PIT AND FISSURE SEALANT

Pit and fissure sealing is defined as the application and mechanical bonding of a resin
material to an acid-etched enamel surface, thereby sealing existing pits and fissures from the
oral environment.
This prevents bacteria from colonizing in the pits and fissures and nutrients from reaching the
bacteria already present.
although sealants are used for the most part on permanent molars and bicuspids, they may be
used in primary teeth as well.
Examination: Visuotactile examination using probe. A radiograph is of minimal value in
diagnosis of pit and fissure caries.
CONTRAINDICATIONS:
1. Rampant caries or interproximal lesions are present.
2. Occlusal surfaces that are already carious with involvement of dentin require
restoration.
3. All caries-susceptible surfaces should be carefully evaluated, because caries is
unlikely in well-coalesced pits and fissures. In this case, sealants might be
unnecessary or, at least, not cost effective.
4. Teeth that has just erupted in the oral cavity.
5. Finally, although sealant application is relatively simple, the meticulous technique
requires patient cooperation and should be postponed for uncooperative patients until
the procedures can be properly executed.
After selection, the tooth is washed and dried and the deep pits and fissures are reevaluated. If
caries is present, restoration or a combination of restoration and sealing may be indicated.
Marking centric stops with articulating paper provides information so that excess sealant does
not interfere with the occlusion. This is not necessary when the tooth has just erupted but is
helpful in a well-established occlusion.
ARMAMENTARIUM:
1. Bristle brush
2. Prophylactic paste
3. Rubber dam/ cotton rolls
4. Mouth mirror, explorer
5. Acid etchant
6. Pit and fissure sealant
7. Light cure unit
8. Articulating/ marking paper
Steps involved in pit and fissure sealant application:
1. CLEANING: adequate retention of the sealant requires that the pit and fissures be
clean and free of excess moisture. Use bristle brush and prophylactic paste
2. ISOLATION: the tooth (or quadrant of teeth) to be sealed is first isolated. Rubber
dam isolation is ideal but may not be feasible in certain circumstances. Cotton rolls
with effective suctioning, may also be used effectively.
3. ETCHING: microporosities in the enamel surface are created by the acid-etching
technique. This permits a low-viscosity resin to be applied that penetrates the
roughened surface and produces a mechanical lock of resin tags when cured. Use
acid etchant for 15-30 seconds.
4. WASHING AND DRYING: wash 20 seconds. Dry 10 seconds. The dry etched
enamel should exhibit the characteristic frosty appearance.
If isolation is compromised after this stage re isolate and Re etch the teeth.
5. APPLICATION OF SEALANT: the sealant is applied to the prepared surface in
moderation and then gently teased with a fine brush or mini sponge or probe or
applicator tip into the pits and grooves.
With mandibular teeth, apply the sealant at the distal aspect and allow it to flow mesially.
With maxillary teeth, apply the sealant at the mesial aspect and allow it to flow distally.
After the material has been cured and while the treated teeth are still isolated, the
unpolymerized surface layer should be removed by washing and drying the surface to
avoid an unpleasant taste.
6. EXPLORE THE SEALED SURFACE: Sealed surface is checked for voids, excess
and deficiencies. Interproximal excess are checked using an explorer or dental
floss.
7. CHECK OF OCCLUSAL INTERFERENCES: articulating paper should be used
to check for occlusal interferences and the occlusion adjusted if necessary. All centric
stops should be on enamel.
8. REEVALUATION: is necessary every 6 months because the maximal sealent loss
in noted in the first 6 months of application.
The re evaluation should be done for the checking the loss of material, voids or
caries.