AQ

Sealants (Chapter 35) - Vocabulary Flashcards

What Are Sealants?

  • Definition: thin plastic coatings painted on teeth that seal the grooves (pit and fissures) to keep out food and bacteria.
  • Appearance: sealants are clear or white and don’t hurt to apply.
  • Timing: first adult molars come in around age 6 — a good time for sealants; newly erupted teeth should be sealed as soon as fully erupted when indicated.
  • Function: protect teeth from cavities for several years by preventing food and bacteria from accumulating in pits and fissures.

Development of Sealants

  • Developed by Dr. Michael Buonocore and a group of dental scientists at the Eastman Dental Center in Rochester, New York.
  • Early research focused on enamel surface preparation to improve adhesion.
  • Demonstrated that acid-etchant treatment alters enamel to increase retention.
  • This acid-etching breakthrough significantly advanced esthetic and preventive dentistry.

Types of Dental Sealants

  • Resin-Based Sealants
    • Material: plastic resin (BIS-GMA or UDMA); available in colored forms; opaque white is most common.
    • Main benefits: lasts the longest, strong, aesthetically acceptable, good for deep pits/fissures when kept dry.
    • Main drawbacks: technique-sensitive; requires a very dry tooth to work properly.
  • Glass Ionomer Sealants (GI)
    • Material: special glass (fluoroaluminosilicate) + acid that sets without light; self-cured; releases fluoride.
    • Main benefits: works even if the tooth is a little wet; fluoride release helps protect tooth; allows minerals in and out; does not require acid-etchant.
    • Main drawbacks: does not last as long; more likely to wear away; thicker than resin sealants; fast setting time (~2 minutes). Good for kids, partially erupted teeth, or hard-to-dry situations.
  • Compomer Sealants
    • Material: mix of resin + glass ionomer (resin plus fluoride-releasing component).
    • Main benefits: moderate fluoride release; stronger than GI because of resin content but less than pure resin sealants.
    • Main drawbacks: fluoride doesn’t last long; still needs a dry tooth; not much long-term research; Rarely used; option if you want both fluoride and resin-like strength.

Color Classification

  • Available: clear, tinted, and opaque.
  • Purpose: quick identification for maintenance assessment.
  • Effect: clear, tinted, or opaque sealants do not differ in retention.

Indications for Sealants

  • Indications depend on individual health, diet, and lifestyle; age of tooth and past caries experience; tooth anatomy.
  • Patients at risk for dental caries (any age) have additional considerations:
    • Xerostomia (dry mouth) from medications or other causes.
    • Orthodontic treatment.
    • Incipient pit and fissure caries limited to enamel with no radiographic evidence on an adjacent proximal surface.
    • Low socioeconomic status.
    • Diet high in sugars.
    • Inadequate daily oral health care.

Selection of Teeth

  • Newly erupted teeth: place sealant as soon as the tooth is fully erupted.
  • Occlusal contour: seal when the pit or fissure is deep and irregular.
  • Figure reference: a molar with deep fissures (evidence of prior caries in adjacent teeth may be present, e.g., amalgam filling on a nearby tooth).

Contraindications for Sealant Placement

  • Cannot place sealants after fluoride application (varnish, gel, or foam).
  • Reason: fluoride leaves a fluoride-rich coating on the enamel surface, reducing surface energy and blocking the micropores created by etching, which are needed for resin flow and bonding.
  • Result: weaker micromechanical retention and increased risk of sealant failure.

Contents of a Pit or Fissure; Effect of Cleaning

  • Contents may include:
    • Dental biofilm, pellicle, debris.
    • Rarely, intact remnants of tooth development.
  • Effect of Cleaning:
    • Cleaning the tooth prior to acid etching can increase sealant retention.
    • Use of an air polisher or laser before etching is not strongly supported due to added cost.
    • Cleaning the tooth with a toothbrush and water is ideal because narrow fissures are difficult to clean completely.
    • Removal of pumice used for cleaning and thorough washing are necessary for sealant retention.
    • If pumice was used, complete removal is essential.
    • Retained cleaning material can block the fissure from being filled and can mix with the sealant.

Polymerization Method Classification

  • Self Cure: a two-liquid system for sealing pits and fissures.
  • After etching and thoroughly drying surfaces, mix equal amounts of Parts A and B and apply the liquid with a brush.

Maintaining a Dry Field

  • Dry-field technique requires moisture control devices.
  • Common tools include Dri-Angle and Isolite systems (moisture control, illumination, and retraction).

Isolite System

  • The Isolite system provides continuous illumination, moisture control, and retraction during dental procedures.
  • It combines a light source, suction, and a mouthpiece with a built-in bite block.
  • Considered a more efficient and comfortable alternative to traditional methods like rubber dams and manual suction.

What is Acid Etch?

  • Etching process creates a chalky white appearance on enamel.
  • Uses phosphoric acid (acid tastes sour).
  • Process cleans tooth surface and dries the tooth with air for at least 10 seconds.
  • Typically uses 30%–50% phosphoric acid.
  • Purpose: creates irregularities in the enamel surface (micropores) to allow for mechanical retention of a resin-based sealant or bonding agent.

Acid Etch: Delivery and Timing

  • Etchant solutions can be:
    • Liquid: low viscosity, flows into pits/fissures, but harder to control.
    • Gel: tinted, thick, better visibility and control, but harder to rinse.
    • Semi-gel: tinted, viscous enough for visibility, control, and rinsing ease.
  • Typical etchant: Phosphoric acid in the range of 15% to 50% depending on product/manufacturer.
  • Timing varies from 15 to 60 seconds; follow manufacturer instructions.
  • Delivery methods:
    • Liquid etch: small brush, sponge, or cotton pellet; apply by patting rather than rubbing to keep surface moist.
    • Gel/semi-gel: syringe, brush, or manufacturer-supplied cannula.
  • Example product reference: ULTRADENT (illustrative manufacturer).

Sealant Placed on Smooth vs Etched Surface

  • Unetched enamel remains relatively smoother; etched enamel has micro-porosities for retention.
  • Applications involve enamel, dentin, and pulp considerations; generally, etching is required for resin-based sealants to achieve good bonding.

Applying Acid Etch

  • Action: creates micropores to increase surface area for retention; removes surface contamination; provides antibacterial action.
  • Etchant composition: phosphoric acid in the range of 15% to 50% depending on product; forms micropores.
  • Delivery and timing details are as listed above.

Steps for Placement of a Photopolymerized Dental Sealant

1) Patient preparation

  • Review medical/dental history, explain procedure, obtain consent.
  • Equipment: patient chart, PPE, mirror, explorer.
    2) Tooth cleaning
  • Remove plaque/debris from occlusal surface; avoid oil- or fluoride-containing paste.
  • Equipment: prophy brush or cup, pumice/water slurry, slow-speed handpiece, air/water syringe.
    3) Isolation
  • Maintain a dry field to prevent contamination.
  • Equipment: cotton rolls, dry angles, rubber dam; saliva ejector or high-volume evacuator (HVE).
    4) Dry tooth
  • Thoroughly air-dry occlusal surface for 10 seconds.
  • Equipment: oil-free compressed air, air/water syringe.
    5) Acid etch
  • Apply 35–37% phosphoric acid to pit and fissure areas.
  • Timing: 20–30 seconds for permanent teeth; 15–20 seconds for primary teeth.
  • Equipment: etchant (gel or liquid), syringe tip or microbrush.
    6) Rinse
  • Rinse thoroughly with water to remove all etchant.
  • Equipment: air/water syringe.
    7) Dry and evaluate
  • Dry for 10 seconds; look for frosty white, chalky appearance.
  • Equipment: air/water syringe, mirror.
    8) Re-etch if contaminated
  • If moisture contamination occurs, re-etch for 10 seconds, rinse, and dry again.
  • Equipment: etchant, air/water syringe.
    9) Apply sealant
  • Place sealant material into pits/fissures, avoid overfill; allow it to flow but not pool.
  • Equipment: sealant syringe or brush, sealant material.
    10) Polymerize (light cure)
  • Hold curing light tip close to surface; cure according to manufacturer’s time (usually 20–40 seconds).
  • Equipment: visible light-curing unit, protective orange shield or glasses.
    11) Evaluate
  • Use an explorer to check for complete coverage and absence of voids; add material if needed and re-cure.
  • Equipment: explorer, mirror.
    12) Check occlusion
  • Use articulating paper; adjust high spots if necessary.
  • Equipment: articulating paper, finishing bur, slow/high-speed handpiece.
    13) Apply topical fluoride
  • After final sealant is placed and adjusted, apply fluoride (varnish or gel) as post-insertion instructions.
  • Equipment: fluoride varnish or gel, applicator.

Sealant Depth

  • Penetration depth data (examples of studied sealants):
    • GC Fuji Triage: 82.85\%
    • Admira Seal: 76.28\%
    • GC Fuji VII Glass Ionomer: 85.82\%
    • Clinpro Sealant: 78.26\%
    • Delton FS Sealant: 74.89\%

Maintenance

  • Replacement: follow manufacturer instructions.
  • Tooth preparation for replacement is the same as for original placement.
  • Removal of any firmly attached residual sealant is not needed.
  • Re-etch the tooth if sealing needs to be reapplied.

Retention

  • Check sealants at least every 6 months.
  • Properly placed sealants can be retained for years.
  • Factors affecting retention:
    • Precision of technique and moisture/contamination exclusion.
    • Patient self-care and dental hygiene care.

Documentation

  • Minimum documentation in the patient record:
    • Reason for selecting certain teeth for sealants; informed consent of patient/parent/caregiver.
    • Type of sealant used, preparation of tooth, manner of isolation, patient cooperation during administration; postinsertion instructions given.
    • Sample documentation for placement may be reviewed in Box 35-1 (reference).

Factors to Teach the Patient

  • What to expect from a sealant, how long it lasts, and how it helps prevent dental caries.
  • Need for examination of the sealant at frequent, scheduled maintenance appointments and need for replacement when missing or chipped.
  • Avoid biting hard items (pencils, hard candy, or ice cubes) to increase sealant retention.

Additional Notes

  • The material emphasizes moisture control, isolation, and careful technique to maximize sealant retention and longevity.
  • The information provided includes practical steps, material properties, and clinical decision factors to guide sealant placement, maintenance, and documentation.