Moisture Tolerant Sealant – Clinical Technique with Embrace Wetbond Pit and Fissure Sealant
Main Article: Moisture Tolerant Sealant
See also: Dental Sealant – Studio Dentaire
When using Embrace WetBond Pit and Fissure Sealant, etched enamel surfaces are lightly dried and left slightly moist during sealant placement. Although the clinical use of pit-and-fissure sealants is relatively straightforward, errors in technique can result in premature sealant failure. For Embrace WetBond, following the directions below will contribute to clinical success.
Examine and evaluate the occlusal surfaces to be considered. In the case shown (Fig. 4), sealants had been placed eight years previously. At evaluation, the mandibular first molar needed sealant reapplication, and the mandibular second molar required a preventive resin restoration because of caries on the distal surface. This technique will focus on the sealant placement for the first molar.
Isolate the field with a rubber dam. Other methods of isolation include the use of cotton rolls, which should be changed frequently to keep the area dry, and the use of an Isolite (Isolite Systems, Santa Barbara, CA), a combined bite prop-high velocity evacuator-oral illumination device. If using cotton rolls, consider the use of a Garmers cotton roll holder to stabilize the position of the cotton rolls.
After isolating the teeth, clean the tooth surfaces with a water-pumice paste with a disposable prophylaxis angle in a slow-speed handpiece. Other methods for cleaning teeth before sealant placement include using a non-fluoride, pumice prophylaxis paste and an air abrasion device.
After cleaning, rinse the teeth surfaces thoroughly with an air-water spray and then dry.
Etch the teeth for 15 seconds with a phosphoric acid etchant. In this case, Etch-Rite (Pulpdent Corporation) was used to etch the teeth (Fig. 5). Then rinse the etchant from the teeth with an air-water spray for 10 seconds, followed by very light drying of the treated surfaces. With Embrace WetBond, the typical dull, frosted appearance of the etched surface is not desired. Rather, the surface should be lightly dried and very slightly moist with a glossy appearance. To accomplish this, compressed air or a cotton pellet should be used to remove the excess moisture (Fig. 6). There should be no visible pooling or drops of water on the tooth surfaces.
Apply Embrace WetBond to the occlusal surface using the supplied applicator tip (Fig. 7). After dispensing, use a micro-brush applicator to place the sealant, covering all pits and fissures and extending onto the cusp ridges. The final sealant thickness upon application should be at least 0.3mm.
After application, light cure the sealant for 10 seconds, holding the light curing probe at right angles to the occlusal surface as close as possible using a high intensity LED curing light. In this case an Allegro (Den-Mat, Santa Maria, CA) light was used (Fig. 8).
Evaluate the sealant for retention, seal of the occlusal surfaces and occlusion (Fig. 9).
Although the most common practice is to apply the pit and fissure sealant directly to the etched enamel, various studies have evaluated the efficacy of using an intermediate adhesive resin before sealant placement. The use of an intermediate adhesive resin has the potential to increase sealant retention with traditional sealants, but the disadvantage with this procedure is that it increases the number of steps and adds cost in time and materials. It also increases the potential for contamination when treating a paediatric patient, possibly resulting in premature loss of the sealant.37 With Embrace WetBond Pit and Fissure Sealant adhesive bonding agents are not required. Although saliva contamination should be avoided whenever possible, it does not affect the bond of Embrace WetBond sealant.
