Received: 21 March 2018 Revised: 29 June 2018 Accepted: 5 August 2018

DOI: 10.1111/jerd.12423

RESEARCH ARTICLE

Effects of staining and polishing on different types of enamel

surface sealants
Nicoleta Corcodel DMD1 | Alexander J. Hassel DMD1 | Sinan Sen DMD2 |
Daniel Saure MSC, Dr Sc Hum3 | Peter Rammelsberg DMD1 | Christopher J. Lux DMD2 |
Sebastian Zingler DMD2

1
Department of Prosthodontics, University
Hospital of Heidelberg, Heidelberg, Germany
2
Department of Orthodontics, University
Hospital of Heidelberg, Heidelberg, Germany
3
Institute of Medical Biometry and Informatics,
University of Heidelberg, Heidelberg, Germany
Correspondence
Sebastian Zingler, Department of
Orthodontics, University Hospital Heidelberg,
Im Neuenheimer Feld 400, 69120 Heidelberg,
Germany.
Email: sebastian.zingler@med.uni-
heidelberg.de
Abstract
Objective: To assess surface discoloration of four enamel sealants based on different chemical
compositions after exposure to artificial aging and staining solutions. Furthermore, their clean-
ability after polishing will be evaluated.
Materials and Methods: Selected sealants were a composite resin-based sealant with fillers (Pro
Seal), a composite resin-based sealant without fillers (Light BondSealant), a resin-modified glass
ionomer-based sealant (ClinproXT Varnish) and a silicon-based sealant (Protecto). Natural teeth
served as medium. Immersion solutions were water, juice, tea, and turmeric. In a standardized
setting, all samples were measured seven times with a spectroradiometer (Photoresearch
PR670) at baseline, after thermocycling; 7 days; 2 and 4 weeks of immersion; and after finally
polishing.
Results: Thermocycling had no significant effect on color stability. After exposure to staining
solutions, all sealed surfaces showed significant color changes. Color change predominately
occurred for all sealants in the first week of staining (P ≤ .01). Best resistance to staining
decreased as follows: Protecto > Light Bond Sealant > ProSeal > Clinpro XT Varnish. Surface
cleaning by polishing significantly reduced the color change.
Conclusion: Sealed enamel surfaces are prone to discoloration, which is most prominent in filled
composite and glass-ionomer-based sealants. Staining can be reduced by polishing; however, in
this in vitro setting the original color could not be restored.
Clinical Significance: Enamel sealants might exert adverse effects in terms of discoloration. This
should be taken into consideration by clinicians and patients, particularly when sealants are
applied in esthetically critical areas.

KEYWORDS

color, esthetic, orthodontic, sealant, spectroradiometer, staining

1 | I N T RO D UC T I O N daily fluoride.5,6 “Patient compliance,” however, remains problematic.

One of the most common adverse effects of orthodontic treatment
with fixed appliances is enamel decalcification of the labial tooth sur-
face.1,2 This decalcification becomes clinically visible as white-spot
lesions. Because these lesions often appear on the labial surface of
maxillary lateral incisors and canines, decalcification is not only a car-
3,4
iological issue, but also a serious esthetic problem.
Various methods of prevention have been suggested, such as
home-based biofilm removal by systematic tooth brushing and use of
Because enamel sealants are compliance free and can also be used to
reduce decalcification during orthodontic treatment, they can be a
good way to manage this problem.7–10 Sealants can be applied both
before and after attaching orthodontic brackets to labial tooth sur-
faces and serve as a physical barrier against acid attack on enamel.
These sealants also release fluoride and, therefore, inhibit enamel
demineralization adjacent to orthodontic brackets.11
In recent years, several different sealant materials have been
introduced commercially. The main types in use are filled and unfilled

580 © 2018 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/jerd J Esthet Restor Dent. 2018;30:580–586.
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CORCODEL ET AL. 581

resin-based sealants.10 In addition, resin-modified glass-ionomer-

Abbreviation
based sealants and, more recently, silicone-based sealants have

LightBond

Protecto
ProSeal

ClinPro
become available.12
Dental restorative materials such as composites or glass ionomers
tend to discolor in the oral cavity.13,14 These color changes can result
in patient dissatisfaction and replacement of restorations.15 High inci-

Frankfurt, Germany
Reliance orthodontic

Reliance orthodontic

3M Unitek, Seefeld,
dence of color change has been observed in studies of orthodontic

products, Itasca

products, Itasca

BonaDent GmbH,
adhesives in particular.16,17 Accordingly, enamel sealants applied to

Germany
entire labial tooth surfaces can expose a larger surface area to poten-

Supplier
tial colorants. These sealed tooth surfaces may discolor during treat-
ment, negatively affecting the patient's appearance. More than 90%
of orthodontic practices in Germany currently use resin-based (filled

N178061
or unfilled) sealants and various varnishes and liners for compliance-

4102384
111980
Lot.-no.

11892
independent prophylaxis18; however, little information is available on
the color stability of enamel sealants and, to the best of our knowl-
edge, no study has yet compared the color stability of different ortho-

15-60 seconds
dontic surface sealants.19,20 Hence, the main objective of this study

30 seconds

30 seconds
was to evaluate and compare the color stability of different types of

Etching
commercially available sealant materials after exposure to artificial

None
aging and different staining solutions. Because polishing may be a via-
ble means to restore the esthetics of stained composite restorations,
the secondary objective of our study was to evaluate the cleaning

20 seconds, light

20 seconds, light
10 seconds, light

Compositions are according to the manufacturers' specifications; curing and etching are according to the manufacturers' instructions.
60 seconds, air
effectiveness of the professional polish.21

Curing
2 | MATERIAL AND METHODS

2.1 | Ethical approval dimethacrylate, urethane dimethacrylate, tetrahydrofurfuryl

Part B (liquid): copolymer of acrylic and itaconic acids, water,

polyethyleneglycol diacrylate, fluoride containing glass frit
Ethoxylated bisphenol A diacrylate, urethane acrylate ester,

The study protocol, including the use of extracted human teeth, was
Bisphenol A diglycidylmethacrylate, triethyleneglycol

approved by the ethics committee of the Medical Faculty of Heidel-

methacrylate, water, bisphenol A diglycidyl ether

berg University (approval no.: S-301/2011). Before extraction, all par- Part A (paste): silane treated glass, 2-hydroxyethyl

2-hydroxyethyl, calcium glycerophosphate

methacrylate, hydrofluoride methacrylate

ticipants or their parent(s)/guardian(s) received oral and written study

information and signed a consent form.
dimethacrylate, silane treated silica
Ethylacetate, siliconepolyacrylate
Composition (main components)

2.2 | Sealants
The four sealants tested in this study are shown in Table 1. All sealants
were applied in accordance with the manufacturers' instructions
(Table 1). Light curing was performed by use of a Bluephase G2 polymer-
ization lamp (Ivoclar Vivadent AG, Schaan, Liechtenstein); luminescence
was tested regularly and the mean values were above 1000 mW/cm2.

2.3 | Preparation of the enamel specimens

glass ionomer

Enamel specimens were prepared from extracted human wisdom

Resin-modified,
Products used in this study

teeth or from teeth obtained from patients who had received extrac-
Composite,

Composite,
unfilled
Category

tion treatment for orthodontic reasons. After extraction, the teeth

Silicone
filled

were cleaned of adherent tissue and stored in artificial saliva

(16.1 mM KCl, 14.4 mM NaCl, 1.9 mM KH2PO4, 1.4 mM CaCl2,
pH 6.8)22 at 4
C until further processing. Only clean teeth free from
Clinpro XT Varnish
Light Bond Sealant

caries, fractures, or discoloration were used for this study. Preparation

of the enamel specimens was performed by use of an inner diameter
Protecto

saw (Leica, Wetzlar, Germany). First, roots were removed at the

Pro Seal
Product
TABLE 1

cementoenamel junction. Next, the crowns were separated longitudi-

nally into two equal segments at their mesio-distal axis, each half

582
serving as a separate specimen. Then, the dental pulp tissues were
completely removed. Two straight lines were etched to divide the
enamel surfaces into defined test (sealed) and control (unsealed) areas,
crossing at right angles with the point of intersection in the center of
the gingival third of the enamel specimens. This was achieved by use
of a diamond-coated separating disc (Komet; Gebr. Brassler, Lemgo,
Germany). The measurement spot, which had a defined diameter, was
aligned on both test and control areas so that it touched both marking
lines (Figure 1). To facilitate precise replacement, specimens were
embedded by use of a gray vinylpolysiloxane impression material
(Compact Putty; Detax, Ettlingen, Germany) in a standardized alumi-
num specimen holder, in accordance with Zenthöfer et al.23 For iden-
tification and randomization purposes, both the enamel specimen and
corresponding impression materials were numbered on the bottom by
use of a high-speed small round bur (Komet; Gebr. Brassler, Lemgo,
Germany). Specimens were stored in artificial saliva at 4
C until the
experiment started.22
2.4 | Group allocation
Eighty specimens were prepared and randomly assigned to four
experimental groups (n = 20 per group) corresponding to the four
sealants being tested. From each experimental group, 15 specimens
were exposed to staining solutions and 5 specimens were set in dis-
tilled water. Computerized generation of the random allocation
sequence was carried out by a statistician (D.S.).
2.5 | Artificial aging
To simulate temperature changes in the mouth, specimens were
exposed to 6000 cycles in a thermocycler at 6.5
C/60
C (dwell time
45 seconds, intermediate pause 4 seconds; Thermo Haake Thermo-
stat DC10 steel dips W15 TC01, Germany).
2.6 | Staining procedure
Four different solutions were used: distilled water as a control agent;
black tea (Darjeeling; TEEKANNE GmbH & Co. KG, Düsseldorf, Ger-
many); apple, blackcurrant, and raspberry fruit juice (Rio D'oro; Aldi
SÜD GmbH & Co. oHG, Mülheim, Germany); and 0.1% turmeric
FIGURE 1 Measurement spot on the sealed/test side (orange) and
nonsealed/control side (yellow)
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CORCODEL ET AL.
(curcuma) solution. All immersion solutions were prepared in accor-
dance with the manufacturers' instructions and cooled to room tem-
perature (mean: 20
C). Room temperature is defined in Germany as
the range from 18
C to 22
C (Standard ISO 13443:1996). Turmeric is
an oil-soluble dye extracted from curcuma roots which is often used
in curry powders. The solutions were renewed every third day.
2.7 | Polishing procedure
After the staining period, all specimens were polished by use of a pol-
ishing brush (Hawe Miniature Cleaning & Polishing Brushes; Ker-
rHawe, Bioggio, Switzerland) and a ready-made nonfluoridated
prophy paste (Cleanic; KerrHawe, Bioggio, Switzerland) for 5 and
15 seconds, using a low-speed handpiece (Sirona Dental System, Ben-
sheim, Germany).
2.8 | Color measurement
Color measurements were performed by use of a spectroradiometer
(PR-670; SpectraScan, Photo Research, Chatsworth, California) fitted
with a Macro-Spectar MS-75 lens (Photo Research). The spectrometer
was placed on a tripod at a distance of 400 mm from the measured
object. The device aperture was set to 1
, providing an optical config-
uration of 2
to ensure precise examination of the object. This set-up
has been described in the specialist literature.23 To ensure maximum
consistency of measurements, no adjustments were made to the
experimental set-up throughout the test procedure. Because color
measurements are influenced by ambient light, an Ulbricht sphere was
used to screen out surrounding light and prevent the formation of
shadows. An Ulbricht sphere was chosen because it simulates D65
light, with a correlated color temperature of 6500 K and a color-
rendering index of 91. The light radiated in two directions at an illumi-
nation angle of 45
and at a distance of 20 cm from the measured
object. Because oscillation of the power supply can affect light condi-
tions and consequently the accuracy of color measurements, we used
a LPS-100-0307 power supply-regulated current (Labsphere, Inc.,
North Sutton, New Hampshire). This power supply both extends the
lifecycle and improves the performance of the lamp. Each measure-
ment was conducted after calibration by use of a reflectance standard
(USRS-99-010; Labsphere, Inc., North Sutton, New Hampshire) and
repeated three times. By performing the experiment in a dark room,
we managed to avoid any potential effects of external light. The lens
was kept positioned toward the surface of the specimen to ensure
standardized measurements throughout the experiment. Spectral
reflectance from 380 to 780 nm with a 2-nm interval was obtained
(Spectrawin 2.0, Photo Research) and subsequently converted to L*,
a*, and b* values, as described by the Commission Internationale de
l'Éclairage: lightness (L*) represents the lightness axis, and a* and b*
denote coordinates on the red-green and yellow-blue color axes,
respectively.24 Color difference (ΔE) between two coordinates can be
described by use of the following equation25:
qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
ΔEab ¼ ðL1 −L2 Þ2 + ða1 −a2 Þ2 + ðb1 − b2 Þ2
Whereas experienced industry color matchers have determined an
acceptable color difference of ΔE = 1, several studies using porcelain disks
 17088240, 2018, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jerd.12423 by Cochrane Peru, Wiley Online Library on [31/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
CORCODEL ET AL. 583

have defined the acceptability threshold for color difference as ΔE = 2 and
ΔE = 2.72. 26,27
In a more complex clinical setting, Johnston determined an
acceptability limit of ΔE = 3.7.28 Because measuring the exact spot on a
tooth is quite challenging and because the tooth changes color immediately
after drying out, Johnston calculated mean L*, a*, and b* values from the
three measurements conducted on each tooth. The tooth was removed
from the storage fluid and measured within 40 seconds on both the sealed
and the control side. This process was performed three times with a re-
wetting time of 30 minutes between the three measurements.
2.9 | Color assessment
Color on both the sealed and control side was measured after sealing
(baseline); after thermocycling; after immersion for 7 days, 2 weeks, and
4 weeks; and finally after 5 and 15 seconds of polishing. We choose
4 weeks as the longest period of immersion in staining solutions on the
basis of the following calculation: 4 weeks of immersion are 28 days of
immersion contact, which is equivalent to orthodontic treatment for
20 months with approximately 1 hour's tooth-beverage contact per
day. This calculation is in accordance with the recommendations of the
German Nutrition Society to drink a minimum 1.5 L of liquids per day.
2.10 | Reliability assessment for the color
measurements
To assess reliability, the measurement protocol described above was
performed over 2 days, with 24 hours between measurements. The
intraclass coefficient (ICC single rater) was calculated.
2.11 | Statistics
Mean, SD, range and, if appropriate, confidence intervals were calculated
for descriptive analysis. Because of the data structure, we considered it
appropriate to use nonparametrical statistical methods to investigate the
common effects of thermocycling, time, type of sealant, and group (con-
trol/sealed), and to determine the differences between any two groups
with respect to the variables L*, a*, b*, and ΔE. For example, we used a
nonparametric analysis of covariance (ANCOVA) and, for post hoc tests,
the Mann-Whitney U test. Statistical analysis was conducted by use of
SAS (Version 9.2; SAS Institute, Inc., Cary, North Carolina). Because of
the exploratory nature of the study, no adjustment was made for multi-
ple testing, and test results surpassing a 5% confidence level were inter-
preted as statistically significant.
3 | RE SU LT S
3.1 | Reliability assessment of the measurement
setting
The ICC for all L*, a*, and b* values was >0.93 (lower bound CI
>0.71), indicating a high reliability of measurements. Average ΔE
between measurements on the 2 days was <1 ΔE unit.
3.2 | Effect of thermocycling on the sealed and
nonsealed control surfaces
After thermocycling, mean L*, a*, and b* values for all surfaces mea-
sured were only slightly higher than those at baseline (<1 ΔE unit). No
significant differences were found between sealed and nonsealed
control surfaces (P > .05).
3.3 | Color changes in the distilled water group
Mean L* and b* values did not differ significantly when specimens
were exposed to distilled water. In contrast, mean a* values differed
significantly (maximum 0.13, P = .282); however, this is below the
threshold for clinical significance.
3.4 | Comparison of discoloration between sealed
and nonsealed surfaces
After exposure to staining solutions, significantly lower mean L*
values and higher mean b* values were recorded for sealed surfaces
(all sealants were pooled) than for nonsealed surfaces. Overall, discol-
oration was more significant for sealed surfaces than for nonsealed
surfaces (Table 2).

TABLE 2 Changes in mean L*, a*, b* values (with SD) between baseline measurements and exposure to staining solutions after 1, 2, and 4 weeks
for sealed and nonsealed tooth surfaces
L* a* b*
Staining (n = 60) Staining (n = 60) Staining (n = 60)
Sealed Nonsealed Sealed Nonsealed Sealed Nonsealed
Baseline 78.510 78.076 −1.060 −0.973 17.422 17.864
(2.628) (2.964) (1.122) (1.167) (4.148) (3.609)
Change (baseline to 1 week) −10.897 −9.525 2.685 2.75 4.812 −2.440
(6.412) (7.067) (3.867) (2.310) (15.01) (8.132)
Change (baseline to 2 weeks) −13.387 −12.56 2.582 3.237 6.947 −2.470
(8.415) (8.637) (4.367) (2.627) (19.50) (10.172)
Change (baseline to 4 weeks) −13.492 −10.847 3.162 2.510 12.857 3.810
(6.492) (5.04) (2.605) (3.092) (21.67) (11.140)
P <.001 .9597 <.0001
 17088240, 2018, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jerd.12423 by Cochrane Peru, Wiley Online Library on [31/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
584 CORCODEL ET AL.

3.5 | Comparison of discoloration between the four

(sealed—nonsealed)
different sealant materials
Changes of mean (with SD) L*, a*, b* values of sealed and non sealed tooth surfaces of the four test groups after 4 weeks of staining as compared to baseline measurements. The respective

6.96 (12.43) A

12.48 (10.76)
mean differences between sealed and nonsealed surfaces were used to compare the color differences among the four sealants (in each column: values with same letter are not significant at α = 0.05)

0.67 (2.91) A
Difference

5.54 (7.91)
Mean differences between L*, a*, and b* values for sealed and non-
sealed surfaces were used to compare color changes between the
four sealants after staining (Table 3). Nonparametric ANCOVA showed
that sealant type and staining time, and their interaction, all had a sig-
nificant effect on all color coordinates (P-value for L*, a*, and b*

−0.34 (7.23)

−0.16 (8.87)
17.67 (3.76)

17.29 (3.11)

18.63 (3.96)

17.01 (3.10)
Nonsealed

0.64 (7.75)

0.01 (7.19)
values: <.0001). Post hoc pairwise comparison of the four sealants
revealed that the greatest color changes occurred for ClinPro. For
sealant type and staining time together, resistance to staining
decreased in the following sequence: Protecto > LightBond > ProSeal

12.49 (16.55)
15.83 (4.20)

19.58 (4.32)

16.86 (3.02)

15.80 (3.10)
6.62 (18.64)

5.38 (15.12)
> ClinPro. Regarding the effect of staining time, the greatest color
1.31 (7.62)

changes occurred in the first week of staining for all sealants (between
Sealed

T1 and T2) (P-value <.0001, data not shown), indicating that sealants
b*

had presumably achieved saturation.

(sealed—nonsealed)

−0.37 (1.40) A, B

−0.79 (1.89) A, B
3.6 | Effects of polishing on stained sealants
−0.43 (1.04) A
Difference

1.54 (2.24)

After staining, sealants were polished for 5 and 15 seconds (Figure 2).
Neither 5 nor 15 seconds was sufficient to restore the original color
of the teeth/sealant; however, polishing did reduce the color changes
of all sealants. After 5 seconds, the median ΔE values calculated for
Protecto, ProSeal, and Light Bond were lower than the ΔE threshold
−1.35 (1.27)

−0.71 (1.01)

−0.86 (1.16)

−0.75 (0.90)
Non sealed

2.21 (2.49)

2.14 (2.01)

2.51 (2.01)

1.75 (1.88)

for clinical detection (ΔE > 3.7). This was also the case for the ClinPro
group after 15 seconds.

4 | DI SCU SSION
−1.08 (1.17)

−1.05 (1.13)

−1.05 (1.13)

−0.81 (0.89)
1.78 (2.46)

1.76 (2.75)

4.05 (3.61)

0.96 (3.04)
Sealed

4.1 | Methodological considerations

a*

We used an in vitro model with natural teeth to simulate the clinical

(sealed—nonsealed)

environment as closely as possible. Advantages of the in vitro model

are that it ensures a highly precise instrumental measurement setting,
−1.13 (3.62) B

−0.57 (2.96) B
−4.85 (3.02)
Difference

1.88 (3.33)

a standardized environment, and controlled staining procedures. The

in-vitro model also ensured precise sealant application without mois-
ture contamination, which might have resulted in some uneven seal-
ant surfaces.20 Because it is impossible to postulate that every tooth
−8.33 (7.05)

−7.73 (5.68)

−9.07 (5.92)

−7.36 (5.27)
78.64 (3.85)

77.62 (2.77)

77.97 (2.05)

76.46 (4.10)
Nonsealed

−13.92 (7.01)
−6.45 (4.32)

−8.86 (4.97)

−7.93 (5.07)
79.60 (2.60)

77.58 (2.77)

78.34 (2.19)

76.94 (3.47)
Sealed
L*

15

15

15

15
n

Change (baseline

Change (baseline

Change (baseline

Change (baseline
to 4 weeks)

to 4 weeks)

to 4 weeks)

to 4 weeks)

FIGURE 2 ΔE differences of sealed and nonsealed control surfaces

Lightbond
Protecto
Baseline

Baseline

Baseline

Baseline

(all nonsealed control surfaces were pooled) before and after 5 and
TABLE 3

ProSeal

ClinPro

15 seconds of polishing (medians and interquartile ranges and 3rd and

97th percentiles; circles: extreme values)

CORCODEL ET AL.
behaves in an identical way when stained, each specimen served as its
own control: one half of its surface was sealed and the other half was
left unsealed as a control. The sealant materials tested were selected
to represent different types of materials commercially available. We
selected two composite-based sealants (filled and unfilled); a resin-
modified, glass-ionomer-based sealant; and a silicone-based sealant
because they are the most frequently used.
We used a noncontact high-precision spectroradiometer for color
measurements. The spectroradiometer's reliability and the validity of its
color measurements are well documented and it is the gold standard for
in vitro color measurements.29–32 Use of a spectroradiometer in the field
30–32
of dental color research has been described several times.
4.2 | Effects of staining
Of the materials we tested, the greatest tendency toward staining was
observed for the resin-modified glass ionomer-based sealant (ClinPro).
These results are consistent with previous studies of restorative mate-
rials in which it was reported that resin-modified glass ionomers have
poorer color stability than dental composites.14,33 The higher staining
susceptibility of the resin-modified glass ionomer might be attributed to
its water sorption properties.34 High water sorption facilitates penetra-
tion of colorants into materials.35 In addition, resin-modified glass iono-
mers are more prone to surface roughness than composite-based
materials.36 Discoloration of composite-based materials (filled and
unfilled) was significantly higher in comparison to nonsealed surfaces.
Similar findings were reported by Griggs, who compared ProSeal-treated
teeth and untreated teeth in vitro.19 For both composite-based mate-
rials, the filled sealant (ProSeal) discolored more than the unfilled sealant
(LightBond). These findings are in contrast to other data obtained for
restorative composites.37 We cannot, however, exclude the possibility
that the greater surface roughness of the filled sealer caused greater
adhesion of staining particles. In this context, it should be noted that
most filled composite-based sealants seem more resistant to mechanical
wear (e.g., daily brushing) than their unfilled counterparts.20 Because
composite-based sealants provide an intact layer of material which pro-
tects the enamel from acid-forming microorganisms, it could be
expected that this sealant type has a caries-resistant effect.38
The smallest color changes were observed for the silicone-based
product (Protecto). With respect to mean ΔE values, the overall
decrease in lightness of Protecto-sealed surfaces was even smaller
than that of the control surfaces. The high color stability of silicone-
based materials might in part be because such materials have hydro-
39
phobic properties that reduce water sorption, among other effects.
Although silicone-based sealants might be an alternative to
composite-based sealants, studies comparing silicone-based sealants
to composite-based ones have reported fewer benefits in terms of
12
preventing enamel demineralization.
4.3 | Effect of polishing
The secondary objective of this study was to evaluate the possibility of
reversing color changes in sealants by means of polishing. We found
that polishing reduced color changes for all sealants. After 15 seconds,
ΔE* values for all sealants were on average below the clinically
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585
acceptable threshold described in the specialist literature, that is, ΔE* =
3.7. These results are in agreement with those presented by Samra
et al. (2012), who evaluated the effect of professional prophylaxis on
reducing discoloration of four esthetic restorative materials.40 Polishing
procedures may, however, cause abrasive wear to dental materials.41
Chan et al. found that depth of dye penetration in restorative compos-
ites is approximately 3 to 5 μm.42 Anfe et al. showed that staining
caused by coffee and red wine occurs in a superficial layer (depth
<20 μm), which can be removed by polishing.21 Sen et al. investigated
how professional tooth cleaning using a polishing brush affected surface
layer thickness changes for Pro Seal, Light Bond, and for Opal Seal, a
glass ionomer-based, filled sealant.20 Directly after application, mean
measured film thickness varied from 69 μm (Light Bond) to 134 μm
(ProSeal). Whereas the filled sealants, ProSeal and Opal Seal, lost
between 2 and 3 μm of layer thickness per second of polishing, the
unfilled sealant, Light Bond, lost significantly more of the protective
layer (3-4 μm/second). Considering the low abrasion resistance of
enamel surface sealants, it is possible that polishing has an adverse
effect on sealant integrity. Sealant polishing to reduce color changes
occurring after contact with staining solutions should, therefore, be used
with care, particularly for unfilled or partially filled (e.g., the tested Light-
Bond) sealants. Further studies are needed to investigate how much
sealant remains, and whether reapplication after polishing is needed. If
reapplication is needed, discoloration of the sealants remains a major
concern.
5 | CONC LU SION
Sealed enamel surfaces are prone to discoloration, particularly when
filled composite and glass-ionomer cement-based sealants are used.
Staining can be reduced by polishing; however, in this in vitro setting
the original color could not be restored. This should be taken into con-
sideration by clinicians and patients, particularly when sealants are
applied to teeth in an esthetically important anterior area.
CONFLIC T OF INT E RE ST
The authors declare no potential conflicts of interest in respect of
authorship and/or publication of this article.
DISC LOSURE
The authors do not have any financial interest in the companies
whose materials are included in this article.
ORCID
Sebastian Zingler https://orcid.org/0000-0001-6020-6877
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How to cite this article: Corcodel N, Hassel AJ, Sen S, et al.
Effects of staining and polishing on different types of enamel
surface sealants. J Esthet Restor Dent. 2018;30:580–586.
https://doi.org/10.1111/jerd.12423