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

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

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

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

5. 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

6. 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

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

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

9. 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

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

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

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

13. 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

14. 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

15. 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.

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

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

18. 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

19. 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.

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

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

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

23. 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

24. 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.

25. 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

26. 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

27. 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

28. 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.

29. INDICATIONS

30. INDICATIONS

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

32. Proper Age ? For Deciduous Teeth 3 - 4 years
For First Permanent Molars years
For Second Permanent Molars years
& Premolars

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

34. 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.

35. The Clinical Procedure
Fissure Sealants
The Clinical Procedure

36. 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

37. Armamentarium

38. 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

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

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

41. 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 .

42. Isolation of Tooth Surfaces

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

44. ACID ETCHING

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

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

47. 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

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

49. 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

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

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

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

54. 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

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

56. 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

57. Evaluate the Sealant

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

59. 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

60. 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

61. 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

62. 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.

63. 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

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

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

66. 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.

67. Thank you