Etchant Gel Precautions: Seal America™ Etching Gel contains 35% (w/w) of phosphoric acid. Protective eye wear is recommended for both dental staff and patients while using etchants. Contact with oral soft tissue, eyes, and skin should be avoided. If accidental contact occurs, flush immediately with large quantities of water and consult a physician.

Technique varies depending upon the type of isolation used. Cotton rolls with and without cotton roll holders and dry angles are usually used. Cotton roll holders are particularly important when sealing a half mouth at a time. Most providers who do not use cotton roll holders seal a quadrant at a time.

Select Teeth. Teeth with shallow, broad fissures may not require sealing. Sealing is not indicated in the case of Diagnosed caries.

1. Thoroughly clean the teeth which will be sealed.  Traditionally, teeth have been cleaned with a mounted prophylaxis brush and pumice slurry. To do so, clean the surfaces to be sealed with a pumice-water slurry and a prophy brush. Rinse well and dry the tooth (teeth). Note: Commercially available prophy pastes are not recommended as some additives interfere with etching.
1.  
2. Many sealant programs have recently achieved satisfactory retention rates using a dry toothbrush to clean the teeth. The children are asked to brush. The provider checks the teeth for cleanliness and then re-brushes the teeth to ensure that all debris has been removed. The teeth are thoroughly rinsed before they are isolated.

Isolate Teeth. The patient should be positioned so that the treatment site is visible and accessible. The patient’s head can be tilted so that saliva pools on the opposite side of the mouth from the teeth being sealed. A high volume evaculator should be used. Cotton rolls or cotton roll holders and dry angles should be positioned as desired. Dry angles are most effective if placed over the parotid duct opening. Some providers like to place a dry angle between the cotton roll holder and lingual surface of mandibular teeth to create an additional barrier for the tongue. The teeth should be thoroughly dried with oil free air.

Condition the Enamel. The cleaned and dried surfaces are etched with Seal America™ Enamel Conditioner for 20 seconds. Using a Seal America™ acid resistant brush, apply the Seal America™ Etching Gel. The tooth surface is etched one or two millimeters beyond the anticipated location of the sealant material.

Rinse Etched Enamel. After 20 seconds, the etchant is thoroughly rinsed off the teeth. It is critical that saliva not come in contact with the prepared tooth surfaces during this step. The dry angles and cotton rolls may need to be replaced. Excess moisture also can be removed with the high-speed evacuator. Sometimes dry cotton rolls or dry angles are placed over the moist ones.

Dry Etched Enamel. Thoroughly dry the etched surfaces. Air should be oil and water free. Upon drying, a properly etched surface will have a dull matte or frosty appearance in contrast to the glossy appearance of un-etched enamel. Should salivary contamination occur after this point, the surface must be washed, dried, re-etched for 10 seconds, and washed and dried again before proceeding to the sealant application step. Immediately apply sealant.

Applying Sealant. Using either Seal America™ Part A and Seal America™ Part B or Seal America™ Quick Set Part A and Seal America™ Quick Set Part B, mix in a 1:1 ratio (one drop Part A for each one drop Part B). The patient’s head should be positioned so the occlusal plane is parallel to the floor so the sealant does not flow distally before it cures, leaving the mesial pits underfilled. Using the blue Seal America™ Sealant Brush applicator, dispense an equal number of drops of the Part A and Part B resins. Using the disposable Seal America™ brush and disposable mixing tray, mix to a uniform color (5-10 seconds) and immediately cover all etched surfaces before returning to contour the sealant. Apply sealant half way up the cuspal slopes. The sealant should extend from cusp to cusp, but should not cover the marginal ridges. If more than one tooth in a quadrant is being sealed, the most posterior tooth should be treated first since maintaining dryness is more difficult in the back of the mouth.

Sealant Inspection. Isolation of the teeth should be maintained until the sealants are checked visually and with an explorer to make sure coverage of the pits or fissures is complete. If there is a surface air bubble, more sealant can be applied as long as the tooth has remained uncontaminated. Otherwise, the tooth must be re-etched for 10 seconds, washed, and dried before adding sealant.

A thin surface film of sealant will remain un-polymerized because of contact with air. This film has an unpleasant taste and should be wiped off with a wet cotton roll. The isolation materials can then be removed and the patient allowed to rinse. The patient should be informed that the sealants may feel "high" but will be worn down in the next few days by the patient’s own occlusion.

Do not cross contaminate sealant vials in self-cure kits by interchanging caps.

Do not expose materials to elevated temperature.