Presentation on theme: "Sealants, Preventive Resins and Posterior Composites"— Presentation transcript:
1Sealants, Preventive Resins and Posterior Composites Department of Pediatric DentistryUniversity of Isfahan medical sciences 2009
2Sealants Indications Recently erupted teeth Tooth can be isolated No, or only minimal pit and fissure stainingNo, or only minimal “catches” in the groovesNo evidence of radiographic caries
3Sealants Material in Y/O Clinic Ultraseal XT ® plus™ Manufacturer: UltradentAdvantagesHigh strengthFilled resin sealant (approximately 60% )Low shrinkageClinically and radiographically opaqueFluoride releasingMay be used for sealants and microrestorative (PRR’s)
4Sealants Technique - Prior to etching the tooth: Isolate tooth (i.e. rubber dam, dry-angle, cotton roll)Pumice tooth with non-fluoridated pumiceWash and dry.Drag grooves with explorer to remove any remaining pumice.If necessary, wash, dry, and re-isolate.
5Sealants Etching: - 35% PA Deliver to the tooth using the blue tip, or using a microbrushEtch the grooves and cuspal inclinesEtch for 15 secondsWash for 10 secondsEvaluate “frosted” enamel
6SealantsApply “PrimaDry” for 5 seconds using the brush tip or microtip brush.99% ethyl alcoholActs as a drying agent and increases bond strengthGently dry
7SealantApply sealant using the spiral brush tip, or using a microbrush.Sealant should flow into grooves and up cuspal inclines.Cure for 20 seconds
8Sealant Evaluate quality of sealant: Marginal integrity? Pits or voids in sealant?Overhangs?Heavy occlusion?
9Sealants Areas of concern Retention rates on buccal pits and grooves of mandibular molars and distolinqual grooves of maxillary molarsSealants need periodic maintenanceMoisture contamination secondary to incomplete eruption and difficulty in isolation - predicted 30% failure rate within 5 years in these areas.Marginal integrity and wear.
10Preventive Resins Restorations IndicationsTooth can be isolated.No, or only minimal pit and fissure stainingMinimal “catches” in the grooves, or areas with distinct incipient enamel caries.No evidence of radiographic caries.
11Preventive Resin Restorations Type ACaries is incipient and limited to enamelNo radiographic cariesType BCaries extends minimally into dentin and is small and confinedNo radiographic findingsMany clinical situations can not be classified according to type until the operator has completed the required exploratory preparation
13Preventive ResinIsolate tooth (i.e. rubber dam, dry-angle, cotton roll)Pumice tooth with non-fluoridated pumiceWash and dry.Drag grooves with explorer to remove any remaining pumice.If necessary, wash, dry, and re-isolate.
14Preventive ResinRemove decalcified pits and fissures with a slow speed 1/4 or 1/2, or with a HS330FGExamine all margins for remaining caries.If caries remains, consider anesthetizing and placing conventional restoration; otherwise proceed in the following manner:
15Preventive Resin “A” Etch surface with 35% PA for 15 seconds Wash for 10 seconds and dryFor lesions which are completely within enamel, restore in the same manner as described for sealants.
16Air dryPlace sealantCure for 20 secondsAdjust occlusion if necessary
17Preventive Resin “B” If caries extends to dentin: Anesthesia? Etch for 15 seconds with 35% PARinse for 10 seconds and dry.
18Preventive Resin “B”Apply drying agent to pulpal floor of the prep for 5 seconds, then dryApply thin layer of Ultraseal XT plus to base and along enamel wallsCure for 15 secondsDepending upon the extent of dentin involvement, DBA’s should be considered!
19Preventive Resin “B”Apply drying agent to gingival portion of the prep for 5 seconds, then dryApply thin layer of Ultaseal XT plus to base and along enamel wallsCure for 15 secondsPlace composite into prep, and cure
20Preventive Resin “B”Apply drying agent to gingival portion of the prep for 5 seconds, then dryApply thin layer of Ultaseal XT plus to base and along enamel wallsCure for 15 secondsPlace composite into prep, and cureExamine margins for integrity
21Preventive Resin “B”Apply drying agent to gingival portion of the prep for 5 seconds, then dryApply thin layer of Ultaseal XT plus to base and along enamel wallsCure for 15 secondsPlace composite into prep, and cureExamine margins for integrityRe-etch, seal, cure and adjust occlusion if necessary
22Posterior Composite Indications Non-stress bearing area of the tooth - occlusal contacts in natural enamelHigh esthetic demand by the patientConservative restoration in natureBuccal linqual width not greater than 1/3 of occlusal tableAll margins must be free of caries/decalcificationRounded internal line angles
23Posterior Composites Materials System must have compatable components EtchDBAFlowable composite (liner)CompositeSealant
24Posterior Composites Small confined lesions “chasing” grooves Select teeth appropriatelySmall confined lesions“chasing” groovesDecalcified groovesMinimal radiographic involvementOutline can avoid heavy occlusal contact
25Posterior Composites Anesthetize and isolate Open pits and fissures with 330HSRemove remaining caries with slow speed or spoon excavatorExamine for clean margins
26Posterior Composites Utilize total etch technique In cases of deep caries, it may be beneficial to place a glass ionomer linerEtch for 20 seconds and rinse.Dry, but DO NOT desicate the dentin
27Posterior Composites Remoisten dentin slightly with a damp microbrush Place dentin bonding agent according to manufacturer instructions (critical step) on dentin and enamel .CureIn this example, Prime and Bond NT® , a one-step system, is being used
28Posterior Composites Place flowable composite on pulpal floor Cure Acts as a stress breaker during curingMinimizes shrinkage and gap formationCure
29Posterior CompositesPlace composite incrementally, beginning with eventual cuspal areas.Cure between increments - minimizes overall shrinkage and gap formation
30Posterior Composites Adjust occlusion if required Finish composite in the usual manner with high speed finishing burs and polishing points
31Posterior CompositesDuring 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
32Posterior CompositesDuring 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 dryApply unfilled resin sealant such as “Fortify”CureCheck marginal integrityOcclusal adjustment should not be necessary
33SummaryAll 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
34SummaryThere 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