Pit and Fissure Sealants

Uses of pit and fissure sealants in dentistry , dental,health, pediatrics, pedodontics, pedodontist, prevention dentistry, fillings, resin

1. Pit and Fissure Sealants By: Mohammed Kareem Radhi

2. 1 2 3 4 Table of contents Introduction Definition of Pit and fissure sealants classification of occlusal fissure Indications 5 Contraindications 6 Types of Sealants 7 Preparation & Equipment 8 Sealant Application

3. Introduction Pits and fissures of the occlusal surfaces of the posterior teeth are more prone to caries development than the smooth surfaces due to their morphological complexity, making dental hygiene more challenging leading to increased plaque accumulation. The use of pit and fissure sealants provides a physical barrier that inhibits microorganisms and food particles accumulation, preventing caries initiation, and arresting caries progression

4. classification of occlusal fissure Nagano(1960) in study of crown sections classified occlusal fissure into five types on the basis of fissure morphology: V, U, Y, I, K types.

5. Permanent first molars , followed by second molars , show the highest caries prevalence. The management of occlusal caries on permanent molars represents a significant challenge because the onset of caries occurs soon after they erupt into the oral cavity. The effectiveness of pit and fissure sealants relays on their long-term retention

6. Definition Pit and fissure sealants are defined as ‘ a cement or a resin which is introduced into unprepared occlusal pits and fissures of caries susceptible teeth forming a mechanical and physical protective layer against the action of acid producing bacteria and their substrates

7. Indications Pit and fissure sealants can be utilized as a primary prevention tool when the tooth or the patient is at an increased risk of experiencing caries or as a secondary prevention method interrupting the progression of incipient caries.

8. The indications for placing a pit and fissure sealant are as follow: Pits and fissures of deciduous teeth in children when the tooth, or the patient, is at an increased risk of experiencing caries Pits and fissures of permanent teeth in children and adolescents when the tooth, or the patient, is at risk of experiencing caries Pits and fissures of permanent teeth in adults when the tooth, or the patient, is at risk of experiencing caries . Incipient carious lesions (non-cavitated) of pits and fissures in children, adolescents, and adults Pit and fissures of primary and permanent teeth should be considered in children and young people with medical, physical, or intellectual disabilities, mostly when systemic health could be jeopardized by dental disease or the need for dental treatment

9. Contraindications Dental professionals should decide to place a pit and fissure sealant based on the patient's risk, not the age or time lapsed since tooth eruption . If the patient does not exhibit any risk factors or is at low risk of developing carious lesions, there is no need to perform this preventive measure at that time. However, it is essential to highlight that all children should be regularly monitored for any changes in cariogenic risk factors or clinical or radiographic changes . Generally its not used if : Open occlusal carious lesion. Caries exist on other surfaces of the same tooth. A large occlusal restoration is already present

10. Types of Sealants Based on generation 1. Generation 1 Sealant (photocured via UV light). 2. Generation 2 Sealant (auto or chemically-cured). 3. Generation 3 Sealant (photocured via visible light). B. Based on fillers Unfilled. Filled sealant (fillers increase abrasion resistance strength). Fillers: glass and quartz particles. Fluoride -Releasing .

11. Types of Sealants C. Based on Color Helps in quick identification for equation during maintenance assessment: 1. Clear: Esthetic but difficult to detect in follow up. 2. Tinted/opaque sealant: easy to detect. Three types of materials are utilized as sealants: Resin Glass ionomer (traditional and resin-modified) Polyacid-modified resins . The most commonly accepted material is the Resin-based sealant , as it has shown superior retention rates compared with glass ionomer sealants

12. Preparation & Equipment Preparation The need and the method for surface cleansing of pits and fissures before placing a sealant may seem controversial. Some authors have suggested using pumice or air-polishing instruments to obtain an optimal acid-etch pattern of the enamel. At the same time, others believe that acid etching alone is sufficient for surface cleaning Equipment Air/water syringe Mouth mirror Explorer Excavator tip Two by two gauze squares Cotton rolls Cotton pellets Forceps/cotton pliers Articulating paper Curing light Handpiece Dappen dish with pumice

13. Procedure of Pit and Fissure Sealant Application 1. Surface Cleanliness of the Tooth Usually the acid etching alone is sufficient for surface cleaning. Pumice and water slurry are used to the occlusal surface. Slurry must be non-fluoride, oil free mixture to avoid contamination of the tooth surface. Hydrogen peroxide also been tried as a cleaning agent but, it has the disadvantage that it produces a precipitate on the enamel surface. All heavy stains, deposits, and debris should be off the occlusal surface before applying the sealant. 2. Dryness of the Tooth Surface The teeth must be dry at the time of sealant placement. A dry field can be maintained by several ways, such as by the use of rubber dam, applying cotton rolls, bibulous pads over the opening of the parotid duct. Isolation of a tooth are done mainly by using cotton rolls.

14. Procedure of Pit and Fissure Sealant Application 3. Preparing the Tooth for Sealant Application Acid Etching Most frequently used: 37% orthophosphoric acid (gel) Gel applied either directly with special application tips or with a small disposable brush Should be applied to all the susceptible pits and fissures and extend up to cuspal inclines Etch for 15 seconds for permanent molars, 15 to 30 seconds for primary teeth. Teeth with dental fluorosis require additional etching time If glass ionomer cement is being used, etching is not required, and a surface conditioner may be used Rinse well with air-water spray Dry the tooth If the surface becomes contaminated, re-etching must be done

15. Procedure of Pit and Fissure Sealant Application 4. Sealant Placement and Curing Many sealant kits have their own dispensers and instructions that must be followed. Apply sealant, allow to flow into pits and fissures In mandibular teeth, apply the sealant from the distal aspect, allow flowing mesially In maxillary teeth, apply the sealant from the mesial aspect, allowing to flow distally Use a fine brush, mini sponge, and carry sealant material up to the cuspal inclines Air bubbles should not be incorporated Visible Light Cured Sealant 10 to 20 seconds: exposure to visible light

16. Retention of Sealants Plastic sealants are retained better on recently erupted teeth. It is better on first molars than on second molars . It is better retained on mandibular than on the maxillary teeth.

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18. REFERENCES Clifford M Sturdevant . The art and science of operative dentistry. William Gilmore H. Operative dentistry. Robert G Craig. Restorative dental materials. Norman O Harris, Arden G Christen. Primary Preventive Dentistry. 3 rd edition. Pediatric Dentistry: Infancy Through Adolescence Sixth edition Janice Carvalho JC. Caries process on occlusal surfaces: evolving evidence and understanding. Caries Res. 2014;48(4):339-46. Rohr M, Makinson OF, Burrow MF. Pits and fissures: morphology. ASDC J Dent Child. 1991 Mar-Apr;58(2):97-103. Liu W, Xiong L, Li J, Guo C, Fan W, Huang S. The anticaries effects of pit and fissure sealant in the first permanent molars of school-age children from Guangzhou: a population-based cohort study. BMC Oral Health. 2019 Jul 16;19(1):156. Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch B, Ismail A, Kohn W, Siegal M, Simonsen R., American Dental Association Council on Scientific Affairs. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2008 Mar;139(3):257-68.

19. REFERENCES 10. Ahovuo-Saloranta A, Forss H, Walsh T, Nordblad A, Mäkelä M, Worthington HV. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev. 2017 Jul 31;7(7):CD001830. 11. Naaman R, El- Housseiny AA, Alamoudi N. The Use of Pit and Fissure Sealants-A Literature Review. Dent J (Basel). 2017 Dec 11;5(4) 12. Handbook of pediatric dentistry 4th edition