What are the current flowable composite options?

In the past I have been very critical of flowable composites, especially in the use of sealants as I would constantly see sealants that were broken or chipped.  A leaking sealant is worse than no sealant and within a year or so I would see at least one that was broken making we wonder if the sealant was really sealed 100% all the way around.  I quit allowing anyone else in the office from doing sealants and when I did I would not use flowable composite but use my regular bonding protocol and regular composite warmed up.  That worked MUCH better but takes more time and makes doing sealants cost prohibitive.

Today more filled flowables are available and the results are much better.  Due to this fact and that we now have a pediatric dentist in our office and are in need of more preventive services we are placing more sealants.  In this post I share some of the research on today’s flowable composites.

Basic rules of dental flowable composites for sealants

• Use shortly after eruption as teeth are not fully mineralized then and more likely to get decay
• Permanent and primary teeth of high risk kids
• More fully filled flowable composite work better than conventional sealant material
• Clean/disinfect, etch, bond, composite – don’t skip steps!
• Warm your resin material
• SDF on potential lesions?  Impact on bonding?  SDF is new (2014) but we have been using to arrest regularly.

Sealant protocol using flowable composite

1. Isolate – we use Isolight or Isodry
2. Microetch PROPHYFlex 3 by KaVo or Cavitron JET-Fresh with Na bicarbonate or Al tri-hydroxide (this gets into the grooves and cleans far better than pumice).  I currently use Solea hard tissue laser.
3. Etch enamel 15 seconds then wash and dry (with bac etch an MMP inhibitor)
4. Consepsis/Cavity Cleanser 30-60 sec suggested (only beneficial on areas etched) air dry
5. Gluma 10-20 seconds with scrubbing and blot/suction dry (some say 2 60 second treatments – Rella C)
6. Bisco All Bond Universal 1 or 2 coats 10-15 seconds each air dry 10 seconds
7. To cure or not to cure at this step is debatable.  We dual cure resin and composite together.
8. WARMED flowable composite in thin layer