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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

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

14. Select teeth to be sealed and isolate
Pit and Fissure Sealants
Select teeth to be sealed and isolate

15. Pit and Fissure Sealants
Clean the tooth surfaces with an air polisher or prophy paste using a rubber prophy cup or brush

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

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

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

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

20. Apply sealant material
Pit and Fissure Sealants
Apply sealant material

21. 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.

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

23. No-Rinse Sealant Placement Technique
Pit and Fissure Sealants
No-Rinse Sealant Placement Technique

24. 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

25. 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

26. 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.

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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