Dental Health International Nederland
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Chapter 7 - Monitoring ART Restorations and Sealants
Careful monitoring of restorations and sealants is important. Methods for monitoring and ways to replace or repair restorations or sealants that have been judged to be defective are briefly described in this chapter.
Monitoring Restorations and Sealants
ART can be used both in the dental clinic and in communities where no clinic exist. For example, ART restorations and sealants can be performed in schools and health centres in urban and remote areas.
No restoration or sealant, irrespective of the material used, lasts forever. Some restorations will last for many years, others may fail earlier. For ART restorations always follow the instructions in this manual to obtain the best results. It will reduce the number of restorations and sealants which fail. Faulty restorations and sealants need to be identified and repaired. Keeping records of the kind of treatment which has been performed will help in understanding how well people have been treated. Monitoring is more easily undertaken in schools than in clinics, since students/pupils will normally be available when you visit the school.
When to Monitor
It is useful to collect information about any pain experienced and whether ART was accepted. Therefore, ask patients about pain felt during and after treatment, and their overall satisfaction within a period of 4 weeks after being treated. As any serious problems tend to occur soon after the treatment is finished, the first clinical evaluation could take place after half a year. Further evaluations can be planned on an annual or biannual basis depending on factors such as expected caries development, length of time students stay at school and the possibility of seeing the individuals again (remote areas).
What to do with failed or defective Sealants and Restorations
Failed or Defective Sealant
A sealant appears to be defective or has disappeared completely. Examine the tooth carefully for signs of caries. If the surface is hard, leave it alone. If the surface is carious, reseal or make a small restoration. What to do depends on the extent of the defective sealant or of the caries present. Resealing is done in the same way as described for sealing in chapter 6. If a cavity continues to extend under an old sealant, follow the instructions for the one-surface cavity procedure in chapter 4.
Failed or Defective Restoration
A restoration may not be acceptable or unsatisfactory anymore for several reasons:
1. it is completely missing,
2. a large part of it has broken away,
3. the restoration is fractured,
4. much of the restorative material has worn away,
5. caries has developed at the restoration margin or elsewhere on the tooth surface.
1. Restoration is completely Missing
Some of the reasons for failure could be:
- contamination with saliva or blood during the restorative procedure,
- mix of material was too wet or too dry,
- not all the soft caries had been removed,
- thin undermined enamel had been left behind, and this later broke off.
Whatever the reason, clean the cavity completely, apply dentine conditioner and refill the cavity according to the description in chapter 4 or 5.
2. Part of the Restoration has Broken away
It is probable that the restoration was too high or air bubbles were trapped in the material during placement of the restoration. Whatever the reason, clean the tooth surface and/or remaining restorative material with an explorer or small excavator and wet cotton wool pellets first, before conditioning the entire surface and material. Fill the gap with a new mixture of glass-ionomer and ensure that the restoration is not too high.
3. The Restoration has fractured
This most commonly happens in a multiple-surface restoration which was too high. The way to repair it very much depends on the location of the fracture line and the mobility of the fractured part. If the fractured part is loose and can be removed, repair the gap as described under point 2. However, if the fractured part cannot be removed, repair through ART is not possible and traditional treatment using a drill is needed.
4. The Restoration has worn away
Possible reasons for this are the patient eats very hard food frequently, the patients clenches his/her teeth frequently or the mixture had been too wet or dry. It may take years, but it is possible that so much material has been lost that the restoration should be rebuilt. Ensure that all the surfaces of the tooth and the remaining restoration are clean and free from soft tooth tissues. Apply dentine conditioner over the glass-ionomer and the cavity walls. Place a new layer of glass-ionomer on top of the old one. Finish the restoration as described in chapter 4.
5. Caries has Developed in the adjacent Fissures or Surface
Remove the soft tooth tissues. After all decay has been removed, clean and fill the new cavity adjacent to the restoration according to the standard procedures.