October giveaway! Kona Adapter 2.0, Tube Kit and 10 Isolite mouthpieces!

Isolite mouthpiece. Excellent performance. Makes placing sealants enjoyable.

Isolite mouthpiece. Excellent performance. Makes placing sealants enjoyable.

To enter for your chance to win this month’s prize all you have to do is share your current sealant protocol in the comment section.  The winner will be chosen on Thursday, October 15th, 2015.  Good luck!

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https://konaadapter.wordpress.com

My current sealant protocol:
1. Place Isolite for isolation, retraction and evacuation
2. Clean the tooth with an ultrasonic scaler or hand scaler (if necessary) and then clean with a micro etcher (I use a cheap eBay air polisher with aluminum oxide powder)
3. Rinse thoroughly
4. Acid etch for ~15 seconds
5. Rinse thoroughly and air dry
6. Work sealant material into the grooves and pits with a micro brush and then fully cover the remaining occlusal surface with a thin layer of sealant material.  I use a wet-bond sealant like Embrace or Ultradent’s hydro sealant.
7. Light cure for ~15 seconds
8. Trim any excessive sealant material with hand scalers.

I also use 4.5x loupes with a Lumadent headlight.  I personally believe magnification is necessary to place high quality sealants.

15 thoughts on “October giveaway! Kona Adapter 2.0, Tube Kit and 10 Isolite mouthpieces!

  1. Sounds good.
    Isolation via IsoLight or IsoDry or equivalent is critical… nobody can bond well if saliva is in the picture. If saliva contaminates the enamel at any point after one begins, I’d start over in order to get the very best sealant.

    Only thing I’d add is that sealants can be inadvertently high in occlusion. They won’t last long if they are. So I suggest checking with a thin articulating film to either demonstrate that it is not in occlusion, or to mark it where the doc needs to trim it down. At minimum, ask the patient afterward if all their teeth come together exactly as they did before…that nothing has changed and the right and left sides both touch completely. (I ask the same question in many forms because pts don’t always understand what information I’m looking for.)

    • One more thing: I think the “~15 sec” you mentioned for light curing is an absolute minimum… I’d go longer…more like ~30 sec.

      There is no concern about overdoing the light curing, but definitely a constant concern about undercuring.

      • It’s about 15 seconds per section of tooth. For example, on #30 I cure the distal half of the occlusal surface, the mesial half of the occlusal surface and the buccal surface, so it’s more like 40-45 seconds.

    • Good point about the occlusion. Both “wet bond” sealants I use are ~37% filled and ~52% filled, but the Clinpro sealant, that I use occasionally, is only ~7% filled, so that particular sealant gets worn down into the grooves, if that makes sense, so the occlusion issue is not much of a factor with Clinpro.

  2. I work at a clinic as of now and I know my technique is not the best. But. I make due with what I am given. 😁
    I like to rinse the patients whole mouth. I polish using pumice. Rinse. Then isolate the tooth with cotton rolls, and a dry angle if needed. Followed by etch. Rinse. Isolate again. Dry. Place sealant, smooth out with microbrush. Use explorer to make sure sealant is flush. Remove excess if needed. Cure.

    • Tracy,
      The key here is to not allow any saliva on etched enamel during the replacement of wet isolation parts with dry ones.
      It’s one thing to say “polish using pumice” and another to say that all plaque and biofilm is removed from the pits and fissures. Mark’s use of scaler and air polisher is about as good as anyone can do.
      A prophy brush has more ability to get pits and grooves than a prophy cup…that plus a scaler and/or explorer tip in pits and grooves before etching might be the best under your circumstances. And when etching, attack the pits and grooves with disposable brush bristles. (The air polishers on eBay are quite cheap…see if you can’t get a hold of at least one of those and some extra tips.)

  3. 1) cleanse tooth with pumice. Rinse well.
    2.) Place dry angle cheek area and cotton roll. Place mouth prop. Dry well.
    3) place etch. Wait 45 sec-rinse, suction, air dry.
    4) place sealant-remove any excess with micro brush
    5) light cure for 30
    6) check sealant, remove any flash or adjust bite if needed. Rinse well.

    • Describe “cleanse tooth with pumice”. Unless that encompasses more than I am imagining, you should consider more effort before etching.

      A tooth deemed a candidate for sealants has occlusal pits and fissures that are a breeding ground for biofilm. It is not likely that use of pumice is going to adequately prepare the pits and fissures for etching or sealing. I suggest you go beyond “cleanse tooth with pumice”.

    • In response to “cleanse” I use a prophylaxis brush and fine pumice to cleanse the tooth as taught in hygiene school. If I had access to use powder to clean, I surely would, but not available in this office.

  4. 1) Air-powder polish grooves & rinse, dry
    2) Acid etch for 10 seconds & rinse, dry
    3) Apply thin layer of sealant material into grooves (Seal-Rite material used currently)
    4) Light cure for 10 seconds
    5) check occlusion with articulating paper & adjust as needed

  5. All sealants will wear down over time, but very premature failure will occur if high in occlusion when the patient gets out of the chair.
    Wear is gradual and smooth and as long as the pits and fissures are sealed, they are doing their job.
    Premature failure is jagged-edged and most or all is gone by the next recare…the pits and fissures may or may not be sealed after this failure. If a sealant is not doing its job for at least 3 yrs, it is a failure.
    That’s my opinion, based on what I’ve read about what to expect. We all have seen many go more than 3 yrs and we’ve seen some not last more than 6-12 months. I think the premature failures are all because of inadequate removal of biofilm in critical areas before etching, (that’s why “clean with pumice” by itself is an inadequate description), or saliva contamination of etched enamel, or being high in occlusion at the start. I suppose some failures could be because some sealant materials are inferior, but I discount that notion… The best materials will fail prematurely with inadequate attention to the details during placement and the weakest materials will last 3 years if well placed.

    • I agree. Sealants, no matter if they’re filled or unfilled, should not be placed with a thickness to the point that it affects occlusion. Not removing biofilm is by far the main reason, IMO, why sealants fail, or not last as long as they should. This is the step I see too many clinicians fail to perform well. I’m currently working on an online video course about placing sealants that will emphasize this step a lot.

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