Triage Sealant Application Tutorial for Low Viscosity Glass Ionomer Cement Sealant

[@RossWilliams89]

1. It appears that quite a bit of contamination happened between rinsing the conditioner and placing the sealant. Is that an issue? 2 what is the name of that song?

[@staceyblock7240]

I really can't see the benefit, or the decrease in time it took to place this sealant over a traditional resin sealant with etch. In fact, it looks like this material might even present, given the way it's dispensed, an occlusal issue that would require additional reduction or countouring after curing. I find the Fuji capsules harder to negotiate in the mouth and harder to control as far as flow of material is concerned. How is this better or faster than using, say, Vertise self etching flowable composite?

[@affiliatedchildrensdental]

On a cooperative patient with fully erupted molars, all 4 first permanent molars can be sealed with one capsule of Triage in less that 3 minutes. That simply is not possible with resin, even with a suction isolation system. But time is the least of my concerns, what's more important is the material. I would never place a self-etching resin on a partially erupted permanent molar. That would likely cause more harm than benefit in the long run. It's too much to explain in a KZbin post, but it comes down to the properties of the materials and what happens over time. I'll copy/paste one of my prior explanations for you; What I noticed over the years when my resin sealants failed was that often under a leaking or chipped resin sealant there were caries/decalcified enamel and/or frank cavitation. The difference with the LVGIC is that as the bulk of material washes out over time, there usually is not caries or decalcification present, but rather, thanks to the sustained fluoride release, enamel that was stronger/better/more resistant to acid attack. This is particularly true for newly erupted 6yr molars that haven't been in the mouth long enough to be exposed to topically applied fluoride and calcium and phosphate from saliva, the immature enamel is carbonate apatite. In time with calcium and phosphate it matures to hydroxyapatite with a critical pH of 5.5 to dissolve... but sealing it with the fluoride releasing LVGIC helps it mature to fluorapatite, which has a critical pH of 4.5, hence more acid resistant. Placing resin sealant on a newly erupted molar can keep the covered enamel in it's immature state, then as the resin leaks in time (which ALL resin does) it more easily gets decal and caries, vs. sealing it with LVGIC which will allow it to achieve the mature, more aciduric fluorapatite. The other aspect is that even when we think/see that the bulk is gone, the low viscosity GIC has actually flowed into the fissure. Please also refer to this JADA Systematic review and meta-analysis, Alirezaei et al July 2018, which shows equivalent efficacy for caries prevention w/resin vs. GIC sealants. Some key points; a). The caries prevention effect of GIC-based sealants is not associated with retention, b). Conditioner (PAA) increased the chance of chelation reaction between the calcium of the enamel and the PAA in the GI matrix, establishing a more stable bonding surface (i.e. please don’t think it’s okay to skip it), c). GIC is preferable in a community based sealant program, d). Studies with HVGICs and RMGIs as sealants have not shown better retention performance, e). Resin sealant loss is associated with the risk of developing caries, but not for GIC-based sealants. Small particles of GIC remain in the bottoms of fissures that act as a fluoride reservoir, enhancing nearby enamel remineralization.

[@babacanoflaz1403]

@@affiliatedchildrensdental great explanation

[@nefernunezmontano2257]

What are those shields that you use for isolation?

[@affiliatedchildrensdental]

dri-aides

[@samanthacook9871]

In the UK they're known as Dryguards and they also come in a smaller size for Paediatric patients

[@rawyhjamal5215]

Nice