techniques for placing sealants

[razor1911]

So what methods do you ppl use for placing sealants?

I've had success rates that vary from lasting only one day to lasting for years.

Tips and tricks would be appreciated.

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[Sam1980DDS]

Isolate tooth ( the most important part)drying the area is the most important part.
Etch enough,
flow your material, brush it and let it sink into the grooves and fissures,
cure it proparly
Rubber dam Isolation is the best.

 

[CoachJawbone]

isolation and dry is key. As a pediatric dental assistant in VA, we are allowed to place sealants.

1) isolate with cotton triangles (cheek) and cotton rolls (tongue) --> we dont us rubber dams unless the child is getting restorative work done

2) etch (10+ sec) rinse and air dry

3) bond and air it, then cure (10sec)

4) place sealant (20sec cure)

Stress the importance to the pt not to eat anything sticky (gum, laffy taffy, etc) or hard (ice, jolly rangers, rocks) for the next 24hr, and try to refrain from them throughout the life of the sealants.

 

[Zzzdentist]

I usually like to prophy the teeth before sealing. I like to use a prophy brush or cup using non-fluoridated pumice and water. Usually these kids will have a bunch of plaque in the pits and fissures which can interfere with the etch. You'll be able to tell that you haven't cleaned off the plaque adequately if you etch, rinse and see a non-frosty area in the region of the grooves. In addition, I'll also run a sharp explorer through the grooves or use a tiny round bur in a slow speed for any questionable grooves just to make sure it's all cleaned out. There's no use trying to bond to plaque or sealing over crap in the grooves.

As mentioned, isolation is paramount. If you can't get it dry, don't bother since it's going to fall off in a day. Garmers are great (cotton roll holders with the chin clamp) as well as Driangles (triangular absorbant cardboard). Rubber dam is ideal, but often you won't be able to clamp comfortably. It takes as much care as any composite resin to place sealants properly. I've seen sealants delegated to auxillaries, but honestly it's a two person job in most cases. Crappy sealants are like crappy composites - they just aren't worth placing. Do it right the first time or else spend the time redoing it again right the next time which will sooner than later.

Etch for 15 seconds; rinse adequately; dry until it's frosty; place sealant; run explorer through the grooves to get rid of any air bubbles if you want; cure for 20-40 seconds depending on the sealant; check the bite with articulating paper and adjust with medium slow speed burs if needed. I've found some products require longer cure times while others are fine with 20 seconds. Make sure you follow the manufacturer's instructions.

 

[12YearOldKid]

I always open the grooves with a bur and "rough up" the area to be bonded.
Etch.
Rinse and dry.
Bond and cure.
Sealant or flowable composite and cure.

Lately I have also been placing sealant directly on the bond and curing together. This seems to be working just as well as my previous protocol.

I also try my best to pry up the sealant with my explorer. Back when I simply etched and flowed material into grooves I could often pull up the sealant. Now those suckers are IN there.

My technique may be overkill, but a crappy sealant does more harm than good. If I'm going to do it, I'm going to do it right. A sealant is just as labor/time intensive as a class 1 composite for me. From a business standpoint, the $27 I get for it is not worth my time. It's just one of those things you do because it's the right thing for your patient. 😀

 

[OceanDMD]

Train your hygienist or DA to place them. 🙂

 

[DrJeff]

Train your hygienist or DA to place them. 🙂

I'll 2nd that one👍😀

 

[Dental916]

I was told that we no longer need to place bonding agent...could this be a specific sealant material protocol?

 

[OceanDMD]

I was told that we no longer need to place bonding agent...could this be a specific sealant material protocol?

Do you mean etchant?
Its called a self etching sealant. Clean and pumice the tooth, place the sealant, wait about 20 seconds and light cure. Unfortunately, the material that we have tried has has a very poor retention rate. Thus we went back to the old school etch then place the sealant.

 

[red88m]

Do you mean etchant?
Its called a self etching sealant. Clean and pumice the tooth, place the sealant, wait about 20 seconds and light cure. Unfortunately, the material that we have tried has has a very poor retention rate. Thus we went back to the old school etch then place the sealant.

yeah, we've also had poor retention with the self etching sealants. "Enamel-loc" was the one we used. It's ugly and comes off in 6 mos (maybe sooner).

 

[DrJeff]

I was told that we no longer need to place bonding agent...could this be a specific sealant material protocol?

The sealant material I use in my office is this type (Embrace sealant by Pulpdent). Simply obtain a MOSTLYdry field (it actually needs to be slightly moist for max bond strengths), etch for 20 seconds, rinse/dry, apply and cure for 20 seconds. Done. The sealant material itself is just a combination of a bonding agent and an unfilled resin as one. My office has been using this product now for almost 3 years, and the % of sealed teeth that need to be resealed/touched up due to sealant failure has been very, very low(well less than 5%).

We briefly tried an all in one, combination self etching sealant material and found that the debonding rates of that material were significantly higher (close to a 25% failure rate at 6 month recall visits😱) and the increased time that the material had to sit on the tooth made it tougher to use, so we went back to the Embrace. I know of a few of my local colleagues who absolutely swear by the self etching sealant. As you'll find in practice, what's a great product in one person's hands might not be such a great product in another person's hands.