Strategies to Improve Sealant Retention

Caries can lead to a lifetime of oral health problems, making the prevention of tooth decay an important health issue. Sealants are one component of the caries prevention armamentarium.^1–9 Developed in the 1960s to reduce caries risk, sealants have a body of research demonstrating their success in caries prevention, as well as their cost efficiency.^{1–7,10–15} 

Today, most sealants are derived from resin-based or glass-ionomer cements.^16–18 Most resin sealant products contain urethane dimethacrylate or bisphenol A-glycidyl methacrylate monomers, and they require a dry field for application.^17,19 In the past few years, resin-based sealants that can be placed in a moist field have been introduced. This ability may decrease application time, which can be particularly helpful when placing sealants in children who have difficulty remaining still.^12,19,20 Compared to glass ionomer sealant materials, resin-based sealants demonstrate longer retention rates.^17,18

While resin materials are monomer-based, glass ionomer sealants are composed of an acidic material that reacts with a glass powder. Glass ionomer sealants can be set in a moist field and they also release fluoride. Typically used as interim sealant products, glass ionomer sealants are indicated for patients in which the use of precise technique is not possible.^17,18

Sealant application may reduce the risk of caries and the rate of active caries by 70% to 95%.^1–9,14,15 While sealants are an important facet of a caries management plan, they only prevent decay in buccal and ­lingual pits and on occlusal surfaces. However, sealing over incipient decay may minimize the progression of noncavitated lesions.¹⁶ Regardless of sealant placement, children and families with poor oral hygiene, cariogenic dietary habits, or developmental structural tooth defects are still prone to dental caries.^1–6

RETENTION IMPROVEMENT PRACTICES

Strategies to improve sealant retention include the use of four-handed dentistry, strict isolation techniques, and adherence to manufacturer directions and standard clinical practice guidelines.^16,21,22 The implementation of four-handed dentistry is one approach to improve the success of sealant placement. With this technique, an assistant uses a high-volume evacuator (HVE) suction tip to maintain a dry field with those sealants that require one, especially if an individual has excessive salivary flow. If a patient is restless, the addition of another individual in the operatory can help manage any challenging behaviors. Four-handed dentistry may also improve team work and efficiency during placement procedures.²¹

As noted previously, not all sealant products require a dry field. But for those that do, the use of dental dams or dental isolation systems ensure that teeth are isolated while also preventing surface contamination. Using damming materials and isolation systems may be especially helpful when treating patients by quadrant. Most practitioners only consider using dental dam materials and isolation systems for restorative procedures, but they can also be used to improve sealant retention. Using additional aids can assist in absorbing or reducing salivary flow. Disposable materials—such as cotton roll holders, disposable bite blocks, cotton rolls, and dry aids—may assist during preparation for sealant placement. If an assistant is not available to help maintain a dry field using HVE and four-handed dentistry, the use of disposables in a variety of combinations to help maintain isolation can also ensure greater retention during sealant placement in those products requiring a dry field.

Dental isolation systems improve retention success results by reducing humidity and improving bonding. Good isolation allows for increased bonding strength, while reducing both potential microleakage and material shrinkage. Additional benefits include retraction, isolation of the working field, illumination, reduced motion, prevention of patient aspiration, and fluid evacuation. If moisture contamination occurs during procedures with sealant materials requiring a dry field, the tooth surface must be re-isolated and re-etched.¹⁶

Following manufacturer instructions can also improve sealant retention. Manufacturers have subtle differences associated with their products’ usage. These variations may be related to a product’s chemical composition; required time for etching, drying, and curing; application methods; or isolation recommendations. As manufacturers of dental materials continue to advance their product materials, clinicians need to understand their properties and how to maximize their clinical effectiveness.

Adhering to clinical practice guidelines is another step in the support of sealant retention. For instance, before applying the sealant material, the tooth surface should be cleaned using a nonfluoridated pumice with a handpiece, toothbrush, or polishing slurry.²²Enamel structure can be damaged, for example, if etchant is rubbed rather than dabbed. Clinicians need to use care so the etchant does not contact soft tissues, potentially causing acid burns. The use of four-handed dentistry and strict isolation techniques—including the use of rubber dams or dental isolation systems—can help avoid these types of clinical errors.

CONCLUSION

Dental caries can cause pain, negatively affect growth in children, decrease productivity, and, ultimately, negatively impact quality of life.^1–5,23 Patients’ self-esteem, appearance, speech, and academic performance can all be affected by tooth decay.^2,4-7 The use of these simple clinical practices can better sealant retention by 70% to 95% and may significantly improve oral health care outcomes in private and public health practices.^14,15 Employing strategies to improve sealant retention is a prudent clinical choice.

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