Dr Melanie Elger describes the modern method for fissure sealing and minimally invasive restorations using Constic, DMG’s new self-adhesive flowable composite
It is important, in one’s own practice, to have and establish routine protocols, not only for quality management, which is becoming ever more important, but also with regard to treatment processes designed as economically as possible.
In the paediatric department of our practice, this plays a large role in terms of rapid treatment. Only proven and safe treatment processes allow the focus to be on behavioural guidance of children for atraumatic treatment.
Since the opening of our practice in 2004, we have consistently used new materials which have improved our processes. Even in the case of restorative materials or adhesives, which many a colleague will understand, there are initially some concerns such as modified handling and material properties. This is even more the case if the prior system worked well. So why should I change my system?
There can be many reasons for this, for example, the material used is no longer produced or a new material promises advantages which improve the economics, either with regard to shortened treatment times or purchasing costs.
When we learned that Ionosit-Seal would no longer be manufactured by DMG, we were forced to look around for a new fissure sealer. I appreciated Ionosit-Seal particularly because of its unique applicator and its opaque-white shade, which in my opinion allowed better control of sealant loss than tooth-coloured or even transparent materials.
In our practice, we use enamel bonding during fissure sealing in addition to the sealing material, this increases the life-span of the sealing. Studies prove better bonding when an additional enamel bond is used. However, the disadvantages of this method are that it requires an increased amount of materials and time.
The new free-flowing composite Constic, from DMG, has the advantage of reducing the number of working steps.
I would like to demonstrate the simple application of the new self-etching and self-adhesive material on the following patient study.
The patient has very deep fissures on all his first molars (Fig ı). Due to his lack of ability with regard to oral hygiene, we recommended sealing to the parents.
We first placed a rubber dam using the slot technique. We use this procedure as a general rule in every restorative treatment and often in the case of fissure sealing, in order to prevent interruption of the work and contamination with saliva. Children tolerate the rubber dam very well if it is meaningfully integrated into behavioural guidance.
After placing the rubber dam, we cleaned the teeth using a fluoride-free paste (Fig 2). Then they were inspected once more, both visually and using a probe.
For fissure sealing, the manufacturer recommends additional enamel etching since the enamel is intact in this case, in contrast to the enamel of a cavity that has undergone minimally invasive preparation. This agrees with the scientific view of the DGZMK regarding fissure sealing. The DGZMK recommends additional etching in the case of self-etching materials. For small, minimally invasive Class I fillings, on the other hand, additional etching can be omitted.
Etching using conventional 37 per cent phosphoric acid was performed on the permanent teeth for 60 seconds, according to the DGZMK recommendation (Fig 3). The teeth were then carefully rinsed and dried. Then Constic was applied using a Luer-Lock-Tip (Fig 4) and massaged in with a brush for 25 seconds (Fig 5).
Initially, massaging in the new flowable using a brush feels somewhat strange. However, since the viscosity is properly adjusted, one need not worry about any formation of air-bubbles while massaging the material in. One advantage of this method is that no additional instruments are needed for its application.
After the material was applied, it was cured with a conventional polymerization light (Fig 6).
Then we checked the occlusion, removed any excess and polished the teeth using a composite polishing brush (Figs 7 and 8).
The opacity of the shade opaque-white is not yet sufficient, but it is currently being revised by the manufacturer.
Our experience is that, particularly in the case of minimally invasive restorations in deciduous teeth, the time-saving advantage is of particular importance. The material can be applied without additional etching and without an additional adhesive system.
Conventional etching on deciduous teeth takes about twice as long as on permanent teeth, depending on the application to some extent. These time-savings even double in the case of paediatric treatment. Here, Constic is a real jackpot!
ABOUT THE AUTHOR
Dr Melanie Elger qualified in dentistry in Hamburg. She specialises in paediatric dentistry, and is a member of the German Society of Paediatric Dentistry and the German Society of Dental, Oral and Maxillofacial Surgery.
Images courtesy of Dr Amin Farah.