pit and fissure sealants in preventive dentistry pit and fissure sealants
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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.
Pit and Fissure Sealants
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.
Pit and Fissure Sealants
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
Pit and Fissure Sealants
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
Pit and Fissure Sealants
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
Pit and Fissure Sealants
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
Pit and Fissure Sealants
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
Pit and Fissure Sealants
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
Pit and Fissure 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”.
Pit and Fissure Sealants
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
Pit and Fissure Sealants
Sealant Placement Techniques
Using a Resin-Based Material
Traditional Technique
“No-rinse” Technique
Pit and Fissure Sealants
Traditional Sealant Placement Procedure
Pit and Fissure Sealants
Select teeth to be sealed and isolate
Pit and Fissure Sealants
Clean the tooth surfaces with an air polisher or prophy paste using a rubber prophy cup or brush
Pit and Fissure Sealants
Enamel cleaned of debris
Pit and Fissure Sealants
Etch the enamel (minimum of 15 seconds).
Pit and Fissure Sealants
Rinse and dry etched enamel
Pit and Fissure Sealants
Gently rinse etchant and look for a frosty white appearance
Pit and Fissure Sealants
Apply sealant material
Pit and Fissure Sealants
Light cure for time period recommended via productinstructions. Colored sealant material turns from pinkto tooth colored after light-curing.
Pit and Fissure Sealants
Check sealant coverage using articulating paper. Arrows indicate the points of contact.
Pit and Fissure Sealants
No-Rinse Sealant Placement Technique
Pit and Fissure Sealants
“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
Pit and Fissure Sealants
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
Pit and Fissure Sealants
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
Pit and Fissure Sealants
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
Pit and Fissure Sealants
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
Pit and Fissure Sealants
Apply a churning or spinning motion to the applicator for five seconds to mix the adhesive and fully coat the applicator tip
Pit and Fissure Sealants
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.
Pit and Fissure Sealants
Clear tip indicates improper activation
Tip must be yellow indicating
proper activation
Adper Prompt Self-Etch Adhesive
Pit and Fissure Sealants
• 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.
Pit and Fissure Sealants
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
Pit and Fissure Sealants
Apply a light-cured sealant
Pit and Fissure Sealants
Light-cure the sealant and adhesive together with a halogen,
LED or plasma light for the amount of time specified to cure the
sealant
Pit and Fissure Sealants
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.
Pit and Fissure Sealants
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
Pit and Fissure Sealants
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
Pit and Fissure Sealants
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
Pit and Fissure Sealants
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
Pit and Fissure Sealants
Pit and Fissure Sealants
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
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