How many sealants have you installed in your career? Chances are, you are busy drying, etching and curing sealants every week, in addition to educating your patients even more often. But should you recommend sealants? And if so, how do you choose which kind to use?
The good news is that caulking holes and cracks is still an effective way to create a physical barrier to pathogen colonization, thereby reducing the chance of cavities. Studies show sealant retention of 61% five years after application, with surgical factors such as moisture control, tooth surface preparation and application of dental adhesives affecting retention rates.1 The latest research shows that the caries process is multifactorial and therefore providing an individualized comprehensive caries management program that includes healthy eating habits, fluoride intake and sealants is an effective method of achieving oral health.
The history of dental sealants dates back to the 1970s when they first appeared as a preventive measure against tooth decay. In 2016, the American Dental Association and the American Academy of Pediatric Dentistry (AAPD) developed clinical practice guidelines based on a systematic review of the use of hole and fissure sealants in both permanent and primary molars. The results concluded that sealants are indeed effective compared to no sealants or the use of fluoride varnishes and that sealants can minimize the progression of non-cavitated caries lesions.2
Today, sealants are classified by their primary composition material and often fall into two categories: resin-based or glass-ionomer sealants. However, recent innovation and research has shown self-bonding polymer as an additional category and next-generation sealant, changing the way we apply and think about sealants.
Resin-based dental sealants are most commonly used and are made from an organic resin-based oligomer matrix as well as Bis-GMA. This type is typically applied using a 37% phosphoric acid etch and achieves polymerization by photopolymerization. Resin sealants can also be classified as filled or unfilled. Filled sealants contain various shapes of glass particles, helping to create a more wear-resistant surface. However, the disadvantage of resin-filled materials is that the sealant is thicker and therefore has difficulty reaching pits and crevices.1
Glass ionomer sealants consist of a combination of glass and acrylic resin and are rapidly gaining popularity due to their ability to slowly release fluoride ions to promote remineralization. Glass ionomer sealants must be mixed at the time of placement and usually rely on a strong acid-base reaction to adhere to the tooth surface. The exception to this are resin-modified glass ionomers and polyacid-modified resins, which are formed by a combination of acid-base reaction and polymerization. Recent studies from 2012-2022 show a lower retention rate (40%) in glass ionomer sealants after two years compared to resin sealants (80%).1
The latest innovation in sealant uses self-adhesive polymer gel technology and is applied without mixing or the need for etching or light curing – simply dry the surface, paint the material and buff off the excess with a 2×2 gauze. Composed of polydimethylsiloxane and invented by a dentist in the 1980s, this completely translucent material automatically chemically bonds to hard surfaces at a thickness of 1 micron (1/70 the diameter of a human hair). As an advantage, it immediately reduces sensitivity when applied to root surfaces and is hydrophobic in nature, preventing biofilm, calculus and stain build-up.3
Since the 1970s, dental sealants have been an effective method of reducing cavities and halting the caries process. However, retention rates vary significantly based on operational factors such as moisture control and application process. However, the latest next-generation sealant technology includes a self-bonding polymer, allowing for an easier application process and biofilm control applications.
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About the Author
Melissa K. Turner, is a new force for change and is on a powerful mission to transform the future of dentistry for both patient and practitioner. An award-winning speaker, key influencer and hygienist, Melissa represents a new generation in dentistry through her focus on inclusion, practitioner wellbeing and innovative technology. He is a 2022 recipient of the Sunstar Award of Distinction, the dental hygiene industry’s highest honor, and is a leading creator of dental content nationally. She leads the Cellerant Best of Class Hygiene awards as Chief Hygiene Officer and Director of Social Strategy. Learn more and contact her at www.melissaturner.com
