Occlusal Surface Management

	Sealant
		With Fluoride?
	Preventive Class I Resin Restoration
	Class I Glass Ionomer
		Primary Teeth
	Class I Composite
	Class I Amalgam

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PIT and FISSURE SEALANTS

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Contraindications

	Exfoliation in Six Months
	Proximal Caries
	Occlusal Caries Visible on Radiograph
	Open Fissure
	Fissure Margins Undermined

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“The results support the safety of sealing  incipient caries…”

	Handleman et al.
	JADA 1986

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Isolation

	Rubber Dam
		Unless Gingival Clamp Required
	Cotton Rolls
	Dri-Angles
	Saliva Ejector Always

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Evaluate Retention

	Immediately Post Curing
	Use Explorer at ALL Margins
	Most Failures in First 24 Hours
	Evaluate at EVERY RECALL
		As with ALL Restorations

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LISTEN TO ME!

	THIS IS IMPORTANT!!!

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Preventive Resin Class I Restorations

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Waggoner, William F.: Pit and Fissure Application: Updating the Technique, JADA,V 127, ‘96, pp 351-61.

Isolation

	One Second Salivary Exposure: No Bond
	Operculum Caused 50% Failure Rate at 36 Months
		Wait for complete eruption
	Rubber Dam and Cotton Rolls Done Correctly Give Equal Results
		Clamp Discomfort, Local Anesthesia for Soft Tissue, More Time and Infection Control Cost
	DriAngles, VacEjector (Bite Block & Hi-Speed Evac)

Prophylaxis???

	Tooth Surface Must Be Clean
	Toothbrush  Adequate; Explorer Through Fissures
	Prophy Did Not Increase Retention Rates vs. TB
	Fluoride in Prophy Paste Not a Problem

Attempts to Increase Retention

	Prophy-Jet or Cavi-Jet: No Difference
	Hydrogen Peroxide Wash: No Difference
	Air Abrasion Systems: No Difference
	Widening Fissure with Bur (Prophylactic Odontotomy): No Difference
		Also MUST be performed by Doctor, not RDH

Etching

	37% Orthophosphoric Acid
	Gel vs. Liquid: No Difference in Penetration, Bond Strength, Retention
	20 Second Etch Time vs. 60 Seconds: No Difference
	Primary Teeth Do NOT  Require Extended Etch or Roughening
	Etch Must Extend 2 mm Beyond Fissures

Rinse and Dry

	One to Two Second Rinse Equal to 20 Second Rinse
	Drying Time Should Be Based on Chalky Appearance
	Test Air Lines for Oil or Water

Materials

	BIS-GMA
	Urethane
	Glass Ionomer
		poor retention
	Filler Particles: Similar Retention Rates

Glass Ionomer Cements

	Primary Molars
	Ease of APPLICATION
	Fluoride Content
	Wear and Crush Resistance
	Thermal Insulation

Tinted or Opaque Sealants

	Similar Bond Strength and Retention
	Easier to See at Recall
	Masks Fissure Staining; Prevents Unnecessary Removal
	NYS  Medicaid Required 1996

Fluoride in Sealants

	Is Bioavailable
	Similar Bond Strengths
	No Clinical Data on Value to Patient
	May Have Effect on Proximal...Unknown

Bonding Agents

	Controversial Benefit
	May Increase Retention
	Clearly Increases Time Needed and Cost

Curing

	Light (visible)
	Autopolymerizing
	No Difference in Bond Strength or Retention

Polymerization

	Wait 20 Seconds AFTER Applying: Penetrates Farther (3x)
	Monitor Light Intensity Frequently
		Wand Tip Cleanliness
		Damaged Fiber Optics
		Age of Bulb
		Use Light Meter to Monitor
	Autopolymerized: Need at Least 2 Minutes to Cure

Salivary Contamination

	Must Re-etch
	15 to 20 Seconds, Wash, and Dry

Miscellaneous

	Remove Bubbles Before Curing
	Repair Voids By Addition
	Attempt to Dislodge; Most Failures Within 24 Hours
	Check Occlusion; Especially with Filled Resin
	Evaluate and Replace Fully or Partially at Every Recall

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