Tooth sealing

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Fissure sealing of a molar

A tooth seal is a coating of the teeth with a thin layer of plastic or, more rarely, of glass ionomer cement to protect them from caries . As a rule, the tooth fissures are sealed - the notches on the chewing surface - which is why one speaks predominantly of fissure sealing . In contrast to filling therapy , it is used preventively before a carious defect has occurred in a tooth. With the extended fissure sealing , particularly narrow or ampoule-shaped fissures are widened beforehand.

application

It is most commonly used in children and adolescents to protect fissures and pits. Likewise, plaque-retentive buccal and palatal fissures including pits at the transition to the tubercula Carabelli and foramina caeca on the upper incisors are found . Earlier concerns that undiagnosed initial caries could progress under the seal have clearly been refuted. Due to the lack of substrate replenishment, the caries cannot develop any further, the bacteria die if the seal is intact. Residual risks can be largely eliminated through regular follow-up checks. The dental associations advocate a general use of tooth sealing for prevention. Even in the early stages of caries, in which the enamel-dentin border has not yet been penetrated by caries, the sealing can be used without major removal of tooth substance. If the carious process has already progressed into the dentin, minimally invasive filling therapy may be indicated instead of conventional filling therapy.

history

Buonocore first described the basic principle of tooth sealing in 1955. Controlled clinical trials were conducted in the mid-1960s, and in 1976 they were recognized as safe and effective by the American Dental Association (ADA). In Germany, seals were not recommended without reservations in the 1960s and 1970s, as long-term experience was not considered sufficient at the time.

operation area

The German Federal Dental Association (BZÄK) and the German Society of Oral and Maxillofacial Surgery (DGZMK) recommend according to an S3 guideline, not infested pits and fissures in the chewing surface to seal the back teeth in children and adolescents with high caries risk.

The principle of caries protection

A preventive seal is supposed to protect against food residues from getting stuck in the indentations of the tooth, where they are badly removed with a toothbrush and supply carious bacteria on the tooth surface with nutrients for acid production.

Sealing of slightly caries-infected wells is supposed to shield the bacteria underneath from further food intake. This severely limits their caries activity and survivability. In order to ensure that there is no - hardly recognizable - further expansion of the caries, a complete seal must therefore be ensured. This must be checked regularly. If this is no longer the case, the seal must be repaired.

execution

Rubber dam applied to dry out the tooth

Preventive fissure sealing

The implementation of the fissure sealing is completely painless. First, the tooth surface is cleaned of tartar and plaque . The teeth are then dried so that no saliva can come into contact with the tooth surfaces to be sealed. This is done using cotton rolls or a rubber cloth ( rubber dam ). Then the area of ​​the tooth enamel to be sealed is etched with a 37% phosphoric acid, which is applied in gel form. This roughened the surface so that the seal in the microscopic enamel depressions can hold retentively on the tooth surface. After rinsing off the acid, the tooth is dried with the air blower. The sealing material is then applied thinly to the predilection sites and either cured with special light or a self-curing sealing material is used, which consists of two components that are mixed beforehand.

Extended fissure sealing

With the extended fissure sealing, narrowly tapering or ampoule-shaped fissures are opened with the smallest diamond burs or hard metal drills (spherical or flame-shaped) before the fissure sealing is carried out as described above. If the enamel-dentine boundary has been overcome by caries, fissure sealing is no longer carried out, but a filling is carried out according to the specifications of minimally invasive therapy.

Follow-up care and integration into other measures

The seal must be checked regularly for intactness as part of individual prophylaxis. If it is damaged, it must be repaired or replaced. A tooth seal can in no way replace general prophylactic measures such as fluoridation, a healthy diet and oral hygiene at home, since the seal only protects the fissures, but not the rest of the tooth surface.

A study found a caries reduction of 95% over 10 years, in the event that 2-4% of the seals are repaired every year.

Risks

In a Kiel study, many cases were reported in which the incidence of caries increased after sealing. It was considered likely that careless handling overcompensated for the positive effect of sealing by weighing in a false sense of security .

Materials used

The materials used are primarily light-curing composites , but also self-curing composites or glass ionomer cements. Composites have been found to be the most durable. The cements have a shorter shelf life, but have a similarly high effectiveness against caries in the medium term, which is explained by their release of fluoride. Etching and an absolutely dry environment can be dispensed with during processing, which is why these dental cements can be more economical to use on young children, milk teeth and permanent teeth that are still breaking through the gums.

Distribution in Germany

Various studies since 2000 show that 35–80% of 12-year-olds in Germany have fissure seals.

costs

The dentist can charge a fissure sealing of the permanent molars in 6 to 17-year-olds in Germany as a contract dental service ( IP 5 ). A caries-free fissure is a prerequisite. Seals on the milk teeth , premolars or on the predilection sites described above are charged privately in accordance with Section 2000 of the Schedule of Fees for Dentists .

Web links

  • Fissure sealing. (PDF; 120 kB) - Patient information from the German Dental Association and the German Society for Dentistry, Oral and Maxillofacial Medicine (February 2011)
  • S3 guideline "Fissure and dimple sealing" , AWMF register number: 083-002, status: January 2017. Valid until January 2022. Accessed on April 28, 2017.

Individual evidence

  1. ↑ J. Beauchamp, PW Caufield, JJ Crall, K. Donly, R. Feigal, B. Gooch, A. Ismail, W. Kohn, M. Siegal, R. Simonsen; American Dental Association Council on Scientific Affairs: Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs. In: J Am Dent Assoc. 139 (3), Mar 2008, pp. 257-268. PMID 18310730 . (Review)
  2. ↑ A. Ahovuo-Saloranta, H. Forss, T. Walsh, A. Hiiri, A. Nordblad, M. Mäkelä, HV Worthington: Sealants for preventing dental decay in the permanent teeth. In: Cochrane Database of Systematic Reviews. Issue 3, 2013, Art. CD001830. doi: 10.1002 / 14651858.CD001830.pub4 (Review)
  3. ↑ MG Buonocore: A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. In: Journal of Dental Research. 34 (6), 1955, pp. 849-853.
  4. ↑ a b DR Gore: The use of dental sealants in adults: a long-neglected preventive measure. In: Int J Dent Hygiene. 8, 2010, pp. 198-203. doi: 10.1111 / j.1601-5037.2009.00425.x
  5. ↑ About the DGZMK statements ( memento of the original from November 8, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Information from the Department of Dentistry - University of Munich  @1@ 2Template: Webachiv / IABot / www.dent.med.uni-muenchen.de
  6. ↑ a b c d ZZQ Guideline Guideline Fissure Sealing Nov 2010 (PDF; 1.4 MB) Dental Central Office for Quality Assurance sponsored by the German Medical Association ISBN 978-3-00-031772-9 .
  7. ↑ S3- guideline guideline fissure and dimple sealing of the German Society for Dentistry, Oral and Maxillofacial Medicine. In: AWMF online (as of 2010)
  8. ↑ a b Ella M. Oong, Susan O. Griffin, William G. Kohn, Barbara F. Gooch, Page W. Caufield: The effect of dental sealants on bacteria levels in caries lesions - A review of the evidence. ( Memento of November 14, 2013 in the web archive archive.today ) In: Journal of the American Dental Association . vol. 139, no. 3, March 2008, pp. 271-278.
  9. ↑ Fissure sealing. University of Göttingen
  10. ^ DR Gore: The use of dental sealants in adults: a long-neglected preventive measure. In: Int J Dent Hygiene. 8, 2010, pp. 198-203. doi: 10.1111 / j.1601-5037.2009.00425.x : Romcke and others proved occlusal caries could be reduced by 95% over 10 years if 2–4% of the sealants were routinely repaired each year (53).
  11. ↑ Tooth sealing makes sense? Study by Kiel University shows increased caries. Press release 59/2004 of June 17, 2004 from the University of Kiel