Sealants, Topical fluoride
Part of a COMPLETE caries prevention program
Topical fluoride
-protects smooth surfaces
Sealants
-protects pits and fissures
Nutritional analysis
Homecare analysis (plaque, flossing, & brushing technique)
What are other components of a prevention program?
Liquid polymer (resin)
Flows into pits and fissures
Bonds to enamel by mechanical retention
Barrier-'seals off' the pit and fissure
Prevents bacteria from collecting in pits and fissures
What are sealants and how do they work?
KNOW TABLE 37-1 FOR FINAL (Key words: Pit and Fissure Sealants)
KNOW TABLE 37-1 FOR FINAL (Key words: Pit and Fissure Sealants)
Acid etchant
In sealant placement, the enamel surface is prepared by the application of phosphoric acid, which etches the surface to provide mechanical retention for sealant
Articulating paper
Paper treated with dye or wax used to mark points of contact (occlusion) between the maxillary and mandibular teeth
Bibulous
Absorbent; a falt bibulous pad, placed in the cheek over the opening of Stensen's duct, is used to aid in maintaining a dry field while placing sealants
Biocompatibility
The ability of things to exist together without harm
Bis-GMA
Bisphenol A-glycidyl methacrylate; plastic material used for dental sealants
Bonding (mechanical)
Physical adherence of one substance to another; the adherence of a sealant to the enamel surface is accomplished by an acid-etching technique that leaves microspaces between the enamel rods; the sealant becomes mechanically locked (bonded) in these micros
Bond strength
Expression of the degree of adherence between the tooth surface and the sealant
Conditioner
A substance added to another substance to increase its usability; in sealant placement, the acid etchant is added to the enamel to prepare it for bonding with the sealant
Curing
The process is used for polymerization of resin-based sealant and composities so the material hardens by which plastic becomes rigid
Incipient caries
early or beginning caries, caries not limited to the enamel
In vitro
Under laboratory conditions
In vivo
Within the living body
Micropores
Tiny openings
Polymer
A compound of high molecular weight formed by a combination of a chain of simpler molecules (monomers)
Polymerization
A reaction in which a high molecular weight product is produced by successive additions of a simpler compound
Photopolymerization
Polymerization with the use of an external light source
Autopolymerization
Self-curing; a reaction in which a high-molecular-weight product is produced by successive additions of a simpler compound; hardening process of pit and fissure sealants.
Sealant
Organic polymer that bonds to an enamel surface by mechanical retention accommodated by projections of the sealant into micropores created in the enamel by etching
filled and unfilled
What are the two types of sealants that are both composed of Bis-GMA?
Filled sealant
Contains, in addition to Bis-GMA, microparticles of glass, quartz, silica, and other fillers used in composite restorations; fillers make the sealant more resistant to abrasion
Viscosity
In general, the resistance to flow or alteration of shape by any substance as a result of molecular cohesion
*End of Table 37-1
*End of Table 37-1
Acid Etch
Serves as enamel-sealant interface
Produces irregularities or micropores in the enamel
Allows liquid resin to penetrate into the micropores and create a bond or mechanical locking
Provides antibacterial action
Acid Etch
Composition of Acid etch
Phosphoric acid: 15% to 50%
Liquid: low viscosity=good flow, may be difficult to control
Gel: tinted gel with thick consistency=increased visibility and control, but harder to rinse off
Semi-gel: tinted, with viscosity between liquid & gel
Phosphoric acid
: 15% to 50%*
Liquid
: low viscosity=good flow, may be difficult to control
Gel
: tinted gel with thick consistency=increased visibility and control, but harder to rinse off
Semi-gel
: tinted, with viscosity between liquid & gel
15 to 60 seconds
What is the timing of Acid Etch?
Liquid Delivery of Acid Etch
Use small brush, sponge, or cotton pellet and patting motion to apply during etch time & keep the surface wet
Gel and semi-gel Delivery of Acid Etch
use a syringe, brush, or single-use cannula
Criteria for Ideal Sealant Material
Prolonged bonding to enamel
Biocompatibility with oral tissues
Simple application procedure
Free-flowing, low viscosity
Low solubility in the oral cavity
Low viscosity
-thinner, like water, flows readily
High viscosity
-thick like syrup
Low solubility
-does not dissolve easily
High solubility
-dissolves easily (sugar in hot tea)
Filled, Unfilled, Fluoride releasing filled
What are the three types of sealant material?
Filled
Glass and quartz particles
Increases viscosity & bond strength
Higher resistance to abrasion and wear
Unfilled
Clear, usually does not require occlusal adjustment
Advantage in school/community programs
Fluoride-releasing filled
Enhances caries resistance and remineralization of incipient caries at base of pit or fissure
Self-cured or Autopolymerized
Light-cured or Photopolymerized
What are the Methods of Polymerization
Self-cured or Autopolymerized
Preparation: material is supplied in two parts. When mixed they quickly polymerize (harden).
Advantages: no special equipment required
Disadvantages: mixing required; working time limited because polymerization begins when the material is mixed
Light-cured or Photopolymerized
Preparation: 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 and protec
Risk for dental caries (any age)
Teeth
Indications for Placement
Risk for dental caries (any age)
Xerostomia-from medications or other reasons
Orthodontics
Incipient caries-limited to enamel and no radiographic evidence of caries on adjacent proximal surface
Teeth
Newly erupted-place sealant asap after eruption
Occlusal contour-pit or fissure is deep and irregular
Caries history-restorations or caries present on other teeth
Contraindications for Placement
Radiographic evidence of proximal dental caries
Pit and fissures are well coalesced and self-cleansing
Partially erupted (only contraindicated for resin)
Low caries risk
Clinical Procedures- Resin
General rules:
Do each quad (or side) separately
Use four-handed method with an assistant
Follow manufacturer's directions for each product
Retention depends on how well each step is completed.
Follow the steps in Table 37-1 in the text
False (will NOT be retained)
T/F: Resin sealants WILL be retained if a dry field is NOT maintained during etch and sealant placement
Retention
What is sealant success measured by?
Patient, Operatory, and Tooth
What needs preparation before sealant?
Patient prep
Explain procedure/steps to be performed
Patient must wear safety eyewear
Operatory prep
Set up tray ahead of time
Correct patient/operator/light position
Tooth prep
Debride occlusal surfaces WITHOUT fl2 (Prophy jet, pumice and prophy brush, or toothbrush)
Rinse for 20 seconds
Evaluate debridement
Etching
Isolate area
Dry teeth with air (20 seconds)
Apply etch for 15-60 seconds
Rinse etch away and use
high volume suction
If contaminated with saliva, re-etch for 5 seconds
Re-isolate area with dry, clean rolls/angles
Dry for 20 seconds and look for chalky ap
Sealant Material Application
Reisolate the tooth before sealant application
Apply a SMALL amount of sealant material to etched pits and fissures only
Use a CLEAN, DRY micro brush, explorer, or cotton tip applicator to smooth and remove excess material before curing
Light cure while m
After isolation and thorough cleaning of the occlusal surface to be sealed
A
After acid-etching, rinsing, and drying
B
With sealant applied
C
Evaluation
Check for voids and air bubbles
Add additional sealant material if necessary
Re-etch if saliva contamination occurred
Check occlusion with articulating paper
Floss contact areas - why is this important?
Fluoride, Re-eval
What are the final steps of placing a sealant?
GLASS IONOMERS
GLASS IONOMERS
Glass Ionomers
Antimicrobial properties High fluoride levels
Forms a semipermeable skin which allows calcium and phosphate ions to pass through to strengthen tooth
Works in a moist field
-
No isolation required
No etch required
- Uses conditioner
Fluoride releasing (6x
Glass Ionomer Placement Indicators
Incipient caries
Xerostomia
Orthodontics
Head & neck radiation
Infrequent preventive care
High caries experience
Newly erupted posterior teeth
Visible plaque
Pattern of snacking between meals
GI Sealant placement Order
Prep tooth
Shake capsule
Activate capsule
Immediately mix capsule
Prep the tooth GI Sealants
Debride with pumice
Place conditioner for 10 seconds,
then rinse off
Activate the capsule
Push in plunger
Capsule in applier and click lever ONCE, remove
Immediately mix the capsule
Triturate for 10 seconds
Immediately load capsule back into applier
GI Sealant Placement
60-90 seconds working time
'Gently' and
not completely
, dry tooth
Extrude material onto occlusal surface
Force into grooves with finger or condenser or blot with cotton roll and/or micro brush
60-90 seconds
What is the working time of a GI sealant?