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You don't need a bonding agent you just acid etch and
apply FS.
If FS get detached that means that your moisture
control was not efficient, to solve this problem you must
maintain a good moisture control and you can apply a
bonding agent on the tooth surface after acid etching and
then put the FS.
If the occlusion surface after applying FS was high you
correct it by using white stone bur.
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Safety issues regarding FS:
Estrogenicity of sealant:
Estrogen (estradiol-major estrogen in the body-) is a hormone
produced by testes and ovaries responsible in reproductive tract, so
how it's related to FS?
A study in 1996 said that BPA is not a direct ingredient of FS; it's
a chemical that appears later after curing when the raw materials
fail to fully react so the residual monomers leak outside of the cured
resin.
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1- To apply pumice with rubber cup which you put on slow speed
hand piece, get the pumice (small particles of sand) and wet it with
water until its a paste and use this to abrade FS
2- You can use cotton on FS surface after polymerization.
3-cure the FS for 40 seconds (the ideal is 20s).
So why does FS fail?
1-Moisture contamination which is a common mistake.
Current recommendation to place bonding agent because it's
hydrophilic so even if saliva (very little drop not to have the tooth
swim in the saliva) contaminate it, so it won't actually hurt.
2-Trapped voids when you place FS you have to distribute it on the
fissure surface in order to have no voids.
3-Wearing of tooth structure because the patient may have
bruxism.
4- Marginal leakage because of polymerization shrinkage or
moisture control problems and this will lead to secondary caries.
5- Polymerization shrinkage.
Sealed teeth should be monitored clinically every 6-12 months
and a radiograph is taken if indicated.
So after you write your treatment plan you should assign an
appointment for recall and follow up between 6-12 months
according to the caries risk of the patient.
Defective sealants should be investigated and a fresh sealant is
placed if you have lost some of the old FS or if there is marginal
leakage due to FS shrinkage…
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Definition of PRR: is a preventive approach to restore caries
with acid etch composite resin (AECR) &FS on the surface as an
alternative to amalgam in young permanent molars.
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So the PRR is a filling that is done for the occlusal surface of
posterior teeth or the facial or lingual pit for any tooth
I No Enamel -FS
-CR & FS
II Yes Dentin -GIC & FS
(optional) (small) -GIC & CR & FS
III Yes Dentin -GIC & FS
(large) -GIC & CR & FS
Note that in both type II & III you can place GIC then CR then FS.
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There are 4 different combinations of materials used:
FS
CR & FS
GIC & FS
GIC & CR & FS
Also we have RMGI & compomer.
The choice of restoration depends on:
• Clinical and radiograph diagnosis.
• Size of the caries.
• Caries risk of the patient.
Look page 26, upper slide:
This is PRR-illustrated: we have a layer of GIC, then CR and on the
top of the whole surface FS
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Look to the lower one on the same page:
(B) In this case here is a buccal pit; sealing of this buccal pit is
essential
(C) There is extensive occlusal caries in 1st permanent molars it
could have been prevented with FS
Placement of GIC in PRR instead of CR has advantages &
disadvantages:
Advantages Disadvantages
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Apply FS or CR+FS or GIC+CR+FS (when you apply
composite resin don’t forget to place a bonding agent, but in
case of glass ionomer you don’t need to place a bonding
agent).
Adjust occlusion
Student asked why do we use round bur only?
Dr said because we want to prepare very small cavity and small
round bur is designed for this purpose.
Benefits of PRR:
1-conservative
2-esthetic alternative to amalgam.
3-prevention of caries.
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Fluoride was detected in human dental enamel in 1805
and waterborne fluoride was detected by Berzelius in 1822.
Fluoride containing dentifrices ( )معجون السنانbecame
available at least as early as 1902.
When ingested, fluoride is rapidly absorbed into plasma
from the gut.
Peak plasma fluoride occurs within 1 hour of ingestion.
Salivary & gingival cervicular fluid levels also elevated &
provide topical effects on teeth either by direct contact when
drinking water for example, or by gingival cervicular fluid.
Fluoride has a strong affinity for Ca salts especially
calcium phosphate crystals and becomes incorporated into
bone and teeth during dental development.
Bone is the body’s major reservoir for fluoride
deposition not teeth.
Fluoride is not immediately incorporated in hard tissue
and it’s rapidly excreted in urine and to a lesser degree in
sweat and feces.
Fluoride continues to enter bone after development but
after teeth have been fully formed negligible amounts of
fluoride are incorporated by continued apposition of
cementum (root).
Fluoride enters hard tissues by replacing hydroxyl
groups to form calcium fluorapatite.
Fluoride effects on dental caries: 50% less dental caries
in areas where the drinking water contains about 1 ppm of
fluoride and is ingested throughout the period of dental
development compared with non fluoride areas.
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