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Tuesday, July 12, 2011

New Sealant Technique

Over the years I have placed numerous sealants, I have always felt a little uneasy when placing the sealant- asking myself is this really protecting this tooth or am I raising the odds that this tooth will someday need further treatment.

The first rule of sealant placement is ISOLATION- we all know it and I tend to think whatever technique works best for you is the one you should use.

Even when I felt that I achieved total isolation I still thought there must be a better technique to placing sealants.

I recently started following Dr. Gordon Christensen's sealant technique and I have never felt better about my sealants.
I urge you to try this technique and see for yourself:

1) Clean the tooth. Use an air slurry polisher (Cavitron® Jet Plus?, Prophy-Jet?, or many other brands) on the grooves of the tooth. This sodium bicarbonate slurry removes stain, plaque, and any minimal calculus that may be present. If this is not done, acid used in the sealant technique cannot penetrate into the tooth grooves, plaque remains, and in my opinion, the sealant is doomed to eventual failure beginning on the day it was placed. Stain or calculus on the tooth surface will also provide a false positive reading with the DIAGNOdent. Remove the stain and calculus!
2) Diagnose the tooth for caries. Observe the tooth clinically with a radiograph or a DIAGNOdent. If no overt observable carious lesions are present, continue to step three.
3) Neutralize the sodium bicarbonate residue. Place conventional phosphoric acid gel or liquid into the grooves for a few seconds to neutralize the basic sodium bicarbonate. Wash off the soluble “salt” produced in the acid-base reaction.
4) Acid-etch the tooth. Use your routine acid-etching material, either liquid or gel, to produce a standard acid etch of the grooves. If the grooves are especially deep, tracing them with a sharp explorer will assist in eliminating the bubbles in the grooves. Wash off the acid.
5) Wet the grooves with unfilled liquid resin. Use any unfilled resin to break the surface tension in the groove area. As an example, this liquid can be the last component of any multi-bottle bonding agent, such as the commonly used second component of CLEARFIL? SE (Kuraray) bond or other brands. After applying this material, blow on the tooth surface to the extent that only a very thin layer of the liquid remains.
6) Place the sealant. For more than 20 years, I have used as my sealant material a very small amount of the same fully-filled restorative resin that I place in a typical Class I or Class II resin restoration. The technique is simple. Place a small amount of the putty restorative resin on the groove area. Place your bonding-agent lubricated fingertip on the resin on the occlusal surface, warm up the resin for a few seconds with your finger, push the resin into the grooves, slide your finger off the tooth to the facial or lingual, observe the bulk of resin to make sure it is not too much, and cure the resin. You have now placed a “sealant” that will last indefinitely! If you prefer to place more flowable conventional sealant materials, do so. However, you should expect the conventional sealant materials to have a shorter service life than standard restorative resins due to lower filler content, less strength, and less adequate wear resistance.

For the full dental economics article click here

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