Dental sealants
Educational objectives
At the end of this course, the student is able to:
- To determine the indications and benefits of sealing pits and fissures.
- To know the operating protocol for applying dental sealants.
- Introduction
Sealing fissures or “sealant” is a simple, effective, inexpensive and widely proven way to prevent fissure caries in posterior teeth.
- Definitions
- Fissure sealing : is defined as “a non-invasive procedure to fill the fissures with a fluid adhesive material.
- Sealant: is a plastic material that is usually applied to the occlusal surfaces of premolars and molars. This plastic resin bonds to the pits and fissures of the occlusal surface of posterior teeth. The product acts as a barrier, protecting the enamel from plaque and acids.
- Interest in dental sealing
Sealing furrows has a double benefit:
-Reduce the frequency of occlusal caries in subjects with a high RCI. In this case, the aim is to protect the occlusal surfaces from a risk of caries to which all teeth are exposed;
– Reduce the frequency of cavities in the fissures. This involves specifically protecting areas that are inaccessible to other means of prevention.
4- Indications
– Any permanent tooth that is not decayed in subjects at risk of decay.
-Any permanent tooth that is not decayed but has irregular pits and fissures in subjects at low risk of decay.
-Children and young patients with medical, physical or intellectual disorders
-stop the progression of carious lesions limited to the enamel. Regular monitoring of these sealed teeth is necessary.
– Pit and fissure sealing can be performed on all at-risk teeth, particularly temporary molars in patients at high caries risk
5- Contraindications
Caries reaching the dentin
6- Dental sealants
- Composite resins
In the context of groove seals, fluid or ultra-fluid composite resins based on Bis-GMA (bisphenol A glycidyl methacrylate) are used.
Flowable composite resins are obtained by decreasing the percentage of fillers relative to the matrix volume, by increasing the percentage of viscosity reducers or by combining these two processes.
Ultra-fluid composites are, depending on the manufacturer, very lightly filled or unfilled. A resin is considered unfilled if its proportion of inert particles is less than 10%.
Properties
An unfilled resin is more favorable in terms of flow and therefore penetration into crevices. On the other hand, it has poor mechanical properties.
- Glass ionomer cements
CVIs have two interesting characteristics as pit and furrow sealing materials:
-they naturally release fluoride (anti-cariogenic effect)
-they adhere spontaneously to the enamel
However, they are more soluble in saliva, lack hardness and are less resistant to abrasion than resins
Furthermore, it has been demonstrated in vitro that fluoride released by glass ionomer cements inhibited colonies of Streptococcus mutans and, more intensely, colonies of Streptococcus sobrinus.
The addition of resin to glass ionomer cements improves their mechanical properties while retaining their biological properties: better resistance to abrasion and adhesion to dental tissues, lower solubility in saliva.
- The varnishes
Fluoride varnishes are concentrates of fluorides in a resin or synthetic base.
Currently, they are the only fluoride-based topicals for exclusively professional use.
The fluoride concentration level varies from 1,000 to 56,000 ppm depending on the products marketed.
Indication in the context of groove seals
The application of fluoride varnish of at least 22,600 ppm is an alternative to fissure sealants when the isolation of the tooth to be sealed is impossible or imperfect, according to the recommendations of the SFOP of 2004 and the HAS of 2005.
To be effective, fluoride varnishes must be applied regularly according to the RCI since their effect disappears when applications cease. In addition, their preventive effect on erupting first permanent molars would be increased by the prior application of a layer of povidone-iodine.
Figure 1: Decision tree for the installation of a pit and fissure sealing material
7- Operating protocol
- Operating protocol for resin-based sealing materials
– Clinical examination and diagnosis
-Isolation : Isolation of the tooth during the placement of an MSR is the primary factor for success, as with any bonding, thus determining the durability of the seal. In order to obtain satisfactory isolation of the tooth, the use of an operating field or rubber dam remains the first choice.
-Prophylactic cleaning : either mechanically dry using a dry brush without prophylactic paste for 20 seconds, or by air polishing using a pulsed jet of sodium bicarbonate. These two methods do not leave any debris that could alter the bonding of the resin.
-Enamel preparation and conditioning : Conditioning of the enamel surface consists of etching with 35-40% orthophosphoric acid applied for 15 to 30 seconds followed by rinsing for at least 15 seconds to stop the action of the acid, then careful drying until a chalky white enamel is obtained at the surface to be sealed.
Laying the resin-based sealing material
-Application of the material and passage of the probe into the pits and cracks to eliminate bubbles and improve the spreading in low thickness of the resin.
-Waiting 15-20s before photopolymerization improves the penetration of the material into pits and cracks
-Photopolymerization, 20 s,
- Other operating protocols
When it is not possible to isolate the tooth satisfactorily, other alternatives to MSR are then considered:
- If the insulation of the tooth to be sealed is imperfect:
-Either sealing the grooves with a CVI-based material;
-Repeated applications of fluoride varnish of at least 22,600 ppm at the level of the furrows;
- If isolation of the tooth to be sealed is completely impossible:
It is recommended to postpone the sealing of pits and fissures and to reinforce other means of prevention, in particular the multiple daily use of fluoride toothpaste of at least 1,500 ppm.
8- Monitoring, control visits
Furrow sealing is part of a global prevention approach which requires regular monitoring, which varies depending on the initial RCI:
– in the event of a high initial RCI, a follow-up visit is recommended 3 to 6 months later;
– in the event of a low initial RCI, a follow-up visit is recommended once a year. The monitoring frequency is modified over time depending on the evolution of the RCI.
9- Conclusion
Sealing the grooves, pits, and fissures of permanent molars is part of a comprehensive preventative approach . Under no circumstances should this procedure be used in place of other methods of preventing caries. The practitioner must make the child and their parents aware of the need to maintain oral hygiene, dietary hygiene, and regular checkups to ensure the longevity of the sealant and dental structures.
10- Bibliographies
1- French Agency for the Safety of Health Products (Afssaps). Use of fluoride in the prevention of dental caries before the age of 18. October 2008.
2- High Authority of Health. Recommendations for clinical practice: Assessment of caries risk and indications for prophylactic sealing of the grooves of the first and second permanent molars in subjects under 18 years of age. November 2005.
3- High Authority of Health. Public health recommendations: Strategies for preventing dental caries. March 2010.
4- Bénédicte Calmet. Sealing of grooves, pits and fissures: retrospective study at the dental care center of the Brest University Hospital. Life Sciences [q-bio]. 2014. dumas-01320241.
Dental sealants
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