Pit
and fissure sealant use, though widely accepted as being cost effective
in preventing decay, as opposed to future treatment, still suffers
from lingering doubts about what is happening beneath a sealed restoration.
Without the ability to detect growing lesions beneath a sealant, many
clinicians are reluctant to seal a tooth surface. Sealed bacteria
with leakage can lead to extensive, often undetectable decay. Over
a period of years, these cases can lead to very large restorations
and can compromise the future of these teeth. Some practitioners currently
do not place sealants for these reasons. The ability to both see and
detect what is happening beneath a sealant is the critical need to
solving this dilemma. In this debate, it is more important to see
what is happening beneath the sealant than it is to actually see the
sealant itself. What is needed is a sealant that both seals a tooth
effectively and allows detection of decay, beneath the restoration,
should this occur.
This report presents AURAVue™, a Clear
Pit & Fissure Sealant and Sealer , that has been FDA approved
for use with caries diagnostic devices, such as DIAGNOdent. DIAGNOdent
is a diagnostic device that aids the dentist in making treatment
decisions with confidence. DIAGNOdent is a reliable adjunct for
the detection of sub-surface caries. It removes the guesswork
that accompanies many treatment decisions regarding questionable areas,
such as stained or discolored grooves. DIAGNOdent is sold by KaVo
Dental Corporation. The use of DIAGNOdent for caries detection is
shown in Figure 1.
The FDA approval of AURAVue™, for use with
caries diagnostic detecting devices was obtained after review of clinical
evidence indicating AURAVue™’s ability to allow detection of decay
beneath a restoration. AURAVue™ has also demonstrated, in non-carious
teeth, the ability to seal effectively, over a long period of time. This
combination of properties has led to its FDA acceptance as a sealant
for use with caries detecting diagnostic devices. As part of the approval
process, AURAVue™ demonstrated the ability of DIAGNOdent to detect
decay beneath a sealant.
Clinical Results
The following cases show the
use of AURAVue™ and DIAGNOdent together to solve this lingering
question. This results in improved efficiency in placement of sealants
and enhanced clinical diagnostic ability. AURAVue™ contains
no solvents, and is cured with all dental lights.
In Figure
2, tooth #19, was found to have decay. Prior to treatment, a DIAGNOdent
base-line value was 32, confirming the need for restorative treatment.
In this special case, the decay was temporarily sealed in and a
DIAGNOdent reading of 32-33 was obtained, immediately after sealing.
The sealant was then removed. After caries removal, and before placement
of AURAVue™, the DIAGNOdent reading was 2-3, indicating successful
removal of the decay.
In Figure 3, placement of AURAVue™ has
occurred. A post treatment value for AURAVue™ was 4-5. In
Figure 4, the restoration and tooth #19 is shown at 10 months of service. A
DIAGNOdent reading of 3-4 was recorded, proving absence of decay and
good sealing ability of AURAVue™.AURAVue™ provides the ability to
diagnostically evaluate the restoration, over time. The color stable
nature of AURAVue™, combined with its excellent sealing ability, has
produced these results that were reported in part, at the 2007 IADR
Meeting (1).
In an orthodontic case, tooth #5 was scheduled for
extraction, as shown in Figure 5. This tooth, at baseline, had a
DIAGNOdent reading of 42. This value indicates that restorative treatment
is necessary. Upon removal of the decay, a DIAGNOdent reading of 5
was recorded. The tooth was then sealed and evaluated at one month. At
the extraction appointment, a DIAGNOdent reading of 6 was recorded.
Upon extraction, Figure 6, the tooth was stained with methylene blue,
to observe any leakage of the sealant, which did not occur.
In another orthodontic example, tooth #21 was scheduled for
extraction. This tooth had decay intentionally sealed in. Upon extraction
at one month, the tooth was again stained with methylene blue, and
sectioned, Figure 7, and no leakage was observed. At the base of the
restoration, one can observe the bacteria and debris that was initially
detected with the DIAGNOdent and also detected, just prior to extraction.
In Europe, clinicians often seal in decay, based upon the assumption
that under anerobic conditions, some bacterial growth is eliminated,
if not significantly diminished. Use of the DIAGNOdent can be helpful
in watching subsequent lesion activity after sealing. In either treatment
regimen, the ability now, to observe, detect, and follow carious activity
beneath a restoration, using AURAVue™ and caries detecting devices,
has been established and accepted for clinical use in the United States.
