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

2. Reference
CH36 Wilkins

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

4. Sealant Definition

5. 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

6. Sealant Structure

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

8. 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

9. Sealant Properties

10. 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

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

12. 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

13. 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

14. Acid Etch

15. 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

16. 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

17. (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 Jan;13(1):61–70.)

18. Sealant Criteria

19. 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

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

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

22. 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

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

24. 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

25. 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.

27. 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

28. 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

29. Fluoride in Glass Ionomer: Mosby’s

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

31. 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

32. 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

33. 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

34. 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

35. Indications for Placement

36. 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

37. 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

38. Contraindications

39. 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

40. 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

43. 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

44. 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

45. Sealant Procedure

46. 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

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

48. 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

49. 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

50. 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

51. 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

52. 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 seconds
Maintain dry isolation ready for sealant application

53. 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

54. 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

55. 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

56. Sealant Procedure
After etching dry tooth very well for at least 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

57. 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

58. 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

59. 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

60. 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

61. 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

62. 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

63. 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

64. 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

65. Sealant Maintenance

66. 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

67. 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

68. 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

69. 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

70. 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

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