pit and fissure sealants used in dentistry

this topic is of public health dentistry

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Pit & Fissure Sealants
Presented By Dr. Swarenima Khichi
PG Public Health Dentistry

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Pit:isdefinedassmallpinpointdepression
locatedatthejunctionofdevelopmental
groovesoratterminalsofthosegrooves.
Fissure:isdefinedasdeepcleftsbetween
adjoiningcusps.
Theyprovideareas
forretentionofcaries.

4. History of Pit & Fissure Sealant
•1905:ApplicationofSilvernitratebyMiller.
•1922:Hyatt-“ProphylacticOdontomy”.Fillingthe
fissuresoferuptingteethwithsilverorcopper
oxyphosphatecement.Afterfulleruption,smallocclusal
cavityisprepaperdandfilledwithsilveramalgam.
•1929:Bodecker,wideningthefissure‘Fissure
Eradication’.
•1955:Buonocore,adheringresintoanacidetchedenamel
surface.
•1962:Bowen&associates,developedBis-GMAresin.
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Types of fissures
“V” Type “U” Type
Inverted –“Y” Type
“IK” Type/ Hour glass Type“I” Type/ Narrow slit Type

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Morphology of pit and fissure

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PitandFissureSealant:
Definedas“acementorresinmaterialwhichis
introducedintounpreparedocclusalpitandfissure
ofcariessusceptibleteethformingamechanicaland
physicalprotectivelayeragainsttheactionofacid
producingbacteriafromtheirsubstrates”

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BASED ON TYPES CHARACTERSITICS
I. GENERATIONS 1. First Generation
Sealants.
Activated by UV light
No more used
2. Second Generation
Sealants.
Chemical curing
resins.
3. Third Generation
Sealants.
Activated by visible
light
4.Fluoride containing
Sealants
Fluoride releasing
light activated resin
CLASSIFICATION OF SEALANTS

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BASED ON TYPES CHARACTERSITICS
II. FILLER 1. Unfilled Flow is better.
2. Filled More resistant to wear.
III. COLOUR OF THE
SEALANTS
1. Clear Esthetic but difficult to
identify.
2. Tinted Can be easily identified.
3. Opaque Can be easily identified.
CLASSIFICATION OF SEALANTS

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TYPES OF SEALANTS
•Cyanoacrylate
•Polyurethanes
•BIS-GMA –Bisphenol-A-glycidyl
methylacrylate

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INDICATIONS
•Presenceofdeepocclusalpitandfissuresof
newlyeruptedteeth.
•SuspectedorinitialenamelcariesinPits&
Fissures.
•Inchildrenwhoaresusceptibletoocclusal
caries.
•Inthosesusceptibleareasofteethpalatalaspect
ofupperlateralIncisors,upper1stmolars
palatalgroove,buccalpitsoflowermolars.

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CONTRAINDICATIONS
•Presenceofshallowpitandfissuresofmolars
andpremolars.
•Lowcariesrisk.
•Teethwithproximaldecayorocclusalcaries
involvingdentine
•Semi-eruptedteethwhereisolationisa
problem.
•Inuncooperativechildren

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Technique for sealant application
•Preparation Of Tooth
Polishthetoothsurface
-ByusingprophylacticcupandPumicewithwater.

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Technique for sealant application
•Isolation
Canbebestdonebyrubberdam
application.
•DryTheTooth
•EtchingOfToothSurface
Thetoothshouldbeetchedwith37%
orthophosphoricacidfor30-60seconds

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•RinsetheTooth
Thetoothshouldberinsedforapproximately
30sec.
•Isolateanddrythetooth
Shouldbedriedwithcompressedairuntilit
hasawhite,chalkyfrostedappearance.
Moisturecontaminationatthisstageisthe
mostcommoncauseofsealantfailure.
Technique for sealant application

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Technique for sealant application
•Applybondingagentandcureit.
•Materialapplication
Thesealantisappliedaccordingtothe
manufacture’sdirection.
.

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Technique for sealant application
•Evaluatethesealantvisuallyand
tactically
•OcclusalEvaluation
•Followup-Retentionandperiodic
maintainance.

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FACTORS AFFECTING RETENTION
•Types of Sealant
•Position of Teeth in the mouth
•Clinical skill of the Operator
•Age of the Child
•Eruption Status of Teeth

19. •It involves use of dental hand piece to remove only those
areas of the tooth affected by caries.
•Then bonding resin restorative material into them.
•Covering all restorative material and any remaining
fissured anatomy with sealant.
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PREVENTIVE RESIN RESTORATION
(PRR)

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PREVENTIVE RESIN RESTORATION
(PRR)

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SEALANT V/S AMALGAM
S.no.Sealants Amalgam
1. Preventivetechniquewhere
toothlossisminimal.
Restorativetechniquewith
considerablelossoftooth
structure.
2. With sealant loss,
reapplicationofmaterialon
intacttooth.
Replacementofdefective
amalgamresultsingreater
toothloss.
3. Timetakentoplacesealant
isless.
More
4. HighlytechniquesensitiveLesstechniquesensitive.
5. Costeffectiveonlonger
duration
Costeffectiveonshorter
duration

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ART
Atraumatic
Restorative
Treatment

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Introduction
TheAtraumaticRestorativeTreatment(ART)isa
procedurebasedonremovingcarioustoothtissuesusing
handinstrumentsaloneandrestoringthecavitywithan
adhesiverestorativematerial(Glassionomercement).
Wasfirstpioneeredinthemid1980’sinTanzania
byJoFrencken.

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Principles of ART
•Thisprocedureisbasedontheprinciples
Removingcariesusinghandinstrumentsonly.
Restoringthetoothwithanadhesivefilling
material-glassionomer.

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Applications of ART
Introducingoralcaretoveryyoungnot
previouslyexposedtodentistry.
Forpatientswithextremefear/anxiety.
Formentallyand/orphysicallyhandicapped
patients.
Forhome–boundelderlyandthoselivingin
nursinghomes.
Inpatientwithmultiplecariouslesions-asan
intermediatetreatmenttostabilizeconditions.

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Contraindications
•Presenceofabscess
•Exposedpulp
•Teethwhichispainfulsincelongtime.
•Clearsignsofcavity,suchasproximalcaries
whichcannotbeenteredfromtheproximalnor
theocclusaldirection.

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Instruments and Materials used
Mouth mirrors
Explorers
Pair of tweezers
Carvers
Glassslab
Spatula

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•Dentalhatchets,
•Small and
medium sized
spoonexcavators

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Materials for ART
•Theessentialmaterialsare
gloves.
•Cottonwoolrollsandpellets.
•Glassionomerrestorative
materialandconditioners.
•Petroleumjelly(Vaseline)
wedges,plasticstrips.

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Operating Positions

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The principle steps of ART
Isolatethetoothwith
cottonrolls
Rationale:Easiertowork
inadryenvironmentthanin
wetone.

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The principle steps of ART
Cleanthetoothsurfacetobe
treatedwithawetcotton
pellet
Rationale:Thewetcotton
woolpelletremovedebrisand
plaquefromthesurface,thus
improvingvisibilityoftheextent
ofthelesion.

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The principle steps of ART
Widentheentranceofthelesion
Rationale:Thehatchetreplacesthebur.By
rotatingthetip,unsupportedenamelwillbreak
off,makinganopeninglargeenoughforthe
smallexcavatortoenter.

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The principle steps of ART
•Removethecaries:Depending
onthesizeofthecavity,useeither
thesmallormedium sized
excavator.
Rationale:Allsoftcariesshould
beremovedtopreventcaries
progression.

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The principle steps of ART
Cleantheocclusalsurface:All
pitsandfissuresshouldbeclearof
plaqueanddebris.
Rationale:Theremainingpits
andfissureswillbesealedwiththe
samematerialusedforfillingthe
cavity.
Conditioningincreasesthebond
strengthofglassionomers.

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The principle steps of ART
•Providepulpalprotectionifnecessary
Rationale:Calciumhydroxidestimulatesrepairof
dentinandglassionomersarebiocompatible.
•Mix glass ionomer
according
tomanufacturer’s
instructions

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The principle steps of ART
•Insertmixedglassionomerinto
thecavityandoverfillslightly
•Presscoatedglovedfingerontop
oftheentireocclusalsurfaceand
applyslightpressuresothat
GlassIonomerreachesthe
deeperpartsofthepitsand
fissures

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The principle steps of ART
•Removeexcessmaterialwiththe
carvers.
•Coverfillingorsealantwithpetroleumjelly
(Vaseline)orapplyvarnish.
•Instructthepatientnottoeatforatleastone
hour.

39. Reasons for using hand instrument
•Conserves sound tooth structure.
•Low cost of hand instrument.
•Limitation of pain.
•Simplified infection control.
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40. •It sticks chemically to both enamel and dentin.
•Fluoride is released from restoration which will prevent and
arrest caries.
•Similar to hard oral tissue and does not inflame pulp or
gingiva.
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Reasons for using glass ionomer

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Advantages of ART
•Accessibleforallpopulation
•Minimalcavitypreparationandlesstraumatoteeth.
•Costeffective
•Simplifiedinfectioncontrol
•Glassionomeradhereschemicallytobothenameland
dentine.
•Fluorideisreleasedfromthecementtopreventand
arrestcaries

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