PLACEMENT OF DENTAL SEALANTS 1. TITLE SLIDE: PLACEMENT OF DENTAL SEALANTS. Pit and fissure sealants are a resin material placed on the occlusal surfaces of posterior teeth to reduce the risk of caries.

2. The pits and fissures on the occlusal surfaces of permanent posterior teeth are especially susceptible to caries. This susceptibility is caused by the morphology of the individual teeth; deep pits and fissures provide shelter for streptococcus mutans bacteria and block effective oral hygiene. This cross-sectional view of a permanent molar shows typical fissure morphology. As you can see, the narrow width and depth of pits and fissures make them an ideal shelter for food debris and bacteria. Toothbrush bristles are too large to enter and clean the pits and fissures.

Pit and Fissure Sealant 3. Pit and fissure sealants are a resin material that covers the pits and fissures of teeth to prevent caries. The image on the left shows an enlarged cross section of a tooth with a sealant. The sealant material is a liquid resin when placed on the tooth. The liquid becomes a hard resin through polymerization. The sealant acts as a physical barrier that prevents the streptococcus mutans bacteria and dietary carbohydrates from entering into the fissures. (LifeArt image copyright 1999 Lippincott Williams & Wilkins. All rights reserved.)

Method of Polymerization - self-cured resin Sealant products differ in their method of polymerization (polymerization is also called curing). Both light-cured and self-cured sealants are available. Self-cured sealants (also called chemically cured sealants are supplied as a two-component system: a universal resin and a catalyst resin. Equal amounts of each are dispensed and mixed together. When mixed, they quickly polymerize; this usually occurs within 1 minute. Care should be taken when mixing the two liquids together; use a gentle motion to avoid incorporating air into the mixture. Two components: base and catalyst Equal amounts of base and catalyst are mixed together Resin self-polymerizes in about 1 minute

Method of Polymerization - light-cured resin Single-dose sealant material 5. Method of Polymerization - light-cured Light-cured sealants (also called light-activated sealants) do not require mixing. An intense blue light initiates polymerization after placement of the resin. Light-cured sealants are available in single-dose applicators or in a multi-use container. Resin polymerizes when exposed to blue light Multi-use sealant material

Sealant Color: - clear - tinted - opaque 6. Color of Sealant Sealant products also differ in color; the materials are available as clear, tinted or opaque. Tinted or opaque resins are easier to see when placing sealants and checking for sealant retention. clear sealant opaque sealant opaque sealant in place

Sealant Material Sealant Material Etchant Gel Selection of the sealant type and brand are often personal choices related to cost and ease of use. Etchant Gel

Moisture Control Rubber dam isolation Cotton roll isolation 7. It is important to maintain a dry operating field when placing sealants. Moisture contamination is the main cause of sealant loss (retention failure). Rubber dam or cotton roll isolation is used to maintain a dry field. Rubber dam isolation is the ideal method of moisture control, but can be uncomfortable for patients without local anesthesia. Properly placed cotton rolls, with dri-aids, can be effective in preventing moisture contamination. Rubber dam isolation Cotton roll isolation

8. The following slides will demonstrate assisting with placement of a sealant on tooth #30. Prepare the operatory for the sealant procedure. Armamentarium needed for light-cured sealant using cotton roll isolation includes: 1. cotton rolls and cotton roll holders 2. air/water syringe tip 3. etchant 4. sealant 5. prophy angle with prophy brush or cup 6. pumice 7. dri-angles 8. 2x2 gauze 9. welled-solution dishes 10. applicators 11. articulating paper and forceps 12. basic exam instruments (mouth mirror, explorer and cotton pliers) 13. saliva ejector 14. high volume evacuator tip 15. curing light and appropriate light shield

Examine the Tooth 9. After preparing the operatory, seat and position the patient and yourself. Transfer a mirror and explorer to the clinician. The clinician will examine the teeth to be treated to ensure that the tooth has deep pits and fissures, is caries free and is sufficiently erupted (so that a dry field can be maintained).

Polish the Occlusal Surface 10. The clinician will clean the teeth with a nonfluoride pumice to remove plaque and debris from the occlusal surface. Prepare the pumice in a dappen dish. Transfer the slow speed handpiece. Hold the dappen dish in the transfer zone. The clinician will use the prophy brush and pumice to clean the occlusal surface of the tooth. An air abrasive device or a spin brush may also be used to clean the pits and fissures.

Spin Brush or Manual Brush An air abrasive device, a spin brush or a manual toothbrush may also be used to clean the pits and fissures.

Rinse and Dry the Tooth 11. Rinse the teeth thoroughly with water following prophylaxis and evacuate.

Isolate the Tooth Dry angles Cotton rolls and holder Dry angle placement 12. Prepare and pass the isolation materials. Assist the clinician in isolating the area. Saliva from the parotid gland enters into the oral cavity through the Stenson,s duct. As discussed in module, “Describe the Temporomandibular Joint and Salivary Glands” in the unit “Understanding Human Biology”, Stensons’s duct is located on the buccal mucosa in the area of the maxillary second premolars. Placement of a dry angle over the buccal mucosa in this area will help absorb moisture as well as provide some tissue retraction. Cotton rolls in a cotton roll holder (Garmer clamp) effectively absorbs moisture and retracts the cheek and tongue. After isolation, air dry the teeth for at least 30 seconds with the air syringe. The teeth must be completely dry for the tooth conditioner to etch the tooth. Cotton roll placement

Etch the Occlusal Surface 13. Assist with acid etching the tooth. Unit dose etchant and/or injectable etchant may be used to place the etchant directly on the tooth. Etchant may also be placed using a microbrush. Transfer the applicator to the clinician and hold the dispensed etchant in the transfer zone. The clinician will apply a generous amount of etchant to the occlusal surface and etch the tooth for the manufacturers recommended amount of time. Transfer applicator Apply etchant

Rinse and Evacuate 14. Thoroughly rinse and dry the teeth.

Completely Dry the Tooth 15. Dry each tooth to be sealed completely. The surfaces must be dry for the sealant to bond to etched enamel. The dried etched surface will appear chalky white. If the occlusal surface does not appear chalky or becomes moisture contaminated, the etching procedure must be repeated to ensure proper bonding of the sealant resin to the enamel surface. Bonding agents may be used if moisture control is not adequate. Air-dry the tooth Chalky appearance of etched tooth

Transfer Sealant 16. Prepare the resin according to manufacturer’s directions. This slide demonstrates multi-use sealant dispensed into a holding tray. The amount of sealant needed depends on the number of teeth to be treated. Immerse the applicator tip into the resin and transfer the applicator to the clinician. Hold the dispensed resin in the transfer zone.

Sealant flows into the pits and fissures Sealant Placement 17. The clinician places a thin layer of resin on the etched enamel. The sealant flows into the occlusal pits and fissures. Apply sealant Sealant flows into the pits and fissures

Cure the Sealant 18. Cure the sealant. Hold the curing light tip about 1-2 mm from the tooth surface and activate the curing light. Do not look directly at the light source without eye shields. Each surface to be sealed should be exposed to the curing light for 20 seconds.

Wipe Surface With Cotton Rolls 19. Pass a cotton roll. The clinician uses the cotton roll to wipe the occlusal surface to remove the thin, sticky film of resin that remains on the surface. Transfer cotton roll Wipe surface

Evaluate Sealant 20. Receive the cotton roll and transfer the explorer. The clinician examines the surface of the tooth with the explorer to check for complete coverage and sealant retention. The sealant should be smooth and hard.

Transfer Articulating Paper 21. The clinician removes the isolation shields and cotton roll holders. Receive the shields and cotton roll holders. Rinse and suction the patient. The clinician may want to check the occlusion. Transfer the articulating paper and forceps if requested.

Registering occlusion Evaluate Occlusion 22. The clinician requests the patient to close and chew on the articulation paper to evaluate the occlusion. If any areas covered with sealant are marked by articulating paper, it may be necessary to use a rotary instrument to remove excess sealant. If this situation occurs, put a finishing bur in the slow speed contra-angle handpiece and transfer the handpiece to the clinician. The clinician removes excess sealant with a finishing bur. Dismiss the patient. Escort the patient to the reception area. Give the patient and parent postoperative instructions. This completes the slide presentation. Registering occlusion Occlusal markings