Dr: Abdelmonem Altarhony Pit and Fissure Sealants Dr: Abdelmonem Altarhony

Why do pits and fissures decay? Morphology of the pits & fissures

Pits and fissures are the fossa and grooves that failed to fuse during development Similar to adding Vit C to prevent scurvy etc

Pits and fissures Two main types of pits & fissures: 1. Shallow, wide, V-shaped fissures

Why do pits and fissures decay? 2. Deep, narrow I-shaped or bottle neck shaped fissures Plaque retention Mechanical plaque removal is difficult Depth of fissure is in close proximity to the DEJ

Why do pits and fissures decay? Bacteria accumulate in the narrow pits & fissures Even a single Toothbrush Bristle is too large to enter & clean pits and fissures

Historical Efforts To Prevent Occlusal Caries 1. Extension for prevention Although developed over years ago, this concept is still practiced

Historical efforts to prevent Occlusal Caries 2. Prophylactic odontotomy Hyatt (1923) advocated: Placing a small amalgam restoration before caries develop in deep pits fissures

Historical efforts to prevent Occlusal caries 3. Fissure Eradication Bödecker(1929) suggested: Modifying Deep fissure anatomy by using a large round bur into Wide non-retentive grooves

Historical efforts to prevent Occlusal caries 4. Application of Impregnating solutions by applying Silver nitrate & zinc chloride

Historical efforts to prevent Occlusal caries 5. Application of non-adhesive material Zinc phosphate cement copper cement But with High solubility & poor retention

Historical efforts to prevent Occlusal caries 6. Development of occlusal sealant pit and fissure sealants Introduced into clinical dentistry in 1967 by Michael Buonocore

What is a Fissure sealant ? Definition A low viscosity material flowed into pretreated Pits and Fissures (on occlusal, buccal or palatal surfaces) The Material polymerizes to become hard Sealing decay out

How does a Fissure Sealant Prevent Caries ? 1. Acts as a physical barrier between the sealed area (tooth) & Bacteria in the oral cavity Sealing decay out

How does a Fissure Sealant Prevent Caries ? 2. Eliminate the Environment ( conducive to caries) by Depriving Bacteria from Nutrients Provide a barrier bt pits and fissures – areas which are inaccessible to toothbrush bristles and fermentable CHOs and s mutans.

How does a Fissure Sealant Prevent Caries ? 3. The Microorganisms Covered by the sealant become Static due to: lack of air lack of nutrition

How does a Fissure Sealant Prevent Caries ? 4. Make pits/fissures Easier to clean by - toothbrushing & mastication

Is it necessary to fill the entire depth of the fissure? The sealant is not necessarily required to: Fill the Entire Depth Of The Fissure But Must extend along its entire length

Requirements of Sealant material Adhesion to enamel for extended time. Simple clinical application. Biocompatible. Free flowing (capable of entering narrow fissures). Rapidly polymerized. Low solubility in oral fluids. Enough compressive strength.

Types of Sealant Material 1- ACCORDING TO METHOD OF POLYMERIZATION Autopolymerized. Light-polymerized . 2- ACCORDING TO MATERIAL Resin based Glass ionomer based

Types of Sealant Material 3- ACCORDING TO FILLER CONTENT Filled Unfilled 4- ACCORDING TO COLOR Transparent – clear sealant Colored sealant

Types of Sealant Material 5- ACCORDING TO FLUORIDE CONTENT Fluoridated Sealants. Un fluoridated sealants.

1- ACCORDING TO METHOD OF POLYMERIZATION Autopolymerizing Less expensive Supplied as base and catalyst Operator has no control over polymerization initiation Light-polymerized High cost Need light curing machine Supplied as single liquid (no need for mixing) Operator has control over polymerization initiation

2- ACCORDING TO MATERIAL Glass ionomer sealants Advantages Compared to Resin-Based Sealants: Chemical bonding to enamel. Do not require acid etching of the tooth surface. Not as moisture-sensitive. Generally are easier to place.

Restorative GICs Thicker than the Glass ionomer sealants. Are Not suitable as fissure sealants: Thicker than the Glass ionomer sealants. Do not flow well into Narrow/Deep Pits & fissures

3- According To The Filler Content Filled More resistant to abrasion & wear. Need to be adjusted after placement UnFilled Wear quicker Usually do not need occlusal adjustment

4- ACCORDING to color Colored sealant Transparent or clear sealant More esthetically acceptable Colored sealant The increased visibility: - More precise placement. - Retention can be more accurately monitored

INDICATIONS 1. Caries free, deep or irregular fissures, fossa, or pits in Newly erupted teeth. 2. Fully erupted fossa. 3. If a fossa is well isolated from another fossa with a restoration present. 4. where the contra-lateral tooth surface is carious or restored. 5. Incipient carious lesions. 6. Patient with high caries susceptibility.

INDICATIONS

INDICATIONS

Partially erupted teeth ? To seal or not to seal? Operculum (gum flap) leaks crevicular fluid Apply Fluoride Varnish

Proper Age ? For Deciduous Teeth 3 - 4 years For First Permanent Molars 6 - 7 years For Second Permanent Molars 11-13 years & Premolars

Sealants in adults Should be considered if Evidence of impending caries Such as: - Excessive intake of sugar - Xerostomia cases

CONTRAINDICATIONS If pits and fissures are well coalesced & self-cleansing. Patient behavior does not permit isolation There is an open occlusal or proximal carious lesion. A large occlusal restoration is already present.

The Clinical Procedure Fissure Sealants The Clinical Procedure

Armamentarium Mouth mirror Explorer Acid etch syringe Evacuator Tip Cotton rolls Cotton roll holder Prophy brush Prophylactic Paste (without fluoride) Acid etch syringe Sealant applicator with dispensing tip Curing light Articulating paper Handpiece Round Bur

Armamentarium

Step 1 - Clean the Tooth Surface The tooth surface must be thoroughly cleaned prior to the placement of the sealant. Cleaning can be accomplished by using A Prophylactic Paste (without fluoride) & Prophy Cup or Brush A Toothbrush Hydrogen Peroxide

Clean the Tooth Surface Use products containing No Fluoride or Glycerin After cleaning The tooth surface is rinsed for 20 seconds

An Explorer is used to remove any debris in the pits or fissures

Step 2 - Isolate the Tooth Surfaces The most critical issue For the proper placement of sealants 1. Rubber dam The ideal method But it is not always possible or appropriate for young children. 2. Cotton Rolls are also used with success .

Isolation of Tooth Surfaces

Step 3 - Etch the Tooth Surface Etching the surface (conditioning) by using 37% orthophosphoric acid ( liquid / gel). Etching time 20 seconds (primary /permanent teeth)

ACID ETCHING

ACID ETCHING The Etchant Produces Selective dissolution of the enamel Opening pores into which the resin can flow

Retention of the sealant The Sealant Penetrates into these Surface Irregularities To form : Resin “Tags” approximately 15-25 microns (in length).

Step 4 - Rinse & Dry the Tooth Surface Rinse surfaces with water ( to remove the acid ) Thoroughly dry the etched tooth surface. Check for effectiveness of etching (by drying with air) The surface should appear “chalky white” If not, repeat etching procedure

Step 4 - Rinse and Dry the Tooth Surface Avoid Salivary Contamination If the tooth surface is contaminated by Saliva Repeat The Etching Process

Step 5- Apply the Sealant Material Place Sealant material on the prepared tooth using A Syringe The sealant material should be placed in the pits & fissures up to 2/3 of cusp slopes Use the correct amount Too much material can result in Occlusal Interferences

Step 5- Apply the Sealant Material Chemically cured sealant material ( two components mixed just ) before placement Light cured sealant material ( without any mixing)

Step 6 - Curing the Sealant Before Curing : The Sealant Should Remain Undisturbed For 20 seconds To allow the resin to flow into The pores created by etching

Step 6 - Curing the Sealant Concentrated visible light about 30 seconds The Tip of the curing light wand Held approximately 3 to 5 mm from the surface of the sealant

Chemically cured sealant The curing process Begins as soon as the sealant material is Mixed After the sealant is applied should remain undisturbed for 60 seconds For complete curing

Step 7 - Evaluate the Sealant Immediately after Curing : Evaluate the sealant for Coverage, Retention , Flaws & Occlusion Use an explorer to check for Retention & Flaws

Step 7 - Evaluate the Sealant Check the occlusion Use Articulation tape or paper If there is any occlusion interferences The excess sealant should be Removed Use A Handpiece with Round Finishing Bur

Evaluate the Sealant

Follow-up Educating patients The importance of evaluating sealants on a six-month basis

Sealant failure Is highest soon after placement Sealants within 1 year of placement Sealants To be evaluated clinically for Partial or Total Loss it should be replaced

What if the Sealant Falls Out? If the Occlusal Bulk worn away or lost The clinical evidence Indicates That The Resin Tags remain to protect the surface

Sealant Failure Partially erupted teeth Poor isolation Patient behavioral problems (Very young patients) Occlusal parafunctional habits (wear of sealant) Enamel structural defects : - amelogenesis imperfecta - dentinogenesis imperfecta

For Successful Sealant Retention Have maximum surface area. Seal deep & irregular pits and fissures. Clean & absolutely dry surface at the time of sealant placement. Avoid any contamination with saliva.

Will the unsealed etched enamel surface be more susceptible to caries? Remineralization Begins as soon as saliva coats the surface Saliva forms an organic pellicle over the etched tooth surface protection by remineralization

Sealing Incipient Lesions Do the Caries Continue to Progress? Research findings Consistently indicate The caries process is inhibited

Cost Effectiveness – Do We Save Money? The average cost of: a one surface restoration is more than Double The Cost of a Sealant

Important Information Always read and carefully follow the manufacturer’s instructions when applying dental sealants. The application technique and etching times may vary between manufacturers.

Thank you