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Occlusal SurfaceManagement

u Sealant

–With Fluoride?

u Preventive Class I Resin Restoration

u Class I Glass Ionomer

–Primary Teeth

u Class I Composite

u Class I Amalgam

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PIT andFISSURE

SEALANTS

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ContraindicationsuExfoliation in Six Months

uProximal Caries

uOcclusal Caries Visible onRadiograph

uOpen Fissure

uFissure Margins Undermined

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“The results supportthe safety of sealingincipient caries…”

Handleman et al.

JADA 1986

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IsolationuRubber Dam

–Unless Gingival ClampRequired

uCotton Rolls

uDri-Angles

uSaliva Ejector Always

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Evaluate Retention

uImmediately Post Curing

uUse Explorer at ALL Margins

uMost Failures in First 24 Hours

uEvaluate at EVERY RECALL

–As with ALL Restorations

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10 years later At time of placement

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LISTEN TO ME!THIS IS IMPORTANT!!!

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Preventive ResinClass I

Restorations

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Waggoner, William F.:Pit and Fissure

Application: Updatingthe Technique,

JADA,V 127, ‘96, pp351-61.

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Isolationu One Second Salivary Exposure: No Bond

u Operculum Caused 50% Failure Rate at 36Months

– Wait for complete eruption

u Rubber Dam and Cotton Rolls Done CorrectlyGive Equal Results

– Clamp Discomfort, Local Anesthesia for Soft Tissue,More Time and Infection Control Cost

u DriAngles, VacEjector (Bite Block & Hi-SpeedEvac)

Prophylaxis???u Tooth Surface Must Be Clean

u Toothbrush Adequate; ExplorerThrough Fissures

u Prophy Did Not Increase RetentionRates vs. TB

u Fluoride in Prophy Paste Not aProblem

Attempts to IncreaseRetention

u Prophy-Jet or Cavi-Jet: No Difference

u Hydrogen Peroxide Wash: NoDifference

u Air Abrasion Systems: No Difference

u Widening Fissure with Bur(Prophylactic Odontotomy): NoDifference

– Also MUST be performed by Doctor, not RDH

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Etchingu 37% Orthophosphoric Acid

u Gel vs. Liquid: No Difference inPenetration, Bond Strength, Retention

u 20 Second Etch Time vs. 60 Seconds:No Difference

u Primary Teeth Do NOT RequireExtended Etch or Roughening

u Etch Must Extend 2 mm BeyondFissures

Rinse and DryuOne to Two Second Rinse

Equal to 20 Second Rinse

uDrying Time Should Be Basedon Chalky Appearance

uTest Air Lines for Oil or Water

MaterialsuBIS-GMA

uUrethane

uGlass Ionomer– poor retention

uFiller Particles: Similar RetentionRates

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Glass IonomerCements

uPrimary Molars

uEase of APPLICATION

uFluoride Content

uWear and Crush Resistance

uThermal Insulation

Tinted or OpaqueSealants

uSimilar Bond Strength andRetention

uEasier to See at Recall

uMasks Fissure Staining; PreventsUnnecessary Removal

uNYS Medicaid Required 1996

Fluoride in Sealants

u Is Bioavailable

uSimilar Bond Strengths

uNo Clinical Data on Value toPatient

uMay Have Effect onProximal...Unknown

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Bonding Agents

uControversial Benefit

uMay Increase Retention

uClearly Increases TimeNeeded and Cost

CuringuLight (visible)

uAutopolymerizing

uNo Difference in BondStrength or Retention

Polymerizationu Wait 20 Seconds AFTER Applying:

Penetrates Farther (3x)

u Monitor Light Intensity Frequently– Wand Tip Cleanliness

– Damaged Fiber Optics

– Age of Bulb

– Use Light Meter to Monitor

u Autopolymerized: Need at Least 2Minutes to Cure

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SalivaryContaminationuMust Re-etch

u15 to 20 Seconds,Wash, and Dry

Miscellaneousu Remove Bubbles Before Curing

u Repair Voids By Addition

u Attempt to Dislodge; Most FailuresWithin 24 Hours

u Check Occlusion; Especially with FilledResin

u Evaluate and Replace Fully or Partiallyat Every Recall