Sealants and Preventive Resin Restorations

SEALANTS AND PREVENTIVE
RESIN RESTORATIONS
 Dental caries should be diagnosed and managed as
a dynamic disease of enamel and dentin
 The disease process is initiated whenever a tooth
surface is exposed to acids produced by the
fermentation of carbohydrates in cariogenic
bacteria
 In enamel, calcium and phosphate are lost from
enamel crystals on the surface and sub-surface
layers after the pH of oral fluids drops to less than
5.5
 If the loss continues large microporous areas
develop; “white spot” lesion
 The goal of examining a patient for the presence of dental
caries is to detect the earliest signs of this disease in enamel
and root surfaces
 If early signs of demineralization are detected; advise and
provide preventative care to reverse the caries process
 Important to consider that dental caries is an infectious
disease. “Drilling and filling” a tooth is not the only
solution to the damage caused by the caries process and is
not an effective method to treat the cariogenic infection
(Gregory et al 1998).
 A comprehensive preventative and treatment program is
necessary to manage dental cries especially for patients
with progressive or rampant caries
 A comprehensive preventative and treatment
program is necessary to manage dental cries
especially for patients with progressive or
rampant caries
 In caries active patients an evaluation is carried
out to identify factors such as dietary habits; use
fluoride products; microbial infection in the
mouth; salivary flow and buffering capacity and
oral hygiene practices.
 When examining patients, the goal is to predict the
caries process as well as to diagnose the presence
of dental caries
 The first step in assessing the caries status of a
patient after all interview examinations are
completed, is to inspect visually all tooth surfaces
with a mirror, explorer and air syringe
 An explorer is useful in caries diagnosis as a tool
to remove plaque and debris and check the
surface characteristics of suspected carious lesions
 There is no need to apply too much pressure on an
explorer because studies have found that this does
not increase the accuracy of caries detection (Lussi
1991)
 Gentle pressure is defined by the force just
required to blanch a fingernail without causing
 Following the principle that dental caries is a
dynamic process, management should focus on
identifying surfaces with questionable caries
activity; tooth surfaces with early non-cavitated
lesions and those lesions that should be cleaned
and restored
 Each patient new or regular; should be assessed
for caries activity. Primary preventive
recommendations should be based on caries risk
status.
PIT AND FISSURE CARIES
 THOUGHT TO FORM AT BASE OF FISSURE INVOLVING
DEEPER ASPECTS BEFORE THE WALLS AND CUSPAL
INCLINES OF THE FISSURE
 INCLINES ARE ACTUALLY AFFECTED FIRST
 1ST EVIDENCE OF LESION FORMATION IS AT ORIFICE OF

THE FISSURE
 ENAMEL AT THE BASE IS AFFECTED TO A GREATER

EXTENT AND LESION PROGRESSES LATERALLY AND
RAPIDLY TOWARDS THE DEJ
 ONCE CAVITATION BEGINS THE LESION IS NOW

CLINICALLY DETECTABLE
 ENAMEL SUFACES WITH PITS
AND FISSURES RECEIVE MINIMAL
CARIES PROTECTION FROM
FLOURIDE (SYSTEMIC/TOPICAL)
 LITTLE DEPTH OF ENAMEL AT

BASE OF FISSURE
 UNDERLYING DENTIN BECOMES

INVOLVED RAPIDLY
 WHEN CARIES OCCURS ON

SMOOTH SURFACES A
CONSIDERABLE AMOUNT OF
ENAMEL MUST BECOME
INVOLVED BEFORE DENTIN IS
REACHED (UP TO 3-4 YRS)
CURRENT PIT AND FISSURE TREATMENT
ALTERNATIVES
OBSERVATION ONLY
SEALANT PLACEMENT
PREVENTIVE RESIN RESTORATION
RESTORATION
INDICATIONS FOR SEALANT
PLACEMENT
 DEEP RETENTIVE FISSURES WHICH MAY CAUSE
WEDGING OR CATCHING OF THE EXPLORER
 STAINED PITS AND FISSURES WITH MINIMAL

DECALCIFICATION OR OPACIFICATION
 PIT AND FISSURE CARIES OR RESTORATIONS OF

PITS AND FISSURES IN OTHER TEETH
 NO RADIOGRAPHIC OR CLINICAL EVIDENCE OF

INTERPROXIMAL CAREIS IN NEED OF RETORATION
ON TEETH TO BE SEALED
INDICATIONS FOR SEALANT
PLACEMENT
 USE OF OTHER PREVENTIVE TREATMENT SUCH AS
SYSTEMIC OR TOPICAL FLOURIDE THERAPY TO
INHIBIT INTERPROXIMAL CARIES FORMATION
 POSSIBILITY OF ADEQUATE ISOLATION FROM

SALIVARY CONTAMINATION
 THE TOOTH CONSIDERED FOR SEALANT

APPLICATION ERUPTED LESS THAN 4 YEARS AGO
CONTRAINDICATIONS FOR
SEALANT PLACEMENT
 WELL COALESCED, SELF CLEANSING PITS AND FISSURES
 RADIOGRAPHIC OR CLINICAL EVIDENCE OF INTERPROXIMAL

CARIES IN NEED OF RESTORATION
 PRESENCE OF MANY INTERPROXIMAL LESIONS OR

RESTORATIONS AND NO PREVENTIVE TREATMENT TO INHIBIT
INTERPROXIMAL CARIES FORMATION
 TOOTH PARTIALLY ERUPTED AND NO POSSIBILITY OF

ADEQUATE ISOLATION FROM SALIVARY CONTAMINATION
 PIT AND FISSURE SURACE THAT HAS REMAINED CARIES FREE

4YRS OR LONGER
PREVIOUS GUIDELINES FOR SEALANT
PLACEMENT
 CARIES RISK ASSESMENT OF THE INDIVIDUAL AND THE TOOTH ARE
IMPORTANT AS DETERMINANTS TO SEALANT NEED
 CARIES RISK ON SURFACES WITH PITS AND FISSURES MAY CONTINUE

INTO ADULTHOOD; THERFORE POST-ERUPTIVE AGE ALONE SHOULD
NO LONGER BE USED AS A MAJOR CRITERION FOR SEALAND
DECISIONS
 SEALANTS SHOULD BE USED TO PREVENT CARIES IN AT RISK TEETH

(PREVENTIVE SEALANTS)
 SEALANTS SHOULD BE USED TO TREAT TEETH WITH QUESTIONABLE

CARIES CONFINED TO THE ENAMEL PITS AND FISSURES
(THERAPEUTIC SEALANTS)
 SEALED TEETH NEED TO BE EVALUATED PERIODICALLY FOR

SEALANT INTEGRITY AND RETENTION
CURRENT PHYLOSOPHY
 SELANT USE MUST BE BASED ON PERSONAL, TOOTH
AND SURFACE AT RISK (MAY CHANGE AT ANY TIME
IN LIFE OF PT)
 CURRENT PROFESSIONAL LEADERSHIP HAD

ADVOCATED THAT ANY FISSURE LESION JUDGED
TO BE LIMITED TO ENAMEL IS A CANDIDATE FOR
SEALANT
 IT IS SPECULATED THAT SEALING OF PITS AND

FISSURE COULD HAVE AN EFFECT ON THE OVERALL
COUNT OF STREPTPCOCCUS MUTANS IN THE ORAL
CAVITY
SOME HISTORY
 1ST PAPER PUBLISHED ON THE SUBJECT OF

PIT AND FISSURE SEALANTS WAS BU CUETO
AND BOUNOCORE IN 1965
 BOUNOCORE INTRODUCED THE 1ST

SEALANT MATERIAL THAT UTILIZED THE
ACID ETCH TECHNIQUE
USED CYANOACRYLATE
IN 1982 RESIN BASED SEALANT
MATERIALS WERE INTRODUCED
THESE HAD TWO DIFFERENT TYPES

OF POLIMERIZATION
AUTOPOLYMERIZATION
PHOTOPOLYMERIZATION
BENEFITS OF LIGHT CURE VS
CHEMICAL CURE
 MATERIAL SETS IN 10-20 SECONDS
 NO MIXING OF RESINS
 VISCOSITY REMAINS CONSISTENT DURING

INFILTRATION OF THE ETCHED ENAMEL
PORES
 SEALANT DOES NOT SET UNTIL ACTIVATED

DISADVANTAGES
 COST OF THE LIGHT CURING UNIT
 NEED FOR MULTIPLE UNITS

ADVANTAGES OF LASER
CURING
 FURTHER REDUCTION IN SETTING TIME
 CONTROL OVER SPECIFIC RADIATION

ENERGY WAVELENGTH AND AREA OF
EXPOSURE
 A DECREASED IN THE PERCENTAGE OF

UNPOLYMERIZED RESIN COMPARED WITH
VISIBLE LIGHT CURING
DISADVANTGES
COST OF THE LASER UNIT
NEED FOR ADEQUATELY TRAINED

PERSONEL
GLASS IONOMER SEALANTS
ADVANTAGE
ABILITY TO RELEASE
FLOURIDE
DISADVANTAGE
POOR RETENTION
FILLED VS UNFILLED SELANTS
 PENETRAION IMPORTANT IN SEALANT
APPLICATION AND RETENTION; IS INVERSLY
PROPORTIONAL TO VISCOSITY, THEREFORE IT CAN
BE REASONED THAT AN UNFILLED RESIN WILL
PENETRATE DEEPER INTO THE FISSURE (ex Guardian
Seal 30% filled)
 UNFILLED SEALANT WILL ABRADE RAPIDLY (24-

48HRS) IF IT IS LEFT IN OCCLUSION WITH AN
OPPOSING CUSP TIP.
 FILLED SEALAND MAY REQUIRE OCCLUSAL

ADJUSTMENT INCLUDED AS A ROUTINE PART OF
THE APPLICATION PROCEDURE
COLORED VS CLEAR SEALANTS
 OPAQUE IS EASIER TO DETECT AT RECALL
 LATEST TREND IS TO INCORPORATE COLOR

CHANGE INTO POLYMERIZATION OR CURING PHASE
USE OF INTERMEDIATE BONDING
LAYER
 BONDING AGENT UNDER SEALANT ON WET

CONTAMINATION YIELDS BOND STREGTHS
EQUIVALENT TO THE BOND STRENGTH OBTAINED
WHEN SEALANT IS BONDED DIRECTLY TO CLEAN
ETCHED ENAMEL
 WHEN SALIVA IS AIR DRIED ONTO THE SURFACE

THERE WAS NO SIGNIFICANT DIFFERENCE IN BOND
STRENGTHS WHETHER OR NOT A BONDING AGENT
WAS USED
 MIXED STUDIES
FLOURIDE RELEASING
SEALANTS
 INITIAL ATTEMPTS TO INCORPORATE FLOURIDE INTO BIS-GMA
SEALANTS WERE DISSAPPOINTING
 INCORPORTED FLUORIDE WAS TRAPPED WITHIN THE INERT

SEALANT MATERIAL AND UNAVAILABLE FOR RELEASE
 ION EXCHANGING RESINS WERE THEN DEVELOPED; HAVE

RELATIVELY HIGH FLUORIDE CONTENT AND EXCHANGE
FLUORIDE IONS FROM THE SEALANT MATERIAL FOR
HYDROXYL AND CHLORIDE IONS IN THE ORAL ENVIRONMENT
 MIXED STUDIES
CLINICAL TECHNIQUE
 CLEANSE THE TOOTH
SURFACE
 FLUORIDE FREE PUMICE
 AIR POLISHING DEVISE
 ENAMELPLASTY
 ISOLATE TOOTH
SURFACE FROM
SALIVARY
CONTAMINATION
 RUBBER DAM
 COTTON ROLL
ISOLATION
 ACID-ETCH TOOTH SURFACE
WITH 37.5% PA GEL ETCH
(15-20 SEC)
 RINSE AND DRU ETCHED
TOOTH SURFACE
 RINSE WITH AIR-WATER
10-20 SEC
 DRY 5-10 SEC
 DRIED ETCHED ENAMEL
SHOULD HAVE A FROSTY
WHITE APPREARANCE
 APPLY SEALANT TO ETCHED

TOOTH SURFACE
 ALLOW TO FLOW INTO
PITS AND FISSURES
 MOVE SEALANT INTO
SECONDARY AND
SUPPLEMENTAL FISSURES
 APPLY VISIBLE LIGHT 10-
20 SECONDS ACCORDING
TO
MANUFACTURER/ALLOW
TO AUTOPOLYMERIZED
 EXPLORE THE SEALED TOOTH SURFACE
CK ALL PITS AND FISSURES
 CK FOR VOIDS
 APPLY ADDITIONAL MATERIAL AS NEEDED
 UNISOLATE
 PERIODICALLY REEVALUATE AND REAPPLY
SEALANTS AS NECESSARY
Areas of concern
Retention rates on buccal pits and grooves of

mandibular molars and distolinqual grooves
of maxillary molars
Sealants need periodic maintenance
Moisture contamination secondary to
incomplete eruption and difficulty in
isolation - predicted 30% failure rate within
5 years in these areas.
Marginal integrity and wear.
PREVENTIVE RESIN
RESTORATIONS
 USED FOR RESTORING
ISLOLATED PITS AND FISSURES
AND SIMULTANEOUSLY
PREVENTING CARIS IN THE
REMAINING UNAFFECTED PITS
AND FISSURES
 INVOLVES WIDENING THE PITS

AND FISSURES AND REMOVING
THE ENAMEL OR DENTIN
AFFECTED BY CARIES
 DEPENDING ON THE EXTENT OF

THIS REMOVAL, EITHER AN
UNFILLED OR A FILLED RESIN
MATERIAL IS PLACED OVER
THE REMAINING INTACT PITS
AND FISSURES AS WELL AS
OVER THE RESORED PITS AND
FISSURES
Preventive Resins Restorations
Indications
Tooth can be isolated.
No, or only minimal pit and fissure staining
Minimal “catches” in the grooves, or areas with
distinct incipient enamel caries.
No evidence of radiographic caries.
Preventive Resin Restorations
 Type A  Type B
Caries is incipient Caries extends
and limited to minimally into
enamel dentin and is small
No radiographic and confined
caries No radiographic
Many clinical situations can not be
classified according to type until the findings
operator has completed the required
exploratory preparation
PRR “A” vs. PRR “B”
Type A Type B
Preventive Resin
 Remove decalcified pits

and fissures with a slow
speed 1/4 or 1/2, or with
a HS330FG
 Examine all margins for
remaining caries.
 If caries remains,
consider anesthetizing
and placing conventional
restoration; otherwise
proceed in the following
manner:
Preventive Resin “A”
Etch surface for 15

seconds
Wash for 10
seconds and dry
For lesions which
are completely
within enamel,
restore in the same
manner as
described for
Air dry
Place sealant
Cure for 20 seconds
Adjust occlusion if
necessary
Preventive Resin “B”
If caries extends to
dentin:
Anesthesia?
Etch for 15
Rinse for 10
seconds and dry.
Apply bonding
agent (lightly air
dry if needed) and
light cure for 10
seconds
Depending upon the

extent of dentin
involvement, DBA’s
should be considered!
 Place composite into

prep, and cure
 Flowable compomer;
flowable composite;
composite or
compomers may be
used as needed
Examine margins
for integrity
Place sealant
material, cure
and adjust
occlusion if
necessary
THE END

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SEALANTS AND PREVENTIVE

 INCLINES ARE ACTUALLY AFFECTED FIRST

 1ST EVIDENCE OF LESION FORMATION IS AT ORIFICE OF

 ENAMEL AT THE BASE IS AFFECTED TO A GREATER

 ONCE CAVITATION BEGINS THE LESION IS NOW

 LITTLE DEPTH OF ENAMEL AT

 UNDERLYING DENTIN BECOMES

 WHEN CARIES OCCURS ON

PREVENTIVE RESIN RESTORATION

 STAINED PITS AND FISSURES WITH MINIMAL

 PIT AND FISSURE CARIES OR RESTORATIONS OF

 NO RADIOGRAPHIC OR CLINICAL EVIDENCE OF

 POSSIBILITY OF ADEQUATE ISOLATION FROM

 THE TOOTH CONSIDERED FOR SEALANT

 RADIOGRAPHIC OR CLINICAL EVIDENCE OF INTERPROXIMAL

 PRESENCE OF MANY INTERPROXIMAL LESIONS OR

 TOOTH PARTIALLY ERUPTED AND NO POSSIBILITY OF

 PIT AND FISSURE SURACE THAT HAS REMAINED CARIES FREE

 CARIES RISK ON SURFACES WITH PITS AND FISSURES MAY CONTINUE

 SEALANTS SHOULD BE USED TO PREVENT CARIES IN AT RISK TEETH

 SEALANTS SHOULD BE USED TO TREAT TEETH WITH QUESTIONABLE

 SEALED TEETH NEED TO BE EVALUATED PERIODICALLY FOR

 CURRENT PROFESSIONAL LEADERSHIP HAD

 IT IS SPECULATED THAT SEALING OF PITS AND

 1ST PAPER PUBLISHED ON THE SUBJECT OF

 BOUNOCORE INTRODUCED THE 1ST

THESE HAD TWO DIFFERENT TYPES

 VISCOSITY REMAINS CONSISTENT DURING

 SEALANT DOES NOT SET UNTIL ACTIVATED

 COST OF THE LIGHT CURING UNIT

 NEED FOR MULTIPLE UNITS

 FURTHER REDUCTION IN SETTING TIME

 CONTROL OVER SPECIFIC RADIATION

 A DECREASED IN THE PERCENTAGE OF

COST OF THE LASER UNIT

NEED FOR ADEQUATELY TRAINED

 UNFILLED SEALANT WILL ABRADE RAPIDLY (24-

 FILLED SEALAND MAY REQUIRE OCCLUSAL

 OPAQUE IS EASIER TO DETECT AT RECALL

 LATEST TREND IS TO INCORPORATE COLOR

 BONDING AGENT UNDER SEALANT ON WET

 WHEN SALIVA IS AIR DRIED ONTO THE SURFACE

 INCORPORTED FLUORIDE WAS TRAPPED WITHIN THE INERT

 ION EXCHANGING RESINS WERE THEN DEVELOPED; HAVE

 APPLY SEALANT TO ETCHED

Retention rates on buccal pits and grooves of

 INVOLVES WIDENING THE PITS

 DEPENDING ON THE EXTENT OF

 Remove decalcified pits

Etch surface for 15

Depending upon the

 Place composite into

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