by Mary Govoni, CDA, RDA, RDH, MBA
Pit and fissure sealants aren't products we normally get excited about, but I think that we have reason to be with the introduction of some great new product developments.
Sealants have been used for nearly 40 years and, in that time, studies have demonstrated that sealants provide excellent therapeutic value. When the first studies of sealants were conducted in 1967, the material was a powder and liquid silicate mixed together to form a paste. There was no acid etch preparation of the tooth surface. The material wasn't as strong as today's materials and wasn't retained on the tooth surfaces as well as today's materials. But it was the start of a treatment modality now being referred to as surface protection. Research demonstrated that covering or protecting caries-prone tooth surfaces, such as occlusal surfaces, from acids and bacteria could significantly decrease the incidence of the disease.
The term surface protection makes sense, since it better describes the goal of placing these materials on tooth surfaces. There are still practitioners who don't trust the therapeutic value of sealants, questioning whether the "seal" is effective or even possible. But the goal really is to protect the surfaces, and we currently have some very effective products to meet a variety of patient needs.
Because each patient's needs, diet, and oral hygiene habits will be different, one type of surface protectant may not meet all needs. Until recently, surface protectants or sealants were available in two basic categories — filled and unfilled resins. Those who place sealants regularly know the challenges of the task — keeping the tooth dry after the acid etch procedure and the ability to see where the material was placed on the tooth.
To address the visibility concern, two products were introduced several years ago that utilize color-change technology to make placement easier and for checking retention of the material at recare visits. The first of the two products is Helioseal Clear Chroma by Ivoclar Vivadent (right). This product is a clear, unfilled resin that turns a pale green when exposed to the curing light, thus allowing the clinician to see if there is adequate coverage on the tooth surface. Once the material is completely cured, the color fades and the sealant is clear on the tooth. When the patient returns for a future visit and the sealants are checked for retention, exposing the material to the curing light will cause the material to turn green again, making it very visible to both the patient and the clinician.
The second product is Clinpro Sealant from 3M ESPE. This is an opaque unfilled resin that is pink during application (see below) and once cured, the pink color fades. The advantage of this product is excellent visibility for placement. It is much easier to see whether the application is adequate to protect the surface or too bulky, which may lead to decreased retention.
No matter whether you use a flowable composite or a filled or unfilled resin, moisture is a difficult problem with which to deal. A major cause of sealant failure is lack of retention due to moisture contamination during placement. If the dentist is placing sealants, he or she most likely has a chairside assistant to help facilitate the process, making isolation easier and making it easier to maintain a dry field. If a hygienist or an assistant is placing the sealant, they are more likely to be working unassisted, and keeping the tooth dry after etching is a challenge at best.
In these cases, it might make sense to consider a product that is not as sensitive to moisture for effective retention. The most recently introduced product is Embrace Wet Bond from Pulpdent (below). This resin product can be placed on slightly moist tooth surfaces, thus reducing the challenge of keeping the teeth isolated and dry during placement.
A non-resin surface protectant also recently introduced is Fuji Triage from GC America, which is a glass ionomer surface protectant. Glass ionomers release fluoride when placed, and the fluoride release is recharged whenever additional fluoride is applied with in-office treatments, home rinses, and toothpastes. Triage can be placed in a moist environment and is an ideal product to place on a not yet fully erupted tooth. Since the tooth enamel does not become completely mineralized until after eruption, this material acts on the hypomineralized enamel to provide even earlier intervention in caries prevention.
The newest of the surface protectants or sealants on the market is Aegis from Bosworth. Aegis is a resin that uses a calcium phosphate, a bioactive material, as a filler. The calcium phosphate affects remineralization of tooth surfaces. Because it is a resin product, acid etching and good drying/isolation is necessary for retention, but it also promises good therapeutic benefit for the patient.
Get excited about surface protection. You have so many more tools at your disposal to provide your patients with the best that dentistry has to offer.
Author's Note: As always, this column is not meant to be a comprehensive product review.
Mary Govoni is a Certified and Registered Dental Assistant and a Registered Dental Hygienist, with over 28 years of experience in the dental profession as a chairside assistant, office administrator, clinical hygienist, educator, consultant, and speaker. She is the owner of Clinical Dynamics, a consulting company dedicated to the enhancement of the clinical and communication skills of dental teams. She can be reached at [email protected].
