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.
- Remove excess: Wet your finger with a petroleum gel (Vaseline), coconut butter or silicon oil slightly to prevent the GI sticks to your finger.
- Bite! To achieve desired occlusion. This avoids adjusting the occlusion afterward.
- 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.
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.