Prophylaxis.

Community Dentistry

DENTAL SEALANT TECHNIQUE WITH COMPOSITE RESINS

(PRACTICAL CONSIDERATIONS)

Alina CRISTIAN1, Gabriela BOŢA2, Andreea Angela STETIU2,

Cristina Adriana DAHM TĂTARU1

Assist. Prof. PhD, “Lucian Blaga” University, Sibiu, Romania

1

Assoc. Prof. PhD, “Lucian Blaga” University, Sibiu, Romania

2

Corresponding author: Andreea Angela Stetiu; e-mail: andreea.stetiu@ulbsibiu.ro

Abstract enameloplasty [1]. In 1923, Hyatt advocated the

Introduction: Fluorides are very effective in reducing
early introduction of small restorations in grooves
the number of carious lesions occurring on smooth enamel and fossae before the carious lesions had the
and cement surfaces. Unfortunately, they are not as chance to develop. He called this procedure
efficient in protecting the occlusal grooves and fossae, “prophylactic odontotomy”. Again, this operation
where most carious lesions are present. Considering that
occlusal surfaces represent only 12% of the total tooth is more a treatment than a preventive approach.
surface area, this means that grooves and fossae are about Several methods have been used unsuccessfully
eight times more vulnerable than smooth surfaces. Placing in the attempt to seal or to make fissures more
sealant materials represents a highly efficient means of
resistant to decay, including the use of topically
prevention. The principal aim of the paper is to reveal the
importance of this technique for assuring a better retention applied zinc chloride, potassium ferrocyanide
and a successful sealing, therefore some relevant cases are and of ammonium silver nitrate. Fluorides that
presented. Materials and methods: The present study, protect smooth tooth surfaces are less effective
conducted over a period of 2 years (2019-2021), included
32 children and 59 teeth, following the evolution of the on surfaces. Following fluoride usage, a large
sealed occlusal surfaces of 6 year-old molars that met the reduction in the incidence of surface caries has
criteria for sealant application. For each patient, a treatment been noticed, as opposed to a lower one in
plan is proposed after complete anamnesis and dental
occlusal caries in grooves and fissures [2-5].
examination. Sealant of different types are applied and
analyzed. Results and discussion: The factors that caused In the late 1960’s and early 1970’s, another
failure of the operation (air bubbles, porosities and cavities option became available: the use of sealants in
left under the sealant) were identified and analyzed; grooves and fossae. Thus, a liquid resin is
equally, the advantages offered by one of the materials
used (Fissurit F light-curing sealant) were outlined. introduced onto the occlusal surface of the tooth
Conclusions: The study showed that, after one year, the to penetrate deep fissures and fill areas that
retention of resins is superior to that of glass ionomer cannot be cleaned by brushing. The sealant acts
cements, namely the complete retention of the Fissurit F
material is 83.9%; in 9.7% of cases, the sealant is partially
as a barrier between the tooth and the oral
detached, and in 6.5% of cases the sealant is missing. environment. At the same time, there is a
Keywords: decay, composite, dentistry, prophylaxy, significant reduction of Streptococcus mutans on
sealant. the treated surfaces [6,7].
According to Brauer (1978), the ideal
1. INTRODUCTION characteristics of a sealant material are to
penetrate deep and narrow fissures; to be
Over time, several types of sealants have been sufficiently fluid; to have adequate working time;
tried to protect the deep fossae and fissures to be durable; to have law solubility in saliva; to
present on the occlusal surfaces. In 1895, Wilson have good adherence to the etched enamel
placed dental cement in grooves and fossae to surface; they should be cariostatic; cause minimal
prevent cavities. In 1929, Bodecker suggested that tissue irritation (biocompatibility) [8].
deep fissures could be enlarged by using a large Materials used for sealing are included in the
round bur to make the occlusal areas more category of preventive dental materials, together
accessible to self-cleaning, a procedure known as with fluoride gels and mouthguards [9].

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 DENTAL SEALANT TECHNIQUE WITH COMPOSITE RESINS

2. MATERIALS AND METHODS the disadvantage of producing a precipitate on

the enamel surface.
The criteria for inclusion of permanent first
Sealing of grooves and fissures has proven to
molars in our study were:
be an effective method of preventing tooth decay,
- sufficiently erupted teeth to achieve the
but the materials and techniques used are
necessary sealant isolation
different. Apart from fluoride, sealants do not
- teeth without clinically detected carious
contain ingredients to prevent cavities. Their
processes
prophylactic function is provided by their
- teeth that do not show hypoplasia or other
adhesion to the enamel surface and physical
developmental abnormalities
filling of grooves and fissures. As long as the
- teeth without fillings
sealant remains intact, well adapted, the carious
- teeth with deep grooves and pits susceptible
process will not occur beneath it. Therefore,
to tooth decay.
retention of sealing materials is the first condition
for a successful sealing. Case Presentation
The study, conducted over a period of 2 years Patient: R.A, Sex: M, Age: 7 years-old,
(2019- 2021), included 32 children and 59 teeth, Domicile: Urban environment
and followed the evolution of the sealed occlusal
surfaces of 6 year-old molars that met the criteria Reason for presentation:
for sealant application. The success of sealing The patient comes to the dental service
depends on the rigour with which the practitioner accompanied by both parents for the first
follows, on the one hand, the working technique specialist dental consultation.
and, on the other, the instructions recommended Personal pathological history:
by the manufacturing company for the applied
material. Although the working technique is The patient has no systemic conditions and is
simple, each step must be carried out with not on medication; his parents claim that he had
maximum care, without compromise, so that a vicious habit (thumb sucking).
adhesion of the material to the tooth surface is Nutrition and development:
as desired [13,14]. For retention, we must have a
Parents claim that the diet is high in sugars
maximum retention area, irregular and deep
and that the child has developed an affinity for
grooves and fissures; the tooth surface must be
sweets (especially chocolate), but that he has
clean and dry at the time of sealant placement,
learned rigorous hygiene by brushing his teeth
and uncontaminated by saliva. These are the four
even three times a day with an electric toothbrush.
important steps which cannot be ignored when
applying the sealant [15]. Exo-oral examination:
Generally, the technique with composite No changes in symmetry or proportion of the
resins requires cleaning of the tooth surface, for face are observed.
removing the bacterial plaque and debris from
the enamel surface. It is carried out through Oral examination:
professional brushing using a brush and a paste No caries present; the oral hygiene is proper;
not containing fluoride (as this forms a film on physiological wear of temporary teeth and
the tooth surface and interferes with the presence of mixed dentition.
demineralisation process). The paste remaining
in the grooves is removed with the tip of a probe, Plan of treatment:
then the tooth surface is carefully washed [16,17]. Following the examination, the specialist
Other methods used to clean the surface of the decided, together with the parents, to seal the
tooth before introducing the sealing material are permanent molars to perform occlusal caries
polishing, and the use of hydrogen peroxide. prophylaxis. Molar 4.6 will be the first to seal,
Polishing has proven to remove residual debris while the others will follow in subsequent
from grooves and fossae. Hydrogen peroxide has sessions. To this end, a photopolymerisable resin

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Alina CRISTIAN, Gabriela BOŢA, Andreea Angela STETIU, Cristina Adriana DAHM TĂTARU

with continuous fluoride release – Fissurit F – the concentration and form of presentation of
Was preferred. the agent used, as well as with the type of
The working technique is simple enough, but dentition - permanent or temporary. It is
each stage must be carefully carried out. Upon classically recommended that demineralisation
inspection and palpation with a buccal probe, it be done for 60 seconds for permanent teeth and
is found that 4.6 has an indication for sealing as 120 seconds for temporary teeth, respectively.
it is a tooth with a well-represented, intact The demineralising agent can be either gel or
occlusal surface. solution. To ensure that the edges of the seal are
The risk of tooth decay is increased due to in the demineralised area, regardless of the type
excessive consumption of sweets. Cleaning is of demineralising agent used, it should be
necessary to remove the bacterial plaque from the applied to the cusp slopes over an area
enamel surface to be sealed. It is carried out using approximately 2 mm beyond the edges of the
a prophylactic brush and a paste not containing future seal. The demineralised enamel not
fluoride, which interacts with the demineraliser. covered by the sealing material will remineralise,
It is very important to achieve and maintain a dry because saliva is oversaturated with calcium
and saliva-free operating field throughout the salts. The demineralizer should be applied
application of the sealing technique. In this case, carefully to avoid contact with soft tissues. If
insulation was made with cotton rolls. The coming into contact with them, the acid can
demineralising agent, phosphoric acid with a produce a mild inflammatory response, and
concentration of 36%, is applied in grooves and also a strong acid taste, which is often hard to
fossa and on cusp slopes and left on for 60 seconds. tolerate.
After demineralisation, the etched surface will be Washing and drying. After demineralisation,
washed with a vacuum cleaner positioned the etched enamel surface will be washed with
immediately next to the tooth, to remove the a continuous jet of water under isolation, to
demineralising agent. It is important to maintain remove the demineralisation agent and the
isolation, so that the enamel surfaces should not reaction products resulting from it. After
be contaminated with saliva. After washing and washing, the dental surfaces should be dried
drying, the enamel should have a dull, gloss-free, with uncontaminated air. It is important that
chalk-like white aspect, otherwise the process of both operations are carried out under thorough
demineralisation must be repeated [18]. isolation. Failure to do so will lead to
Isolation is very important to achieve and contamination of the surfaces to be sealed. The
maintain a dry operating field throughout the saliva film formed cannot be removed by
application of the sealing technique. Possible simply washing and drying of the contaminated
saliva contamination would allow surface, so that a new demineralisation of the
remineralisation of the enamel surface prepared enamel surface will be necessary. After washing
for sealing, while contamination during sealant and drying, the enamel should have a matt,
application would have a negative influence on opaque, gloss-free, chalk-like white appearance,
sealing. [19] otherwise the demineralisation process must
A dry field can be maintained in several ways: be repeated.
by the use of rubber dams, isolation with cotton Preparation of the sealing material considers
rolls, or placing absorbent pads over the opening the recommendations of the manufacturer and
of the parotid gland duct. The ideal isolation is also some general observations. Application of
achieved by applying a rubber dam, but it has the sealing material is done with the recommended
the disadvantage that it can cause discomfort to tools, supplied by the manufacturer (fine brush,
the patient [20]. applicator).
Preparation of the enamel surface is carried When using self-curing sealants, one should
out by demineralisation with a demineralising know that: the working time is limited;
agent, usually phosphoric acid, in a concentration polymerisation of the material starts as soon as
of 30-50%, 37% being the most used concentration. the catalyst is added to the base; mixing of the
The demineralisation time varies according to two components must be done meticulously; a

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 DENTAL SEALANT TECHNIQUE WITH COMPOSITE RESINS

high ambient temperature alters polymerisation, is present, the use of a scaling probe may be
thus shortening the working and setting time. necessary for removal.
The use of light-curing sealing material offers Regular checks are required every 6 months.
some advantages, such as: the working time is A seal is only considered effective when it shuts
longer, since the material can be influenced by the pits and fossa system for as long as possible.
the light of the dental unit and of the surrounding A seal may be assessed in two ways: clinically -
environment, so it must be removed from the through probe examination; paraclinically –
syringe only when applied to the tooth; the radiographically. A properly carried out seal
possibility of air bubbles incorporation is generally lasts a few years, but still requires
reduced; hence, the seal will be more homogeneous regular check-ups.
and resistant. On clinical examination by inspection and
Light-curing or self-curing sealants must first palpation with a probe, several situations are
be placed in pits of maximum depth. The material possible, which will require actions in accordance
should not only fill the fissures, but also cover with:
about 2 mm of the cusp slopes [21]. 1. intact sealing - no intervention
To increase retention, it is recommended to 2. the sealant is completely lost - repeat sealing
delay the application of the light source for 5 to
3. the seal is partially lost - the suitability of the
20 seconds after application of the sealing
remaining sealant is checked and, if it is good,
material. In this way, the material penetrates
its surface is roughened with a fine stone, and
three times further into the demineralised enamel
the area is engraved with the lost sealant and
areas than if light-curing were to occur
filled it with a new sealant.
immediately after its application.
4. the sealant has minor faults - it is checked
Sealing checking. After polymerisation, the
with X-rays to detect any cavities under the
sealing should be carefully examined before
sealant.
discontinuing the isolation. If voids are evident,
application of the sealant can be done without
the need for additional demineralisation. The 3. RESULTS
hardened sealant has an oily residue on the
surface. This is an unreacted monomer, which Background prophylaxis. In the case history,
can be wiped off with a cotton ball or can be left other methods of prophylaxis were emphasized,
in place. If sealing requires repair after isolation such as: out of a total of 32 patients, 16 children
is discontinued, it is mandatory to repeat the had never been to the dentist, 7 children had
same demineralisation and drying procedures. received health education in kindergarten or
Checking of the sealed surface is made by probing school, 5 children had received external
for air voids in the material or in incompletely fluoridation, and 4 children had sealants.
covered surfaces. At the same time, an attempt
will be made to remove the sealant, so that the
quality of the connection can be checked. 4. DISCUSSION
Checking in occlusal relationship will allow
the removal of excesses that may generate There are several reasons why sealing may
interference or premature contacts. The excess fail:
sealing material may accidentally overflow. To 1. It may present air bubbles, thus weakening
solve the problem, the occlusion should be the material. The seal must be polished to
checked visually or, if indicated, with articulating expose the air bubble, the void being filled or
paper. Usually, any minor premature contacts in repaired with the same sealing material. The
the occlusion are quickly removed by normal delay of this procedure may lead to the
chewing action. If premature contact is development of cavities.
unacceptable, abrasive stones may be used. The 2. Porosities can develop in the sealant material,
integrity of the interproximal spaces can be if water contaminates the tooth during its
checked with dental floss. If the sealing material application.

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Alina CRISTIAN, Gabriela BOŢA, Andreea Angela STETIU, Cristina Adriana DAHM TĂTARU

3. The seal can be lost. The material must be 2. It is very important to provide children with
applied again, making sure that the technique dental hygiene from an early age, so that they
is correct to ensure the longevity of the become informed and responsible adults.
procedure. Even if the seal is lost, it may still
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