Procedure Sealant Using Thermo-Cure
- Removing plaque from the fissures.
The best way to do this is using Sodium Hypo Chlorine diluted to approximately 1-1.5% for 5-10 seconds with a brush or sponge. Also Dentine conditioner (GC) or Tubilicid can be used. To avoid rejection, inform young patients that the cleaning solution may taste somewhat like swimming pool water. This product is very effective for removing the smear layer without removing minerals that are essential for the chemical bonding of GI. Avoid for the same reason acidic products like etchants. Also a salt blaster can do the job.
- Spray the surface and dry modestly. Do not desiccate!
- Separate using cotton rolls and/or lingual saliva suction. (see figure)
- Mix the capsule and fill up the fissures.
- Use your finger to press the material deep into the fissures.
Wet your finger with a petroleum gel (Vaseline), coconut butter or silicon oil slightly to prevent the GI sticks to your finger.
- Remove excess.
- Bite! To achieve desired occlusion.
This avoids adjusting the occlusion afterwards.
- Heat cure the GIC using a high output LED curing light (min1200mW!!) for 1 minute. Keep the curing light in stable position close to the material.
remarks: After curing is no need for additional protection of the GI surface. Procedure time: In total 1.5 minute! Use capsulated and no hand-mix products. With one capsule you can do 2 fissures in one session. Preferably use thick viscous cement. Fuji IX (Fast, Extra or EQUIA), GCP fill or Ketac fill have the right consistency. Also Fuji Triage (VII) and GCP seal are options, however these cements are more fluid and will be less resistant to solubility. Only use a strong mixing device and high-energy irradiation lamp. A minimum amount of energy is needed for initiating the accelerated process. An easy trick to check whether your LED device generates sufficient heat is to shine the lamp on your finger. Within 10 seconds the irradiated spot should be so hot that you have to withdraw the lamp quickly.
SEM picture of a GI sealant placed (first molar) 4 years ago. You can see clearly the fissures are mineralized and not visible anymore. The fissures are mineralized with natural Fluorapatite.
Posterior GI filling using Thermo-cure
1) Remove soft decay
Soft substance without structure while respecting the pulp using hand instruments if possible
2) Use metal (partial) pre-shaped matrices if needed.
3) Clean and disinfect the cavity
NaOCl (1-1.5%) using a brush. Alternatives: dentine conditioner 10%, Tubilicid.
4) Spray the cavity and dry modestly.
Do not desiccate!
5) Separate using cotton rolls and lingual saliva suction
6) Mix capsule (no hand-mix!) and fill cavity.
Keep the tip of the capsule into the material to avoid air bubbles!
7) Use finger or instrument to press the material into the cavity.
Slightly wet your finger or instrument with Vaseline or cocao butter to prevent stickiness!
8) Remove excess.
9) Thermo-cure the GI with a high output LED device for 1 – 1.5 minutes.
10) Adjust the surface and occlusion using fine diamonds with water spray.
Because of the excellent biocompatibility of GIC and its potential of remineralizing adjacent demineralized tooth structure, cavity preparation can be limited to removal of the structure less caries. Therefore, the depth of preparations towards the pulp can be less profound compared to the ones for amalgam or composite restorations. The soft, structure less carious substance can easily be removed with a hand excavator. Material that is hard enough to resist the instrument is still suited for remineralization. Unsupported enamel, without underlying dentine, has to be left alone as long as access to the decay process is still possible. Thanks to the good matching of the thermal expansion of CI and dentine, premature cracking through thermal cycling has not to be expected. This new way of cavity preparation will lead to less harm for the teeth and improved survival rate of the pulp. Application of above described techniques show clinical a reduction of app 50% in endodontic treatments when compared to amalgam restorations and even 75% compared to composite fillings. Possibly, this outcome is partly to be ascribed to better biocompatibility and partly to less invasive preparation. After Ca(OH)2, GI is reported to be the best product for the pulp protection so there is no need for liners or other protection for the pulp as long there is no serious pulp damage. Thermo curing is also the way to overcome the initial weakness of self-curing GI. The bulk GI restoration may be cured in one thick layer. Heat curing of GI is reported to be as deep as 8 mm. Obviously, the surface of the restoration is substantially harder than the deeper layers. Proximally, heat can only be delivered through conduction with metal matrices. To assure good contact areas, partial metal preformed matrices are necessary. Use a soft version which doesn’t bend back after preforming! (so called: dead soft) Extended restorations might be cured in separate steps. Firstly the mesial part for 1 min, keeping the LED lamp as close as possible to the surface in a fixed position and secondly the distal part (or reverse) for an additional 30-40 sec till noticeable hardness. The water content of the GI and the Endothermic reaction prevents the material becoming overheated, whereby the pulp remains out of danger.
Aesthetic cervical fillings, Class V
Abfraction caused by mall articulation
Clean with NaOCl 1,5%
Apply GIC (EQUIA FILL)
Modelling (OptraSculpt, ivoclar)
Result directly after placement
Result after 14 years –> GIC is mineralized into fluor apatite
Modified Sandwich Technique
Biomimetic Dentistry is a new way of dentistry, which takes advantages of the natural mineralization processes in the mouth without using harmfully products.
Decay is an unbalance of re- and demineralization leading to a loss of minerals like Calcium and Phosphates. Biomimetic Dentistry aims to reverse this unbalance by offering the lost minerals back to the tooth. Hand excavation (ART protocol) is preferred to keep as much as tissue which
can be re-mineralized. Glass Ionomers can be used to deliver the desired minerals. Glass Ionomers are with normal auto cure are too weak to survive all the forces in a loaded multi surface posterior filling. With the help of Thermo-cure the properties can be boosted to get a permanent restoration, which can compete with the strength of a sound tooth. Also minerals in a past or as a sealant can prevent ongoing decay. When the majority of the tooth is lost.