ICP L16: PRR minimally invasive occlusal cavity

Question 1

What is SR/PRR

Answer 1

Sealant restoration / Preventative resin restoration is a composite / GIC restoration with the remaining fissures and pits sealed with fissure sealant

Question 2

When is a PRR used

Answer 2

When diagnostic methods (visual inspection, bitewings) indicate a stained fissure is a carious lesion just into the dentine and if caries is in one area of the pit or fissure, it will be restored and with PRR and the rest of the pits and fissures will be sealed with fissure sealant

Question 3

What does an extensive carious lesion require

Answer 3

Conventional restoration (cannot use a preventative resin restoration)

Question 4

What is the aim of a sealant restoration

Answer 4

To ensure the optimum management of possible fissure caries in permanent molars

Question 5

What are the advantages of sealant restorations/ PRRs

Answer 5

The appropriate management of the early carious lesion may prevent the child entering the restorative cycle restoration unnecessarily

Question 6

What are the disadvantages of sealant restorations/ PRRs

Answer 6

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

Question 7

Outline the technique for deciding on the placement of a sealant restorations/ PRRs

Answer 7

1. Thoroughly clean the fissure of all debris and dry the tooth in bright direct light view
2. View a good quality bitewing radiograph of the tooth
3. If there is micro-cavitation, shadowing under enamel adjacent to fissure or dentinal caries visible then place a sealant restoration/ PRR if the depth is less than 1mm
4. If it is greater than this then a conventional composite restoration should be placed to limit the sire of the carious lesion
5. Fissure seal the remaining fissure system

Question 8

What materials are used for sealant restorations/ PRRs

Answer 8

• unfilled resin
• filled resin
• GIC

Question 9

Outline the clinical restoration for a sealant restoration/ PRR

Answer 9

1. Remove soft plaque/ organic substance with surface cleaning
2. LA if the caries is minimally into the dentine
3. Isolate with rubber dam if using LA or with dry guard/ cotton wool rolls
4. Remove caries minimally using Jet 330 small diameter bur
5. Etch the enamel with 37% phosphoric acid, wash and dry
6. Verify frosted appearance on occlusal surface
7. Apply prime to dentine for 15 seconds, air dry for 5
8. Apply bond adhesive to dentine for 15 seconds, air dry for 3
9. Light cure for 20 seconds
10. Apply composite resin to fill the cavity using flowable resin
11. Apply fissure sealant material to cover all remaining pits and fissures up-to one third of cuspal incline
12. Light cure for 20 seconds and check occlusion for defects

Question 10

Why is LA needed for sealant restorations/ PRRs

Answer 10

Because the caries is into the dentine and so the dentinal tubules will relay sensations to the pulp

Question 11

Why is a cavity lining not indicated for sealant restorations/ PRRs

Answer 11

Because the cavity is just into dentine and not very deep and so far away from the pulp