Toothbrush Abrasion Rates of Enamel Sealants

FINAL REPORT
WORK ORDER #1
TOOTHBRUSH ABRASION RATES OF ENAMEL SEALANTS
SPONSOR INFORMATION
Sponsor name: Reliance Orthodontic Products, Inc.
Sponsor Address: 1540 West Thorndale Ave
Itasca, IL 60143
Contact person: Mr. Paul Ganges
Title: President
Voice: (630) 773-4009
Mobile: (630) 546 4477
Email: paulgropi@aol.com
PRINCIPAL INVESTIGATOR INFORMATION / CONTACT PERSON

Proposal developed by:
Dr. Fred Rueggeberg
Professor and Section Director
Dental Materials
College of Dental Medicine (AD-3265A)
Georgia Regents University

Augusta, GA 30912-1260
USA
Phone: (706) 721-3354

Cell : (706) 399-1933
FAX: (706) 836-4660
Email: frueggeb@gru.edu
TABLE OF CONTENTS
(note: Simultaneously click the CONTROL button and select a topic with the mouse
Left button to be taken directly to that location in the proposal body)
STUDY PURPOSE.......................................................................................................... 3
Objective...................................................................................................................... 3
STUDY METHODS ......................................................................................................... 3

Enamel sealants tested ............................................................................................... 3
Characterization of dental light-curing unit used .......................................................... 4
Specimen Fabrication .................................................................................................. 4
Tooth preparation ..................................................................................................... 4
Initial surface scanning ............................................................................................. 5
Application of enamel surface sealers ...................................................................... 7
Scan of enamel surface following initial sealant application ..................................... 8
Specimen Testing ...................................................................................................... 10
Toothbrush abrasion machine ................................................................................ 10
Simulated intervals for measurement of tooth brushing wear................................. 11
Assessment of periodic enamel sealant loss.......................................................... 12
Determination of enamel sealant loss within the defined area ............................... 14
Enamel sealant rate loss ........................................................................................ 14
Total number of specimens tested ............................................................................. 15
RESULTS AND DATA ANALYSIS ................................................................................ 16

Rate of loss of resin with respect to time ................................................................... 17
Opal Seal ............................................................................................................... 17
L.E.D. Pro Seal ...................................................................................................... 18
Overlay of wear rates ............................................................................................. 19
Normalizing Results ................................................................................................... 21
Opal Seal Specimens ............................................................................................. 22
L.E.D. Pro Seal Specimens .................................................................................... 26
CONCLUSIONS ............................................................................................................ 30
LED Pro Seal Tooth Brush Abrasion Test page 2/31

FINAL REPORT
WORK ORDER #1
TOOTHBRUSH ABRASION RATES OF ENAMEL SEALANTS
The manuscript is the final report of the above referenced project work order and title,
and represents the completion of all aspects of the proposed study, as it was outlined in
the original experimental protocol delivered at contract signing.
STUDY PURPOSE
This project was designed to compare the ability of a Reliance Orthodontic enamel
sealant (L.E.D. Pro Seal) and a competitive product (Opal Seal, by Ultradent
Products) to resist tooth brushing using an in-vitro testing model. Specifically,
clinically relevant placement of each type product was made on the flattened surface
of bovine enamel. Specimens were subjected to long-term tooth brush abrasion in a
V-8 brushing machine, and the cross-sectional thickness at a reproducible location
of each type product was measured and compared at specific times into brushing, to
simulate durations of clinical tooth brushing.
This study had 1 major objective.
Objective
To measure and compare the amount of vertical sealant loss within a defined
location after various durations of simulated toothbrush abrasion between two
commercial brands of enamel sealants: Opal Seal and L.E.D. Pro Seal.
STUDY METHODS
Enamel sealants tested
A table of the enamel sealants used is listed below.
Table 1
Enamel sealant products tested
PRODUCT NAME MANUFACTURER ITEM NUMBER LOT NUMBER EXPIRATION DATE

L.E.D. PRO SEAL Reliance Orthodontic Products, Inc LEDPRO 1211705 01/2015
OPAL SEAL Ultradent Products, Inc 500-063 B7YFW 07/2014

The sponsor supplied sufficient amounts of each product to enable the study to be
accomplished.
Characterization of dental light-curing unit used

A blue-only, commercial dental curing light (the Elipar S10, 3M/ESPE) was used to
light-cure all specimens. The spectral irradiance of this light (sn# 939112009734 )
was measured using a laboratory grade spectral radiometer (6” integrating sphere
with internal NIST-traceable light source (Labsphere, N. Sutton, NH),
spectroradiometer (USB2000, Ocean Optics, Dunedin, FL), and analytic software
(SpectraSuite, Ocean Optics). A graph of the spectral output and the average
irradiance of 5 independent readings is presented in the figure below (1,027 ±2
mW/cm2).
20
1,027 (±2) mW/cm2

15
IRRADIANCE
(mW/nm/cm 2)
10
0
350 375 400 425 450 475 500 525 550
WAVELENGTH (nm)
Figure 1
Spectral irradiance of light curing unit used in the testing (Elipar S10, 3M/ESPE)
Specimen Fabrication
Tooth preparation
The facial surface of a lower bovine incisors having a large mesio-distal
measurement were flattened to 320 grit SiC on a water-cooled, rotating, flat surface.
The crown segment was then removed from the root portion, and was trimmed to fit
within the recess of a custom-made, polymer matrix. Undercuts were placed in the

side opposite the flattened surface, and the tooth was mounted in the matrix using
light-cured dental composite, so that the plane of the flattened tooth surface was co-
incident with the top surface of the titanium holder in which it rested. By positioning
the tooth segment in this manner, the flat surface of the tooth brush bristles were
located at the proper position on the specimen. This type arrangement allowed for
easy placement and removal of the specimen held within the custom matrix material,
permitting periodic surface scanning and re-insertion for continued tooth brushing.
The tooth/matrix assembly was placed on the table of a micro-drill press to create
two small, shallow (about 300-micron deep) semi-circular depressions at the lateral
sides of the exposed, flattened enamel surface.
COMPOSITE MATRIX
EXPOSED, FLATTENED
ENAMEL SURFACE
SHALLOW DIMPLE
USED FOR HEIGHT
REFERENCING
Figure 2
Diagram of embedded tooth and reference dimples
Initial surface scanning

The matrix containing the flattened enamel surface now having the two reference
dimples was placed in a custom-made positioning jig and the side-to-side surface
profile (mesio-distal dimension) of the flattened enamel surface (to include the two
lateral dimples) was obtained using a contact surface scanning device (Form
TalySurf Series 2, 120i, Taylor/Hobson, Leicester, United Kingdom). This scan
represented the pre-application height of enamel before any sealant has been
placed and cured.

AREA SCANNED
DIGITAL CROSS-
SECTION ANALYZED
Figure 3
Depiction of area to be surface profiled (red outlined area), and the cross-sectional
plane to be analyzed on all future scans (blue dashed line)
Shallow Dimple for

Flattened Enamel Surface
measurement referencing
Empress (A2)
Figure 4
Diagram of cross section depicting the plane connecting the bottoms of the two small
lateral dimples – obtained using computer software from profile scans (see Fig 2
I. blue-bashed line)
Specimen Motion
II.
Scanning probe
Figure 5
Surface profiling system

An example of a scan used for measuring the “slice” of flattened tooth surface and
subsequently placed enamel sealant is seen in the following figure.
ENAMEL
400
300
200
HEIGHT (microns)
100
0
0 2000 4000 6000 8000 10000
-100
-200
-300
-400
WIDTH (microns)
Figure 6
Example of an actual scan of a polished, dimpled enamel surface used in the
experiment
Application of enamel surface sealers

The enamel area between the two lateral dimples was acid-etched for 15 seconds
(Ultra-Etch 35% Phosphoric Acid Gel, Ultradent Products, Inc, South Jordan, UT),
water-rinsed, and air-dried, until a frosted enamel surface was apparent.
The proper amount of unpolymerized enamel sealant was applied to the etched area
in a manner simulating exactly how this material is applied clinically, following
manufacturer’s instructions for each product. The applied material was then light-
cured using manufacturer-recommended exposure durations: 10 seconds.
Care was taken to NOT place any material into the two shallow, reference dimples
made in the enamel surface on the lateral sides of the flattened tooth surface.

These points served as important positioning landmarks and depth normalization
indices for all subsequent measurements to be taken on each individual tooth.
Immediately after polymerization, the surface of each applied sealant was gently
wiped with a cotton gauze to remove any trace of oxygen inhibited layer, even
though the manufacturer might have indicated that none exists.
Scan of enamel surface following initial sealant application

After placement and curing of the enamel sealant layer, the specimen was returned
to the stage and re-scanned for surface profile in a similar manner as described
above. Software was used to, once again, select the identical cross sectional profile
line drawn between the lowest points of the two lateral dimples on the enamel
surface. The data were exported into a spreadsheet program (EXCEL 2003,
Microsoft Corporation, Redmond, WA), where the files were adjusted to superimpose
upon each other.
ENAMEL SEALANT PLACED
Empress (A2)
Figure 7
Diagram of a cross sectional analysis of scan connecting bottoms of the two dimples
after placement of the enamel sealant
Using the software, the height and area of the sealant in the plane connecting the
bottoms of the two shallow dimples was determined, and the area of resin (as well as
its vertical height) was determined, using the depths of the bottoms of the two
dimples as consistent vertical references.

Reference plane for height
determination
Enamel Sealant Layer (set at 0 microns)
Figure
Empress (A2) 8
Diagram showing how the height of the thin enamel sealant film was be determined
An actual example of the overlay of the flattened enamel surface and the freshly
applied enamel sealant is seen in the following figure.
ENAMEL FRESH SEALANT
400
300
200
HEIGHT (microns)
100
0
0 2000 4000 6000 8000 10000
-100
-200
-300
-400
WIDTH (microns)
Figure 9
Overlay graph indicating both the enamel surface prior to sealant placement and the
same location after sealant placement and light-curing.
Note: green line is flattened tooth surface, red line is the outside profile of the actual
layer of sealant applied to the underlying enamel

Note the similar pattern and depths of the two lateral indentations between the two
different scans of the same tooth locations, prior to and subsequent to sealant
application.
Specimen Testing
Toothbrush abrasion machine
Freshly prepared specimens were placed into custom-made matrix mounts and
special protective, metal bands were fastened around the girth of each specimen,
covering the location where the two lateral dimples were located, as well as a small
amount of sealant on either side. In this manner, the dimpled areas were protected
from toothbrush abrasion.
Toothbrush
Head
Specimen holder
holmaterial
Sealant
Protected Dimple
Tooth
Enamelspecimen
Surface
Figure 10
Diagram of protective sleeve placed around the specimen holder matrix in order to
protect the shallow dimple from toothbrush abrasion. Note that a portion of the lateral
sealant was also protected from wearing.
A tooth brushing machine (V-8 Cross Brushing Apparatus, Sabri Enterprises,

Lombard, Illinois) that holds up to eight manual toothbrushes (47 Tufts Medium
Toothbrush, Ranir Co., Great Rapids, MI) was used. This machine simulates
toothbrush abrasion on the groups under a slurry solution composed of 37.5 g of
toothpaste (Crest PRO-HEALTH Whitening, lot 309539, expiration date March, 2015,
Procter and Gamble, Cincinnati, OH) and 37.5 ml of distilled water. The specific
toothpaste (Crest PRO-HEALTH) was chosen for this study because it has a very
high radioactive dentin abrasion (RDA) value: 166 out of a maximum permissible

level of 200. Totally flat-bristles tooth brushes were used at each test station
(Regular Straight 47 Medium, Ranir Corporation, Grand Rapids, MI). The force
applied on each brush was adjusted to 200 g. The tooth brushing machine was
adjusted to provide a specific number of brush strokes (defined as one cycle of
downward and upward motion) to the specimens to simulate a variety of years of
clinical use. The number of reciprocal strokes applied was determined by averaging
the number of strokes used in ten published abrasion studies.
200 g pressure applied
Toothbrush
Motion
Acrylic tube with 1:1 paste

& water slurry
Figure 11
Photographs of the tooth brushing machine used and close-up of the tubes containing
the water slurry of paste
Simulated intervals for measurement of tooth brushing wear

Based on an estimated value of 19,000 brushing cycles equating a year’s worth of
clinical tooth brushing, the following table provides time lines when the machine was
stopped, the specimens removed, and their surfaces scanned in the profilometer.
Table 2
Intervals of brushing at which specimen profile readings will be obtained

CYCLE # SIMULATED YEARS OF BRUSHING NUMBER OF BRUSHING STROKES REQUIRED
1 0.25 4,750
2 0.50 9,500
3 0.75 14,250
4 1.00 19,000
5 1.50 28,500
6 2.00 38,000
7 2.50 47,500
8 3.00 57,000
Note, new toothpaste solutions were applied to all brushing stations on a simulated
yearly basis: after years 1 and 2.
Assessment of periodic enamel sealant loss

An actual example of the wear noted on a specific enamel sealant over the course of
the 3-years of simulated tooth brushing is seen in the following figure.
STATION #1 OPAL SEAL ENAMEL

FRESH SEALANT
Length evaluated for wear 3 MONTHS
400
6 MONTHS
9 MONTHS
300 12 MONTHS
18 MONTHS
24 MONTHS
200 30 MONTHS
36 MONTHS
HEIGHT (microns)
100
0
0 2000 4000 6000 8000 10000
-100
-200
-300
-400
WIDTH (microns)
Figure 12
Overlay graph of the same enamel sealant (Opal Seal) cross-sectional profile
obtained at each time interval of tooth brushing at a specific tooth brushing test
station.

In the above figure, note that only the width area highlighted in the light green box
was used to analyze loss of sealant: the horizontal span from 2400 to 6300 microns.
Only within this area was evidence provided that the brushing caused wear to take
place. The sealant surfaces lateral to the light green box were protected from
abrasion by the thin metal cover, and were thus, not included in any wear
calculations: only the area of sealant within the outlined boxed location.
At times, sealant loss was noted to the extent that the underlying enamel was
exposed, which also was wearing. Areas on the tooth surface where sealant had
totally been worn away needed to be eliminated from the analysis. The following
figure demonstrates how such an occurrence was dealt with, by judiciously selecting
only the horizontal length of area where sealant loss was noted, but not to the level
of enamel exposure.
STATION #2 OPAL SEAL ENAMEL

Length evaluated FRESH SEALANT
300 for wear 3 MONTHS

6 MONTHS
9 MONTHS
12 MONTHS
200
18 MONTHS
24 MONTHS
30 MONTHS
100
36 MONTHS
HEIGHT (microns)
0
0 2000 4000 6000 8000
-100
-200
-300
-400
WIDTH (microns)
Figure 13
Example showing how the horizontal area of sealant wear analysis was restricted to
only that region (between 2400 and 4200 microns) that still had sealant present after
36 months of simulated tooth brushing.

In this example, only the area defined by the light green rectangle was used for wear
analysis, because, on either side of this box, the sealant had worn away so much,
that the underlying enamel itself was wearing at a high rate.
Determination of enamel sealant loss within the defined area

The area under the curve, from the height of the scanned sealant surface to the
flattened enamel surface, was determined using rectangular integration of width and
height data points along the specific scanned profile that joined the deepest points of
the two lateral reference dimples. The area of sealant was thus calculated at each
time point of simulated tooth brushing, when the specimen was retrieved from the
tooth brushing machine and placed on the profile scanner. All the profiles for tooth
brushing duration were then superimposed and adjusted, horizontally and vertically,
so that the bottoms of the lateral reference dimples coincided. Because the actual
area of tooth brushing was restricted (in the width dimension), the width of sealant
specimen analyzed throughout all tooth brushing times for a given specimen was
determined by examining the profile of the last attained scan. During brushing,
where sealant might have been thin and during testing, had totally worn away,
evidence was present that the enamel surface of the underlying tooth had been
exposed, and was also wearing. In addition, because of the protective metal
covering of the lateral portions of each specimen, not all of the applied sealant was
exposed to tooth brushing. Thus, the width of sealant wear analysis was restricted
for each specimen to be that lateral dimension that still demonstrated the continuous
presence of sealant without any signs of enamel wear.
Enamel sealant rate loss

Within the specific width defined for analysis as described above, the vertical area
loss of sealant was calculated by subtracting the measured value at a specific
interval of tooth brushing from that of the amount of original, unbrushed sealant
placed. An example of how this value was calculated can be seen in the following
figure:

STATION #1 OPAL SEAL
400
ENAMEL
FRESH SEALANT
300
3 MONTHS
200
HEIGHT (microns)
100
0
0 2000 4000 6000 8000 10000
-100
-200
-300
-400
WIDTH (microns)
Figure 14
Example showing how the loss of cross sectional area was determined between
when all the sealant was present (red line), and after the first 3 months of simulated
tooth brushing (blue line), from the reference plane of the initial flat enamel surface
(green line). NOTE – only within the light green rectangle were areas determined.
This difference value in areas between the freshly placed sealant and that measured
after a specific number of simulated tooth brushing times was then divided by the
number of simulated number of months that had accumulated up to the point of the
wear profile scan, to determine a monthly vertical sealant loss: square
microns/month.
Total number of specimens tested

There were two enamel sealants tested, and four replications for each test group
were made. The enamel resins were randomly assigned to each test group and also
randomly assigned to a specific location within the tooth brushing machine, to

minimize the effect of operator experience and differences in position on the test
instrument upon the test results.
RESULTS AND DATA ANALYSIS

The independent variables tested were the influence of type of enamel sealant (either
Opal Seal or L.E.D. Pro Seal) and duration of tooth brushing (3, 6, 9, 12, 18, 24, 30,
and 36 simulated months) on the cross sectional area of applied sealant lost (in units
of square microns of depth). Thus, a 2-factor, repeated measures (the same specimen
was measured repeatedly over the course of the experiment) analysis of variance test
was applied to the data to observe the effect of the main variables alone (or when in
combination) on the outcome variable (sealant loss). All statistical testing was
performed at a pre-set alpha of 0.05.
The following table lists the findings of the statistical analysis.
Table 3
ANOVA report for the 2-way, repeated measures test examining the effect of sealant
type and duration of tooth brushing on wear of sealant.
Source of Variation DF SS MS F P
PRODUCT 1 443190475.841 443190475.841 135.704 <0.001
STATION(PRODUCT) 6 19595122.024 3265853.671
MONTHS TBA 7 6286563.809 898080.544 4.873 <0.001
PRODUCT x
7 4831849.308 690264.187 3.746 0.003
MONTHS TBA
Residual 42 7740093.529 184287.941
Total 63 481644104.511 7645144.516
These findings indicated that both the major factors of product tested as well as
duration of tooth brushing had a significant influence on the wear rate of sealants. In
addition, there was a significant (p = 0.003) interaction term between the two main
variables. After further analysis, it became obvious that the interaction term that

arise resulted from the fact that the rate of wear of Opal Seal continued to increase
with exposure to tooth brushing time, whereas that of the L.E.D. Pro Seal did not.
Rate of loss of resin with respect to time

Opal Seal
The rate of vertical surface area loss per month of tooth brushing for Opal Seal is
seen in the following figure.
9000
8000
y = 50.049x + 5170.9 R2 = 0.278534
LOSS RATE (square microns/month)
7000
6000
5000
4000 OPAL SEAL
3000 Linear (OPAL

SEAL)
2000
1000
0
0 5 10 15 20 25 30 35 40
SIMULATED DURATION OF TOOTH BRUSHING (MONTHS)
Figure 15
Rate of vertical sealant loss of Opal Seal over scanned line (square microns/month)
Each data point represents average of 4 experimental runs
Vertical bars represent +/- 1 standard deviation
Equation represents the linear regression of the experimental data
As can be seen, there is an increasing loss of vertical sealant area with accumulated
tooth brushing. During the first three months of simulated brushing, the product lost
the greatest amount of material, and thereafter lost surface area at a linear rate.
Linear regression analysis was performed on the experimental data (not forcing the

data to go through the origin), and the calculated rate of loss line matched the
experimental data fairly well (R2 value of slope = 0.2785, meaning that the measured
data accounted for only about 30% of the variation in the measurements. The slope
of this line, representing the overall rate of loss per month, was approximately 50
square microns and was highly statistically significantly different from zero: p =
0.001907. Thus, although there was quite a bit of variation in the data (low R 2
value), there was a significant trend of increasing rate of wear as tooth brushing
continued.
L.E.D. Pro Seal

The rate of sealant loss with L.E.D. Pro Seal with respect to duration of simulated
tooth brushing is seen in the following figure.
2000
PROSEAL
Linear
1500
(PROSEAL)
y = 4.6009x + 691.88 R2 = 0.3816
1000
500
0
0 5 10 15 20 25 30 35 40
Figure 16
Rate of vertical sealant loss for L.E.D. Pro Seal over scanned line (square
microns/month)

Each data point represents average of 4 experimental runs
Vertical bars represent +/- 1 standard deviation
Equation represents the linear regression of the experimental data
This plot seems to indicate that once the initial wear of L.E.D. Pro Seal has occurred
within the first three to 6 months (the greatest time of wearing), the rate at which the
sealant wears does not seem to change with accumulated duration of tooth brush
abrasion. The overall rate of loss of vertical sealant surface averages only about
one-fifth that found with Opal Seal, and is around 4.6 square microns per month.
Substantiating the observation that the rate of L.E.D. Pro Seal wear does not seem
to change with time is the fact that the slope of the regression line is not significantly
different from zero: having a p-value of 0.3618 (recall, values less than 0.05 would
indicate a significant trend of sealant loss with accumulated tooth brushing).
Overlay of wear rates

The following figure places the wear rates of the two sealants in perspective, by
normalizing all values to the same X- and Y-value coordinates.

9000
8000
y = 50.049x + 5170.9 R2 = 0.278534
7000
6000
5000
4000 OPAL SEAL
3000 PROSEAL
2000 Linear (OPAL

2 SEAL)
y = 4.6009x + 691.88 R = 0.02779
Linear
1000
(PROSEAL)
0
0 5 10 15 20 25 30 35 40
Figure 17
Overlay of the rates of wear of Opal Seal and L.E.D. Pro Seal at similar durations of
simulated tooth brushing.
When placing these two loss profiles on the same coordinate scales, the greater loss
rate associated with Opal Seal becomes very apparent. In the figure, the increasing
loss rate with accumulated brushing of Opal Seal can be seen, and the unchanging
nature of the loss of L.E.D. Pro Seal is apparent.
The Tukey post-hoc test, comparing differences in mean wear rates between the two
commercial enamel sealants at similar durations of simulated tooth brushing
indicated that, for every time interval measured, the wear rate of Opal Seal was
significantly greater (p<0.05) than that of L.E.D. Pro Seal.

Lastly, the 2-way ANOVA also indicated no significant difference in wear rates for the
L.E.D. Pro Seal product within any given time point of simulated tooth brushing
exposure, while many differences were noted between time frames for Opal Seal.
Normalizing Results
Because of differences in viscosities between the two sealant types, one product
consistently left an average thicker layer than did the other: average peak thickness
of Opal Seal was 265 ±43 µm and that of LED Pro Seal was only 111 ±33 µm.
Using an unpaired, 2-tailed Student’s t-test, these values were proven to be
significantly different: p = 0.0016.
To make a more even “playing field” between the two materials, the cross sectional
wear patterns of all specimen runs were adjusted so that only the top 100 microns
was seen. This method created equivalent sealant layer thickness of approximately
100 microns for each run: all data below that level was ignored. The top-most 100
microns cross section of each freshly applied sealant was then plotted as well as
that after 9 and 36 months of simulated tooth brushing. This process was performed
to see if, after these time intervals of brushing, any of the lateral sealant (where it
was thinner) would have been worn through, and exposed the underlying enamel. If
so, then this meant that, subsequent to these time periods, this area, and more
lateral areas would be unprotected by the sealant. The following figures present the
top-most 100 microns of actual data runs for each specimen, showing differences
between the profile of the freshly placed sealant and its profile after 9 and 36 months
of simulated tooth brushing.

Opal Seal Specimens
STATION #1 OPAL SEAL FRESH SEALANT

9 MONTHS
36 MONTHS
320
310
300
290
HEIGHT (microns)
280
270
260
250
240
230
220
210
3000 4000 5000 6000 7000
WIDTH (microns)
Figure 18
Overlay of top-most 100 microns of fresh sealant and sealant after 9 and 36 months
of simulated tooth brushing wear: Opal Seal testing station #1.
Note two things in this Figure. Firstly, the large amount of sealant lost from the 9
months of tooth brushing, as well as the fact that, after this time period, one side of
the enamel sealant would be gone, and would have exposed a lateral border of
enamel 100 microns in width that would no longer be protected. After 36 months of
simulated brushing, very little of the initial 100-micron thick sealant layer is still
present, leaving much of what would have been the underlying enamel surface
uncovered, and unprotected.

9 MONTHS
36 MONTHS
280
260
HEIGHT (microns)
240
220
200
180
160
1500 2000 2500 3000 3500 4000 4500 5000
WIDTH (microns)
Figure 19
Again, the large amount of sealant loss at the 9-month mark is noted in this profile,
as well as the fact that about 300 microns of sealant would have been lost bilaterally
(red circled areas) and exposed underlying enamel on either side of the sealant.
After 36 months of simulated brushing, only a few isolated area still retain sealant,
leaving most of the originally covered enamel without protection.

9 MONTHS
36 MONTHS
220
210
200
190
HEIGHT (microns)
180
170
160
150
140
130
120
110
2000 3000 4000 5000 6000 7000
WIDTH (microns)
Figure 20
As seen before, there is a large amount of vertical sealant loss at the 9-month mark.
About 300 microns of sealant would have been lost laterally (red-circled area),
exposing underlying enamel on one side of the sealant. After 36 months of simulated
brushing, only a small fraction of the original sealant that covered the enamel
surface remains.

9 MONTHS
36 MONTHS
282
272
262
252
HEIGHT (microns)
242
232
222
212
202
192
182
2000 3000 4000 5000 6000
WIDTH (microns)
Figure 21
As is typical, the large amount of vertical sealant loss at the 9-month mark is
evident. In addition, the two lateral sides of the sealant have each lost 300 microns
(red circled areas), which would have exposed this amount of enamel on the lateral
border of the initially place sealant. At the 36 month mark of simulated brushing, only
about a total of 25 of the originally covered enamel would be protected by the
remaining sealant: over 75% of the once-covered enamel would have become
unprotected.

L.E.D. Pro Seal Specimens
STATION #3 PRO SEAL FRESH SEALANT

9 MONTHS
36 MONTHS
120
105
90
HEIGHT (microns)
75
60
45
30
15
2000 3000 4000 5000 6000
WIDTH (microns)
Figure 22
of simulated tooth brushing wear: L.E.D. Pro Seal testing station #3.
In contrast to the profiles above seen of the Opal Seal product, note the very small
amount of vertical sealant loss between initial sealant placement and that observed
after 9 months of simulated tooth brushing. In addition, note that, at the lateral
borders (simulating where the sealant periphery is thin and in contact with the
enamel), little-to-no sealant loss is noted. This finding means that the enamel
remains protected and covered by the sealant at the restoration periphery. Note, as
well that, after even 36 months of simulated brushing, none of the sealant is lost at

the lateral borders, indicating coverage and protection of all sealed enamel for a 3-
year duration.

9 MONTHS
36 MONTHS
140
130
120
110
HEIGHT (microns)
100
90
80
70
60
50
40
30
2000 3000 4000 5000 6000
WIDTH (microns)
Figure 23
The same trend of this product showing very little vertical sealant loss after 9 months
of simulated tooth brushing is seen, as well as little-to-no loss at the sealant
periphery. After 36 months of simulated brushing, only a small portion of one side of
the sealant is seen to be lost: approximately 200 microns. However, about 95% of
the remainder of the enamel surface would have been covered and protected.

9 MONTHS
36 MONTHS
130
120
110
100
HEIGHT (microns)
90
80
70
60
50
40
30
2000 3000 4000 5000 6000 7000
WIDTH (microns)
Figure 24
Once again, relatively little sealant loss is noted, and occurs at the very top center of
the material. No loss is noted at the sealant border, indicating protection of the
underlying enamel throughout this time period. At the 36-month mark, only a small
portion of one lateral border indicates loss of sealant. Once again, however, 95% of
the originally covered enamel surface remains protected by a continuous, large layer
of sealant.

9 MONTHS
36 MONTHS
70
60
50
HEIGHT (microns)
40
30
20
10
0
1000 2000 3000 4000 5000
WIDTH (microns)
Figure 25
As was seen previously, at the 9-month time mark, relatively little vertical sealant
loss is noted, and occurs only at the very top center of the material. Note that this
specimen, after application, was only about 63 microns thick. This means that the
material at the lateral portions is even thinner than with the other specimens. Thus,
this specimen tends to show slight traces of sealant loss at the periphery: only about
50 microns on each side. After 36 months of wear, there is about 200 micron loss of
peripheral sealant on the left side: a similar finding in other specimens noted above.

However, on the right side, a larger portion is lost. This loss can be explained by the
chipping away of a piece of sealant caused by placement of the metal protective
clamp that was used to cover the lateral enamel indentations, used as height and
width reference points. Thus, the loss seen on the right side of this specimen is
considered an artifact, and does not represent true wearing away of the material.
CONCLUSIONS
The major objective of this study was to evaluate the relative rates of surface wear
between the two test enamel sealant products. The results strongly indicated that
L.E.D. Pro Seal wore at a remarkably lower rate than did one of its competitors: Opal
Seal. For both sealants, the most wear occurred during the first three months of
simulated brushing, but even at that time point (and at every time point thereafter),
the rate of sealant loss of L.E.D. Pro Seal was remarkably lower than that of Opal
Seal. In fact, after the initial 3-month duration, Opal Seal continued to have an
increased wear rate with time (approximately 50 square microns a month), while the
wear rate of L.E.D. Pro Seal (measured at only 4.6 square microns per month) did
not significantly increase between 3 months and 36 months of simulated tooth brush
abrasion.
In an attempt to normalize wear findings among all products and specimens, just the
top-most 100 microns of sealant were evaluated for wear, between the time of initial
sealant placement, and after 9 or 36 months of simulated tooth brushing. In this
manner, the results could be associated with placing all materials in a 100-micron
thick later, and then, evaluating the wear. When doing this process, two big
differences were noted in the products. The extent of vertical wear of the Opal Seal
product after 9 months was very might greater than was that of the L.E.D. Pro Seal
product. In addition, this process allowed for an indication of potential loss of sealant
at the peripheral border of the protective resin film at the 9-month brushing time
period. Every specimen of Opal Seal demonstrated that a significant amount of
lateral enamel would have been exposed by sealant loss at the 9-month mark: up to
300 microns (0.3 mm) on each side of the placed film. However, when examining the

L.E.D. Pro Seal under similar conditions, little if any lateral wear was noted. This
finding indicates that, after 9 months of simulated brushing, L.E.D. Pro Seal is still
covering all lateral portions of covered enamel, while Opal Seal was being lost
laterally, and would have exposed the underlying enamel, as mush as 300 microns
(0.3 mm) peripherally.
After 36 months of simulated tooth brushing, the differences in wearing between the
two products became even more evident. On every specimen of Opal Seal, a
significant portion of what would have been the initially protected enamel layer, had
lost sealant coverage, leaving the underlying enamel unprotected, and susceptible to
tooth brush abrasion or decalcification. In contrast, note the extremely lower loss of
sealant in the 36-month brushed specimens of L.E.D. Pro Seal compared to those of
Opal Seal. In every case, enamel surfaces covered by L.E.D. Pro Seal would have
totally protected all underlying enamel, or at least 95% of it. In addition, abundant
sealant remained above the enamel after this time period to provide, yet even longer
protection past the last measured time point.
In short, it can be seen that L.E.D. Pro Seal lasted for 3 years of extensive tooth
brushing with a very abrasive paste, whereas most enamel surfaces covered by
Opal Seal would have lost protection after only 9 months of brushing. The data
indicated that L.E.D. Pro Seal would have provided even longer protection to
enamel, if the testing process been continued.

Toothbrush Abrasion Rates of Enamel Sealants

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Toothbrush Abrasion Rates of Enamel Sealants

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FINAL REPORT

TOOTHBRUSH ABRASION RATES OF ENAMEL SEALANTS

PRINCIPAL INVESTIGATOR INFORMATION / CONTACT PERSON

Georgia Regents University

Phone: (706) 721-3354

STUDY METHODS ......................................................................................................... 3

RESULTS AND DATA ANALYSIS ................................................................................ 16

LED Pro Seal Tooth Brush Abrasion Test page 2/31

This study had 1 major objective.

PRODUCT NAME MANUFACTURER ITEM NUMBER LOT NUMBER EXPIRATION DATE

LED Pro Seal Tooth Brush Abrasion Test page 3/31

Characterization of dental light-curing unit used

1,027 (±2) mW/cm2

LED Pro Seal Tooth Brush Abrasion Test page 4/31

Initial surface scanning

LED Pro Seal Tooth Brush Abrasion Test page 5/31

Shallow Dimple for

LED Pro Seal Tooth Brush Abrasion Test page 6/31

Application of enamel surface sealers

LED Pro Seal Tooth Brush Abrasion Test page 7/31

Scan of enamel surface following initial sealant application

ENAMEL SEALANT PLACED

LED Pro Seal Tooth Brush Abrasion Test page 8/31

ENAMEL FRESH SEALANT

LED Pro Seal Tooth Brush Abrasion Test page 9/31

A tooth brushing machine (V-8 Cross Brushing Apparatus, Sabri Enterprises,

LED Pro Seal Tooth Brush Abrasion Test page 10/31

Acrylic tube with 1:1 paste

Simulated intervals for measurement of tooth brushing wear

LED Pro Seal Tooth Brush Abrasion Test page 11/31

Assessment of periodic enamel sealant loss

STATION #1 OPAL SEAL ENAMEL

LED Pro Seal Tooth Brush Abrasion Test page 12/31

STATION #2 OPAL SEAL ENAMEL

300 for wear 3 MONTHS

LED Pro Seal Tooth Brush Abrasion Test page 13/31

Determination of enamel sealant loss within the defined area

Enamel sealant rate loss

LED Pro Seal Tooth Brush Abrasion Test page 14/31

Total number of specimens tested

LED Pro Seal Tooth Brush Abrasion Test page 15/31

RESULTS AND DATA ANALYSIS

The following table lists the findings of the statistical analysis.

PRODUCT 1 443190475.841 443190475.841 135.704 <0.001

STATION(PRODUCT) 6 19595122.024 3265853.671

MONTHS TBA 7 6286563.809 898080.544 4.873 <0.001

Residual 42 7740093.529 184287.941

Total 63 481644104.511 7645144.516

LED Pro Seal Tooth Brush Abrasion Test page 16/31

Rate of loss of resin with respect to time

4000 OPAL SEAL

3000 Linear (OPAL

LED Pro Seal Tooth Brush Abrasion Test page 17/31

L.E.D. Pro Seal

LED Pro Seal Tooth Brush Abrasion Test page 18/31

Overlay of wear rates

LED Pro Seal Tooth Brush Abrasion Test page 19/31

4000 OPAL SEAL

2000 Linear (OPAL

LED Pro Seal Tooth Brush Abrasion Test page 20/31

LED Pro Seal Tooth Brush Abrasion Test page 21/31

STATION #1 OPAL SEAL FRESH SEALANT

LED Pro Seal Tooth Brush Abrasion Test page 22/31

LED Pro Seal Tooth Brush Abrasion Test page 23/31