sealants, preventive resins and posterior composites department of pediatric dentistry university of...
TRANSCRIPT
![Page 1: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/1.jpg)
Sealants, Preventive Resinsand Posterior Composites
Department of Pediatric Dentistry
University of Isfahan medical sciences 2009
![Page 2: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/2.jpg)
Sealants
• Indications– Recently erupted teeth– Tooth can be isolated– No, or only minimal pit and fissure staining– No, or only minimal “catches” in the grooves– No evidence of radiographic caries
![Page 3: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/3.jpg)
Sealants• Material in Y/O Clinic
– Ultraseal XT ® plus™– Manufacturer: Ultradent– Advantages
• High strength
• Filled resin sealant (approximately 60% )
• Low shrinkage
• Clinically and radiographically opaque
• Fluoride releasing
• May be used for sealants and microrestorative (PRR’s)
![Page 4: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/4.jpg)
Sealants
• Technique - – Prior to etching the tooth:
• Isolate tooth (i.e. rubber dam, dry-angle, cotton roll)
• Pumice tooth with non-fluoridated pumice
• Wash and dry.
• Drag grooves with explorer to remove any remaining pumice.
• If necessary, wash, dry, and re-isolate.
![Page 5: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/5.jpg)
Sealants
• Etching: - 35% PA– Deliver to the tooth using
the blue tip, or using a microbrush
– Etch the grooves and cuspal inclines
– Etch for 15 seconds
– Wash for 10 seconds
– Evaluate “frosted” enamel
![Page 6: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/6.jpg)
Sealants
• Apply “PrimaDry” for 5 seconds using the brush tip or microtip brush.– 99% ethyl alcohol
– Acts as a drying agent and increases bond strength
• Gently dry
![Page 7: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/7.jpg)
Sealant• Apply sealant using the spiral
brush tip, or using a microbrush.
• Sealant should flow into grooves and up cuspal inclines.
• Cure for 20 seconds
![Page 8: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/8.jpg)
Sealant
• Evaluate quality of sealant:– Marginal integrity?
– Pits or voids in sealant?
– Overhangs?
– Heavy occlusion?
![Page 9: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/9.jpg)
Sealants
• Areas of concern– Retention rates on buccal pits and grooves of
mandibular molars and distolinqual grooves of maxillary molars
– Sealants need periodic maintenance• Moisture contamination secondary to incomplete
eruption and difficulty in isolation - predicted 30% failure rate within 5 years in these areas.
• Marginal integrity and wear.
![Page 10: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/10.jpg)
Preventive Resins Restorations
• Indications– Tooth can be isolated.– No, or only minimal pit and fissure staining– Minimal “catches” in the grooves, or areas with
distinct incipient enamel caries.– No evidence of radiographic caries.
![Page 11: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/11.jpg)
Preventive Resin Restorations
• Type A– Caries is incipient and
limited to enamel
– No radiographic caries
• Type B– Caries extends
minimally into dentin and is small and confined
– No radiographic findingsMany clinical situations can not be
classified according to type until the operator has completed the required exploratory preparation
Many clinical situations can not be classified according to type until the operator has completed the required exploratory preparation
![Page 12: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/12.jpg)
PRR “A” vs. PRR “B”
Type BType BType AType A
![Page 13: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/13.jpg)
Preventive Resin
• Isolate tooth (i.e. rubber dam, dry-angle, cotton roll)
• Pumice tooth with non-fluoridated pumice
• Wash and dry.
• Drag grooves with explorer to remove any remaining pumice.
• If necessary, wash, dry, and re-isolate.
![Page 14: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/14.jpg)
Preventive Resin
• Remove decalcified pits and fissures with a slow speed 1/4 or 1/2, or with a HS330FG
• Examine all margins for remaining caries.
• If caries remains, consider anesthetizing and placing conventional restoration; otherwise proceed in the following manner:
![Page 15: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/15.jpg)
Preventive Resin “A”
• Etch surface with 35% PA for 15 seconds
• Wash for 10 seconds and dry
• For lesions which are completely within enamel, restore in the same manner as described for sealants.
![Page 16: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/16.jpg)
• Air dry• Place sealant• Cure for 20 seconds• Adjust occlusion if
necessary
![Page 17: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/17.jpg)
Preventive Resin “B”
• If caries extends to dentin:
– Anesthesia?
– Etch for 15 seconds with 35% PA
– Rinse for 10 seconds and dry.
![Page 18: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/18.jpg)
Preventive Resin “B”
• Apply drying agent to pulpal floor of the prep for 5 seconds, then dry
• Apply thin layer of Ultraseal XT plus to base and along enamel walls
• Cure for 15 seconds
Depending upon the extent of dentin involvement, DBA’s should be considered!
Depending upon the extent of dentin involvement, DBA’s should be considered!
![Page 19: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/19.jpg)
Preventive Resin “B”
• Apply drying agent to gingival portion of the prep for 5 seconds, then dry
• Apply thin layer of Ultaseal XT plus to base and along enamel walls
• Cure for 15 seconds
• Place composite into prep, and cure
![Page 20: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/20.jpg)
Preventive Resin “B”
• Apply drying agent to gingival portion of the prep for 5 seconds, then dry
• Apply thin layer of Ultaseal XT plus to base and along enamel walls
• Cure for 15 seconds
• Place composite into prep, and cure
• Examine margins for integrity
![Page 21: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/21.jpg)
Preventive Resin “B”
• Apply drying agent to gingival portion of the prep for 5 seconds, then dry
• Apply thin layer of Ultaseal XT plus to base and along enamel walls
• Cure for 15 seconds• Place composite into prep,
and cure• Examine margins for integrity• Re-etch, seal, cure and adjust
occlusion if necessary
![Page 22: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/22.jpg)
Posterior Composite
• Indications– Non-stress bearing area of the tooth - occlusal
contacts in natural enamel– High esthetic demand by the patient– Conservative restoration in nature
• Buccal linqual width not greater than 1/3 of occlusal table
• All margins must be free of caries/decalcification
• Rounded internal line angles
![Page 23: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/23.jpg)
Posterior Composites
• Materials– System must have
compatable components
• Etch
• DBA
• Flowable composite (liner)
• Composite
• Sealant
![Page 24: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/24.jpg)
Posterior Composites
• Select teeth appropriately
– Small confined lesions
– “chasing” grooves
– Decalcified grooves
– Minimal radiographic involvement
– Outline can avoid heavy occlusal contact
![Page 25: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/25.jpg)
Posterior Composites
• Anesthetize and isolate• Open pits and fissures
with 330HS• Remove remaining
caries with slow speed or spoon excavator
• Examine for clean margins
![Page 26: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/26.jpg)
Posterior Composites
• Utilize total etch technique
• In cases of deep caries, it may be beneficial to place a glass ionomer liner
• Etch for 20 seconds and rinse.
• Dry, but DO NOT desicate the dentin
![Page 27: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/27.jpg)
Posterior Composites
• Remoisten dentin slightly with a damp microbrush
• Place dentin bonding agent according to manufacturer instructions (critical step) on dentin and enamel .
• Cure
In this example, Prime and Bond NT® , a one-step system, is being used
In this example, Prime and Bond NT® , a one-step system, is being used
![Page 28: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/28.jpg)
Posterior Composites
• Place flowable composite on pulpal floor– Acts as a stress breaker
during curing
– Minimizes shrinkage and gap formation
• Cure
![Page 29: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/29.jpg)
Posterior Composites• Place composite incrementally,
beginning with eventual cuspal areas.
• Cure between increments - minimizes overall shrinkage and gap formation
![Page 30: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/30.jpg)
Posterior Composites• Adjust occlusion if required
• Finish composite in the usual manner with high speed finishing burs and polishing points
![Page 31: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/31.jpg)
Posterior Composites
• During the finishing process, some gaps at the margin will occur. These need to be sealed.
• Etch occlusal surface for 20 seconds with 35% PA.
• Rinse, and dry
![Page 32: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/32.jpg)
Posterior Composites• During the finishing process,
some gaps at the margin will occur. These need to be sealed.
• Etch occlusal surface for 20 seconds with 35% PA.
• Rinse, and air dry
• Apply unfilled resin sealant such as “Fortify”
• Cure
• Check marginal integrity
• Occlusal adjustment should not be necessary
![Page 33: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/33.jpg)
Summary• All techniques are critically dependent upon
adequate isolation. If you can’t keep it dry, or keep it dry long enough, it won’t work.
• Check for poor margins, overhangs, pits and voids - particulary on DLG’s and buccal grooves.
• Failure to adhere to guidelines may result in a poor/failing restoration or post-op sensitivity for the patient
![Page 34: Sealants, Preventive Resins and Posterior Composites Department of Pediatric Dentistry University of Isfahan medical sciences 2009](https://reader036.vdocuments.us/reader036/viewer/2022081420/5517e4cc550346c1568b4690/html5/thumbnails/34.jpg)
Summary• There is often no clear cut line between the
different preventive resin restorations, and PRR’s vs. a conventional posterior composite.
• When in doubt, be more aggressive.
• DBA systems and composites must compliment each other. With some brands of flowable composite, you need to use a DBA first