Sealants Preventive Resins and Posterior Composites Department of

Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009

Sealants • Indications – Recently erupted teeth – Tooth can be isolated – No, or only minimal pit and fissure staining – No, or only minimal “catches” in the grooves – No evidence of radiographic caries

Sealants • Material in Y/O Clinic – Ultraseal XT ® plus™ – Manufacturer: Ultradent – Advantages • • • High strength Filled resin sealant (approximately 60% ) Low shrinkage Clinically and radiographically opaque Fluoride releasing May be used for sealants and microrestorative (PRR’s)

Sealants • Technique – Prior to etching the tooth: • Isolate tooth (i. e. rubber dam, dry-angle, cotton roll) • Pumice tooth with nonfluoridated pumice • Wash and dry. • Drag grooves with explorer to remove any remaining pumice. • If necessary, wash, dry, and re-isolate.

Sealants • Etching: - 35% PA – Deliver to the tooth using the blue tip, or using a microbrush – Etch the grooves and cuspal inclines – Etch for 15 seconds – Wash for 10 seconds – Evaluate “frosted” enamel

Sealants • Apply “Prima. Dry” for 5 seconds using the brush tip or microtip brush. – 99% ethyl alcohol – Acts as a drying agent and increases bond strength • Gently dry

Sealant • Apply sealant using the spiral brush tip, or using a microbrush. • Sealant should flow into grooves and up cuspal inclines. • Cure for 20 seconds

Sealant • Evaluate quality of sealant: – – Marginal integrity? Pits or voids in sealant? Overhangs? Heavy occlusion?

Sealants • 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 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 – Caries is incipient and limited to enamel – No radiographic caries Many clinical situations can not be classified according to type until the operator has completed the required exploratory preparation • Type B – Caries extends minimally into dentin and is small and confined – No radiographic findings

PRR “A” vs. PRR “B” Type A Type B

Preventive Resin • Isolate tooth (i. e. rubber dam, dry-angle, cotton roll) • Pumice tooth with nonfluoridated pumice • Wash and dry. • Drag grooves with explorer to remove any remaining pumice. • If necessary, wash, dry, and re -isolate.

Preventive Resin • Remove decalcified pits and fissures with a slow speed 1/4 or 1/2, or with a HS 330 FG • 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 with 35% PA for 15 seconds • Wash for 10 seconds and dry • For lesions which are completely within enamel, restore in the same manner as described for sealants.

• • Air dry Place sealant Cure for 20 seconds Adjust occlusion if necessary

Preventive Resin “B” • If caries extends to dentin: – Anesthesia? – Etch for 15 seconds with 35% PA – Rinse for 10 seconds and dry.

Preventive Resin “B” • Apply drying agent to pulpal floor of the prep for 5 seconds, then dry • Apply thin layer of Ultraseal XT plus to base and along enamel walls • Cure for 15 seconds Depending upon the extent of dentin involvement, DBA’s should be considered!

Preventive Resin “B” • Apply drying agent to gingival portion of the prep for 5 seconds, then dry • Apply thin layer of Ultaseal XT plus to base and along enamel walls • Cure for 15 seconds • Place composite into prep, and cure

Preventive Resin “B” • Apply drying agent to gingival portion of the prep for 5 seconds, then dry • Apply thin layer of Ultaseal XT plus to base and along enamel walls • Cure for 15 seconds • Place composite into prep, and cure • Examine margins for integrity

Preventive Resin “B” • Apply drying agent to gingival portion of the prep for 5 seconds, then dry • Apply thin layer of Ultaseal XT plus to base and along enamel walls • Cure for 15 seconds • Place composite into prep, and cure • Examine margins for integrity • Re-etch, seal, cure and adjust occlusion if necessary

Posterior Composite • Indications – Non-stress bearing area of the tooth - occlusal contacts in natural enamel – High esthetic demand by the patient – Conservative restoration in nature • Buccal linqual width not greater than 1/3 of occlusal table • All margins must be free of caries/decalcification • Rounded internal line angles

Posterior Composites • Materials – System must have compatable components • Etch • DBA • Flowable composite (liner) • Composite • Sealant

Posterior Composites • Select teeth appropriately – – Small confined lesions “chasing” grooves Decalcified grooves Minimal radiographic involvement – Outline can avoid heavy occlusal contact

Posterior Composites • Anesthetize and isolate • Open pits and fissures with 330 HS • Remove remaining caries with slow speed or spoon excavator • Examine for clean margins

Posterior Composites • Utilize total etch technique • In cases of deep caries, it may be beneficial to place a glass ionomer liner • Etch for 20 seconds and rinse. • Dry, but DO NOT desicate the dentin

Posterior Composites • Remoisten dentin slightly with a damp microbrush • Place dentin bonding agent according to manufacturer instructions (critical step) on dentin and enamel. • Cure In this example, Prime and Bond NT® , a onestep system, is being used

Posterior Composites • Place flowable composite on pulpal floor – Acts as a stress breaker during curing – Minimizes shrinkage and gap formation • Cure

Posterior Composites • Place composite incrementally, beginning with eventual cuspal areas. • Cure between increments minimizes overall shrinkage and gap formation

Posterior Composites • Adjust occlusion if required • Finish composite in the usual manner with high speed finishing burs and polishing points

Posterior Composites • During the finishing process, some gaps at the margin will occur. These need to be sealed. • Etch occlusal surface for 20 seconds with 35% PA. • Rinse, and dry

Posterior Composites • During the finishing process, some gaps at the margin will occur. These need to be sealed. • Etch occlusal surface for 20 seconds with 35% PA. • Rinse, and air dry • Apply unfilled resin sealant such as “Fortify” • Cure • Check marginal integrity • Occlusal adjustment should not be necessary

Summary • All techniques are critically dependent upon adequate isolation. If you can’t keep it dry, or keep it dry long enough, it won’t work. • Check for poor margins, overhangs, pits and voids - particulary on DLG’s and buccal grooves. • Failure to adhere to guidelines may result in a poor/failing restoration or post-op sensitivity for the patient

Summary • There is often no clear cut line between the different preventive resin restorations, and PRR’s vs. a conventional posterior composite. • When in doubt, be more aggressive. • DBA systems and composites must compliment each other. With some brands of flowable composite, you need to use a DBA first