1/3. Sealants: where we have been; where we are going.Sealants are a critical component to the restorative dentistry armamentarium. The introduction of the acid-etch technique has made the sealing of occlusal surfaces effective. Rather than waiting for an occlusal surface to break down to the extent that an occlusal Class I amalgam restoration is indicated, extending preparations to include all caries-susceptible pits and fissures, an occlusal sealant can be placed to prevent caries. Sealants have been shown to be effective when used alone over acid-etched enamel or in conjunction with a methacylate-containing adhesive. Pit and fissure caries can be restored conservatively using resin composite or amalgam, utilizing sealant to prevent future caries. The increasing use of direct and indirect resin composites for Class I and Class II restorations includes the use of sealants over restoration margins and polished resin composite. A newly developed sealant, Clinpro, extends to all pits and fissures that are desirable to seal and is efficient and effective to place. ( info) |
2/3. Occlusal pit-and-fissure caries diagnosis: a problem no more. A science-based diagnostic approach using a laser-based fluorescence device.The subject of occlusal pit-and-fissure caries diagnosis elicits controversy and multiple opinions, depending on the clinician being questioned. The literature, however, points to which direction the profession should be headed in this field, as did the views expressed by the National Institutes of health's "consensus development conference on Caries Prevention and Management," held in March 2001, showing the need for more diagnostically specific caries management protocols and methods. Many clinicians have been surprised by the extent and severity of the carious involvement of a specific tooth, particularly when radiological as well as clinical examination indicates that little or no carious process should be present. It is unfortunate that at the stage when an explorer finally detects an occlusal catch, the degree and extent of demineralization and compromised tooth structure is already far advanced. This leads to the removal of large amounts of tooth structure to achieve a functional restoration. The consequential structural weakening of the tooth could have been prevented if the carious lesion had been detected earlier in its clinical course. Finite, quantitative, and reliable early diagnosis of carious occlusal lesions has remained elusive until now. Intercepting the carious process at an early stage leads to a conservative cavity preparation that preserves sound tooth structure and increases the structural integrity of the tooth. This article reviews the literature related to this topic and describes a relatively new diagnostic methodology that uses a laser fluorescence device (KaVo's DIAGNOdent). It is hoped that this article will serve as a catalyst for adopting a science-based approach to detecting and diagnosing occlusal pit-and-fissure caries at an early stage. The cases presented demonstrate the clinical efficacy and simplicity of this method of caries diagnosis, as well as show how invasive and destructive this "hidden caries" phenomenon can be. ( info) |
3/3. Cariostatic and ultraconservative sealed restorations: six-year results.The objective of this clinical study was to determine the ability of an ultraconservative, sealed composite resin restoration, without a traditional cavity preparation and without the removal of the carious lesion, to arrest Class I caries. tooth preparation was limited to placing a bevel in the enamel. These restorations were compared, over 6 years, with (1) ultraconservative, localized, sealed amalgam restorations with no extension for prevention and (2) traditional, unsealed amalgam restorations with the usual extension for prevention outline form. Caries was arrested by the ultraconservative, sealed composite resin restorations for 6 years. Complete sealant retention on the sealed amalgam restorations was somewhat lower than that on the sealed composite resin restorations; conversely, partial sealant retention was higher for the sealed amalgam group. The marginal integrity of the sealed amalgam restorations was significantly superior to that of the unsealed amalgam restorations. The sealant also protected Class I posterior composite resin restorations against wear. ( info) |