Pit and Fissure Sealants Sealants in Preventive Dentistry                                                                                                                                                                                                        Welcome to the Continuing Education Program: Sealants in Preventive Dentistry

The focus of this presentation is on the role Pit and Fissure Sealants The focus of this presentation is on the role that dental sealants play in preventive dentistry, and two types of placement techniques: the traditional method and a “no-rinse” technique. :01 seconds

Role of dental sealants in preventive dentistry: 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. 1:10 minutes

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: Dentists Registered Dental Hygienists Registered Dental Assistants with Certification :39 seconds

How to determine who should have a dental sealant placed: 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 plaque Cariogenic diet History of caries in the patient or the patient’s family Low fluoride intake Pit and fissure anatomy 2:16 minutes

Other Considerations: 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 3:00 minutes

Situations where sealants would not be recommended: 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 3:31 minutes

Glass ionomer vs.resin-based sealants: 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 4:15 minutes

Glass ionomer vs. resin-based sealants (cont.) 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 4:15 minutes

Are sealants recommended for both children and adults? 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”. 1:50 minutes

Long-term Success of Sealant Therapy 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 4:15 minutes

Sealant Placement Techniques Using a Resin-Based Material Pit and Fissure Sealants Sealant Placement Techniques Using a Resin-Based Material Traditional Technique “No-rinse” Technique

Traditional Sealant Placement Procedure Pit and Fissure Sealants Traditional Sealant Placement Procedure 4:15 minutes

Select teeth to be sealed and isolate 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

Enamel cleaned of debris Pit and Fissure Sealants Enamel cleaned of debris

Etch the enamel (minimum of 15 seconds). Pit and Fissure Sealants Etch the enamel (minimum of 15 seconds).

Rinse and dry etched enamel Pit and Fissure Sealants Rinse and dry etched enamel

Gently rinse etchant and look for a frosty white appearance Pit and Fissure Sealants Gently rinse etchant and look for a frosty white appearance

Apply sealant material Pit and Fissure Sealants Apply sealant material

Light cure for time period recommended via product Pit and Fissure Sealants Light cure for time period recommended via product instructions. Colored sealant material turns from pink to tooth colored after light-curing.

Pit and Fissure Sealants Check sealant coverage using articulating paper. Arrows indicate the points of contact.

No-Rinse Sealant Placement Technique 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

Adper Prompt Self-Etch Adhesive Pit and Fissure Sealants Adper Prompt Self-Etch Adhesive Indications For Use: Bonding light-cured composite and compomer materials to dentin and enamel Desensitization of exposed root surfaces Bonding of light-cure resin based pit and fissure sealants Unidose L-Pop delivery system Before reviewing the clinical technique, I would like to take a few minutes to discuss the Adper Prompt Adhesive. This material has been used for many years to bond light-cured composites, and also to desensitize exposed root surfaces. Another less known indication is for the bonding of dental sealants. Two-vial delivery system

Self-etch Adhesive Clinical Technique 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 Now let’s discuss the technique of placing a sealant using Adper Prompt Adhesive and Clinpro Sealant. As you will see, the manner in which to prepare the tooth to accept the sealant is the same as when using the traditional method using phosphoric acid.

Self-Etch Adhesive: L-Pop Activation Pit and Fissure Sealants Self-Etch Adhesive: L-Pop Activation 11:34 minutes Squeeze the material from the red reservoir into the yellow (middle) reservoir The middle reservoir will expand indicating proper transfer of fluid

Fold back the red reservoir until it meets the flat face 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 11:39 minutes

Pit and Fissure Sealants 11:45 minutes Apply a churning or spinning motion to the applicator for five seconds to mix the adhesive and fully coat the applicator tip

A lightly yellow-tinted applicator tip indicates proper 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. 11:52 minutes

Adper Prompt Self-Etch Adhesive Pit and Fissure Sealants Adper Prompt Self-Etch Adhesive Tip must be yellow indicating proper activation Clear tip indicates improper activation 11:56 minutes

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. 14:36 minutes

The surface will appear glossy, but not moist 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 15:02 minutes

Apply a light-cured sealant Pit and Fissure Sealants Apply a light-cured sealant 15:17 minutes

Light-cure the sealant and adhesive together with a halogen, 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 15:42 seconds

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. 16:05 seconds

Pit and Fissure Sealants Adper Prompt Self-Etch Adhesive and Clinpro Sealant - Key Technique Tips: Activated L-Pop must be a deep golden yellow The L-Pop can be activated up to 10 minutes before the procedure Saves time to activate before bringing patient back to operatory Adhesive must be scrubbed on the surface for a minimum of 15 seconds 12:45 minutes

Key Technique Tips (continued) 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 12:45 minutes

Benefits of Technique: 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 12:45 minutes

Conclusions about the use of dental sealants: 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 17:04 seconds

Vicki L. Svoboda – 3M Dental Division Columbia Dentoform Pit and Fissure Sealants Acknowledgements: The instructional staff wish to gratefully acknowledge the following for their contributions to this project – 3M-ESPE Vicki L. Svoboda – 3M Dental Division Columbia Dentoform The California Association of Dental Assisting Teachers, Inc. © 3M-ESPE/CADAT 2010