Fissure sealing

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1. Fissure sealing

2. Anatomical background The process of enamel mineralization begins long before teething. Immediately after eruption and over the next 2 years, the mineralization of the teeth proceeds quite quickly, then it slows down. In the process of "ripening" occurs first rapid and then slower saturation of the enamel with macro- and microelements. The composition of enamel includes hydroxyapatites, fluorapatites, carboxyapatites and chlorapatites.

3. Anatomical background The enamel of an immature tooth is characterized by greater porosity and a lower crystal packing density. Immature enamel contains fewer fluorapatite-like crystals, which are less soluble in acids than hydroxyapatites, making it more vulnerable to acids. With a decrease in the level of health and the presence of local risk factors for the development of caries, spontaneous fissure sealing does not occur.

4. Anatomical background Often there is a spontaneous sealing of fissures in a natural way. In such cases, dense, highly mineralized formations, heterogeneous in structure, are found in the fissures. Mineral formations are located at the very bottom of the fissures - this is the only anatomical zone where the centrifugal currents of cerebrospinal fluid coming from neighboring tubercles and folds are concentrated at one point, i.e. natural mineral sealing of fissures occurs mainly due to enamel liquor.

5. Types of fissure structure funnel-shaped conical teardrop polypoid open deep "Ampoule" type "Ampoule" type

6. Fissure depth 0.25-3.0 mm Bottom width 0.1-1.2 mm Orifice width 0.005-1.5 mm

7. The method of obturation of fissures and other anatomical recesses of healthy teeth with special sealing materials in order to create a barrier for external cariogenic factors.

8. Fissure sealing functions: Creates a barrier to cariogenic bacteria It has a remineralizing effect on the enamel, if the sealant contains active ions

9. Indications for sealing: Presence of deep fissures Intact fissures, absence of fissure caries Incomplete mineralization of the chewing surface of the tooth Minimum period since tooth eruption Initial caries

10. Contraindications for sealing: Presence of intact wide, well-communicating fissures Teeth with healthy pits and fissures but carious lesions on proximal surfaces Pits and fissures that have remained healthy for 4 years or more do not require sealing Poor oral hygiene

11. Fissure sealants Types of composite sealants: Self-polymerizing or chemo-curing: "Concise White Sealant" (3M, USA), "Delton" (Johnson and Johnson), "Delton", "Fis Seal" (Russia) Photopolymerizable: Estisial LC (Kulrer), Sealant (Bisco), Fissurit, Fissurit F (Voco), Delton-S, Fis Seal-S (Russia)

12. Fissure sealants Opaque (opaque) Transparent: Painted Unpainted Transparent sealants are used to monitor the progress of caries, but are more difficult to detect on the surface of the tooth.

13. Fissure sealants Fluorine containing (Fissurit) Fluorine free (Fissurit F) In recent years, GIC has been used as a sealant. Due to the F, Al, Zn, Ca contained in the GRC, these materials have a pronounced cariesstatic effect. However, their safety, in comparison with composites, is reduced.

14. Sealing materials

15. Sealing methods non-invasive invasive

16. Stages of an invasive sealing method Cleaning of the occlusal surface of the tooth, walls and bottom of the fissure. Rinsing and drying of cleaned surfaces. Isolation of teeth from saliva. Fissure opening. Expansion of the fissure entrance with a needle-shaped diamond bur for visual inspection.

17. Stages of an invasive sealing method If caries is limited to the enamel zone, then the base of the cavity and the entire fissure are etched within 15 seconds. The tooth is rinsed with water for 30 seconds and dried. In case of unsatisfactory results of etching or ingress of saliva, repeat the procedure. A suitable composite is placed in the cavity, a contour is created, light curing occurs within 60 seconds. The composite filling and the entire fissure are covered with a sealant. Occlusion check, correction. Fluorine preparation.

18. Stages of an invasive sealing method In the presence of cavity carious lesions with a small diameter (no more than 1/3 of the distance between the buccal, lingual, palatine tubercles), the fissure is sealed with a lining. SIC is used as a lining. If, during the opening of the fissure, it is found that caries has affected the dentin, and its lateral location leads to the fact that the edges of the filling will be in the zone of occlusal contacts, one CIC cannot withstand chewing loads. It is used as a lining for an occlusal composite filling.

19. Stages of a non-invasive sealing method Thorough cleaning of the occlusal surface of the tooth, walls and bottom of the fissure, removal of soft plaque, food debris using circular brushes and special products that do not contain fluoride and oils (keint paste (voco)). Cleaned surfaces should be rinsed and dried to ensure there is no carious lesion. Isolation of teeth to be sealed with a rubber dam or cotton rolls. Acid surface preparation. Etching of enamel with special gels (“Vokocid” - Voco, Unietch, All-etch-“Bisco”), or others based on phosphoric acid for 15-20 seconds. Rinse with water for 15-20 seconds.

20. Re-isolation of the tooth from saliva. Application of sealant on the prepared enamel surface, distributing a thin layer over the entire surface of the fissure without voids, repeating the contours of the fissure with a probe or brush. For self-curing sealants, wait 3-5 minutes. For light-cured sealants, direct the light source for 15-20 seconds for opaque and filled.

21. After curing, it is necessary to wipe off the surface inhibition layer with a cotton ball, and then check the occlusal contacts using carbon paper and, if there are supercontacts, polish them using ball-shaped carbide or diamond burs. The final stage is the application with a fluorine-containing varnish or gel (Fluoride varnish, Fluocal-gel, Fluoridin gel).

22. Factors for Successful Sealant Application Adequate acid treatment of enamel. Thorough subsequent flushing of the acid. Preservation of the prepared enamel prior to sealant application with dry and unmoistened saliva. Adequate light intensity and penetration for complete polymerization.

23. Fissure sealing is effective for 5-8 years!

24. Thank you for your attention !