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Hi folks: Here is a simple thing to think about. I am finding that it is very rare that I look at a tooth under the scope where I feel that the standard fissure sealant is indicated.
I am writing an article for the ORal health magazine which will be out in the spring on microdentistry and the two most important things for me have been in the introduction of high magnfications to see subtle changes in color of enamel and fissure decalcifications present at magnfications of 10X and above. The second useful tool is the diagnodent which allows me to decide if the decay I spot at high magnfication is progressing into dentin.
I find many times that if I look at high mag that part of the groove is decalcifying and then I dont feel comfortable just covering over it with a sealant. I have been using the laser ( a 400 micron tip) to gently etch the enamel surface at 30 hz adn 100 mj or so (3watts) and then filling with a flowable resin.
This is my glorified resin. Now many years ago I would just fill the small spot that was decaying (in this case the distal pit was 25 on the diagnodent and the buccal was 27), and then leave the rest or FS them. Guess what, when I remove the FS now in alot of cases they arent sealing anything……just the decay is in there and when it gets big enough the FS falls out and you have a stained groove.
At least with the flowables they show you when they are leaking on the external surface.
I dont know if this is right or wrong but just doing fissure sealants on erupted teeth is not something I do routinely now.
How are you handling the following:
1. Fissure sealants
2. Preventative Resin restorations where there is a little bit of decay in one pit.
3. Decay around Fissure sealants.Here is my case……..hoping to stimulate some discussion.
Glenn
Here are the pics from the other case I wanted to show.
Glenn
Here is a tooth that I am going to prepare soon , which shows the same tooth at the 6 steps of magnification under the scope and how the decay becomes more noticeable with high mag.
The patient has decay on the lingual grooves (both of them) and in addition on the diagnodent it was 27 . THe magnification helps me find the spots and then the diagnodent confirms what visually I notice.
(trying to build my case here!!)
Glenn
Am I making anyone else uneasy besides myself from all those darn fissure sealants they told me in dental school to plug in if there was stain and no cavitation?
Another one for the books.
Glenn
Just to show you that I dont do them all with my laser.
Here is a fissureotomy bur which opened up a non cavitated but visibly discolored lesion which was large (forget the number) on the diagnodent.
Glenn
Ok ok I have made a point…….one last one .
Glenn
