Pits and Fissure Sealant

The occlusal surfaces of posterior teeth are known to be the most

susceptible locations for dental caries as they contain pits and fissures,
which retained bacteria and food. Efforts have been made to prevent
decay at these areas.

Historical efforts for prevention of dental caries

o Extension for prevention: G.V Black introduced the concept that

the cavity preparations on occlusal surface should extend to eliminate
non-carious fissures.
o Prophylactic odontotomy: Hyatt 1922, advocated opening of pits
and fissures of newly erupting teeth and sealing with zinc phosphate
as a sealant before appearance of clinical signs of caries.
o Fissure eradication: Bodecker 1929 recommended shaping
retentive, non-carious pits and fissures into wide, non-retentive
fissures, on the occlusal surfaces of premolars and molars.

o Fissure sealing:
A. Buonocore, 1955 sealed the fissures with acrylic resin after
etching the enamel surface with phosphoric acid.
B. Bowen , 1962 was the first to use bis-GMA resin as fissure
sealant.

Definition: They are materials used to seal deep pits & fissures and
change them into non-retentive surfaces. This leads to significant
caries reduction

Types: may be classified according to

Materials: several materials are available

1. Composite (Polyurethane, Cyanoacrylates ,BIS-GMA resin )

2. Glass ionomer cement.
3. Compomer.
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Curing: They are either chemically cured or light cured (visible-Laser
light).

Filler: They may be filled / unfilled

Fluoride content: They may be fluoride release or not

Color: They may be clear, opaque, tinted

Requirements of an ideal fissure sealant material

1. Reduced water sorption and solubility.

2. Increased hardness and abrasion resistance.
3. Ease of manipulation and good flow.
4. Good bond strength to enamel.
5. Antibacterial properties.
6. Fluoride release

Indications

1. Patients with high caries susceptibility (xerostomia, radiation)

2. Patients who perform effective oral hygiene practice and keep
regular dental visit.
3. Patients exposed to some sort of fluoride (protect proximal
surfaces)
4. Newly erupted teeth, with deep pits and fissures, that are free of
decay or have a questionable caries

Technique of application

1. Clean the teeth using pumice slurry on motor driven brush or

rubber cup.
2. Wash the tooth with air water spray.
3. Isolate the tooth with rubber dam or cotton rolls and use saliva
ejector.
4. Etch enamel with etching solution or gel (37% ortho-phosphoric
acid) for one minute.
5. Apply sealant
6. Polymerize resin
7. Check occlusal interferences
8. Check the success of sealant application at 6 monthly period

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 Preventive Resin Restoration (PRR)
They are a logical extension for pits and fissure sealant. This
technique is based upon restoring minimal carious lesion usually in
young permanent molars with minimum removal of tooth structures
and sealing the adjacent deep pits and fissures with sealant.

Types:

A; caries involves enamel only and sealant is applied.

B; caries involves enamel and dentine .Caries is restored with

composite first and sealant is then applied.

C; caries involves enamel and dentine , proceed deep in dentine

. Caries is restored with GIC, composite and sealant is applied
later.

Technique

1. Small round bur may be used for access and removal any carious
tissue.
2. The tooth is then etched.
3. Fill with composite then a pit and fissure sealant is applied.

A Traumatic Restorative Treatment (ART)

Principles: The two main principles of ART are:

1. Removing carious tooth tissue using hand instruments only.

2. Restoring the cavity with adhesive filling material as glass
ionomer.

Carious cavities suitable for ART should be:

1. Accessible to hand instruments

2. Involving the dentin with no pulpal involvement
3. One or two surface only

Contra-indications

1. Presence of abscess or fistula.

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 2. Presence of clinical pulp exposure.

3. Painful teeth

Advantages

1. Easily available and inexpensive procedure.

2. Reach people who otherwise would have never received any dental
care such as handicapped, villages in rural and suburban areas,
home-bound, institutionalized people

Technique:

1. Isolation with cotton rolls.

2. Remove deposits on the surface using wet cotton.
3. Widen the access to the cavity using enamel hatchet.
4. Remove carious dentine with excavators.
5. Remove unsupported enamel with hatchet.
6. Restore with glass ionomer cement.

Laser Light in Preventive Dentistry

Laser plays a role in Prevention of dental caries through:

1. Increasing the resistance of dental tissues to caries by reducing the

rate of demineralization.
2. Sealing pits and fissures and homogenizes the enamel surface by
melting structural elements.
3. Laser application encourages fluoride uptake by dental tissues
4. Laser application to carious lesions vaporizes enamel caries and
adjacent sound enamel fuses and eliminates small defects.
5. Application of laser prior to application of fissure sealants
improves its retention.

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 Remineralizing solutions

Remineralization is the repair of enamel rod structures following

acidogenic episodes

Remineralizing solutions: are solutions containing Ca and Po4 ions,

their application to demineralized areas will result in remineralisation
which could be enhanced by the presence of fluoride.

Common examples of these solutions; are tricalcium phosphate,

amorphous calcium phosphate

Ozone in Preventive Dentistry

Ozone penetrates through decayed tissues; eliminate the ecological

niche of cariogenic microorganisms, as well as priming the carious
tissues for remineralization

Remineralization then takes place with aid of topically applied

remineralizing solution and the recommended patient’s maintenance kit