Pit and fissure sealants

pit and fissure sealants

1. PIT AND FISSURE SEALANTS PRESENTED BY KARUNA SHARMA Pg student

2. INTRODUCTION DEFINITION HISTORY CLASSIFICATION INDICATIONS CONTRAINDICATIONS PROCEDURE CURRENT STATUS OF PIT AND FISSURE SEALANT CONCLUSION CONTENTS

3. DEFINITION

4. According to Simonsen A material that is introduced into the pit and fissures of caries susceptible teeth, thus forming a micromechanically bonded, protective layer cutting access of caries producing bacteria from their source of nutrients .

5. pit-and-fissure-sealants-9pit-and-fissure-sealants-9

6. I1st gener at 1 st generation UV light with wavelength of 356 μ m Eg-Nuvalite 2 nd generation Self cure Eg -Concise white (3M), delton 3 rd generation Visible lightof 430-490 μ m Eg-Helioseal 4 th generation Fluoride releasing Eg -Seal right ( pulpdent )

7. Clear:esthetic but difficult to detect in recall visits White tinted/ opaque:contain opaquing agent titanium dioxide. Coloured:easy to see during placement and recall eg:Helioseal (white colour changes to green) Based on colour

8. Based on curing Autopolymerizing Light cure

9. 1.Resin based sealants and 2.glass ionomer cements. 3.Compomers 4.Fluoride releasing Resin based sealants- Available resin-based sealant materials can be polymerized by autopolymerization , photopolymerization using visible light or a combination of the two processes. ACCORDING TO EAPD

10. Glass ionomer cements are available in two forms, both of which contain fluoride: conventional and resin-modified. Glass ionomer cements, which do not require acid etching of the tooth surface, generally are easier to place than are resin-based sealants. They also are not as moisture-sensitive as their resin-based counterparts. Glass ionomer materials, which were developed for their ability to release fluoride, can bond directly with enamel.

11. The caries preventive effect of a glass ionomer sealant depends on both retention of the sealant and fluoride release. The poor retention of glass ionomer sealants probably precludes them from use as sealants, particularly in lieu of evidence of superior caries prevention despite the poor retention

12. Compomers . Compomers are currently being investigated widely in both in vitro and in vivo studies. Amount of F released in distilled water is considerably less than GIC . Clinical results show comparability with resin FS [ Glavina et al., 2001], their properties should be estimated as comparable to the resins.

13. Fluoride containing sealants. The durability of F containing FS would now appear to be comparable to conventional resin FS.

14. Based on ADA seal of acceptance Alpha fluor seal II Alpha dent chemi cure Alpha dent light cure Concise light cure white cement Helioseal Primashield

15. ACCORDING TO NUGANO 1961 V TYPE U TYPE I TYPE IK TYPE INVERTED Y TYPE MORPHOLOGY OF PIT AND FISSURES

16. EVALUATION OF PIT AND FISSURE SURFACES

17. Tooth surface with an early ( noncavitated ) carious lesion that exhibits a white demineralization line around the margin of the pit and fissure and /or a light brown discoloration within the confines of the pit-and-fissure area.

18. A small, distinct, dark brown early ( noncavitated ) carious lesion within the confines of the fissure.

19. A deep fissure area (arrow 1) and another area exhibiting a small light brown pit and fissure (arrow 2). Note that the lesion does not extend beyond the confines of the pit and fissure.

20. A more distinct early ( noncavitated ) carious lesion (arrow) that is larger than the normal anatomical size of the fissure area.

21. A more distinct early ( noncavitated ) carious lesion (arrow) that is larger than the normal anatomical size of the fissure area.

22. RISK ASSESSMENT OF THE INDIVIDUAL

23. Simonsen in 1983 gave 3 groups of patients Group I : Caries free patients with no risk to decay. Group II : Moderate risk to decay. Group III : Patient with rampant caries at a high risk to decay. Sealing of teeth in group 2 patient is done.

24. Clinical judgment is done to select the teeth that are most likely to decay based on - Age Oral hygiene Familial and individual history of dental caries. Fluoride environment and history. Dietary habits. Tooth type and morphology.

25. CONTRAINDICATIONS If pit and fissure have remained caries free for 4 yr or longer The tooth cannot be isolated Caries on proximal surface of tooth

26. CLINICAL TECHNIQUE

27. Silverstone concluded that salivary contamination will lead to decreased bond strength. Hitt and Fiegal postulated that application of halogenated bonding agent displaced saliva from enamel improving sealant wetting of surface.

28. The clinical technique for pit and fissure sealant application involves strict attention to detail and perfect isolation for maintenance of a dry field. Dry brushing, rotary brushing with pumice paste, air polishing and air abrasion have all been used to clean the enamel surface prior to etching. TOOTH PREPARATION

29. Sol et al, found that use of a sodium bicarbonate air polishing system resulted in a statistically significant higher retention of sealant.

30. RINSE AND DRY THE TOOTH SURFACE   Rinse the etched tooth surface with water for 30 sec. Dry the tooth surface for atleast 15 sec. with uncontaminated compressed air. Dried etched enamel should have frosted white appearance. Repeat the etching step if necessary. Moisture contamination-most common cause of sealant failure.

31. In one study, it was noted that argon laser polymerization provides further caries protection against a cariogenic challenge over that afforded by fluoride-releasing sealants.

32. The sealant should be visually and tactually inspected for complete coverage and absence of voids or bubbles. Attempts should be made to dislodge the sealant with an explorer. If the sealant is dislodged, the tooth should be carefully inspected to see that no debris has been left in the fissure, which may have interfered with the bond. Small voids in the sealant can be repaired simply by adding new material to the void and polymerizing. EVALUATION

33. Some sealants will be completely or partially lost and will require reapplication. The need for reapplication of sealants is usually highest during the first 6 months after placement.

34. CURRENT TRENDS IN PIT AND FISSURE SEALANTS

35. Garcia Godoy, 1977 found out that all the fluoridated sealant had the greatest amount of fluoride release by 24 hrs after mixing and the fluoride release declined sharply thereafter. 60 % reduction in secondary caries and enhanced degree of caries resistance was seen.eg-seal right

36. Two methods of fluoride incorporation into pit and fissure sealants are used. In first method, fluoride is added to unpolymerized resin in the form of a soluble fluoride salt. After the sealant is applied to the tooth, salt dissolves and fluoride ions are released, Helioseal -F is produced based on this procedure.

37. The second method of incorporating fluoride is by addition of an organic fluoride compound that is chemically bound to the resin to form an ion exchange resin; Teethmate F-1 is based on this method.

38. More recently, a commercially available sealant with fluoride was marketed that purportedly releases fluoride ( fluoroshield ). Fluoride releasing sealants have shown antibacterial properties as well as greater resistance to caries in comparison to nonfluoridated sealants.

39. Bonding agents, also known as adhesives, may be used when applying pit-and-fissure sealants. Current bonding systems are marketed as total And self-etch systems. The total-etch systems involve a three- or two- step placement technique, with a separate step for acid etching. The selfetch systems are packaged either as self- etching primers with separate adhesives or all-in- one systems that combine acid etchants, primers and adhesives. Both systems are available in single or multiple bottles.

40. Enamel Loc is the world's first and only self-etching sealant. Self-etching One Step Fluoride-release formula Low viscosity Filled resin Proven adhesion to unetched enamel- 21MPa

41. COLORED PIT AND FISSURE SEALANT CLINPRO SEALANT Rs 1200

42. This sealant is clear to begin with but after polymerization it changes its color. The degree of color change is also an indicator of its setting and adequate polymerization. Easy to see during placement and recall Eg - clinpro pink changes to pink on setting

43. FLUORESCING PIT AND FISSURE SEALANT DELTON SEAL-N-GLO (DENTSPLY) RS 2800

44. This sealant eliminates the guesswork involved with placing sealants and confirming placement during recall appointments. Through the use of a UV pen light, this sealant fluoresces a blue/white color. The fluoroscent glow provides clinicians with a visual verification of the sealant margins at the time of placement and offers the easiest way to verify retention and inspect margins at the time of placement and offers the easiest way to verify retention and inspect margins during patient recall appointments.

45. PIT AND FISSURE SEALANT WITH ACP AEGIS PIT AND FISSURE SEALANT

46. It is a light cured sealant that contains the smart material Amorphous Calcium Phosphate (ACP) that is more resilient and flexible, creating a stronger, longer-lasting sealant. It has a controlled flowability that keeps the sealant on the tooth structure while completely filling occlusal surfaces and it forms a chemical and thermal barrier protecting the tooth enamel on the occlusal surface from carious attacks.

47. WETBOND PIT AND FISSURE SEALANT Embrace Sealant Kit: 4 x 1.2 mL syringes, natural shade + 20 applicator tips $84.25

48. It bonds chemically and micromechanically to the moist tooth, integrating with the tooth structure to create a strong, margin free bond that virtually eliminates microleakage . This is the first pit and fissure sealant resin that can be applied in a moist field. It forms a unique resin acid-integrating network (RAIN) that improves penetration into pits and fissures and provides superior sealing of the margins.

49. COMPOMER PIT AND FISSURE SEALANT

50. The Ionosit Seal compomer pit and fissure sealant contains an ionomer glass in a matrix of polymerizable oligo and polycarbonic acids. Has a high abrasion resistance and, because it releases zinc ions, a bactericidal effect. Consequently it offers a reliable, long lasting seal to caries susceptible pits and fissures. Ionosit Seal is a one-component material supplied in hygienic 0.1ml Mikrotips . It is easily adjustable, and has long tipped nozzles thus making it a more precise application. This can done using either an Ecu -Pen or Ecu -Jet dispenser.

51. SEALANT RETENTION Simonsen reported 15 yrs retention rates for single application of sealants on permanent molars. 27.6% showed complete retention 35% showed partial retention 68.8% remain caries free 17% of unsealed teeth were caries free CRITICAL ISSUES

52. COST EFFECTIVENESS Simonsen suggested that over a 10 yr period the cost of restoring unsealed surface was 1.64 times the cost of application of sealant.

53. According to research, Systemic BPA has not been detected as a result of the use of such sealants, and potential estrogenicity at such low levels of exposure has not been documented. ESTROGENICITY ISSUE

54. Pit-and-fissure sealants can be used effectively as part of a comprehensive approach to caries prevention. While sealants have been used for primary caries prevention, current evidence indicates that sealants also are an effective secondary preventive approach when placed on early noncavitated carious lesions. Caries risk assessment is an important component in the decision making process, and it is important to Reevaluate a patient’s caries risk status periodically. CONCLUSION

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