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Improving 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. 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.

Sealants and Caries Prevention

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. 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.

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Sealant Materials

Today, most sealants are derived from resin-based or glass-ionomer cements. Most resin sealant products contain urethane dimethacrylate or bisphenol A-glycidyl methacrylate monomers. Compared to glass ionomer sealant materials, resin-based sealants demonstrate longer retention rates. Glass ionomer sealants are composed of an acidic material that reacts with a glass powder. Typically used as interim sealant products, glass ionomer sealants are indicated for patients in which the use of precise technique is not possible.

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Four-Handed Dentistry

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 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.

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Isolation

For sealant products that require a dry field, the use of dental dams or dental isolation systems ensure that teeth are isolated while also preventing surface contamination. 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.

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Follow Directions

Adhering to 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.

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Clinical Practice Guidelines

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. Enamel structure can be damaged, for example, if etchant is rubbed rather than dabbed. 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.

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