sealants Flashcards
sealant rationale
1) conservative and preventative
2) both permanent and primary molars, and premolars if warranted
3) caries susceptible
4) micromechanical locking by etching
the explorer
1) gently evaluate enamel surface
2) minimal downward pressure
3) bad
- do not drag through uncured sealant on tooth
4) overly aggressive use
- creates cavitation
isolation is essential
1) do not want to create a pool
2) putting too much can cause fracture
when sealants fail
1) contamination and putting too much
clinical example
1) 7 yr old, #19 and #30 just erupted
2) note deep grooves and fissures and some staining in these areas
3)caries risk is moderate
4) treatment, sealant, or PRR?
-
types of sealants
1) resin
- light cured
- clear, opaque
- fluoride
- unfilled -> partially filled
2) ultraseal XT plus
- partially filled
- BPA free
- visible light cured
- opaque
- etch, primer, and sealant
- contains fluoride
- or the 2-step: hydrophilic component that doesn’t need a primer
3) glass ionomer
- isolation may be critical
- lower compressive strength
- adjacent enamel protection
- retention
- fluoride release
- handling properties
- caries prevention equivalent to RBS
isolation
1) rubber dam
2) isolite
- suctions, bite block, isolates
surface prep?
1) suspicious pits and grooves?
- staining and suspicious
- enameloplasty/ fissureotomy
2) 1/4 round bur slow speed
steps
1) etch 15 sec
2) prima dry 5 sec
3) place sealant
4) cure for 20 seconds
5) carefully check
evaluation
1) isolation adequate
2) no plaque trapped
3) smooth
rational for PRR
1) carious lesion, little stick
2) cannot be through dentin
PRR indications
1) isolated carious area
2) no pulp involvement
3) permanent and primary
4) adequate isolation
5) patient cooperation
types of PRR
1) various designs
2) composite + sealant (most common)
- flowable or packable
3) GI + sealant
PRR technique
1) local anesthesia?
- probable depth of caries
2) prep the carious area
3) etch, prime/dry, and add composite and cure
- check occlusion
post op instructions
1) slight occlusal disharmonies
2) will be checked at recalls
3) continued importance of home oral hygiene
4) sealant abrades quickly
5) composite does not
- adjust
rubber dam
1) quadrant dentistry
2) improved working conditions and safety
rubber dam armanentaria
1) 5x5 non latex
2) 2 step technique
3) anterior
- single tooth isolation
- multiple teeth, retained with floss
clamps
1) winged vs wingless
- wingless is for smaller mouths
- pre-ligate
placement and removal
1) TSD, use euphemisms
, hugging tooth, stretching as dam is placed over clamp
2) practice swallowing under the dam!
3) make sure clamp is not rocking
4) first dam on the frame, and the dam over the clamp
sequencing restorations in the quadrants
1) distal to mesial
2) efficiency
- complete all preps first
3) terminal tooth isolation problems
- place sealant while waiting for anesthesia
- can lead to salivation
4) SSCs before class II alloys
restorative case I
1) is rubber dam possible on #14?
- if yes, do PDLs around the clamped tooth
2) A and B need class II alloys, #14 needs a PRR
3) do the PRR first, you need isolation!
4) alloys do not need as much isolation
1) no rubber dam possible
- use cotton rolls, dri angles
case II
1) rubber dam on #19?
2) need SSC and sealant, and class II alloy
3) start with the sealant, most distal, needs isolation
4) do the SSC and alloy prep at the same time
5) place SSC first
1) no rubber dam possible
2) do sealant first with cotton roll
3) place clamp on K, not L
4) do as much as you can with the clamp on, and then take it off, finish the ssc
5) place the ssc
6) replace the dam, and finish the alloy
case III
1) rubber dam on #3?
2) A and B are getting SSC
1) clamp A if cant clamp #3
2) do your preps as much as possible
which clamp is best for small mouths with limited posterior space
1) W8A, 8A, 14A
2) wingless, W8A
