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PIT AND FISSURE

SEALANTS

INTRODUCTION
► Caries

potential directly related to the shape and depth
pits and fissures.

► Narrow

isolated crevices, grooves- harbor food and
microorganism - important anatomical features leading
to -occlusal caries.

► The

cariostatic property- sealant - prevents penetration
of fermentable bacteria which cannot produce acid in
cryogenic concentration. Effective caries preventive
agents remain bonded to teeth.

DEFINITIONS
► Pit:

Small pinpoint depression - junction of
development grooves or at terminals of the
grooves - (Ash 1993).

► Fissure:

Deep clefts between adjoining cusps. Provide

areas retention of caries producing agents.
► Occlusal

surfaces of the molars and premolars, tortuous

configuration -difficult to assess
- (Orbans 1990)

 The material introduced in occlusal pits & fissure caries susceptible teeth. . forming a micro mechanically bonded protective layer cutting access of caries producing bacteria from their source of nutrients.DEFENITIONS  The fluid material which undergo polymerization when they are used for occluding the caries susceptible occlusal pits and fissures on the premolar and molar teeth.

1.MORPHOLOGY OF FISSURES ► Nango (1960) . . K type ► The shallow. V type 2. wide V & U fissures .self-cleansing & caries resistant.susceptible to caries. narrow. I & K fissures .4 principle types. U type 3. ► The deep. I type 4.

►U ► type .wider opening V type .bottleneck shape ►K type .narrower opening ►I type .

Silver or copper oxy-phosphate cement. Phosphoric acid (85%) for 30 sec. ► Bodecker 1929: Fissure eradication.tooth surface greatly increased. retentive fissures into the cleansable areas. ► Bunocore 1955: Bonded resin. .HISTORY ► Hyatt 1923: Prophylactic odontotomy.fissures transform deep. Mechanical eradication . attachment acrylic resin .

► Mid 1960: First materials -experimentally . Reaction product of Bisphenol A and Glycidylmethacrylate.sealants were Cynoacrylates. . ► Bowen 1965: Reported BIS-GMA.

CLASSIFICATION BASED ON TYPES CHRACTERISTICS First generation sealants Activated by u-v light Second generation sealants Chemical curing resins e. Delton Fluoride containing sealants Double Protection Free of fillers Flow is better Semi filled More resistant to wear Clear Aesthetic but difficult to detect Tinted Can be identified Opaque Can be identified GENERATIONS FILLERS COLOUR OF SEALANTS .g Concise 3M Third generation Activated by visible light e. Fissurit.g.

► Bisphenol A-glycidyl methylacrylate (Bis-GMA) is now the sealant of choice. ► Mixture ► 23 of Bis-GMA and methyl methacrylate.American Dental Association (ADA) . products currently accepted .

D. Type II Ivoclar-Vivadent. Inc. Type II Pulpdent Corp . Inc. Inc. PrismaShield Compules Tips VLC Tinted Pit & Fissure Sealant Dentsply L. Alpha-Dent Light Cure Pit & Fissure Sealant Dental Technologies. Type II Ivoclar-Vivadent.D. Seal-Rite Low Viscosity. Caulk Division Helioseal F.► Alpha-Dent Chemical Cure Pit & Fissure Sealant Dental Technologies. Caulk Division Prisma-Shield VLC Filled Pit & Fissure Sealant Dentsply L. Seal-Rite. Type II Pulpdent Corp. Helioseal. Inc.

sealant locks into spaces .What is Mechanical Retention? ► Physical ► Sealant ► Acid adherence of one substance to another adheres to the enamel etching (conditioner) leaves micro spaces between the enamel rods .

INDICATIONS 1. Erupted less than 4 years age. Minimum decalcification or opacification and no softness at the base of fissures.with open and sticky grooves. 4. permanent bicuspids & molars . Newly erupted primary molars. 2. Patients high caries rate . 3.

Mentally retarded children . Drug or radiation induced xerostomia 7. Excess intake of sugar foods 6. 8. Non fluoridated areas.5.

CONTRA INDICATIONS 1.Wide and self-cleansable pit & fissures. Individual no previous caries experience & well coalesced pit and fissures. 2. . 3. 5. Caries on proximal surfaces 4. Partially erupted tooth. Remained carious free for 4 years or longer.

Adequate working time. 4. 2. A viscosity allowing penetration into deep and narrow fissures even in the maxillary teeth. Rapid cure. Good and prolonged adhesive to enamel.REQUISITES OF AN EFFICIENT SEALANT BRAUER (1978) 1. 3. .

Resistance to wear. Minimum irritation to tissues.5. Cariostatic action. 6. 7. .

Past caries experience 4. Age 2.Approach for selecting the patient SIMENSON (1983) 1. Oral hygiene 3. Present caries experience .

Family history 6. Fluoride environment 8 .5.Tooth type and morphology . Dietary habits 7.

bicuspids & molars- .extensive caries in primary teeth ► Children with special needs – physically/ mentally handicapped or disadvantaged social background. Tooth selection ► Occlussal caries – primary molars.Guidelines for sealant application Patient selection ► Child .

► 6-7 years: 1st permanent molar. ► 11-13 years: 2nd permanent molar and pre molar.sealant applications: ► 3-4 years: Primary molar sealant application. .Age .

Comparison of sealants vs amalgam SEALANTS AMALGAM Preventive technique where there is minimal tooth loss Restorative technique with considerable loss of tooth structure If there is loss of sealant. reapplication of sealant can be accomplished allowing continued caries protection & maintenance of an intact tooth Replacement of an defective amalgam restoration results in a greater loss of tooth structure Time taken to place a sealant is less Time taken to place a restoration is more Highly sensitive technique Less sensitive when compared to sealants Cost effective on longer duration Cost effective on shorter duration .

Evaluation of pit& fissure SURFACE CLINICAL CONSIDERATION DO NOT SEAL Occlussal anatomy Pit& fissure separated by transverse ridge Carious pits& fissures Status of proximal surface Sound Carious General caries activity Many occlusal & few proximal lesions Occlussal morphology Deep narrow pit& fissure Broad well coalesced pit& fissures Tooth age Recently erupted teeth Teeth caries free for 4 years or longer Status of proximal surface Sound Carious General caries activity Many occlusal & Many proximal few proximal lesions lesions Carious Questionable DO SEAL Sound .

 Oral prophylaxis not properly done / fluoride paste used . ORAL PROPYLAXIS : Need to remove plaque & debris form the enamel surface. .  Then cleaning with a slurry of pumice and water.compromise the acid etching procedure & sealant’s effectiveness.TECHNIQUE OF APPLICATION 1.

eliminate contamination from saliva ► Isolated by rubber dam or cotton rolls .2. ► Kept dry. WASHING & DRYING: Washed and then air dried for 10 sec.

3.  Primary teeth 20-30 sec.  Remove 5-10 µm of the tooth surface . ETCHING  Occlussal surface etched 30-50% phosphoric acid for 60 sec.

► Etching produces microscopic porosities enamel. . Resin extends into microscopic porosities which attach firmly to tooth surface.

4. re-etched for an additional 10 – 15 seconds. Dry with cotton rolls & suction. If rubber dam is not used. ISOLATION AND DRYING Dry & moisture free. . ► If contaminated with saliva.

appearance dried (20 sec) frosted when air .► Surface chalky appear dull and white.

APPLICATION OF MATERIAL ► The sealant applied prepared surface in moderation & gently teased with probe into the pits and grooves.5. . ► Care must be taken to avoid air bubbles incorporating in it.

materials has adherent to enamel surface ► Excessive ► Check material .articulating paper for high points . CURING Curing 30-45 sec ► Recheck all pits & fissures are sealed ► Check .6.removed occlusion .

Sealant should . ► Lost .checked at subsequent recall appointments to ensure: ► Firmly adherent ► No sealant material has been lost.7. . RECALL: Along with other forms of dental care.the sealant material – added.

FACTORS EFFECTING SEALANT RETENTION IN MOUTH 1. Clinical skill of the operation 4. Eruption status of teeth. . Type of Sealant 2. Age of the child 5. Position of teeth in the mouth 3.

TYPES OF CARIOUS SURFACES TREATED ► Three types Group A: Deep pit and fissure susceptible to carries ► Preparation ► Unfilled size is very small resin or sealant .restore preparation .

Group B: Minimal exploratory carious lesion ► Caries . ► Preparation size is by size 2 round bur.explored the preparation needs to be extended. . ► Restoration requires some filler to the unfilled resin.

bevel is placed at cavo-surface margin. ► Larger size bur .Group C: Isolated carious lesion ► The caries is very definite and requires considerable preparation. . ► Unfilled resin layer followed by filled composite.

carious areas. . susceptible areas ► Alternative .RECENT MODIFICATIONS IN RESTORATIONS ► PREVENTIVE ► Invasive RESIN RESTORATIONS and non-invasive treatment of borderline or questionable caries.conventional restorations -amalgam. ► Resin placed .

Glass ionomer cements as sealants Suggested .child's pre cooperative behavior and partially erupted permanent molars .deeply fissured primary molars .property of fluoride release GIC .difficult isolate .

antibacterial properties as well as a greater artificial caries resistance compared to a non fluoridated sealant .Fluoride-releasing ► Fluoride-releasing sealants .

even loss of material.markedly more than resin sealant (Winkler et al 1996) ► GIC . .► Preventive ► Resin effect fluoride . modified GIC .provisional sealant. to be reevaluated and later resin sealants.

reduced enamel solubility without compromising sealant properties. sharp fall in second day .additional caries preventive benefits beyond fluoride (Driscoll et al 1995) Fluoride prior sealant application . decreased slowly. .Sealants and Fluoride Pit and fissure sealants . In 1st 24hrs high fluoride release.

. safe and effective preventive material Certain improvements could be made to the clinical technique of the delivery systems and the chemical makeup of the sealant material.Conclusion The pit and fissure sealants are a proven.

Pediatric dentistry 2002. Jayanth V. Textbook of Pedodontics. . Mathewson. McDonald “Dentistry for the child and Adolescent” Eighth 5.24(5):393413. fundamentals of Pediatric dentistry.55(5):261-72. 2. Richard j. Nunn. John J. Murray. Pit and fissure sealant Review of the literature. June H. 3. methods and programs. Journal of Public Health Dentistry 1995. 4. Siegal. Steele. 3rd edition. Pg no. Preventive materials. Robert E. Richard J. 4th edition. Avery. Prevention of oral diseases. Simonsen. Axelsson. Mc Donald. david R. Workshop on Guidelines for sealant use: preface. First edition 6.119-136. Ralph E. Dentistry for the child and adolescent. 8.References 1. Quitessence publishing co. 7. James G. Mark D. Shobha Tandon. Kumar.