Changes in the Use of Pit-and-Fissure Sealants
Many clinicians are now using sealants as a minimally invasive caries treatment.
As concepts for the treatment of caries has evolved, the purposes and uses for sealants has also changed. In the 1980s, sealants were indicated only for preventive sealing of pits and fissures.1-3 In other words, all teeth—even those with no clinical sign of caries—were considered for sealing. Now it is understood that there is no need to preventively seal the teeth of patients with good oral health and no sign of etiologic factors.4,5
Because of this new understanding about caries and how it is contracted, the indications for the use of sealants must be reviewed and broadened. Sealing pits and fissures is no longer indicated only for preventive reasons, but also as a therapeutic procedure used to stem the progression of early caries. In that way, sealants have come to be regarded as part of the minimally invasive philosophy whose objective is early diagnosis and intervention and prevention of future caries. This treatment is first based on the control of the etiologic factors of caries (eg, diet, oral hygiene, and socioeconomic status).4,5 However, in the more advanced stages of caries, minimally invasive procedures are indicated to interrupt the lesion progression and preserve the natural dental structure. In those cases, the use of sealants has become a very effective treatment, not only for caries affecting the enamel,1,2 but also that affecting the dentin.6,7
This case report shows a patient treated according to the minimum intervention philosophy using the therapeutic use of sealants in early caries lesions.
The patient, a 12-year-old girl, presented for a routine dental appointment. After a complete examination, clinical signs of caries were evident in the first and second right mandibular molars. Active caries involving the initial part of dentin and 2 mm of cavitation was observed on the first molar, while the second molar exhibited only enamel involvement with whiter opaque characteristics (Figure 1).
After the proper diagnosis, it was decided to treat the patient based on the precepts of the minimally invasive philosophy. First, the patient was educated about oral hygiene and diet in order to control caries. For both lesions, a resin sealant (UltraSeal XT® hydro, Ultradent Products, www.ultradent.com) was used as the therapeutic method.
During treatment, both teeth were isolated with a rubber dam and an appropriate clamp onto the second molar. The occlusal surface of the teeth was conditioned using 35% phosphoric acid gel (Ultra-Etch®, Ultradent) for 15 seconds, then washed with water spray for another 15 seconds. The surfaces were then dried with a strong air-water spray until they had a matte and whiter aspect. On the first molar, with the caries lesion already in dentin, two independent layers of one-step adhesive (Adper™ Single Bond, 3M ESPE, www.3mespe.com) were applied, removing the excess with a brief air spray for 5 seconds, followed by 3 seconds of curing using an ultra-high–energy broadband LED curing device (VALO®, Ultradent). In sequence, a natural-shade resin sealant (UltraSeal XT hydro) was applied to both teeth surfaces using an Inspiral® brush tip (Ultradent), which facilitates the delivery of the material into difficult-to-access areas, in order to improve the sealant flow and avoid air bubbles. The sealant was cured for 3 seconds using the same curing device. Next, an ultraviolet black lens was attached to the VALO device (VALO® plus VALO Black Light Lens) and the light was placed over the sealed areas (Figure 2). This approach, made possible because of the fluorescence properties of the sealant, enabled the clinician to check the sealed areas to ensure that the sealant was optimally adapted to prevent microleakage and also to assess the quality of the seal, not only immediately, but also in the future. After achieving the marginal seal essential for the interruption of caries (Figure 3 and Figure 4), the occlusion was checked.
This case report showed an alternative treatment of caries using a minimum intervention philosophy. A resin sealant was used to interrupt the caries lesion as a therapeutic maneuver. With this less invasive choice, it is possible to bring more comfort to the patient as well a simplification of dental treatment allied to a higher level of preservation of dental structures.
The authors are paid consultants for Ultradent Products, Inc.
1. Azarpazhooh A, Main PA. Pit and fissure sealants in the prevention of dental caries in children and adolescents: a systematic review. J Can Dent Assoc. 2008;74(2):171-177.
2. Griffin SO, Oong E, Kohn W, et al. The effectiveness of sealants in managing caries lesions. J Dent Res. 2008;87(2):169-167.
3. Oong EM, Griffin SO, Kohn WG, et al. The effect of dental sealants on bacteria levels in caries lesions: a review of the evidence. J Am Dent Assoc. 2008;139(3):271-278.
4. Kramer PF, Feldens CA, Romano AR. Promoção de saúde bucal em odontopediatria. São Paulo: Artes Médicas; 2000.
5. Pitts NB. Are we ready to move from operative to non-operative/preventive treatment of dental caries in clinical practice? Caries Res. 2004;38(3):294-304.
6. Mertz-Fairhurst EJ, Curtis JW Jr., Ergle JW, et al. Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc. 1998;129(1):55-66.
7. Hesse D, Bonifácio CC, Raggio DP, et al. Avaliações clínica e radiográfica do selamento de lesões de cárie. Rev PerioNews. 2008;2(2):137-143.
About the Authors
Anna Carolina Volpi Mello-Moura, DDS, MSc, PhD
Department of Orthodontics and Pediatric Dentistry
University of Sao Paulo
Sao Paulo, Brazil
Rafael S. Beolchi, DDS, MSc
Sao Paulo, Brazil