1. Fissure sealants DCP1 S2 Lecture 8 - part 1 By Dr A. Eldarrat & A. Uni

3. Objectives To understand the following:
Role of fissure sealants in preventive dentistry.
Indications/contraindications; advantages and disadvantages
of fissure sealants.
Different types of materials used as fissure sealants and their advantages and disadvantages.

4. Objectives
Acid etch technique and the mechanism of bonding of resin based sealants.
To be able to apply fissure sealants (Composite resin sealants and Glass ionomer sealants) on natural teeth in the laboratory situation.
To be able to critically evaluate the quality of composite resin fissure sealants after placement.

5. FISSURE CARIES

6. Early caries in fissure
confined to enamel only [Incipient Caries]
Fluoride prevents smooth surface caries – but limited in preventing pit/fissure caries
Pit and fissure caries is major problem for many children

7. Early caries in fissure Enamel spread [Incipient Caries]

8. Spread to DEJ and involves dentine
Caries in fissure
Spread to DEJ and involves dentine

9. Dentine involvement – note: no cavitation
Caries in fissure
Dentine involvement – note: no cavitation

10. Why do pits and fissures decay?
Morphology of the pits (buccal/palatal) and fissures

11. Why do pits and fissures decay?
Two main types of pits and fissures:
1. Shallow, wide, V-shaped fissure

12. 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

13. Diagnosis of pit/fissure caries
Diagnosis of pit/fissure caries - can be very difficult
3 Possibilities
No caries
Definite caries
Questionable caries

14. Are these fissures carious or just stained ?

15. Are these fissures carious or just stained ?

16. Management of Questionable pit/fissure early caries
Monitor tooth surface over period of time in conjunction with other caries preventive measures.
Mechanically open up fissures with a bur/air abrasion and check if carious (invasive?)
Fissure seal with fissure sealant.

17. What is a Fissure sealant ?
Definition:
A low viscosity material which is flowed into pretreated pit or fissure on (occlusal, buccal, palatal surfaces) which fills the pits/fissures.
The Material polymerizes into a hard material.
Acts as a physical barrier between the sealed area of the tooth and the bacteria in the oral cavity.
Sealants are used as preventive and therapeutic treatment.
Sealing decay out

18. How does a Fissure sealant prevent caries ?
1. Physical barrier in the pit/fissure of the
tooth.
2. Eliminate the environment conducive to s.mutans.
3. Make pit/fissures easier to clean by tooth brushing and mastication
Provide a barrier bt pits and fissures – areas which are inaccessible to toothbrush bristles and fermentable CHOs and s mutans.

19. Indications for fissure sealing for children and adults
Caries risk status.
Tooth morphology.
Age of patient.

20. Contraindications to fissure sealing
Shallow, self cleansing pits/fissures.
Patient with low or negligible caries risk (eg. no new lesions or past restorations).
Partially erupted teeth in which all pits/fissures not exposed to oral cavity.

21. Cont.
If can not obtain excellent moisture control (for composite resin FS).
Occlusal caries has progressed into the dentine.
Tooth has proximal caries.
Uncooperative child/patient.

22. Sealing over early occlusal caries? [Advantages and disadvantages]
Caries can be in-activated if
use a CR sealant that is well bonded.
use GIC Fuji 7 sealant.
(Chemical adhesion & high Fluoride release)
Caries can progress
If place a CR sealant which is poorly bonded or partially lost.
(Use your own clinical judgement and assess each case carefully)

23. Partially erupted teeth Seal or wait until fully erupted?
For Composite Resin
If seal whilst partially erupted - Risk of sealant failure
Risk of caries development
For Glass Ionomer Fissure sealant- Fuji 7 only
can be placed in situations where tooth can be partially erupted because of its ability to be placed in conditions where moisture control can not be optimally maintained.
More appropriate material to use in this clinical situation.

24. What type of sealant materials are available?
1. Composite resin (CR)
2. Glass ionomer (GI)

25. Composite resin sealants
BIS-GMA (Bowen’s resin)
low viscosity unfilled or partially filled resins.
Polymerised.
2 bottles
(base and catalyst which are
mixed together)

26. Composite resin sealants
a. Self-cured sealant.
(also known as auto-cured or chemically-cured).
b. Light-cured sealant.
[white light (wavelength nm) equipped with a blue filter].
Kidd and Smith 1996

27. Composite resin sealants
Advantages/Disadvantages
Clear/Opaque sealants

29. Composite resin fissure sealant
- light cured opaque type

30. Glass ionomer sealants
Chemical bond to enamel.
Fluoride release.
New GIC material- Fuji 7
high fluoride release (6 x more) than other restorative GICs.
has good flow properties and flow well into pits/fissures.
moisture tolerant.
has a strong fused layer which is acid resistant & continues
to offer protection to occlusal surface even when it
appears “visually” lost due to wear.
Restorative GICs tend not to be suited as fissure sealants as
are thicker and do not flow well into narrow/deep
pits & fissures

31. Fuji 7 GIC

32. Restorative Glass ionomer fissure sealant
Mount & Hume, 2005

33. Summary
Effective primary preventive measure against pit and fissure caries.
- prevent plaque accumulation - hence prevent pit & fissure caries.
arrest very early pit/fissure caries.
Can be used as part of patients’ overall caries prevention/management plan.

34. Summary Conservative (Minimal Intervention). – non invasive
Relatively Painless.

35. Summary Benefits children and adults- if at risk pit/fissures sealed.
Commonly used fissure sealants are light cured resin sealants but the new Fuji 7 GIC material gives us more options
Cost effective – if careful case selection.

36. Thank you