Dental sealant
Under a dental sealant refers to a coating of the teeth by a thin layer of plastic or rarely glass ionomer cement, to protect them from tooth decay. In general, the Zahnfissuren be sealed - the notches on the occlusal surface - which is why you mostly speaks of the fissure sealing. In contrast to the restorative therapy they will be applied preventively before a carious defect of a tooth has emerged. With the extended fissure sealing previously particularly close or ampoule-shaped fissures are expanded.
Application
Most commonly it is used in children and adolescents for the protection of pits and fissures. Similarly, buccal and palatal fissures plaqueretentive including dimples at the transition to the tubercles of Carabelli and foramina caeca at upper incisors. Earlier concerns that a not detected initial caries could proceed under the seal are clearly refuted. Due to the lack of substrate replenishment caries can not continue to develop, the bacteria die with an intact seal. Residual risks can be largely eliminated by regular follow-up. The dental professional societies advocate a general use of dental sealant for prevention. Even in the early stages of tooth decay, for which the melting - dentine has not yet penetrated by caries, the sealer can be applied without major removal of tooth substance. If the carious process already well advanced into the dentin, a minimally invasive restorative treatment may be indicated instead of a conventional restorative treatment.
History
Buonocore first described in 1955, the basic principle of the dental sealant. Controlled clinical studies have been conducted mid-1960, in 1976 they were by the American Dental Association (ADA), the Association of American dentists, are recognized as safe and effective. In Germany sealings were recommended in the 1960s and 1970s, not without reservations, because at that time were long-term experience as not sufficient.
Area of application
The German Dental Association (BZÄK ) and the German Society of Dental, Oral and Maxillofacial Surgery ( DGZMK ) recommend, according to a S3 - guideline does not infested pits and fissures in the chewing surfaces of the molars in children and adolescents to be sealed with high caries risk.
Principle of caries protection
A preventive sealant to protect against that food particles lodged in the grooves of the tooth, where they are poorly removed with a toothbrush and supply present on the tooth surface carious bacteria nutrients for acid production.
A sealing of caries- affected wells easy to shield the bacteria underneath from further food intake. Thus their caries activity and viability is severely limited. To make sure that there is no - are difficult to identify - comes further expansion of caries, therefore, a complete seal must be ensured. This must be checked regularly. If this is not given, the seal must be repaired.
Implementation
Preventative fissure sealing
The implementation of the fissure sealant is completely painless. First, the surface of dental calculus and tooth surfaces being cleaned. Then the teeth are dried so that no saliva can approach the tooth surfaces to be sealed. This is done using cotton rolls or a rubber blanket ( rubber dam ). Subsequently, the region to be sealed of the enamel with 37 % phosphoric acid, which is applied in paste form, is etched. The surface becomes roughened, so that the seal can hold in the microscopic pits retentive enamel on the tooth surface. After rinsing the acid, the tooth is dried with an air syringe. Then, the sealing material is applied thinly to the sites of predilection and cured either with a special light or a self- sealing material is used, consisting of two components which are mixed beforehand.
Extended fissure sealing
With the extended fissure sealing are closely tapered or ampullenformige fissures with either the smallest ball diamonds, with small and sharp diamond drills ( coarse grain diamond, fine particle diamond for smoothing), possibly with the aid of small round bur, removed before the fissure sealing is performed as described above. Has the melting - dentine overcome by caries, fissure sealing is no longer performed, but performed a filling according to the requirements of minimally invasive therapy.
Follow-up and integration with other measures
The seals must be checked regularly as part of individual prophylaxis on integrity. If damage is to place or renew maintenance. A dental sealant can replace the general prophylactic measures such as fluoridation, tooth healthy diet and oral hygiene at home in any case, since only the fissures are protected by the seal, but not the rest of the tooth surface.
A study presented a caries reduction of 95 % over a 10 year fixed, in the event that each year 2-4% of the seals are repaired.
Risks
In a Kiel study was reported by many cases in which the prevalence of dental caries by sealing increased. It was considered likely that a careless handling more than offset the positive effect of sealers by a weighing false sense of security.
Materials used
The materials mainly light-curing composites, but also self-curing composites or glass ionomer cements are used. Composites have been found to be most durable. The cements have a shorter shelf life, but in the medium term a similarly high activity against caries, which is explained by their release of fluoride. In an etching and an absolutely dry environment can be omitted during processing, therefore, these dental cements may in young children and baby teeth be more convenient to use.
Distribution in Germany
Several studies since 2000 show that 35-80 % of 12 -year-olds have fissure sealants in Germany.
Costs
The dentist can fissure sealing of permanent molars in 6 - to 17 -year-olds settle in Germany as contract dental performance (IP 5). This requires a non-carious fissure. Seals at the milk teeth, premolars or the predilection sites described above are calculated for pleasure, the numeral 2000, the fees for dentists