Pit and fissure sealants

pit and fissure are the best way to protect teeth from any future caries in high caries risk patients

1. Pit and Fissure Sealants Dr Alvi Fatima MDS 1 st year Department of Pediatric Dentistry 1

2. Contents Definitions History Types of fissure Classification Material used as sealants Requisites of an effective Sealants Age arrange for sealant application Indication and contraindication Technique of application Recent advancement 2

3. Pit It is defined as a small pinpoint depression located at the junction of the developmental grooves or at terminals of those grooves. The central pits describes a landmark in the central fossa of the molars where the developmental grooves join --Ash 1993 3

4. Fissure It is defined as the deep clefts between adjoining cusps. They provide areas for retention of caries producing agents. These defects occur on the occlusal surfaces of the molars and premolars, with torturous configurations that are difficult to assess from the surfaces. These areas are impossible to keep clean and highly susceptible to advancement of carious lesions -- O rbans 1990 4

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6. Definition of Pit and Fissure sealants Material that is introduced in the pit and fissures of caries susceptible teeth, thus forming micromechanically-bonded, protective layer cutting the access of caries producing bacteria from their source nutrient. -- S imonsen 6

7. According to ADA An adhesive material that is applied to the pit and fissure of a teeth in order to isolate from rest of the oral cavity 7

8. History methods aimed to eliminate pits and fissures have been tried since 1900s In 1905 : Application of silver nitrate by Miller In 1922: Hyatt advocated a term ‘Prophylactic Odontomy ’. The fissures were filled with silver or copper oxy-phosphate cement as soon as teeth erupted and later, after fully erupted, a small occlusal cavity was prepared and filled with amalgam 8

9. In 1929: Bodecker proposed a technique called fissure eradication. In this mechanical eradication of fissure to transform into deep, retentive fissures in to cleanable areas In 1995: Bunocore introduced a method of adhering resins to an acid-etched enamel surface In 1962: Bowen and associate developed the Bis -GMA resin, which is the chemical reaction product of Bisphenol A and Glycidyl methacrylate 9

10. Types of fissure V type and U type 34% and 14% respectively Are shallow and wide and tend to be self cleansing and some what caries resistance Non-invasive technique is recommended 10

11. I type I t is deep narrow and quite constricted, resemble a bottle neck Are caries susceptible Requires invasive technique Combination type 11

12. IK- type: Seen as narrow slit associated with a larger shape at the bottom (26%), R equires invasive technique, V ery susceptible to caries . Inverted Y type: 5% to 10% 12

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14. Classification According to Mitchell and Gordon (1990) : Polymerization methods Resins systems Filled and unfilled Clear or tinned 14

15. Polymerization method Self activation (mixing two components) Light activation First generation Polymerized with ultraviolet rays of 350nm wave length 15

16. Second generation Self cured or chemically cured. Third generation Visible light cured of 430-490nm wave length. Fourth generation Fluoride releasing sealants 16

17. Resin system Bis -GMA (bisphenol A- glycidyl methacrylate) Urethane acrylate 17

18. Filled and unfilled Filled Resistance to wear Need occlusion adjustment Unfilled Better flow More retention Abrade easily 18

19. Clear or tinned Clear sealants show better flow characteristic than tinned. I t is both advantage and disadvantage according to position of tooth that needs to be sealed Retention rates are similar of both, colored sealants are more appreciated by patients and monitored by dentist at subsequent recalls 19

20. Materials used as sealants Cyanoacrylates Discovered in late 1950s Use as surgical adhesive and tooth sealants In presence of trace of moisture they polymerize rapidly to hard tissues and brittle polymer on etched tooth surface 20

21. Mechanical durability is not satisfactory and its not biodegradable . This was later replaced by butyl and isobutyl ester which was found to be more suitable 21

22. Poly urethanes Not regularly used due to poor mechanical properties and oral durability and toxicity Eg E poxylite 22

23. Dimethylacrylate Methyl methacrylate is highly volatile and lacks penetration Bis -GMA is a viscous amber liquid of low volatile diluted with MMA (3:1) for use of sealant 23

24. Glass ionomer cements Developed by Mc Lean and Wilson Hydrophilic, good adhesion, biocompatible, fluoride release Used for fissure whose orifices exceed 100µm. 24

25. Requisites of an effective Sealants ( Brauer , 1978) A viscosity allowing penetration into deep and narrow fissure even in maxillary teeth Adequate working time Rapid cure Good and prolonged adhesion to the enamel Low sorption and solubility Resistance to wear Minimum irritation to tissue C ariostatic action 25

26. Age range for sealant application 3-4 years of age for primary molars 6-7 years of age for the first permanent molars 11-13 years of age for second permanent molars and p remolars 26

27. The approach for considering only selected patients for sealants by Simonsens in 1983 into 3 groups Group 1: caries free patients judged at no risk to decay Group 2: patients judged to be at moderate risk for decay Group 3: patients with rampant caries at high risk Sealing is done in group 2 and not in group 1 and 3 27

28. Indication Newly erupted both primary and permanent premolars and molars with complete recession of pericoronal operculum and with wide open and/or sticky grooves and fissure. Stained pit and fissures with minimum decalcification or opacification and no softness at the base of fissure The tooth is in question should have erupted less then 4 years ago. 28

29. Contraindication Individuals with no previous caries experience and well coalsced pit and fissure Radiographic or clinical evidence of caries on the proximal surface should not be sealed Wide and self-cleansable pits and fissure Tooth that cannot be isolated or partially erupted Pit and fissures that have been remained carious free for 4 years or longer 29

30. Technique of application 30

31. CLEAN THE TOOTH SURFACE : The surface should be cleaned first with slurry of pumice and water. It is important that not a fluoride containing paste o r prophy paste, as they compromise the acid etching procedure 31

32. Washing and drying The tooth is then washed with water and air dried. Etching Occlusion it then etched with 30-50% solution of phosphoric acid liquid or gel for 60secods 32

33. Washing and drying The tooth is washed for 30 seconds to remove all the etchant and then air-dried. A proper etched tooth has a dull frosted appearance If the surface is contaminated with moisture it has to be re-etched for an additional 10 seconds 33

34. Application of the materials Care must be taken to avoid incorporating air bubble Curing Curing is done according to manufacturer’s direction After fully curing of material it is examined with an explorer for All pits and fissure are cured All excessive material is removed Material id adherent to enamel surface 34

35. Recall Sealant should be checked at subsequent re-calls for It is still firmly adherent No sealant material has been lost 35

36. Pit and fissure sealant product Alpha-dent light cure pit and fissure sealant Baritone L3 Helioseal F Helioseal 36

37. Recent advancements Moist tolerant PSF: Traditional sealants were hydrophobic required a complete dry environment, the new sealant has moisture control chemistry that is hydrophilic moisture-tolerant-resin-based sealant named Embrace Wet Bond . 37

38. Fluoride releasing PFS Fillers are added to the resin sealants which contained fluoride 38 Pit and Fissure Sealants: A Recent Advancement: International Journal of Oral Health Care and Research, Octuber -December 2016;4(4):284-7

39.   ACP-pit & fissure sealants . (Amorphous calcium phosphate sealant ) Eg : Bosworth Aegis pit & fissure sealants 39 Zawaidesh FI, Owais AL, Kawaja W. Ability of pit and fissure sealant-containing amorphous calcium phosphate to inhibit enamel demineralization. international journal of pediatric dentistry2016;9(1 ):10-4

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