ICP L16 PRR Minimally Invasive occlusal cavity (see ipad for pics)

Question 1

what is sealant restoration/ preventative resin restoration (PRR)

Answer 1

when diagnostic methods, visual inspection, bitewings ( radiographs) have confirmed that a stained fissure is a carious lesion just into dentine -> PRR is needed.

Question 2

what is different from a sealant restoration (PRR) and a normal occlusion restoration

Answer 2

caries in 1 area of fissure/pit -> caries is filled + restored
remaining pits/fissures are sealed with fissure sealant

Question 3

what material is used for PRR/SR

Answer 3

composite/GIC restoration with remaining pits/fissures sealed with fissure sealant

Question 4

how can you tell radiographically whether you should choose a PRR/SR or conventional restoration

Answer 4

caries is micro-cavity/ sticky fissure
caries < 1mm INTO DENTINE = PRR/SR
caries > 1mm INTO DENTINE = conventional restoration

Question 5

what is the main aim of SR

Answer 5

ensure optimum management of possible fissure caries in permanent molars

Question 6

what is the advantage of doing PRR/SR

Answer 6

appropriate fix of early of early carious lesions may prevent child entering restorative cycle unnecessarily

Question 7

what is the disadvantage of doing PRR/SR

Answer 7

if sealing-in approach adopted, when managing suspicious fissure -> long term monitoring + repair of fissure sealants is needed

Question 8

describe the steps in the technique used if there is uncertainty if caries is present in a occlusal fissure

Answer 8

• thoroughly clean fissures of debris, dry tooth + view in bright direct light
• view good quality bitewing radiograph of tooth
• if there is micro-cavitation OR shadowing visible under enamel adjacent to fissure OR dentinal caries visible radiographically
• place conventional composite restoration limited to site of carious lesion + fissure seal remaining fissure system

Question 9

what are the 3 materials that can be used as fissure sealants

Answer 9

unfilled resin
filled resin
Glass ionomer

Question 10

what is the most preferred material for fissure sealants + why

Answer 10

unfilled resin

flows better in the fissures

Question 11

describe what unfilled resin looks like + how it is cured

Answer 11

light/chemical cure

clear, tinted or opaque

Question 12

describe what filled resin looks like + how it is cured

Answer 12

light/chemical cure
clear, tinted or opaque
contains filler particles ( little effect on clinical results)

Question 13

what material would you use for fissure sealants when child has salivary/moisture control problems

Answer 13

glass ionomer

Question 14

When would you use Glass ionomers mostly for fissure sealants

Answer 14

useful when isolation is problematic -> less isolation

partially erupted teeth

Question 15

what is the clinical procedure for sealant restoration

Answer 15

• remove soft plaque/organic substance with surface cleaning with or without pumice or oil-free prophypaste
• LA if minimal caries into dentine
• rubber dam isolation if LA used or use dry guard + cotton wool rolls
• remove caries minimally using small diameter bur ( tungsten carbide Jet 330)
• as cavity just into dentine (shallow) - lining not indicated
• etch enamel with 37% phosphoric acid for 15 secs _ wash and dry for 15secs + air dry
• verify frosted look on occlusal
• apply prime to dentine for 15 secs, air dry for 5secs
• apply bond adhesive to dentine for 15secs, air thin for 3secs
• light cure for 20secs
• apply composite resin to fill cavity to its correct occlusal form. if cavity v small - flowing resin composite can be used
• light cure cavity
• apply FS to cover all remaining fissures up to 1/3rd of cuspal incline
• light cure for 20secs + check for defects

Question 16

what are the main overall 2 steps for applying PRR/SR

Answer 16

• 1st cure filling ( allow setting, shaping)

* then fissures ( cleaning, etching, applying)