Pit and Fissure Sealants

Cara Miyasaki-Ching, RDHEF, MS

Legal requirements
 RDA, RDAEF – DDS decision or supervision
 RDH, DDS/DMD – General supervision
 Sealant adjustments
Requirements - minimum
16 clock hours total Student shall:
 4 hours of didactic  Have current CPR
training  Take a written exam
 4 hours of laboratory  RDA or RDA eligible
training (this includes coronal
 8 hours of clinical
polish)
training
Requirements - continued
Patient requirements
 18 years of age or older
 Must be in good health
 A minimum of four (4) virgin, non-
restored, natural teeth, sufficiently erupted
so that a dry field can be maintained.
 A minimum of one tooth per quadrant
Certification Requirements
 Successful completion of written exam
 Successful completion of laboratory and
clinical portions of the course
Pit and fissure sealants
 A thin plastic coating placed in the pit and
fissures of the teeth to act as a physical barrier
to decay
Why pit & fissure sealants needed
 Bacteria produces acid
which causes decay
 “demineralization”
Pit and fissure sealants
 Over 85% of children (5-17 years old) in US have caries in
the pits and fissures
 Fluoride is least effective on pit and fissures
 Only 18% of school-aged children in US have sealants
Effectiveness of sealants
 15 year study – 68%
of sealed teeth were
caries free vs 17% of
unsealed control
group
Other Preventive Programs
 Community water
fluoridation
 50-60% (18-40%)
 School water
fluoridation  40%
 Fluoridated toothpaste  15-30%
 Fluoride mouthrinse  31%
 In-office treatment  26%
Preventive Programs as Related to
Sealants
 Tooth brushing and flossing - mechanical
plaque removal
 Fluoride – chemical prevention
 Dental visits – mechanical plaque removal
and chemical prevention
Preventive Programs as Related to
Sealants - continued
Diet
 Minimize exposure to cariogenic foods and
liquids that have little or no nutritional
value
 Minimize solid and sticky foods
 Minimize slowly dissolving foods
History of Sealants
 Acrylic polymers introduced to dentistry –
1937
 Composites - 1960
 “Occlusal Sealing” – 1965
 Glass ionomers – 1972
Retention of Sealants – 4 year study

Fluoride releasing Non-fluoride

sealant releasing sealant
 91% retention  95% retention
(77% complete (89% complete &
& 14% partial) 6% partial)
 10% caries rate  10% caries rate
Retention of Sealants – 2 year study

Fluoride releasing sealant

 >90% retention
 No caries
Sealant retention
Sealant Failure
 Debris and/or saliva contamination
 Air inclusion during manipulation – voids
 Manipulating self-cured sealants late in the
setting reaction
Loss of Sealant
 A contaminated site from faulty technique
will likely result in complete or partial loss
of the sealant within 6-12 months.
Cost Factors
 Dental Sealants = $25 - $49 per tooth
 Amalgam = $75 to $145 per filling
 Composite = $150 to $200 for a single surface
white composite filling
 Medical reimbursement
 Insurance reimbursement
Preventive Resin Restoration
 The preparation
of fissures by use
of air abrasion,
bur or laser
followed by
filling the prep
with a flowable
composite.
Incipient Caries
 Studies have shown that sealants can be
placed over incipient caries which arrests
the caries process
 Most dentists choose to use air abrasion, a
bur, or a laser to remove the caries before
the sealant is placed
Tooth morphology
 Pits and fissures
Tooth morphology
Tooth morphology
Tooth morphology
 Why fissures are
caries susceptible
Selection of teeth
Considerations
 Patient age
 Oral hygiene
 Caries risk
 Diet
 Fluoride history
 Tooth type
 Morphology
Selection of teeth - continued
 Frequency of pit & fissure caries
 Lower molars – 50%
 Upper molars 35-40%
 Upper and lower second premolars
 Upper laterals and upper first premolars
 Upper centrals and lower first premolars
Indications
 Deep fissures
 Incomplete or ill formed pits
 Newly erupted teeth
 High caries rate
 Children
 Molars
Contraindications
 Shallow fissures
 Well coalesced pits
 Fluoride rich enamel
 Low caries rate
 Occlusal or proximal caries
 Adults
Partially erupted teeth?
 To seal or not
to seal?
 Operculum
(gum flap) –
leaks
crevicular
fluid
Sealant Kits
 Cavity Indicators
 Drying and/or bonding agent (optional)
 Acid etch
 Sealant material
Acid Etch
 Gel
 Liquid
 3M Innovation:
Adper™ Prompt™ L-
Pop™ Self-Etch
Adhesive
Acid etch
 Phosphoric acid 35%-40%-50%
 Dissolves organic portion of
enamel
 “micromechanical retention”
Acid etch - continued
 Creates more
surface area for
better adhesion
 Also high
energy surface
Acid etch - Precautions
 Avoid contact with
adjacent teeth or soft
tissues
 Can use mylar strips
or matrix bands
Acid etch –Precautions cont.
 Active ingredient – phosphoric acid
 Avoid contact with skin, eyes, and clothing.
 If skin contact – flush with water
 If eye contact – flush immediately with water
and seek medical attention
 If ingestion- do not induce vomiting. Give
large amounts of water or milk. Take an
antacid. Call a physician.
Acid etch – storage and handling
protocol
 Protection – protective eyewear, gloves and
clothing
 Toxicity – mild irritation for skin or ingestion
but damage to eye exposure if chronic
exposure.
 Storage - Store at room temperature.
 Handling – Use gloves, protective eyewear and
PPE.
Acid etch - continued
Will an etched tooth be
more prone to decay?
 Remineralization
begins after 24 hours
Drying agent (PrimaDry)
 Acid etching and
Primadry (alcohol
based) allows enamel
to be easily “wetted”
PrimaDry – precautions
 Active ingredient – ethyl alcohol
 If skin contact – wash with soap and water
 If eye contact – flush with lots of water
Ingestion- give large amounts of water or milk.
PrimaDry – storage and handling
protocol
 Protection – protective eyewear, gloves and
clothing
 Toxicity – mild irritation for skin or ingestion
but severe irritation for eye exposure
 Storage - Store at room temperature. Keep out
of heat and/or direct sunlight.
 Handling – Use gloves and protective eyewear.
Sealant composition
 A type of
specialized plastic
(resin) or glass
ionomer material
 Matrix
 Filler
Sealant Types
Resin Sealants Glass Ionomer Sealants
 (Bis-GMA) Bisphenol  Anticariogenic
A-glycidyl  More viscous, less
methacrylate resins retention, more brittle
 Urethane-based resin and less resistant to
occlusal wear
Sealant Types
 Filled sealants
 Unfilled sealants
Accepted Sealant Materials
ADA Council on Scientific Affairs
 3M ESPE – Clinpro Sealant
 Confi-Dental Products Company
 Dental Technologies
 Dentsply International - FluroShield
 Ivoclar Vivadent, Inc. - Helioseal
 Kuraray America Inc. – Teethmate F-1
 PracticeWares Dental Supply
 Pulpdent Corporation
 Southern Dental Industries
 Tru-Tain Prime Dental
 Ultradent Products, Inc. - Ultraseal
 Zenith/DMG Dental Manufacturing
Types of curing for sealants
Chemical cured – “autopolymerization”
 Base and catalyst
Monomer & Initiator + Diluted monomer & 5% Organic
Amine Accelerator = Sealant

Visible light cured – “photopolymerization”

 Pre-mixed
Dimethacrylate + Diluent + Activator + Light = Sealant
Chemical cure sealant materials
Advantages
 No cure light or risk of eye damage
 Can apply sealants to several teeth

Disadvantages
 Variation in setting time (appx 2 min)
 Voids from mixing material
 Changes in viscosity over time
Light cured sealant materials
Advantages
 Short setting time (appx 20 seconds)
 No mixing required
 Won’t set-up – longer working time
 Does not get thick

Disadvantages
 Potential eye damage due to light cure
 Additional cost of cure light
 Cure time increased with number of teeth sealed
 Difficult to manipulate cure light for posterior teeth
Sealant Shades
 Clear
 Tinted
 Opaque
 Clinpro™ Sealant goes
on pink for easy-to-see
application, and cures to
a natural white.
 low viscosity, fluoride-
releasing sealant
Sealant Material – precautions
 Active ingredient – Bis-GMA
 Skin contact – wash with soap and water
 Eye contact – flush with lots of water & call
physician if needed
 Ingestion- in large amounts induce vomiting
Sealant Material – storage and
handling protocol
 Protection – protective eyewear, gloves and
clothing
 Toxicity – mild irritation for skin and eye. Low
possiblility of sensitization upon prolonged
exposure for the skin.
 Storage - Refrigerate when not in use.
 Handling – Use gloves, protective eyewear and
PPE.
Concepts of bonding
 Mechanical bonding – interlocking
 Chemical bonding – use of adhesive
 Physical bonding – attraction of atomic
charges
Requirements for Adhesion
 Clean surface
 Good wetting by adhesive
 Good adaptation to the substrate
 Good interface
 Good curing
 Strength and Viscosity
Characteristics
Viscosity
 The thicker the sealant the
less likely to penetrate to
depth of fissure

Wear of Sealants
 Considerations for wear –
less filler, more wear and
visa versa
Curing units
 Conventional cure light with halogen bulb =
20 seconds cure for each surface

 Plasma arc or laser = 5-10 seconds

Assemble armamentarium
Assemble sealant kit
 Check the operation of
the syringe on gauze
Armamentarium
Curing units

 CAUTION – Avoid looking directly at the

light
Give patient instructions
Verbal instructions
 I will be placing a
dental sealant on your
teeth – it’s like a thin
plastic coating on top
of the tooth and will
help prevent cavities
 If you have any
problems then raise
your left hand
Give patient instructions
Verbal instructions
 This won’t hurt but
you will need to keep
open for a long time
and it doesn’t taste
very good.
Wear personal protective
equipment - operator
 Gloves
 Mask
 Safety glasses/visor
 Protective clothing
 Closed toed shoes
Wear personal protective
equipment - patient
 Safety glasses
 Pt. glasses should be
tinted when using a
curing light
(operator/assistant
should have tinted
glasses on shields)
Position patient
Mandibular Maxillary
Check prescription and teeth
 Occlusal surfaces
 Buccal and lingual pits
on first molars
 Lingual pits on upper
anterior teeth
Suspicious lesions?
 Explorer – “a stick”
 Caries indicator dye
 DIAGNOdent
Prepare the tooth
 Bristle brush or rubber
cup and plain pumice
 Dentist can use bur,
air abrasion or laser
 Sharp explorer to
clean out debris
 Rinse
Prepare the Tooth - continued
 air abrasion, bur,
prophy jet or laser
Position the patient
Check occlusion
 Avoid placing
acid etch and
sealant on
marked areas
from
articulator
paper
Isolate tooth/teeth
Treat quadrants
separately
 To control isolation
 To prevent
contamination by
moisture
Isolate tooth/teeth
 Rubber dam
 Cotton rolls
 Cotton roll holders
 Dri-angle
Dry tooth
Test air/water syringe
before applying blast
of air
Apply acid etch
 15-20 seconds
 Use blue micro tip or
brush tip
 Apply only in pit and
fissures
 For liquid – dab but do
not rub
 Re-etch 10 seconds if
saliva contamination
Apply acid etch - continued
 3M Innovation:
Adper™
Prompt™ L-
Pop™ Self-Etch
Adhesive
 Etch, prime and
bond
Apply acid etch
 Etch pit and fissures
 Extend 1-2 mm beyond
pit and fissures
 Avoid cusp tips
Acid etch - continued
Etch longer
 Deciduous teeth
 Saliva contamination
 Air abrasion or prophy
jet used
 Highly mineralized
teeth
Do not use explorer
Rinse tooth/teeth
 Use HVE and a/w
syringe
 Proper – usually
20 seconds rinse
 Avoid saliva
contamination
 Re-isolate
Dry tooth/teeth
 Should appear chalky
or frosty white if
etched
 If not, re-etch for
another 10 seconds if
not contaminated
with saliva
Apply drying agent (PrimaDry)
 Use brush tip
 Apply and leave for 5
seconds
 Gently blow air to dry
 DON’T RINSE
Apply bond agent
 A bond agent will
improve retention
Apply sealant material
 Most posterior tooth first
 Extend 1-2 mm beyond pit
and fissures
 Gently work into pits and
fissures
 Avoid lifting off tooth
 Don’t overfill
 “pop” bubbles in sealant
with explorer or brush tip
before curing
Light cure for 20 seconds
 20 seconds each tooth
 Don’t touch tip of cure
light to sealant
material
 Don’t let saliva
contaminate the
field…..yet

Note: sealant will appear

shiny/wet
Light cure for 20 seconds – air
inhibition theory
 Top layer of sealant
will remain uncured
 sealant will appear
shiny/wet
Check sealed teeth
 Use explorer
 Tooth should be
smooth but not soft
 Re-apply sealant, if
necessary
(Remove uncured
sealant with wet
cotton roll)
Remove isolation materials
 Moisten Dri-angle
 Rinse the patient’s
mouth
Check occlusion & contact(s)
 Articulating paper
 Dental floss
 Ask patient how it
feels
 Dentist can adjust with
bullet-shaped finishing
bur or polishing stone
Give patient instructions
 The sealant is hard so you don’t have any
restrictions on eating
 If it feels “high” after you go home – you
can come in to get it adjusted
 We will keep checking the sealant at
subsequent appointments
(if using unfilled corposite sealant the bite
will self adjust in 2-3 days)
Documentation
9/1/05 Medical history updated – no changes.
Parent consented to sealants on #19 OB and
#30 OB. Cotton rolls and dri-angle
isolation. Ultraseal etch, primer and light
cured sealant used. Patient tolerated
procedure well. Informed parent that
sealant will be checked at recall
appointments.
Infection control
 Disinfect unit

 Disinfect sealant
syringes

 Throw away brush

tips used in patient’s
mouth
 Sharp tips need to be
placed with sharps
container
Common Problems
Re-etch
 Improperly etched surface – doesn’t appear
frosty and chalky white
 Dentin etching – need to dissolve smear
layer
 Contamination of application site – saliva
 Non-adherence of sealant material
Failure of sealants
 Main cause – moisture
contamination
 Maxillary and
mandibular 2nd molars
 Early loss means less
retention of the resin
Sealing over caries
 For incipient caries –
risk of progression is
very small
Risks associated with sealants
 No carcinogens or toxic materials
 Have xenoestrogens – concentrations too low
 Potential chemical burns from phosphoric acid
 Occlusal trauma
 Danger from cure light
Sealant maintenance
 Loss of all or part of
the sealant

 Staining at edges

 Discoloration
underneath sealant
Repair of sealant
Reapply if totally lost

Repair partial loss

 Roughen with
diamond stone
 Re-etch 20 seconds
 Reapply sealant
Finished!