Outcome 3 - Enamel Sealant - Clinical Application Flashcards
(22 cards)
Why is isolation during sealant placement crucial?
Isolation during sealant placement is crucial to prevent moisture contamination, which can lead to sealant failure.
If moisture contaminates the tooth surface, the sealant may not adhere properly, leading to immediate or eventual loss of the sealant or even decay beneath it.
To achieve proper isolation, the following steps are typically taken after etching, rinsing & drying the enamel:
- Cotton rolls - help absorb saliva and keep the area dry
- Dry-angle - can be positioned to further isolate the tooth and maintain a dry environment
- Dental dam - if possible, using a dental dam provides the most effective isolation by covering the neighbouring teeth and surrounding tissues, ensureing optimal dryness during sealant placement
Which teeth are particularly challenging to maintain isolation on?
It is noted that the max and mand second molars are particulary prone to losing sealants due to challenges in maintaining isolation, especially when a rubber dam is not used. Therefore, employing effective isolation techniques is essential for successful sealant retention and prevention of dental caries.
Etchant Precautions
-Etching agents contain phosphoric acid, so always wear protective eyewear during their use
-Avoid contact with oral soft tissues, eyes, and skin. In case of accidental contact, immediately flush the area with large amounts of water
-If eye contact occurs, rinse immediately with plenty of water and seek medical attention
Sealant Precautions
-Sealant material contains acrylate resins, so avoid using sealants on patients with known acrylate allergies
-Minimize exposure to uncured resin to reduce the risk of allergic responses. Use protective gloves and a no-touch technique
-In case of skin contact, wash the affected area with soap and water. If the sealant contacts gloves, remove a discard them, wash hands, and put on new gloves.
-In case of accidental eye contact or prolonged contact with oral soft tissue, flush with large amoounts of water. If irritation persists, contact a physician.
Protective Eyewear for Light-cured resins
Operators should wear protective glasses when applying light-cured resins. Protective eyewear should also be provided for the patient during sealant procedures
Potential Harm of Bisphenol-A (BPA)
BPA is a chemical present in certain plastics used in dental materials. Research has investigaed its potential harm from sealant materials, but findings, supported by the ADA, suggested that exposure to BPA from sealants is not enough to cause harm to humans
The Purpose of Acid Etching Prior to Placing Sealants
When an etchant is applied to enamel it produces microscopic porosities in the enamel that allows the sealant material to penetrate into these micropores and creates a bond or mechanical locking.
What happens when Acid etch is not applied?
When dental resin, such as a sealant is applied to an enamel surface that has not been etched, the sealant material will spread over the surface, but will not penetrate into it.
How does acid etchant increase the penetration and adherence of the sealant resin?
-Removing about 10 microns of surface enamel, thus removing bacterial plaque and subsurface pellicles from the area to be sealed
-Roughening the surface or creating more pores by removing the surface minerals as well as removing the enamel tags
- Microscopic tags of sealant extend into the surfaces of acid-etched enamel but do not penetrate the non-etched surfaces.
Clinical Appearance of Etched Enamel
Etched surfaces have a dull, frosty, or chalky appearance which will noticeably contrast with unetched or saliva coated enamel. It is when the tooth has this appearance that it is ready to receive the sealant material.
Acid Etching Agents Used to Etch Enamel
The acid etch used in dental procedures usually occur in either liquid or gel forms. In the liquid form, the concentration is 30% - 40% phosphoric acid (H3PO4). It is applied to the enamel with a nylon brush, cotton pellets or a synthetic sponge. The low viscosity in liquids allow it to flow well into the pits and fissures but can be difficult to control.
A 30% - 40% concentration produces the most evenly distributed etch over an enamel surface. At greater acid concentration, less depth is etched.
Advantage of Gel Phosphoric Acid
Its advantage is strict control over the area where the etchant is placed. Most manufacturers supply a gel etchant in a syringe that can be directly applied to one tooth
How to apply Acid Etch
When applying, use a continuous, gentle dabbing motion - not a rubbing motion. Dabbing will not damage the fragile enamel latticework formed during the etching process.
How far should etchant material be flowed over?
Ideally, the acid should be flowed over an area of 2mm beyond what is intended to be sealed. Sealant margins must end in etched enamel.
What happens if a sealant margin ends in sound enamel?
If a sealant margin ends in sound enamel it will be weak, flake off, or allow bacteria under the seal.
How long to leave on etch?
The tooth structure is etched for the length of time recommended by the manufacturer, this usually ranges from 15 to 30 seconds.
Rinsing Etch
Rinse the etched enamel thoroughly with copious amounts of water from the air-water syringe. Suction immediately using the low volume. DO NOT allow the patient to swallow the rinse.
Etching Primary Teeth
Some primary teeth surfaces may require extra etching time
Removal of Smear Layer
Acid etching placed on either enamel or dentin removes a smear layer in preparation for bonding. Acid etch removes inorganic materials and creates tiny micro-crevices that form a reactive surface to which the resin material affixes.
Consideration of Dentinal Tubules when applying etchant
The tubules can transmit fluids and micro-organisms which may result in postoperative sensitivty, pain, or even damage to the pulp when applying etch. A slight amount of moisture must be maintained on the dentin as to not dry out the tooth. IF dentin is completely dried, the tooth structure may be harmed.
Evaluation of Sealants
Sealant should be examined for any voids, bubbles, rough margins, or deficient material.
Sealant retention should also be checked using the explorer in an attempt to remove the sealant to make sure that the sealant is well retained. If the sealant is dislodged, the tooth should be re-etched and new sealant material should be applied.
Check to ensure that no sealant material has flown into the contact areas between the teeth, where the patient could not floss, and be cautious enough to remove excess sealant material over the distal or mesial margins when necessary
