PIT AND FISSURE

SEALANTS
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CONTENTS
INTRODUCTION
 DEFINITIONS:
Pit: is defined as small pin point depression located at the junction
of developmental grooves or at terminals of those grooves.
Fissure: is defined as deep clefts between adjoining cusps.

They provide areas for retention of caries producing agents.

Pit and Fissure Sealant: is used to describe a

material that is introduced into the occlusal pit
and fissure of caries susceptible teeth, thus
forming a micromechanically–bonded,
protective layer cutting access of caries
producing bacteria from their source of
nutrients Simonsen
1. BASED ON GENERATION –
A. First generation sealants:
- UV-light at a wavelength 356 nm.
- Incomplete polymerization of sealant at its depth.
- Damage to retina.
e.g. ; Nuva seal (1972)

B. Second generation Sealants/Self curing resins

- Based on catalyst – accelerator system
- Most are unfilled.
- May be transparent, tinted or opaque
e.g. Concise [3M] 1976, white sealant system, Delton.
- PERFORM BETTER THAN UV CURE RESINS
C. Third generation sealants:

- Visible light at wavelength 430 nm-490nm.

- Filled or unfilled, and with or with out tint or opaquer.
- Most of the unfilled resins are colored white.
- Filled resins are either clear, yellowish white or tan
E.g.: fissure Delton

PERFORM BETTER THAN SELF CURE RESINS

D. Fourth generation sealants:

Helioseal-F, Delton plus, Ultra Xseal, Fluoro-shield

2. Based on filler content

A. Unfilled [ free of fillers ]

-Flow is better
-Retention is more
-Abrade rapidly
e.g. . Concise White, Delton

B. Filled
- Need for occlusal adjustments
- More resistant to wear
e.g.. Prisma shield, Helioseal, Delton plus.
3. Based on translucency

A. CLEAR
-Esthetic, but difficult to detect at recall examination.
-Better flow than tinted or opaque
-More easily appreciated by the patient.

B. TINTED / OPAQUE
-Can be easily identified
 COLOURED
-Easy to see during placement
-Easy to see during recall check up
4. Based on Polymerization:

A. AUTOPOLYMERIZING
- Better retention 88%
- Sets by exothermic reaction

B. LIGHT CURE
- 75% retention
TYPES OF OCCLUSAL FISSURES:

V – Wide at top and gradually narrowing towards the bottom

(34%)

U – Almost same width from top to bottom (14%)

IK – Hourglass, extremely narrow slit associated with a large

space at the bottom (26%).

λ – Inverted Y, bifurcating at the bottom (7%).

I – Extremely narrow slit (19%).

V – TYPE
34%

U – TYPE
14%
K – TYPE
26%, hourglass

INVERTED Y – TYPE
7%

I – TYPE
16%
 PRE-REQUISITES FOR A SEALANT TO BE EFFECTIVE

 Viscosity allowing penetration into deep and narrow fissures

even in maxillary teeth
 Adequate working time
 Rapid cure
 Good and prolonged adhesion to enamel
 Low sorption and solubility
 Resistance to wear
 Minimum irritation to tissues
 Cariostatic action
 Based on age:
3 to 4 years – primary molars

6 to 7 years- first permanent molars

11 to 13 years-second permanent molars and premolars

INDICATIONS :
Possibility of adequate isolation
Questionable enamel caries in PF
Xerostomia

Patients undergoing orthodontic treatment

Deep pits and fissures

Pit and fissure sealants

CONTRAINDICATIONS ;

Posterior teeth that have shallow or well coalesced

fissures
Low caries risk (PF that remained caries free > 4 yrs)
Rampant caries
Teeth with proximal decay or occlusal caries involving
dentine
Allergy to methacrylate
Semi-erupted teeth

Pit and fissure sealants

 Conventional – a) Visual (dry tooth)
b) Probe (explorer)
c) Bitewing radiographs

 Xeroradiographic.

 Digital radiographic.

 Fiber optic transillumination.

 Laser fluorescence.

 Caries detecting dyes.

• When the explorer catches or resists removal after insertion into
a pit and fissure with moderate to firm pressure.
• Softens at the base of area
• Opacity adjacent to the pit & fissure as evidence of
demineralization.
• Softened enamel adjacent to the pit & fissure that can be
scraped away with the explorer.
TECHNIQUE FOR SEALANT APPLICATION

PREPARATION OF TOOTH
ISOLATION
DRYING THE TOOTH
ETCHING OF TOOTH SURFACE
RINSING AND DRYING OF TOOTH
PLACEMENT AND POLYMERIZATION OF
SEALANT
OCCLUSAL EVALUATION
Tooth preparation :

Earlier - cleaning enamel surface with pumice and water

mixture using rotary brush
By patient - Direct bristles of dry brush in PF

Use of explorer

Use of Prophy-Jet : air polishing system

Air abrasion system with 50 um alumina

Mechanical preparation of fissure with tapered fissure
diamond bur - retention
Isolation of teeth :

SALIVA CONTAMINATION AVOIDED TO PREVENT

REMINERALIZATION OF ETCHED SURFACES

Rubber dam isolation provides better retention

rates for UV-light activated sealants
Use of cotton rolls – when using autopolymerized
resins
Rubber dam isolation - used when a quadrant is
to be isolated
Pit and fissure sealants
Etching :
Applied using – small sponge, cotton pellet or brush may be
used
Etchant available as – liquid, gel or semi-gel form
“SKIPPING EFFECT”- USE OF GEL ETCHANT
Concentration used – 30 – phosphoric acid

Technique of application : continuous but gentle dabbing

or agitation of solution on enamel surface
Site Of Application

2/3 rd way up cuspal slopes

Etch approx. 2 mm on either side of an exposed groove
Shorter etching time for primary molars - chances of
contamination, during etching (acceptable for 3-4 yr old
children)

Etching time has no effect on sealant retention

Washing and Drying :

REMOVE ALL ACID AND REACTIONARY PRECIPITATES

Rinse with water for 10-20 seconds and dried for additional 10 sec
Water under pressure in air-water spray + high power evacuation

Evacuator tip placed above/adjacent the tooth and water directed

to the tip
If contamination occurs…

If cotton rolls are being used- replaced after becoming saturated

during etching and washing

If salivary contamination does occur – re-etching for 10 sec

before washing once again

If etched enamel is exposed to saliva for 10 to 60 sec - re-etching

Minimal saliva exposure for less than 10 sec immediate washing

performed
Sealant application --

Sealant applied with disposable bristle brush

For autopolymerizing resins – cover etched areas on each

tooth as quickly as possible with sealant and then bulk can be
added

For light curing resins – no mixing necessary and hence

reduced bubbles

Sealant applied should be –

 too much
 thick
Adjustment and recall –
Surface wiped off to remove surface film –
inspection of surface

Occlusion checked with articulating papers

Occlusal interferences removed

 Filled sealants adjusted with green stone

Sealants should be evaluated every 6 months

 Bite-wing RG: detect caries progression under
sealants
LOSS OF SEALANT

Pit and fissure sealants

RISK FACTORS FOR SEALANTS
CHILDREN RISK FACTORS
1.LOW RISK •No new/incipient caries in past year
•Good oral hygiene
•Regular dental visits
2.MODERATE One new, incipient/recurrent caries in past year
RISK Deep PF
High familial caries experience
Early childhood caries
Frequent sugar exposure
Decreased salivary flow
Compromised oral hygiene
Irregular dental visits
Inadequate fluoride exposure
3.HIGH RISK Two or more new or recurrent carious lesions in past year
Deep PF
Sibling or parents with high caries rate
History of pit and fissure caries
Early childhood caries
Frequent sugar exposures
Decreased salivary flow Pit and fissure sealants
PREVENTIVE RESIN RESTORATIONS
(PRR)–
FISSURE SEALANT OR SEALANT RESTORATION
 It is a natural extension of Pit and Fissure sealants.

 INDICATIONS
 Tooth can be isolated.
 No, or only minimal pit and fissure staining
 Minimal “catches” in the grooves, or areas with distinct incipient
enamel caries.
 No evidence of radiographic caries.
 Three types of PRR – based on extent and depth of carious lesion
as determined by exploratory preparation.

TYPE A: suspicious PF where caries removal limited to enamel

TYPE B: incipient lesion in dentin that is small and confined
TYPE C: is characterized for greater exploratory preparation in
dentin

Pit and fissure sealants

TYPE OF
SEALANT INDICATIONS
RESTORATION

1. Sealant alone Decalcified fissure

No RG involvement of dentin
Less than 2 other carious lesions in mouth

2. Composite + More than 2 other carious lesions in mouth

Sealant Lesion confined to dentin

3. GIC + Sealant Cavity in dentin but confined

Margins not in occlusal contact

4. Laminate Lesion in dentin and lateral spread along DEJ

restoration Cavity margins in occlusal contact

5. Amalgam Large radiolucency in dentin

restoration Significant lateral spread of caries
 RECENT ADVANCES :

 Use of surfactant containing etchant – lower surface tension and contact

angle

 Use of argon laser for polymerization

 Use of Er: YAG laser

 Carbon dioxide conditioning

 Use of DIAGNOdent – detection of caries

under pit and fissures

Pit and fissure sealants

RESIN CEMENTS
 Composition
 The basic COMPOSITION of most modern resin cements
is similar to that of composite resin filling materials, but
generally have lower concentrations of filler particles.

 Powder
– Resin matrix (diacrylate monomer)
– Inorganic fillers
– Coupling agent (organo silane)
– Chemical or photo initiators and activators
 Liquid
– Methyl methacrylate
– Tertiary amine.
 APPLICATIONS
 Cementation of crowns and bridges (etched cast
restorations)
 Cementation of porcelain veneers and inlays.
 For bonding of orthodontic brackets to acid-
etched enamel.
 Properties
 Setting time – 2-4 minute

 Film thickness - < 25 micro meter

 Compressive strength- 70-172 MPa

 Solubility & disintegration in water – 0.00-0.01% weight

 Pulp response – Moderate

Chemistry of Reaction
 Polymerization is achieved by the conventional peroxide-amine
system or light activation.

 A few systems utilize both mechanisms and are referred to as

“dual cure”” materials.

 Light cured cements are normally used for cementation of

restorations or appliances that transmit light.

 Fillers –Silica or glass particles( 10-15 micro meter diameter)

-Colloidal silica

 The filler levels vary from about 30% up to around 80% by

weight.
 Biological Properties
 Resin cements just like the composite restorative
resins are irritating to the pulp.

 Thus pulp protection via a calcium hydroxide

base is important when one is cementing an
indirect restoration in a cavity that involves
dentin.

 If the bonding area involves only enamel, the

irritating properties of the monomers are not
of consequence.
 Technique And Manipulation
 The CHEMICALLY ACTIVATED versions of
these cements are supplied as 2 forms

 Powder and liquid or two pastes.

 The perioxide initiator is contained in one

component an the amine activator in the
other.

 The two components are combine by mixing

on a treated paper pad for 20-30 seconds.
The time of flash removal is critical.

 If it is done while the cement is in a rubbery

state, cement may be pulled from beneath the
margin of the restoration.
 Leaving a void that increases the risk of
secondary caries.

 Removal of the flash is difficult if it is delayed

until the cement has polymerized.
 It is best to remove the excess cement
immediately after the restoration is seated.
.

 LIGHT CURED CEMENTS are single component

systems just as are the light-cured filling resins.
 They are widely used for cementation of porcelain
and castable glass restorations and for direct
bonding of ceramic orthodontic brackets.

 The time of exposure to the light that is needed

for polymerization of the resin cement depends
upon the light transmitted through the ceramic
restoration or bracket and the layer of polymeric
cement.

 The time of exposure to the light should never be

less than 40 seconds.
 The DUAL-CURE CEMENTS are two-component
systems and require mixing just as for the
chemically activated systems.

 The chemical activation is very slow, which

provides extended working time until the cement
is exposed to the curing light, at which point
cement solidifies rapidly.

 It then continues to gain strength over an

extended time period owing to the chemically
activated polymerization.
 Conclusion
Resin cements are virtually insoluble and the fracture
toughness is higher than that for other cements.

Some of them bond to dentin and all can form a strong

attachment to enamel via the acid etch technique.

A primary problem of modern resin cement centers on the

handling characteristics in that it is critical to remove
flash prior to the onset or immediately after seating of the
restoration.

From biological stand point they are irritating to pulp.