For additional ancillary materials related to this chapter, please visit thePoint.
Objectives
After performing the laboratory/clinical exercises in this chapter, the student will be able to do the following:
1. Discuss the factors determining the success of a sealant.
2. List the indications and contraindications for applying a sealant.
3. Describe the acceptable, but different, methods for preparing the enamel surface for a sealant.
4. Summarize the steps of applying a sealant.
5. Evaluate a placed sealant regarding proper isolation, coverage, and defects.
6. Explain the importance of recall visits for sealant maintenance.
7. Professionally speak to the parent of a child who is in need of sealants. Include in the discussion the rationale, procedure, time involved, and prognosis.
Key Words/Phrases
air abrasive polishing
micropores
Introduction
The basic steps for pit and fissure sealant application are discussed in this chapter. It is always important to review—and to follow—the manufacturer’s directions for the application and storage of a particular sealant material.
Clinical success of sealants is determined by proper placement and retention. The most common reasons for sealant failure are inadequate isolation and subsequent contamination. The dentist must choose a sealant material based on the following properties:
- Autopolymerizing (chemical cure) or visible light-cure sealants. Examples of light-activated sealant kits are provided in Figure 25.1.
- Fluoride-releasing or nonfluoride-releasing sealants.
- Clear, tinted, or opaque sealants.
- The composition, properties, and mechanism for retention of bonding resins are discussed in Chapter 4, Adhesive Materials.
FIGURE 25.1. Examples of light-activated sealants. Top. Dispenser with unidose Delton sealant. Bottom, left to right. Bulk Delton sealant, unidose Delton sealant, and bulk Helioseal.
I. Purpose and Indications
Pit and fissure sealant material will literally flow into the deep pit and fissured areas on occlusal surfaces and seal them from bacterial activity. Figure 25.2 illustrates a magnified occlusal surface exhibiting several deep pit and fissure areas. Sometimes, the fissure is shaped in an “I” formation that is very narrow but has a bulbous base. The formation is too narrow to accommodate toothbrush bristles. The “I”-shaped fissure can be seen in Figure 25.3. The American Dental Association Council on Scientific Affairs has determined that sealants are indicated for patients with the following conditions: an elevated risk for caries, incipient caries within enamel in pit and fissure areas, or existing pits and fissures anatomically susceptible to decay.
FIGURE 25.2. Magnified occlusal surface showing deep pit and fissure areas. (Reproduced from Gwinnett AJ. The bonding of sealants to enamel. J Am Soc Prevent Dent. 1973;3:21, with permission.)
FIGURE 25.3. “I”-shape fissure, very narrow with a bulbous base. ll(Reproduced from Gwinnett AJ. The bonding of sealants to enamel. J Am Soc Prevent Dent. 1973;3:21, with permission.)
II. Contraindications
Pit and fissure sealants are contraindicated on tooth surfaces having frank caries or on surfaces that have well-coalesced pits and fissures.
III. Procedure
The clinical success of a pit and fissure sealant is dependent on the meticulous technique of the clinician. The items needed to place sealants are listed in Table 25.1.
TABLE 25.1. Armamentarium for Placing Sealants
A. Surface Preparation
The clinician may use one of the following methods to prepare the enamel surface for sealant application. Research has found them all to be acceptable.
1. Bristle brush or rubber cup and low-speed handpiece with plain pumice and then rinse for 10 seconds.
2. Bristle brush with water.
3. Etchant only (no surface preparation) for patients with good plaque control.
4. Air abrasive polishing (prophy jet; sodium bicarbonate particles propelled by compressed air in a water spray) or very light air abrasion with aluminum oxide.
B. Isolation
Isolation may be accomplished in two ways.
1. Rubber Dam
The rubber dam method is recommended when more than one tooth in the quadrant is to be sealed. If a rubber dam is not utilized, as in mentioned in Cotton Roll Application and Dry Angle (Triangular Cotton) Isolation below, assistance from an auxiliary is highly recommended.
2. Cotton Roll Application
Use the saliva ejector and a Garmer holder for cotton rolls for the mandibular arch (Fig. 25.4A and B).
FIGURE 25.4. A. Right-side Garmer cotton roll holder. B. Cotton roll holder in use. C. Dry angles. D. Dry angle in use.
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