Pit and fissure sealants

Pit and fissure sealants

1. Pit and Fissure Sealants Muhammad Rafay Imran 1

2. Pit and Fissure Sealants According to American Dental Association (ADA) dental sealant is an adhesive material that is applied to pits and fissures of teeth in order to isolate from rest of the oral cavity. 2

3. Why fissure sealants are needed? From a primary prevention perspective , anatomic grooves or pits and fissures on occlusal surfaces of permanent molars trap food debris and promote the presence of bacterial biofilm, thereby increasing the risk of developing carious lesions. Effectively penetrating and sealing these surfaces with a dental material—for example, pit-and-fissure sealants—can prevent lesions and is part of a comprehensive caries management approach From a secondary prevention perspective , there is evidence that sealants also can inhibit the progression of noncavitated carious lesions . The use of sealants to arrest or inhibit the progression of carious lesions is important to the clinician when determining the appropriate intervention for noncavitated carious lesions . Reference : Use of Pit and fissure sealants American Academy of Pediatric Dentistry and American dental association 2016 3

4. Mechanism of Action They eliminate the geometry that harbors bacteria and to prevent nutrients reaching bacteria in the base of pit or fissure. Reference: Chapter#14 Art and Science of Operative Dentistry By Harald O Heymann Edward J Swift Jr Andre V Ritter 4

5. Types of Pit and fissure sealants 5

6. Resin based sealants versus Glass ionomer sealants Background/Purpose Atraumatic restorative treatment (ART) was developed primarily for use in under-served areas of the world. This study was designed to compare caries prevention with high-viscosity glass ionomer cement (GIC) sealants placed according to the ART procedure and light-cured composite resin sealants after 3 years. Methods The study was conducted in a boarding school in the city of Kırıkkale . Four experienced dentists placed a total of 207 sealants (91 GIC and 116 composite resin), without chair-side assistance, on the school premises. Results A total of 137 sealants were available after 3 years. 55.3% of the GIC and 93.8% of the composite resin sealants were lost completely, and the difference between the two groups was statistically significant. Only six of 56 teeth in the GIC group and eight of 81 in the composite resin group showed caries. Conclusion Under field conditions in which moisture control was not effective, a high-viscosity and less technique-sensitive glass ionomer material can be used as an effective sealant material, rather than resin . Reference: Comparison of Caries Prevention With Glass Ionomer and Composite Resin Fissure Sealants 2009 Aylin Akbay Oba ,  Türksel Dülgergil ,  Işıl Şaroğlu Sönmez 6

7. Indications for Pit and Fissure Sealants Patients with a low need for sealants: Indications : Absence of new dental caries in the last year; Absence of dental caries in primary dentition; Absence of dental caries in permanent molars erupted; Good exposure to fluorides; Non-cariogenic diet; Good oral hygiene 7

8. Patients with a moderated need for sealants Indications: A new dental caries in the last year; Dental caries in primary dentition; Some permanent molars affected by dental caries; Low exposure to fluorides; Cariogenic diet; Poor oral hygiene 8

9. Patients with a high need for sealants Indications: Two or more new dental caries in the last year ; People whose parents have high dental caries experience ; Rampant dental caries; Medications that cause xerostomia; Anti Histamines : For example: Diphenhydramine Anti Depressants: For example: Buproplon , Fluoxentine , Paroxentine Anti Psychotic Agents : For example: Haloperidol Sedatives and anxiolytic agents: Diazepam, Loraxipam Alpraxolam Anti Hypertensives: Furosemide, Metaprolol , Calcium Channel Blockers Anti Cholinergic drugs: Atropine , Scopolamine Reference: Fissure Sealants: A Review of their Importance in Preventive Dentistry Nélio J. Veiga1 , Paula C. Ferreira 9

10. Systemic Diseases that cause Xerostomia: Sjogren Syndrome Diabetes Militus Diabetes Insipidious Sarcoidosis HIV Psychogenic Disorders High cariogenic diet; Zero or nearly zero exposure to fluorides; Very poor oral hygiene. Reference: Fissure Sealants: A Review of their Importance in Preventive Dentistry Nélio J. Veiga1 , Paula C. Ferreira 10

11. Advantages Prevention from caries Cost effectiveness : At the 10‐year point of a 15‐year study, it was found that it is 1.6 times as costly to restore the carious lesions in the first permanent molars in an unsealed group of 5‐ to 10‐year‐old children  Anti Bacterial effect Better oral hygiene Better periodontal status Reference: A r eview of the clinical application and performance of pit and fissure sealants RJ Simonsen    RC Neal Fissure Sealants: A Review of their Importance in Preventive Dentistry Nélio J. Veiga1 , Paula C. Ferreira 11

12. Disadvantages of Pit and fissure sealants A key problem of fissure sealants is microleakage . This microleakage may lead to bacterial plaque accumulation, which in contact with enamel, can turn into a carious lesion Mouth´s pH constant variations, as well as the action of bacterial plaque and salivary enzymes, that can cause their chemical degradation. This limitation explains the need for regular appointments to the dentist. Effect of sealants wear due to chewing forces applied on the occlusal surfaces of the teeth. The constant force application on the sealant can lead to the material fracture and microleakage 12

13. Clinical Technique Step 1: The tooth is isolated by using a rubber dam or another effective isolation method such as placing cotton rolls. Step 2: The area is cleaned with a bristle brush Step 3: The tooth surface I dried, and etched with 37% phosphoric acid gel for 15-30 seconds. Properly acid etched enamel surface as a lightly frosted appearance. 13

14. Step 4: The sealant material is then applied with an applicator or small hand instrument. The sealant is gently placed. Step 5: The sealant is light activated for 15 seconds Step 6: The occlusion is evaluated by using articulating paper. If too much sealant is applied, excess can be removed with a microbrush prior to light activation or round carbide finishing bur can also be used for removing excess. 14

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16. References: -Chapter#14 : Art and Science of Operative Dentistry B y Harald O Heymann Edward J Swift , Andre V Ritter -A review of the clinical application and performance of pit and fissure sealants RJ Simonsen    RC Neal -Fissure Sealants: A Review of their Importance in Preventive Dentistry Nélio J. Veiga1 , Paula C. Ferreira -Comparison of Caries Prevention With Glass Ionomer and Composite Resin Fissure Sealants 2009 Aylin Akbay Oba ,  Türksel Dülgergil ,  Işıl Şaroğlu Sönmez -Use of Pit and fissure sealants American Academy of Pediatric Dentistry and American dental association 2016 16