ICP 16 - Preventative Resin Restoration

Question 1

What is a Sealant restoration/Preventative resin restoration

Answer 1

These are composite/GIC restorations with the remaining fissures/pits sealed with fissure sealant

Question 2

When are Sealant restorations/Preventative resin restoration

Answer 2

When visual inspection/bitewings have established that a stained tissue is a carious lesion just into dentine.

Question 3

What is the aim of sealant restorations

Answer 3

Aim of Sealant restorations is to ensure the optimum management of possible fissure caries in permanent molars

Question 4

What is an advantage of sealant restorations

Answer 4

Appropriate mix of early carious lesions may prevent the child entering the restorative cycle unnecessarily

Question 5

What is a disadvantage of sealant restorations

Answer 5

If a sealing- in approach is adopted when managing a suspicious fissure, then careful long term monitoring and repair of fissure sealants is essential

Question 6

What is the appropriate procedure that must be followed if there is uncertainty whether caries is present in an occlusal fissure

Answer 6

• Thoroughly clean the fissures of all debris, dry the tooth and view in bright direct light
• View a good quality bitewing radiograph of the tooth

If there is micro-cavitation OR Shadowing visible under enamel adjacent to fissure OR Dentinal caries clearly visible radiographically

Then place a conventional composite restoration limited to the site of the carious lesion and fissure seal the remaining fissure system

Question 7

What materials are used for PRR/SR

Answer 7

• Unfilled resin that may be light/chemical cure, clear/tinted or opaque
• Filled resin that may be light/chemical cure, clear/opaque/tinted, containing filler particles
• Glass ionomer, useful in partially erupted teeth and when isolation is problematic

Question 8

What is the clinical procedure for Sealant Restoration

Answer 8

• Remove any soft plaque/organic substance with surface cleaning with or without pumice or oil-free prophypaste
• Local analgesia, if very minimal caries just into dentine
• Rubber dam isolation is LA used or use dry guard, cotton wool rolls
• Caries removal minimally using small diameter bur
• As the cavity is just into dentine and not very deep, a lining is not indicated
• Etch the enamel with 37% phosphoric acid for 15 seconds, then wash for 15 seconds and air dry
• Verify frosted appearance
• Apply primer to dentine for 15 seconds, air dry for 5 seconds
• Apply bond adhesive to dentine for 15 seconds, air thin for 3 seconds
• Light cure for 20 seconds
• Apply composite resin to fill the cavity to its correct occlusal form. If the cavity is very small a flowable composite could be used
• Apply fissure sealant material to cover all remaining fissures up to 1/3 of cusps incline
• Light cure for 20 secs and check occlusion for defects