Out of the blue

Dec. 1, 2005
Many acid etchants are delivered using a standard disposable tip, and some young patients think the metal tip of the syringe is a needle.

Many acid etchants are delivered using a standard disposable tip, and some young patients think the metal tip of the syringe is a needle.

Traditional sealants require many steps for successful placement. The surface must be prepared and the material smartly placed and cured. One of the steps involving phosphoric acid may leave a rather bitter taste. Even with isolation techniques, which keep the field dry, the phosphoric acid needs to be rinsed from the surface. What if there was an updated solution to condition the surface and eliminate the “bitter blue?”

Pediatric patients are the primary targets for preventive sealants. These patients sometimes present with oral management challenges. Once a patient experiences the aftertaste of the bitter gel, chances are the clinician will receive a scowl. Even with a quickened rinse cycle, the tart taste may lead to a full-fledged gag response. A surface may need to be prepared again if it is contaminated with saliva, or else adhesion of the sealant may become compromised.

Many acid etchants are delivered using a standard disposable tip, and some young patients think the metal tip of the syringe is a needle. It is important to reassure patients that a needle is not being used. We don’t want them to become scared, and we don’t want to lose their confidence.

3M ESPE has found a solution to the syringe of acid etch called Adper Prompt L-pop. Children are not apprehensive when they see a tiny plastic brush instead of a filled phosphoric syringe.

Adper Prompt Self-Etch adhesive comes in two modes of delivery. The Adper L-Pop comes in a convenient unit dose that works well chairside. Because it is a single-dose disposable (mix and use), infection control is easily maintained. For clinicians who prefer to use a mixing well using drops in a one-to-one ratio, Adper also is available in vials. For single use, the solution is supplied in a small blister-type mixing system with a fiber brush applicator.

The L-Pop is easily activated. First, the large blister on the end is activated by pushing the conditioner up to a medium sized blister, which is popped and activated. The solution then travels up into a small third blister where the product is mixed by using the supplied plastic applicator. The product is now ready for surface application. The material will have a yellow tinge when the pop is properly activated.

The clinician will observe a distinct change when the surface has been prepared with the L-Pop. With the use of 35 percent phosphoric acid preparations, the surface will turn a dry, frosty white when air-dried. With the Adper application the surface enamel will have a gloss.

The fiber brush should be placed on the surface with the activated Adper and scrubbed into the pits and fissures for 15 seconds. The product will appear wet and glossy during the scrub.

Next, the tooth surface will be gently dried with an air water syringe tip to a thin film. A properly air dried surface will not look wet but will have a slight gloss. The air step is important because the product uses water as a solvent for proper mixing and air-drying evaporates the solvent. Studies have shown the L-Pop works as effectively as standard phosphoric acid at 35 percent for preparing the intended surface prior to placement of a sealant.

A benefit to an Adper Prompt over traditional acid etches is that the Prompt not only provides an etched surface, but goes further to prime and bond the surface, all with the single step application. However, one modification must be addressed. When using air polishing (sodium bicarbonate sprayed slurry) prior to sealant placement, consider the nature of the spray. The Prompt Pop alone will not fully neutralize on the surface to prep and accept the sealant. A very brief phosphoric etch step, followed by the Adper Prompt fully scrubbed for 15 seconds, may be advisable. What about the cure step? It is not recommended to cure the Adper Prompt for the best attainable adhesion when performing sealants. Instead, after applying the L-Pop, place a light cure sealant material directly on to the air-dried surface. This will simultaneously cure the adhesive L-Pop and the sealant material. The sealant has a higher bond to the surface when both materials are cured together.

The Adper Prompt is acidic to the point it etches drill-prepped surfaces, as well as surfaces that are conserved without the touch of a drill. Adper Prompt is known as a self-etching adhesive, so applying it saves the clinician steps. Also, this product may already be found in your office if the doctor is doing direct bonded composites. Still, a product labeled self-etching adhesive does not automatically indicate it can be used as a stand-alone. In some cases instructions will require acid etch and an additional application of an adhesive. When experimenting with any self-etchant products, refer to product instruction to see what abilities the self-etchant holds.

Trying new techniques for an old procedure is thought-provoking. When results are favorable with the current method, why change? For years I referred to the acid etch as “the smurf gel.” However, today’s children are not familiar with the Smurfs. Perhaps updating the sealant technique to include an L-pop shows technique and materials could use a modern change.

The author did not receive compensation for product discussion. A sample containing the Adper Prompt is available by calling 1-888-640-7121 Ext. 3, or visiting www.3mespe.com/clin prosealant.

Karen Kaiser, RDH, graduated from St. Louis’ Forest Park dental hygiene program in 1994 and currently practices at the Center for Contemporary Dentistry in Columbia, Ill. She has written several articles for RDH and other publications, sits on dental hygiene panels, and is an evaluator for Clinical Research Associates. She can be contacted at [email protected].