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4.2 The Dental-Sealant-Application Process

Two-Handed vs. Four-Handed Placement

Two-handed dental sealant placement is the placement of sealants by a primary operator alone; four-handed placement is the placement of sealants by a primary operator with another person’s assistance. Four-handed sealant placement is associated with higher retention rates.11 OOH recommends four-handed placement (e.g., having a dental hygienist and a dental assistant place sealants). Following is a detailed explanation of the steps in the sealant-application process.6,11

Two-Handed Four-Handed
Two-handed Four-handed


Step 1: Tooth Preparation

Sealant material manufacturers recommend that tooth surfaces be cleaned before acid etching. Demonstrations have shown that sealant retention rates for teeth cleaned with a toothbrush are at least as high as for teeth cleaned with a handpiece.12 OOH recommends using a toothbrush to clean the surfaces of teeth to be sealed before acid etching.