1. UltraSeal XT plus 4.5 2a. Clinpro Sealant 4.0 2b. Guardian Seal

© 2006 REALITY Publishing Co. Vol. 20 The Ratings 817

1. UltraSeal XT plus 4.5 Ultradent

2a. Clinpro Sealant 4.0 3M ESPE

2b. Guardian Seal 4.0 Kerr

2c. Teethmate F-1 4.0Kuraray

3a. Admira Seal 3.8 Voco

3b. Cosmeseal 3.8Cosmedent

3c. Embrace WetBond Pit & Fissure Sealant 3.8Pulpdent

4a. Delton FS+ 3.7 Dentsply Professional

4b. EcuSeal 3.7 DMG/Zenith

4c. Seal-Rite/Seal-Rite Low Viscosity 3.7Pulpdent

5. Delton Plus 3.5 Dentsply Professional

SEALANTS

SEALANTS

Seal-Rite/Seal-Rite Low Viscosity

Sealants UltraSeal XT

plusUltradent

Clinpro Sealant3M ESPE

Guardian SealKerr

Teethmate F-1Kuraray

Admira SealVoco

CosmesealClear

Cosmedent

CosmesealFilled

Cosmedent

Cost/mlKit $36.63 $18.43–$24.79 $25.65 $21.60 $14.98 $19.63 $23.89

Refi lls $10.41 $9.92–$15.75 N/A $23.20 N/A $21.68 $26.25

Filler % by Weight 58 6 30 N/A 54 N/A 36

Delivery

Syringes with Inspiral

Brush Tips,Unidose Syringes

Syringes, Squeeze Bottles

Syringes Squeezable Pen Syringes Syringes Syringes

Shades

4: Clear,Universal (A2),Opaque White,

A1

1: Pink to Yellow1:

White Opaque

2:Opaque and

Natural

1:Off-White Opaque

1: Clear1: Almost colorless

Flow1 0.5–1.0 2.0 1.0 0.0-2.0 2.0 1.0 3.5

Best cure time (sec) 20–40 20–40 10Natural: 10–20Opaque: 20–40

20–40 20–40 20–40

Sealants Embrace

WetBond Pit & Fissure Sealant

Pulpdent

Delton FS+Dentsply

Professional

EcuSealDMG/Zenith

Seal-RitePulpdent

Seal-Rite LVPulpdent

Delton PlusDentsply

Professional

Cost/mlKit $13.44 $35.69 $31.12 $9.48 $9.48 $37.39

Refi lls $10.33 $19.97 $21.59 $8.33 $8.33 $26.96

Filler % by Weight 36.6 55 33 34.4 8 38

Delivery Syringes Syringes Tips Syringes Syringes Tips

Shades2:

Natural and Off-White

1: Opaque1:

Off-White Opaque

2: Clearand

Off-White

2: Clearand

Off-White

1:Opaque

Flow1 4.0 2.5 2.5 0.0 3.5 1

Best cure time (sec) Natural: 10-20Off-White: 20-40

40 40 20-40 20-40 20-40

1 0.0 1.0 2.0 3.0 4.0 5.0

MOST FLOW LEAST FLOW

FLOW TESTSUltraSealXT plus

(OW)(0.5)

UltraSealXT plus

(A1)(0.5)

UltraSealXT plus

(A2)(0.5)

UltraSealXT plus(Clear)

(1.0)

ClinproSealant

(2.0)

Guardian Seal(1.0)

TeethmateF-1

Natural(0.0)

TeethmateF-1

Opaque(2.0)

AdmiraSeal(2.0)

CosmesealClear(1.0)

CosmesealFilled (3.5)

EmbraceWetBond

(4.0)

Delton FS+

Opaque(2.5)

EcuSeal(2.5)

Seal-Rite(Reg)(0.0)

Seal-RiteClear(Reg)(0.0)

Seal-Rite(LV)(3.5)

DeltonPlus(3.0)

5 5

4 4

3 3

2 2

1 1

0 0

While the application of pit and fi ssure sealants is into its fourth decade of use, there are some practitioners that consider it out-of-date and potentially dangerous to teeth. Th is latter claim is due to the discovery that secondary caries seems to be discovered with increasing frequency when “suspicious” areas under sealants are exposed through cavity preparation.

However, advocates of sealants maintain that, from a public health standpoint, they are still the best modality to noninvasively protect pits and fi ssures from carious attack. In addition, it is speculated that the reason many sealants seem to fail is due to their poorly controlled placement. Since sealants are usually applied by an auxiliary working alone, moisture control, essential to proper placement, has probably not been exemplary in many instances.

818 The Ratings © 2006 REALITY Publishing Co. Vol. 20

© 2006 REALITY Publishing Co. Vol. 20 The RatingsThe RatingsT 819

SEALANTS

4.5

1

UltraSeal XT plusUltradentwww.ultradent.com

PRICES

DOCTOR KIT

$43.99/1.2ml ($36.63/ml)

REFILLS

Syringes/4 (1.2ml ea) $49.99/4.8ml ($10.41/ml)

Unit Dose/50$99.99/10ml ($10.00/ml)

UltraSeal Action DVD or video$9.99

UltraSeal Comic Book$2.99/12 ($0.25 ea)

SHELF LIFE

2 years

RAVES & RANTS

+ Best viscosity+ Inspiral tips dispense and push sealant into pits and

fi ssures

– Do you really need the PrimaDry?– Tips clog occasionally

Composition Filled 58% by weight, releases fl uoride, radiopaque. PrimaDry (in kit) is 99% ethyl alcohol.

Consistency and Handling 0.5–1.0

0.5 1.0


Quite runny. Flows well into pits and fi ssures. However, due to application with the Inspiral tips, it doesn’t seem runny intraorally, since you can control the amount dispensed very precisely.

Best Curing Time (seconds)

Curing LightHARDNESS (KNOOP)

5 sec 10 sec 20 sec 40 secOptilux 501 16.1 20.1 22.1 23.7

LEDemetron II 16.2 19.5 25.2 28.1

Shades 4 Clear, Universal (A2), Opaque White, and A1.

Clear Universal (A2) Opaque White A1

Marketing“UltraSeal” cartoon action fi gure (looks like a purple Rambo with a seal head) is featured in a comic book showing how “Ultraseal” kills and seals out the bugs in your teeth. Th ere is also a DVD or video for the reception room and brochures.

Criteria for SelectionFlowFor a sealant to be eff ective, it must have adequate fl ow, but not be excessively liquid to restrict proper placement. Sealants are supposed to be placed in the pits and fi ssures—they are not intended to cover the entire occlusal surface. Conversely, if a sealant is too viscous, it will not fl ow adequately into the small recesses of the pits and fi ssures.

DispensingDirect placement with a syringe or other instrument is most effi cient, assuming you can control the volume of material being dispensed. If you dispense an excessive amount, you’ll waste time removing the excess. Th e design of the dispensing instrument can be quite unique and whether you will like it or not is a personal preference choice. However, some of these applicators are diffi cult to clean, which can aff ect their long-term use.

ShadeTh is is a matter of preference—some dentists want opaque sealants to

allow easy identifi cation during periodic examinations while others (dentists and patients) prefer “invisible” sealants.

Fluoride ReleaseAll things being equal, it certainly seems that fl uoride release adds another aspect of prevention to sealants. Th erefore, in general, we prefer sealants that release fl uoride, although the amount of fl uoride being released and its ability to reduce caries susceptibility is questionable.

Best Curing TimeWe tested the hardness of these materials aft er curing for various times with the following lights using the large tips needed to polymerize the entire occlusal surface at one time. From these hardness measurements, you can see the diff erences between the various curing times. Th ese times are listed in the commentary for each product.

Curing lights and tips • Optilux 501/13mm tip• LEDemetron II/11mm Turbo

SEALANTS


´´´´ (4.0)

2a Clinpro Sealant3M ESPE

PRICES

KITS

Bottle Intro Kit$221.10/12ml ($18.43/ml)

Syringe Intro Kit$59.50/2.4ml ($24.79/ml)

REFILLS:

Bottles$59.50/6ml ($9.92/ml)

Syringes $18.90/1.2ml ($15.75/ml)

SHELF LIFE

2 years

RAVES & RANTS

+ Pink to yellow color change+ Choice of dispensing systems

– Poor illustrations inside lid– Dispensing needs improvement

Composition BIS-GMA, TEGDMA, colorants, initiators, fl uoride-releasing. Filled 6% by weight with amorphous silica.

Consistency and Handling 2.0

2.0


Even though the syringe needle tip was fi ne gauge, it was somewhat diffi cult to control the fl ow, which led to dispensing too much sealant. When the needle tip was changed for another brand, control was better.

Best Curing Time (seconds)Syringe



LEDemetron II 11.3 14.9 15.8 16.4

Bottle



LEDemetron II 10.1 11.4 12.8 15.2

Shade 1 Pink but changes to opaque light yellow when cured. Defi nitely helped to ensure all pits and fi ssures were sealed. Th e color change upon curing was also appreciated.

Before Light Curing After Light Curing

MarketingNone.

´´´´ (4.0)

2b Guardian SealKerr

PRICE

KIT

$84.65/3.3ml ($25.65/ml) REFILLS

N/A

SHELF LIFE

2 years

RAVES & RANTS

+ Cartoon character on box+ Cures in 10s

– No clear version– Need practice to dispense correct amount

Composition Filled 30% by weight, 14.4% by volume, fl uoride-releasing.


1.0


Even though this material’s fl ow is somewhat less than others in this category, the fl ow-through applicator tips did not allow as much control as other delivery systems. On the other hand, if you master the “feel” of this system, the applicator tips works well with burnishing the material into the pits and fi ssures.




LEDemetron II 16.1 15.7 17.3 18.9

Shade1 White Opaque

White Opaque

MarketingNone.

SEALANTS


´´´´ (4.0)

2cNEW

Teethmate F-1Kuraraywww.kuraraydental.com

PRICES

KIT

$108.00/5ml ($21.60/ml)

REFILLS

$58.00/2.5ml ($23.20/ml)

SHELF LIFE

3 years

RAVES & RANTS

+ Contains MDP adhesion promoter+ 20s curing

– No metal tips—only plastic– 14 pages of directions for a sealant?

Composition TEGDMA, hydrophobic dimethacrylate, HEMA, MDP, Methacryloyl fl uoride-methyl methacrylate copolymer, dl-Camphorquinone.

Consistency and Handling Natural 0.0Opaque 2.0

0 2.0


Best Curing Time (seconds)Natural



LEDemetron II DNS 27.3 28.9 29.9

Opaque



LEDemetron II DNS 21.3 23.5 26.4

Shades 2 Natural (clear) and Opaque (light yellow).

Natural Opaque

MarketingNone.

SEALANTS


´´´´ (3.8)

3a Admira SealVocowww.voco.com/usa

PRICE

KIT

$29.95/2ml ($14.98/ml)

REFILLS

N/A

SHELF LIFE

2 years

RAVES & RANTS

+ Best fi ne needle tips+ Ormocer chemistry may be better biologically

– Labels peeled off syringes when box was opened– No choice of shades

Composition Filled 54% by weight, 42% by volume with 0.7µ fi ller particles and silicon dioxide, based on Ormocer technology.


2.0





LEDemetron II 18.2 23.5 26.4 28.6

Shade1 Off -white opaque

White Opaque

MarketingNone.

SEALANTS


´´´´ (3.8)

3bNEW

CosmesealCosmedentwww.cosmedent.com

PRICES

KITS

Clear$54.95/3g/2.8ml ($19.63/ml)

Filled$54.95/3g/2.3ml ($23.89/ml)

REFILLS

Clear$19.95/1g/0.92ml ($21.68/ml)

Filled$19.95/1g/0.76ml ($26.25/ml)

SHELF LIFE

4 years for Clear3 years for Filled

RAVES & RANTS

+ Two shades+ Microfi ll polishability

– Does a sealant need to be polishable?– Thicker viscosity requires more attention to application

Composition Filled is fi lled 36% by weight, 24% by volume with microfi ll fi ller. Clear is unfi lled.

Consistency and Handling Clear 1.0Filled 3.5

1.0 3.5


Best Curing Time (seconds)Clear



LEDemetron II 14.7 21.2 22.1 24.4

Filled



LEDemetron II 12.2 18.9 22.9 24.0

Shades 2 Clear and Filled (almost colorless).

Clear Filled

MarketingNone.

SEALANTS


´´´´ (3.8)

3cNEW

Embrace WetBond Pit & Fissure SealantPulpdentwww.pulpdent.com

PRICES

KIT

$64.50/4.8ml ($13.44/ml)

REFILLS

$32.50/3ml ($10.33/ml)

SHELF LIFE

2 years

RAVES & RANTS

+ Bonds under adverse conditions+ No Bisphenol A

– Achieving the optimal wetness is not easy– Too runny and sticky as a restorative material

Composition Filled 36.6% by weight. Contains di-, tri- and multi-functional acrylate monomers in what is being called Resin Acid-Integrating Network (R.A.I.N.), which is presumably very hydrophilic. Th e material is supposed to be activated in the presence of moisture and is recommended for use on surfaces that are slightly moist. Does not contain Bisphenol A.

Consistency and Handling Natural 4.0Off-White 4.0

4.0


Adequate fl ow for a sealant, but too runny and sticky as a restorative, for which it is also being recommended.

Best Curing Time (seconds)Natural



LEDemetron II 12.5 19.2 21.7 23.1

Off-White



LEDemetron II 15.0 18.9 23.4 25.4

Shades 2 Natural (A1-B1) and Off -White (off -white).

Natural Off-White

MarketingNone.

SEALANTS


´´´´ (3.7)

4a Delton FS+Dentsply Professional

PRICES

KIT

Complete Kit$85.65/2.4ml ($35.69/ml)

REFILL

$95.85/4.8ml ($19.97/ml)

SHELF LIFE

1.5 years

RAVES & RANTS

+ High fi ller load+ Not too runny, not too thick

– Low hardness– Only available in opaque

Composition Glass-fi lled 55% by weight, low viscosity monomers, triethyleneglycol dimetharcylate, BisGMA, barium aluminofl uoro-borosilicate glass, titanium dioxide, sodium fl uoride, polymerization initiator.


2.5





LEDemetron II 8.1 12.5 15.3 18.5

Shades 1 Opaque

Opaque

´´´´ (3.7)

4b EcuSealDMG/Zenithwww.zenithdental.com

PRICES

KIT

Intro Kit$159.70/5ml ($31.94/ml)

REFILLS

$110.60/5ml ($22.12/ml)

SHELF LIFE

3 years

RAVES & RANTS

+ Nifty dispenser+ Even etch is unidose

– Dispenser not as natural in hand as syringe– Keeping dispenser clean is a hassle

CompositionFilled 33% by weight with aluminofl uorosilicate glass, fl uoride-releasing.

Consistency and Handling2.5 Plenty of fl ow to get into pits and fi ssures. However, we found almost no voids.

2.5





LEDemetron II 16.6 19.4 24.0 29.2

Shade1 Off -white opaque. If you like a bright, white sealant that is easily distinguishable from tooth structure, this is not it. If you want the sealant to disappear, this is not it. If you want something in between, this is it.

MarketingNone.

White Opaque

MarketingNone.

SEALANTS


´´´´ (3.7)

4cENCORE

Seal-Rite/Seal-Rite Low ViscosityPulpdentwww.pulpdent.com

PRICES

KIT

$45.50/4.8ml ($9.48/ml)

REFILLS

$25.00/3ml ($8.33/ml)

SHELF LIFE

2 years

RAVES & RANTS

+ Choice of two viscosities and two shades+ Least expensive

– Syringe tips are too large for precise placement– Regular is runnier than LV

Composition Regular viscosity is fi lled 34.4% by weight. Low viscosity is fi lled 8% by weight. Contains Bis-GMA.

Consistency and Handling Regular 0.0Low viscosity 3.5

0 3.5


Best Curing Time (seconds)Regular



LEDemetron II 12.4 22.0 23.8 27.5

Low Viscosity



LEDemetron II 20.0 22.0 26.0 27.5

Shades 2 Clear and Off -White (ivory).

´´´´ (3.5)

5 Delton PlusDentsply Professional

PRICES

KIT

Introductory KitDirect Delivery System$149.55/4ml ($37.39/ml)

REFILLS

$107.85/4ml ($26.96/ml)

SHELF LIFE

2 years

RAVES & RANTS

+ Not too runny, not too thick+ Unidose

– Expensive– No clear option

Composition Glass-fi lled 38%, low viscosity monomers, triethyleneglycol dimetharcylate, BisGMA, barium aluminofl uoroborosilicate glass, titanium dioxide, sodium fl uoride, polymerization initiator.


0% 100%

TRANSLUCENT OPAQUE




LEDemetron II 8.3 13.3 18.4 19.1

Shade 1 Opaque

Opaque

MarketingNone.

Clear Off-WhiteMarketingNone.

REALITY


SEALANTS

UltraSeal XT plus

STRENGTHS Excellent delivery system, good viscosity, fl uoride-release, four shades. If you want to see the sealant after application, use the Opaque White. A1 and A2 are also somewhat visible, while Clear is totally invisible. Also available in unidose syringes to make the system even more complete. And it is the only product in this category with an effective marketing program oriented toward children and their parents.

WEAKNESSES None.

BOTTOM LINE Simply the best.

Clinpro Sealant STRENGTHS Offers unique color change technology, being pink when it is applied and then turning to an opaque light yellow (very visible on the tooth) after it is cured. This property gives you good visible feedback during application and after curing. The material also has good fl ow properties.

WEAKNESSES Supplied needle tips compromised the dispensing control, causing too much material to be placed. The directions, especially the illustrations inside the lid, need improvement.

BOTTOM LINE The “I’m sure it’s cured” sealant.

Guardian Seal STRENGTHS Fairly runny, fi lled material that includes unique, fl ow-through applicator tips, which are effective in burnishing the material into the pits and fi ssures once you get the hang of it. Will cure in 10 seconds, fastest in this category.

WEAKNESSES Although it is supposed to be opaque enough to see, it is not very visible after placement. From a marketing perspective, if we could only get a life-sized version of the cartoon character gracing the front of the box, we’d really have something.

BOTTOM LINE No-nonsense approach to sealants and ultra-fast too.

Teethmate F-1 STRENGTHS Squeezable, pen-like dispenser is unique and, with its smooth surface, easy to clean. Adhesion promoter MDP, which is a key ingredient in adhesives and cements, promises better adhesion. Two shades give option between translucent and opaque.

WEAKNESSES No metal tips—only plastic.

BOTTOM LINE Strong performer, but it needs better dispensing tips.

Admira Seal STRENGTHS Only product in this category that is based on Ormocer chemistry, which is supposed to be more biocompatible due to its advanced cross-linking and minimal release of residual monomers. The material itself fl ows well and the very fi ne needle tips, appreciated by all evaluators, allow more precise placement, minimizing the tendency to use it as an occlusal rather than pit and fi ssure sealant.

WEAKNESSES There is a tendency to the material to keep extruding after use—you need to retract the plunger slightly to counteract this effect. One evaluator also mentioned that it was too sensitive to the dental light.

BOTTOM LINE If you want a pretty good sealant and one that is potentially more biocompatible, this is it.

Cosmeseal STRENGTHS Two versions: clear and fi lled, with the latter being a microfi ll for polishability and wear resistance. All evaluators felt the handling and viscosity of clear was about right.

WEAKNESSES Who polishes sealants? Directions tell you to prep tooth with diamond, which effectively mandates dentist involvement as opposed to having it as a total hygiene procedure. One evaluator thought the fi lled version was too thick and sticky. All evaluators felt the version was too thick and sticky. All evaluators felt the fi lled version did not have any clinical advantages over fi lled version did not have any clinical advantages over the clear version.

BOTTOM LINE Protection and the esthetics of a microfi ll rolled into one product, but you may want to stick with the simple, unfi lled version.

REALITY


SEALANTS

Embrace WetBond Pit & Fissure Sealant

STRENGTHS Proprietary chemistry facilitates adhesion even to saliva-contaminated tooth surfaces, which is not uncommon when treating young children. Two shades give option between translucent and opaque. All evaluators stated its viscosity and handling as a sealant was about right and the opaque shade provided good contrast to tooth structure.

WEAKNESSES Long-term stability of bonding to wet and/or contaminated enamel still needs to be proven. Two evaluators felt it was too runny and/or too sticky to be used as a restorative. Most evaluators thought the natural shade did not blend into tooth structure as well as anticipated.

BOTTOM LINE A viable option when you treat kids and getting their teeth dry is an impossible task.

Delton FS+ STRENGTHS Medium fl ow and an opaque version that is clearly visible.

WEAKNESSES No translucent or clear option.

BOTTOM LINE The Delton name gives it instant credibility.

EcuSeal STRENGTHS Unit dose tips and nifty dispenser allow quick application in a reasonably precise manner. The single shade is reasonably opaque and is visible after placement.

WEAKNESSES Keeping the dispenser clean is a nuisance. No translucent or clear option.

BOTTOM LINE Convenient, well-designed sealant system.

Seal-Rite/Seal-Rite LV

STRENGTHS Two viscosities. Two shades give option between translucent and opaque. Least expensive.

WEAKNESSES Syringe tips are very large and do not allow precise dispensing, which means applying an excess amount that will need to be removed before curing a high probability. Low viscosity version was thicker than regular one.

BOTTOM LINE Viscosity and shade options combined with a bargain price.

Delton Plus STRENGTHS Medium fl ow, the DDS delivery system, and one opaque shade that defi nitely can be seen after application.

WEAKNESSES No translucent or clear option. Very expensive.

BOTTOM LINE The original unidose delivery system combined with its heritage continues to give this material wide appeal.

AegisBosworth

Baritone L3 C-Dent

Conseal fSDI

FissuritVoco

Fissurit FXVoco

Fluro-ShieldDentsply/Caulk

Helioseal ClearIvoclar Vivadent

Helioseal Clear ChromaIvoclar Vivadent

Helioseal FIvoclar Vivadent

Prisma-ShieldDentsply/Caulk

SealantBisco

OTHER PRODUCTS IN THIS CATEGORY

Documents

1. UltraSeal XT plus 4.5 2a. Clinpro Sealant 4.0 2b. Guardian Seal