Dental Tribune Middle East & Africa Edition

12 Dental Tribune Middle East & Africa Edition | July - August 2013RESEARCH es again (0.03 ± 0.08). The three other species (Pg, Tf, Td) reached concent- rations at this time of 0.28 x, 0.26 x, 0.18 x 106 respectively. The microbio- logical situation three months after treatment showed the colonization for all four bacteria to be at a lower level than in the original findings. The bacteria P. gingivalis and T. for- sythensis were at an even lower level at this time than was analyzed du- ring measurement immediately after intervention. Only A. actinomyce- temcomitans showed a rudimentary recolonization at three months after total elimination when examined at the six week point, with an increase to 0.03 x 106. Porphyromonas gingivalis had reduced to 0.28 at three months which signifies a mean elimination of 84% compared to the original fin- dings. The bacterium T. forsythensis exhibited a reduction to 0.26 which corresponds to a mean elimination of 59% compared to the baseline fin- dings. Microbiological profiles Microbiological analysis of the pooled samples, based on data not detailed here, showed, when initially examined, that 37% of the samples presented with Aa, 83% Pg, 51% Pi, 91% Tf and 89% Td. The proportion of contaminated po- ckets decreased immediately after treatment and increased again after six weeks, and in the third month, but without returning to the original values. Pg exhibited the greatest pre- valence of all the species of bacteria at each point; the bacterium was detec- ted in 40% of pockets prior to treat- ment and in 20% of pockets immedi- ately after therapeutic intervention, in 33.33% after six weeks and in 6.6% in the third month after the AIR-N-GO PERIO treatment. Tf occurred in 60% of all pockets at the initial examination. Post-opera- tively, the species was only found in 30% (immediately after intervention), 60% (in the sixth week) and 36.67% of pockets after three months. Td was detectable in 63.33% of all pockets pre-operatively. Immediate- ly after therapeutic intervention, the prevalence of the species decreased (30%) and in the third month post- operatively increased again only slightly (36.6%) with an incidence of 60% after three months, Td al- most reaches the original values for the base line investigation again and therefore almost complete recolo- nization of the periodontal pockets examined. The similarly high percentages of po- ckets in which the species of the “red complex” (Pg, Tf, Td) were detected was striking. Pg, Tf and Td together colonized 77.27% of all pockets prior to treatment, the prevalence of the complex became lower immediately after intervention (33.0%) and rose again in the third month post-opera- tively (47.2%). At each point in the in- vestigation, most of the pockets pre- sented a combination of four bacteria (35.1% of pockets pre-operatively) and 20.8% and 28.8% of pockets im- mediately after intervention and after six weeks irrespective of the form of therapy used. The proportion of po- ckets with only one species of bacteria increased in the third month. Conclusion The effect on the obligatory patho- genic bacteria such as Actinobacillus actinomycetemcomitans, Porphyro- monas gingivalis und T. forsythensis, which are the most difficult to control in therapy, is very promising. Howe- ver, this is a reduction in the marker bacteria, not the required elimination of the obligatory pathogenic bacteria. The results allow one to conclude that a better long-term outcome can be achieved after classic periodontal therapy using the low-abrasion, so- nically-assisted air polishing system investigated (AIR-N-GO PERIO®). References available from the author. D ental sealants have been recognized as an effective approach of preventing pit and fissure caries in primary and permanent teeth in children. They are placed to prevent caries initiation and to arrest caries progression by providing a physical barrier that inhibits microorganisms and food particles from collecting in pits and fissures. It is generally accep- ted that the effectiveness of sealants for caries prevention depends on their long term retention1 . Which technique of cleaning the fissures prior to sealant application, contributes better to the sealant re- tention? It has been long known that remo- val of debris from the depth of the fissures is essential prior to etching in order to allow adequate bonding of the sealant. The classic technique for removing of the debris prior to sealing is prophylaxis with a non flu- oridated toothpaste, new techniques however have emerged, such as air polishing, air abrasion techniques. Air-polishing technique with sodium bicarbonate is a non-invasive removal of organic and other elements from pit and fissures, that increases the depth of the sealant resin penetra- tion and when combined with acid etching produce higher mean bond strength2 . Although it is recommen- ded, never became the standard for sealant application procedure due to equipment cost and complexity of the procedure. Air abrasion with aluminum oxide particles is another alternative for cleaning of the fissu- res, and also produces roughening of the enamel surface. However is not a substitute to acid etching and appears to be inferior to the acid-etch tech- nique for use in public health settings. When both techniques of air abrasi- on and air polishing are used, tensi- le bond strengths have been found greater than when enamel is only air-abraded and then acid-etched2 . Enameloplasty or reshaping of ena- mel, is indicated in deep and narrow fissures to improve sealant penetrati- on, to increase the fissure width and surface area available for etching and to enhance the accuracy of visual ex- amination. Studies have shown with this technique fewer voids and gaps being evident and less microleakage, however it’s disadvantages are higher polymerization shrinkage and un- necessary removal of intact enamel surface3 . Does the use of a bonding agent pri- or to sealant application influence its retention? Results from an vitro study4 , in ext- racted 3d molars, suggest the use of a bonding agent after etching and pri- or to sealant application since less mi- croleakage was found even in the case of contaminated with saliva enamel. However results from in vivo stu- dies5 , found no statistical significant difference in sealant retention for up to two years of follow up. The use of a bonding agent however before sealant application is suggested by the Ame- rican Academy of Pediatric Dentistry, especially in deep fissures and early carious lesions, since data from in vit- ro studies support that there is deeper penetrance of the sealant and less mi- croleakage after its use6 . What type of sealant material has the higher retention rate? Two types of sealant materials are the most commonly used, the resin based and the glass ionomer sealants. Resin- based sealants exhibit the highest re- tention rates and have better stability under occlusal forces due to their main component, Bis ¬GMA7 . How- ever teeth sealed with glass ionomers develop caries less frequently than those sealed with resin and this has been attributed to the fluoride release from the glass ionomer cement. Even more, if the glass ionomer sealant is lost, some of the material remains in the depth of the fissures providing ex- tra preventive effect8 . How successful are sealants over the years? What problems do you expect to occur? Data on 200 patients after 15 years with autopolymerized sealants on permanent first molars, showed com- plete retention in 60% of the teeth while 68% had partial retention. Ca- ries or restored surfaces were found in 31% of sealed teeth and 83% of the unsealed9 . Regarding the surfaces sealed, retention was lower in pits/ fissures of Carabelli’s cusps of maxil- lary molars2. Caries experience was low under partially retained sealants or missing sealants (4.5 %) and com- pletely retained (0.4%), as compared to the teeth that were never sealed, suggesting that the resin sealants pro- vide some anticaries prevention even when completely or partially lost. Retention rates for the second molars were comparable to the first ones10 . Sealants can be repaired3 Figure 1 a,b, by removing the superficial plaque contaminated layer, acid etching, re- placing the sealant material and light curing. Does placing sealants over early ca- rious lesions, influence their reten- tion rate? Placement of pit and fissure sealants significantly reduces the percentage of non cavitated carious lesions that progress in children, adolescents, young adults for as long as five years after sealant placement, compared with unsealed teeth11 . Results of a sys- tematic review on the effect of dental sealants on bacteria levels in caries lesions, found that that sealants redu- ced bacteria in carious lesions but that in some studies, low levels of bacteria persist12 . However, caution should be used when applying sealant over de- calcified enamel since the enamel on surfaces with early caries may change in structure and content (Ca, P and C) due to organic residues remnants of cycles of re and demineralizati- on that may inhibit the penetrance of the sealant material at the deeper levels of enamel. In vitro results on extracted 3d molars showed that in decayed surfaces the sealant penet- rance was statistically significant less than in the healthy surfaces13 . Fur- thermore microleakage was found to be higher in teeth with initial caries14 , all suggesting that the retention may be negatively influenced. Is there any risk of toxicity using pit and fissure sealant materials? There has been a growing concern recently regarding the BPA - Bisphe- nol A. used in the synthesis of matrix monomers such as dimethacrylate monomers for denta composites and fissure sealants. Due to inadequate curing, some residual monomers can leach out of the cured resin to the patient’s saliva, as a result of the action of salivary enzymes on bisphenol-dimethacrylate. BPA has the potential to bind to the estrogen receptor, activate estrogen-response elements and stimulate the growth of an estrogen sensitive cell line, thus has potential estrogenicity. According to the ADA however15 , “No cause for concern about potential exposure to BPA from composites or sealants at this time” ADA,2007. ADA has issued recommendations in order to reduce potential toxicity from sealants from unpolymerized BPA. Treat the surface layer of the sealant remaining on the tooth using a mild abrasive pumice on cotton applicator or prophy cup, gargle with tepid water for 30 sec, wash the surface of the sealants for 30 sec with an air water and syringe and suction. Examples of BPA Fissure Sealants free products are: Embrace, Ultraseal F, Helioseal F type II, Seal- rite type II, Conseal F, Ultraseal F. Figure 1 a,b: Partially retained re- paired, by removing the superficial plaque contaminated layer, acid et- ching, replacing the sealant material and light curing. References 1. Ahovuo-Saloranta A: Pit and fis- sure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev 2004(3):CD001830 2. Simonsen R : Pit and fissure sealant: review of the literature. Pediatr Dent. 2002; 24:393-414 3. Kavvadia K, Eliades G: Recent ad- vances on the application of pit and fissur sealants. Odontostomatol Proo- dos 1997; 51(3):148-161 4. Asselin M, Fortin D, Sitbon Y, Romρ P: Marginal Microleakage of a Sealant Applied to Ρermanent Εnamel: Evaluation of Αpplication Protocols Pediatr Dent 2008; 30:29-33 5. Mascharenhas A, Nazar H, Al- Mutawaa S, Soparkar P: Effectiveness of primer and bond sealant retention and caries prevention. Pediatric Den- tistry 2008; 30(1):25-28 6. AAPD. Guideline on Restorative Dentistry, Reference Manual 2013; 34(06): 214-221 7. Mejare I, Mjør I: Glass-ionomer and resin-based fissure sealants: a clinical study. Scan J Dent Res. 1990; 98:345-50 8. Yengopal V, Mickenautsch S, Be- zerra AC, Leal S: Caries-preventive effect of glass ionomer and resin- based fissure sealants on permanent teeth: a meta analysis. J Oral Sci. 2009; 51(3):373-82 9. Simonsen R: Retention and ef- fectiveness of dental sealant after 15 years. J Am Dent Assoc. 1991; 122(10):34-42 10. Wendt L, Koch G, Birkhed D: On the retention and effectiveness of fissure sealant in permanent mo- lars after 15-20 years: a cohort Stu- dy. Comment Oral Epidemiol. 2001; 29(4):302-7 11. Beauchamp J Caufield P, Crall J, Donly K, Feigal R, Gooch B, Ismail A, Kohn W, Siegal M, Simonsen R. Evidence-based clinical recommen- dations for the use of pit-and-fissure sealants. JADA, 2008; 139:257-268 12. Oong E, Griffin S, , Kohn W Gooch B, Page W, Caufield: The ef- fectiveness of sealants in managing carious lesions JADA 2008; 139(3) 271 - 278 13. Hevinga M, Opdam N, Frencken J, Bronkhorst E, Truin G. Micro- leakage and sealant penetration in contaminated carious fissures. J Dent 2007; 90: 9 – 914 14. Michalaki M, Oulis C, Lagouvar- dos P. Microleakage of three different sealants on sound and questiona- ble occlusal surfaces of permanent molars: an in vitro study. European Archives of Paediatric Dent 2010; 11(1):26-31 15. ADA Positions and Statements: Bisphenol A and dental sealants, composite dental fillings 2007. www. ada.org/prof/resources/positions/ statements/bisphenola.asp Current Concepts On Improving Sealants Retention By Katerina Kavvadia DDS, MS, PhD Associate Professor and Director of Pediatric Dentistry Postgraduate Education in European University College Dubai - UAE ________________________ Fig. 3 AIR-N-GO SUPRA air polisher for connection to the air turbine. Fig. 4 Subgingival sampling was carried out using sterile paper points according to Slots (1986). Univ.-Prof. Dr. Wolf-Dieter Grimm Emeritus DGP™ specialist for periodontology, Department of Dentistry Faculty of Health University of Witten/Herdecke Contact Information Practice team Hasslinghausen Univ.-Prof. Dr. Wolf-D. Grimm Mittelstr. 70, 45549 Sprockhövel Tel.: 02339 911160 E-Mail: wolfg@uni-wh.de www.ph-zahnaerzte.de Contact Information Fig. 1 a, b Partially retained repaired, by removing the superficial plaque contaminated layer, acid etching, replacing the sealant material and light curing. EUROPEAN UNIVERSITY COLLEGE Katerina Kavvadia DDS, MS, PhD Tel.: 00 971 4 362 4790 E-Mail: info@dubaipostgraduate.com www.euc.ac.ae Contact Information

Dental Tribune Middle East & Africa Edition

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