Interesting … how well does the Diagnodent “see through” the FS? Both my kids have FS and it is good to know that older FS gives a false sense of security. My son just got more of during his recent appointment.

Based on what I’ve seen clinically over the last fifteen years I strongly concur with the fissure sealant findings of Dr. van As. Since obtaining an erbium laser in 2001 we open the fissures creating mechanical retention and providing some depth for thickness of the restorative material. We restore these with posterior composite. If it were my child, this is the type of “sealant” that I would want the dentist to place.

Some thoughts:

1) From an ethical standpoint, what should we charge for this “preventive resin” procedure? It’s not a “sealant” which could be delegated to auxillaries and I would charge about &#3638 US. This procedure can only be performed by the dentist, yet it probably won’t take me as long to do this when compared to a full posterior occlusal composite for which I would charge about &#36170.

2) I estimate the depth of these “preventive resins” to be about 1mm. This may be less than ideal for long term fracture resistance as the restorative material encounters occlusal forces. How long should we expect these restorations to be functional? I have three year studies where they appear to be holding up well.

Al

I routinely see secondary decay around FS also. Many of them I’ve placed. I am not ready yet to give up on them, though. I conceed that most of my failures have been from improper diagnosis or inadequate isolation. I have begun using the Isolite during sealants. First, I check the pits and fissures with the diagnodent (if not done at the exam visit or significant time since last exam). I then run the grooves with the DELight, then place BA and seal. Time will tell if this proves to be successful. I think I should increase my sealant fee from &#3635.00 if I’m going to be doing them – not delegating them.