The type of sealant material you're using each day may be a bigger decision than you think. Here's some information on the types of sealants and basic characteristics:
Glass Ionomer Sealants
For patients with heavy salivary flow, or in areas that are difficult to keep dry, a glass ionomer may be your sealant material of choice. Glass ionomers can be placed when it's difficult to keep the area dry. They chemically bond to the enamel and self-set, although light curing will help some glass ionomers set more quickly. Glass ionomers release fluoride, and recharge with fluoride from topical fluorides like toothpastes and rinses.
The main difference in handling resin-based sealants compared to glass ionomers is that the tooth surface needs to be completely dry during placement for resin-based sealants to bond to the enamel. In a 2012 clinical evaluation published in the Journal of the American Dental Association, the ability of resin-based and glass ionomer sealants to adhere was similar.
Unfilled vs. Filled Resin-based Sealants
Resin-based sealants can be light-curing or self-curing. An unfilled resin-based sealant is less resistant to wear and allows the material to wear down on its own, so no adjustment is needed after placement. If you work with a high volume of patients, which is also the case when placing sealants for students in a school, not having to adjust the occlusion can save you a ton of time in the long run. With filled sealants, small particles of glass or quartz are added that make them more resistant to wear. The material is also more viscous, which some people prefer. However, you'll need to check the occlusion and make adjustments after placing a sealant with fillers. Keep in mind that color-tinted sealants don't necessarily contain fillers; they simply make the visualization of the sealant material easier at the time of placement.
Giomer contains resin and surface reaction-type pre-reacted glass-ionomer particles (S-PRG). Like glass ionomers, giomer releases fluoride and recharges with fluoride from topical fluorides. Giomer sealants are light-cured.
Self-cured vs. Light-cured
A self-curing sealant eliminates the need for a curing light and protective eyewear. It's great if you're sharing equipment or aren't ready to purchase your own. However, it has to be mixed at the time of placement, which limits the amount of working time you have to prep and place the light before the material starts to set. With a light-cured product, the sealant won't harden until it's exposed to the curing light. No mixing is necessary, which makes it easier to apply from the get-go. This gives you additional time for placement, but it also means you need to have the right equipment on hand.
Stop the Guessing Game
You may want to keep two or three different types of sealants in your operatory. That way you can select the one most appropriate for a particular patient without trekking across the office. This keeps you from having to use a single product on everyone, and crossing your fingers that it will stay put. Do you have a light? Is the patient's salivary flow heavy? Is there a higher risk of decay for this individual? These are all important questions to ask yourself the next time you are planning to place sealants.
- Understand what category of sealant material to choose for the level of isolation. Glass ionomers can be placed in a damp environment, whereas resin can't.
- Choose filled or unfilled sealants if selecting a resin-based one. Filled material is more viscous, which some people prefer. Unfilled sealants don't require any adjustment, but they aren't as wear resistant.
- Select polymerization based on preferences. Light-cured sealants give you more working time, but self-curing sealants omit the need for this light.
- Decide whether you want a fluoride-releasing sealant.
Why It's Valuable
Knowing which sealant material works best in a particular situation helps you tailor your care to best protect your patient's dental health, and you may reduce the need for replacement sealants.