries extends minimally into dentin and is small and confined
No radiographic findings
Many clinical situations can not be classified according to type until the operator has completed the required exploratory preparation

12. PRR “A” vs. PRR “B”
Type A
Type B

13. Preventive Resin
Isolate tooth (i.e. rubber dam, dry-angle, cotton roll)
Pumice tooth with non-fluoridated pumice
Wash and dry.
Drag grooves with explorer to remove any remaining pumice.
If necessary, wash, dry, and re-isolate.

14. Preventive Resin
Remove decalcified pits and fissures with a slow speed 1/4 or 1/2, or with a HS330FG
Examine all margins for remaining caries.
If caries remains, consider anesthetizing and placing conventional restoration; otherwise proceed in the following manner:

15. Preventive Resin “A” Etch surface with 35% PA for 15 seconds
Wash for 10 seconds and dry
For lesions which are completely within enamel, restore in the same manner as described for sealants.

16. Air dry
Place sealant
Cure for 20 seconds
Adjust occlusion if necessary

17. Preventive Resin “B” If caries extends to dentin: Anesthesia?
Etch for 15 seconds with 35% PA
Rinse for 10 seconds and dry.

18. Preventive Resin “B”
Apply drying agent to pulpal floor of the prep for 5 seconds, then dry
Apply thin layer of Ultraseal XT plus to base and along enamel walls
Cure for 15 seconds
Depending upon the extent of dentin involvement, DBA’s should be considered!

19. Preventive Resin “B”
Apply drying agent to gingival portion of the prep for 5 seconds, then dry
Apply thin layer of Ultaseal XT plus to base and along enamel walls
Cure for 15 seconds
Place composite into prep, and cure

20. Preventive Resin “B”
Apply drying agent to gingival portion of the prep for 5 seconds, then dry
Apply thin layer of Ultaseal XT plus to base and along enamel walls
Cure for 15 seconds
Place composite into prep, and cure
Examine margins for integrity

21. Preventive Resin “B”
Apply drying agent to gingival portion of the prep for 5 seconds, then dry
Apply thin layer of Ultaseal XT plus to base and along enamel walls
Cure for 15 seconds
Place composite into prep, and cure
Examine margins for integrity
Re-etch, seal, cure and adjust occlusion if necessary

22. Posterior Composite Indications
Non-stress bearing area of the tooth - occlusal contacts in natural enamel
High esthetic demand by the patient
Conservative restoration in nature
Buccal linqual width not greater than 1/3 of occlusal table
All margins must be free of caries/decalcification
Rounded internal line angles

23. Posterior Composites Materials System must have compatable components
Etch
DBA
Flowable composite (liner)
Composite
Sealant

24. Posterior Composites Small confined lesions “chasing” grooves
Select teeth appropriately
Small confined lesions
“chasing” grooves
Decalcified grooves
Minimal radiographic involvement
Outline can avoid heavy occlusal contact

25. Posterior Composites Anesthetize and isolate
Open pits and fissures with 330HS
Remove remaining caries with slow speed or spoon excavator
Examine for clean margins

26. Posterior Composites Utilize total etch technique
In cases of deep caries, it may be beneficial to place a glass ionomer liner
Etch for 20 seconds and rinse.
Dry, but DO NOT desicate the dentin

27. Posterior Composites Remoisten dentin slightly with a damp microbrush
Place dentin bonding agent according to manufacturer instructions (critical step) on dentin and enamel .
Cure
In this example, Prime and Bond NT® , a one-step system, is being used

28. Posterior Composites Place flowable composite on pulpal floor Cure
Acts as a stress breaker during curing
Minimizes shrinkage and gap formation
Cure

29. Posterior Composites
Place composite incrementally, beginning with eventual cuspal areas.
Cure between increments - minimizes overall shrinkage and gap formation

30. Posterior Composites Adjust occlusion if required
Finish composite in the usual manner with high speed finishing burs and polishing points

31. Posterior Composites
During the finishing process, some gaps at the margin will occur. These need to be sealed.
Etch occlusal surface for 20 seconds with 35% PA.
Rinse, and dry

32. Posterior Composites
During the finishing process, some gaps at the margin will occur. These need to be sealed.
Etch occlusal surface for 20 seconds with 35% PA.
Rinse, and air dry
Apply unfilled resin sealant such as “Fortify”
Cure
Check marginal integrity
Occlusal adjustment should not be necessary

33. Summary
All techniques are critically dependent upon adequate isolation. If you can’t keep it dry, or keep it dry long enough, it won’t work.
Check for poor margins, overhangs, pits and voids - particulary on DLG’s and buccal grooves.
Failure to adhere to guidelines may result in a poor/failing restoration or post-op sensitivity for the patient

34. Summary
There is often no clear cut line between the different preventive resin restorations, and PRR’s vs. a conventional posterior composite.
When in doubt, be more aggressive.
DBA systems and composites must compliment each other. With some brands of flowable composite, you need to use a DBA first