PUBLIC HEALTH

DENTISTRY
PIT AND FISSURE SEALANTS

Guided By : Dr. Gaurav Gupta Submitted By: Sahaj Samaiya

Dr. Saurav Singh BDS III Year
 INDEX
 Introduction
 History
 Morphology of pits and fissures
 Types of sealants
 Procedure of sealant application
 Factors affecting sealant Retention
 Cost effectiveness
 Preventive resin restorations
 Conclusion
 INTRODUCTION
 Caries potential is directly related to shape & depth of the pit and fissure.
 The cariostatic Properties of sealants are attributed to the physical obstruction of
the pit and grooves.
 Sealants are the effective caries protective agents to the extent they remain bond
safe & their effectiveness should justify their routine use as a preventive measure.
 HISTORY
 In 1905: Application of Silver Nitrate by Miller
 In 1922: Hyatt proposed “Prophylactic odontomy”
 In 1929: Bodecker introduced “Fissure Eradication”
 In 1955: Buonocore introduced a method of adhering resin to an acid-etched
enamel surface
 In 1962: Bowen and his associates developed the Bis-GMA resin, which is the
chemical product of Bisphenol A and Glycidyl methacrylate
 DEFINITION
 According to the European Academy of Paediatric Dentistry (EAPD):
“A fissure sealant is a material that is placed in pits and
fissures of teeth in order to prevent or arrest the development of dental
caries”
 MORPHOLOGY OF PITS AND
FISSURES
 PITS : Small pin point depression located at the junction
of developmental grooves.
 FISSURES : Deep clefts between adjoining cusps
 TYPES OF FISSURES

1. V type & U type

• Are shallow and wide and tend to self cleansing and
somewhat caries resistant
• Non – invasive technique is recommended
2. I type
• Is deep , narrow and quite constricted, resembling
a bottle neck
• Are caries susceptible
• Requires invasive technique
3. Combination types
 TYPES OF PIT AND FISSURE
SEALANTS
Based on curing method
1st Generation UV light cured at 356 Eg: alphaseal,
nm nuvalite, alphalite
2nd Generation Self cured Eg: concise white
sealant, delton
3rd Generation Blue visible light cured Eg: Stephen K.W,
at 490 nm Strang
4th Generation Fluoride releasing Eg: Toma L.Morphis,
Jack toumba
Based on presence of filler
• Unfilled – better flow
• Semifilled – strong and resistant to wear

Based on color
• Tinted – for easy identification
• Clear – difficult to select
• Opaque – for easy identification
• Pink(Fuji VII, G.C Company) – better fluoride release
MATERIALS USED AS SEALANTS

 Resins : bond to the underlying enamel by acid etching, a tight seal

prevents leakage of micronutrients to microflora.
 Glass Ionomer Cements : bonds chemically to dentin without
etching and releases fluoride
 Compomers : their properties are similar to resins
 Fluoride containing sealants : durability is comparable to resins
but long term use I not yet determined
 INDICATIONS AND CONTRAINDICATIONS OF SEALANT
Surface diagnosis Clinical consideration Do seal Do not seal

Carious Occlusal anatomy If pits and fissures are Carious pits and fissure
separated by transverse
ridge, a sound pit or
fissure may be sealed

Questionable Status of proximal surface Sound Carious

General caries activity Many occlusal lesions, Many proximal lesions

few proximal lesions
Sond Occlusal morphology Deep, narrow pit and Broad, well coalesced pit
fissure and fissure
Tooth age Recently erupted teeth Teeth caries free for 4
years or more
Status of proximal surface Sound Caries
 PROCEDURE OF SEALANT
APPLICATION
 Time to seal
 Polish the tooth surface
 Isolate and dry the tooth surface
 Acid etching
 Rinse the tooth
 Isolate and dry the tooth
 Material application
 Evaluate the sealant
 Check occlusion
 Retention and periodic maintenance
Pit and Fissure sealants require :
• Good moisture control when being placed
• Clean surfaces
• Appropriate etching and drying time
• Appropriate coverage of the surface
• Checking occlusion for interferences
• Regular monitoring and maintenance after placement
The sealant restoration should be :
• Provided to patients with continuing caries risk who have fissure caries just into dentin
• Preferred to amalgam placement as it requires less loss of tooth structure and provides
full occlusal protection against caries
• Placed over glass ionomer cement within cut fissures if space allows and monitored and
maintained for retention
FACTORS AFFECTING SEALANT
RETENTION
 Type of sealants : 2nd Generation sealants are superior than other sealants
 Position of teeth in the mouth : Better sealant retention in anterior and
mandibular teeth
 Clinical skill of the operator : Skilled operators produce better sealant retention
 Age of the child :Retention is compromised in younger children due to habits
 Eruption status of teeth : Sealants placed early require replacement quickly
 COST EFFECTIVENESS
 Sealing molars is costly but reduces subsequent dental treatment
 Meta analyses show sealing molars reduces caries up to 48 months
 In a population with average caries rate it has been calculated that 5-10 sealants must
be placed to have one molar surface from becoming carious

Cost of the treatment can be minimized by the following

measures :
1. Selective application on teeth with the greatest caries risk
2. Delegating treatment to auxillary personnel where legally permitted
3. Selecting commercial products that have the highest proved success rates and are
approved by statuory organizations
4. Following meticulous application protocol
5. Applying sealants in conjunction with optimal fluoride therapy
PREVENTIVE RESIN RESTORATION

 Are a natural extension of the use of occlusal sealants

 Integrates the preventive approach of the sealant therapy for caries susceptible pit
& fissure with therapeutic restoration of incipient caries with composite resin that
occur on the same occlusal surface
 Are the conservative answer to conventional “ extension for prevention”
philosophy of class I amalgam cavity preparation
 There are three types of preventive resin restoration based on the extent & depth of
carious lesion as determined by exploratory preparation
 Simonsen (1978) has classified them as :
Type A
• Suspicious pits & fissures where caries removal is limited to enamel
• Local anesthesia is not required
• A slow speed ¼ or ½ round bur is used to remove decalcified enamel
• Sealant is placed
Type B
• Incipient lesion in dentin that is small & confirmed
• No local anesthesia is needed
• An appropriate base is placed in areas of dentin exposure, composite resin is placed &
the remaining pit & fissure are covered with a sealant
Type C
• More extensive dentinal involvement & requires restorations with posterior
composite material
• Appropriate base is placed over dentin
• Pits & fissures are covered with a sealant
• Local anesthesia is required
 CONCLUSION

Sealants prevent the penetration of fermentable carbohydrates and so the remaining

bacteria cannot produce acid in cariogenic concentrations
Educating parents and patients on the importance of dental sealants is critical.
They are often unaware of its existence.
They can be informed about sealants in school health programs etc.
THANK
YOU