Current Modalities in

Restorative Dentistry
 Most
conservative
approach
 The long term
objective of treatment
should be helping the
child reach adulthood
with an intact
permanent dentition.
 Principles of Minimal
Intervention dentistry

 Control the disease through

reduction of cariogenic flora
 Remineralize early lesions
 Perform minimal intervention
surgical procedures as required
 Repair rather than replace
defective restorations
 Cavity design should be
predicated entirely on the extent
of the lesion and should not be
dictated by preconceived notion
of a geometric pattern.
PITS AND FISSURES
SEALANT
 Sealant types
Polymerization Resin system
• Chemical • Urethane acrylate
(Helioseal)
• Light
• Bis GMA (Concise,
Fillers Delton)
• Filled
(Prismashield) Color

• Unfilled • Clear
(Concise, Delton, • Opaque
Helioseal)
Factors that affect bonding
of sealant
• Topography of the etched enamel
• Etching time
• Etching agent
• Etchant concentration
• Clean enamel (dry, free of
salivary contamination)
Handelman etal. J Dent Res
75, 1996

Only little more than

10 - 15 % of children
had sealants
Deficient sealants are not
effective in caries prevention
arguing for continued follow up of
the originally sealed surfaces at
every recall visit. Maintenance of
sealants is vital for success over
the long term.
Romcke etal. J Canad Dent Assoc 56, 1990
Chestnutt etal. Br Dent J 177, 1994
Feigal Pediatr Dent 20(2), 1998
 Applying sealant
by probe or
brush gave same
results

Oliveira, Abs 2366

J Dent Res 2000
Etching time

15 seconds

Wang Am J Orthod Dentofacial

Orthop 100, 1991
Intermediate bonding layer

Hitt & Feigal

Pediatr dent 14, 1992
Quintess Int 25, 1994
 Intermediate bonding layer

• Better bond and less leakage

• Viscous sealant, especially the
filled, spreads better after
bonding agent placement and wets
the surface of the fissure
Symons, J Oral Rehabil 23, 1996
Davenport & Feigal, J Dent Res 76, 1997
For difficult areas to seal
where isolation is hard as not
fully erupted teeth and the
palatal fissures of upper molars
Feigal, 1993 suggested an
intermediate bond layer for
sealants while Frencken,
1994 suggested using GIC
 Sealant prognosis

• The more anterior the tooth

• The more skilled the operator
• The older the child
• The more fully erupted the tooth

.....The better the prognosis

 Occlusal
Hidden
Caries

Weerheijm etal,
J Dent Child,
1989, 1990,
1992
PREVENTIVE RESIN
RESTORATION
(PRR)
Simonsen 1978
Croll TP & Cavanaugh RR; 1997

• Sealant
• Bond + composite + sealant
• Primer + bond + composite
+ sealant
 Extension for
prevention

Seal for prevention

• ANESTHESIA.
• ISOLATION.
• CARIES REMOVAL.
• ETCHING, WASHING & DRYING.
• BOND.
• COMPOSITE.
• SEALANT.
 Most conservative.
 Caries removal.
 Future caries prevention.
 The longevity of PRR
is dependant to a
great extent upon the
retention of the
overlying sealant
Proper cavity
sealing is more
important than
using liners and
bases
1st GENERATION
2nd GENERATION
3rd GENERATION
5Th 4th
CLASS II

• TUNNEL
• ROUNDED SLOT: OCCLUSAL ,
BUCCAL OR LINGUAL APPROACH
• PROXIMAL SLICE
• OPEN STYLE