PEDODONTICS 1-6 Dr. Abdullah Abumoamar

Pit and Fissure Sealants

Pit and Fissure Sealants Robertson wrote in 1835 that the caries potential was directly related to the shape and depth of the pits and fissures. GV Black noted that 43-45% of all caries occurred on the occlusal surfaces. Debris remained in the fissure sites regardless of the means of prophylaxis

Pit and Fissure Sealants - The National Health and Nutrition Examination Survey (NHANES III) conducted in 1988-1991 demonstrates that occlusal caries accounted for 56% of the caries in children and adolescents, compared to the 32% of buccal caries or 12% of proximal caries

Pit and Fissure Sealants - The Caries reduction of about 92% is achieved if the sealant remains intact over the pits and fissures for a period of 5 years

Pit and Fissure Sealants - Hyatt,1924 first advocated the term ‘Prophylactic Odontotomy Bodecker, 1929 suggested widening the fissures mechanically Gore, 1939 used polymers as sealants Buonocore, 1955 observed that attachment of acrylic resin to tooth surface was greatly increased after treatment of enamel with concentrated phosphoric acid solution.

Pit and Fissure Sealants Bowen, 1962 used BISGMA, but it was too viscous and required dilution with other monomers. Buonocore, 1970 utilized same system but employed an ultraviolet sensitive polymerization inititator (benzoin methyl ether).

Pit and Fissure Sealants - Dental sealants are non-invasive technique that preserves the tooth structure and at the same time prevents dental decay. - Sealants should be used as part of a preventive program that includes the use of fluorides, dietary considerations, plaque control and regular dental check-up.

Pit and Fissure Sealants - Definition: Sealant is a thin plastic coating of low viscosity material (resin) which is flowed into pretreated pit or fissure. -It acts as physical barrier between the sealed area of the tooth and the bacteria in the oral cavity, so it eliminates the entrance of S.mutans to pits and fissures and make them easier to clean.

Pit and Fissure Sealants Types of pits and fissures: 1) Shallow, wide, V-shaped fissure

Pit and Fissure Sealants Types of pits and fissures: 2) Deep narrow I-shaped or bottle neck shaped fissures.

Pit and Fissure Sealants These fissures favor plaque retention which is difficult to be removed mechanically. The depth of the groove or fissure is close to the DEJ, thus they are more vulnerable to decay.

Pit and Fissure Sealants Indications of Sealants: 1- The caries risk status should be evaluated and sealant applied to high risk patient. 2- Non-coalesced pits and fissures are the most indication.

Pit and Fissure Sealants Contraindication: 1- Shallow, well-coalesced pits and fissures which are self-cleaning. 2- Patients with low or negligible caries (ex. no new lesions or previous restoration). 3- Partially erupted teeth in which all pits and fissures are not exposed to oral cavity. 4- Tooth has proximal caries or occlusal caries. 5- Uncooperative child/patient.

Pit and Fissure Sealants •Reduced water sorption and solubility • Increased hardness and abrasion resistance after curing • Sufficient strength, surface hardness, dimensional stability, etc • Good flow • Suitable short setting time and adequate working time • Same thermal conductivity as tooth

Pit and Fissure Sealants • Good bond strength with enamel • Chemically inert, anticariogenic, etc • Low volatility • Reduced polymerization shrinkage.

Pit and Fissure Sealants Types of Pits and Fissure Sealants: 1) Composite resin (CR): BIS-GMA 2) Glass Inomer (GI): GIC material-Fuji 7 - It bonds chemically to enamel. - It has continuous fluoride release. - Restorative GICs tend not to be suited as fissure sealants as they are thick and cannot flow well into narrow deep pits and fissures.

Pit and Fissure Sealants Types of Pits and Fissure Sealants: 3) Sealants may be filled or unfilled (according to filler contents). -The purpose of filler material in the sealant is to reduce the occlusal wear. Unfilled—better flow Semifilled—strong and resistant to wear

Pit and Fissure Sealants Types of Pits and Fissure Sealants: 4) Sealant color may be clear, tinted or opaque (white) -Tinted or opaque sealants are easier to see than clear sealants when applied and on checking for retention on subsequent visit. -Some brands have a tint that is visible during application but turns clear after polymerization.

Pit and Fissure Sealants Types of Pits and Fissure Sealants: 5) Fluoride release sealants are also available and release fluoride after polymerization which creates a fluoride-rich layer at the base of the sealed groove..

Pit and Fissure Sealants Types of Pits and Fissure Sealants: 6) According to polymerization there are: a) Self cured materials that are supplied as a two-part system (base and catalyst) when these pastes are mixed together, they quickly polymerize. b) Light cured materials which do not require mixing because it hardens by light application after placement.

Pit and Fissure Sealants Technique of Sealant application: 1) Cleaning: - Mechanical cleaning by rubber cup and paste. - Fine abrasive and light pressure must be used. - Rinsing with water.

Pit and Fissure Sealants Technique of Sealant application: 2) Isolation: - The cleaned tooth must be dried and isolated by rubber dam. - Cotton roll may also be used.

Pit and Fissure Sealants Technique of Sealant application: 3) Etching: - Enamel is etched using 37 % phosphoric acid for 20 seconds. - The etchant can be applied by special syringe or cotton.

Pit and Fissure Sealants Technique of Sealant application: 4) Washing and dry: - The etchant gel should be washed and dried by oil-free air thoroughly but not vigoursly in order not to destroy the formed resin tags. - The enamel must show the frosty appearance.

Pit and Fissure Sealants Technique of Sealant application: 5) Material application: - The sealant material is then applied and any excess is removed with cotton and then light polymerization is started.

Pit and Fissure Sealants Technique of Sealant application: 6) Evaluation: - The surface is checked with an explorer for any voids or incomplete coverage and extra sealant can be reapplied if required.

Pit and Fissure Sealants Technique of Sealant application: Factors influencing sealant retention: 1- Moisture contamination in the primary cause of failure of sealant retention. 2- Inadequate etching is also a factor in loss of sealant retention 3- Wear factors (bruxism-abrasive dentifrices).

Pit and Fissure Sealants Technique of Sealant application: Factors influencing sealant retention: 4-Inadequate light curing (minimum of 20 seconds). 5- Unfilled cusp slope, buccal pit and lingual groove. 6- Voids from air bubbles.

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