PIT AND FISSURE SEALANTS

AND PREVENTIVE RESIN

RESTORATION

SUBMITTED BY:
KRISHNANUNNI K M
REG NO: 180021745
 CONTENTS
 Introduction
 History
 Pit and fissures
 Pit and fissures sealants
 Effectiveness
 Classification
 Requirements
 Indication
 Contraindication
 Technique of application
 Recent Advances
 CONTENTS
 Preventive resin restorations
 Types
 Techniques
 Clinical perspective
 Advantage
 Precaution
 Conclusion
 Reference
 INTRODUCTION
 The high susceptibility of pit and fissure to caries presents a major dental problem and provides the rationale for caries
control of these areas.

 Caries potential is directly related to shape and depth of the pit and fissure.

 In a caries susceptible person, when carbohydrate in food comes in contact with the plaque, acidogenic bacteria in the
plaque creates acid.

 This acid damage the enamel wall of the pit and fissures and caries result.

 The enamel in the bottom of the pit and fissures may be very thin, so that early dentin involvement frequently occurs.
 HISTORY

 Milestones of pit and fissure sealant

 Methods to eliminate pit and fissure has been tried since 1920s

Hyatt(1923) • Proposed technique called “prophylactic odontomy”

• Consist of filling the fissures with silver or copper oxy-phosphate cement

Bodecker (1929) • Proposed technique called fissure eradication

• This technique involved mechanical eradication of fissure in order to
transform deep, retentive fissure into cleansable areas.

Bunocore (1955) • Advocated the fillings of pit and fissures with bonded resin

Bowen (1965) • Reported bis-gma material development

• Bis-gma is a reaction product of bisphenol a and glycidylmethacrylate
• Bis-gma is the base resin to most of the current commercial sealants
 PIT AND FISSURES
 Pit: It is defined as a small pinpoint depression located at the
junction of developmental grooves or at terminals of grooves
 Fissures: It is defined as deep clefts between adjoining cusps
They provide areas for retention of caries producing
agents. These defects occurs on occlusal surface of molars and
premolar
 MORPHOLOGY OF FISSURES
 Pit and fissures are enamel faults, narrow shaft or cracks of some length whose blind ends are directed more
or less towards the dentinoenamel junction
 Nango (1960) in a study of crown sections described four principle types of fissures, based on the
alphabetical description of shape
 V type
 U type
 I type
 K type
 Deep, narrow 1 shaped fissures are quite constricted and resembles a bottle neck. These are caries
susceptible and may also may also have a number of different branches.
 K type fissures are also very susceptible to caries
 Non invasive technique is recommended for u and v types and invasive technique for I and K types of
fissures
 PIT AND FISSURE SEALANTS
 Fissure sealants are defined as whereby pits and fissure that occurs principally on the occlusal surface of the
molar and premolar teeth are occluded by fluid materials, which are then polymerised.
 According to Simonsen:
Materials that are introduced in to pit and fissures of caries susceptible teeth, thus forming
micromechanically bonded protective layer cutting access of caries producing bacteria from their source of
nutrients.
 According to ADA:
An adhesive material that is applied to pit and fissures of teeth in order to isolate from rest of the oral cavity
 EFFECTIVENESS OF SEALANTS
 For sealant to be effective, first of all it must be retained and depend up on the:
1. Technique of application
2. The type of sealant material
3. The morphology of the tooth surface to which it is applied
 CLASSIFICATION
 Mitchell and Gorden (1990) stated that sealants can be differentiated in the following ways:
1.Polymerization methods
• Self activation
• Hight activation
- First generation: uv light
- Second generation: self cure
- Third generation: visible light
- Fourth generation: flouride releasing
2. Resin systems
- Bis-gma
- Urethane acrylate
3. Filled and unfilled
4. Clear or tinted
Clear sealants have been shown to have better flow characteristics than tinted or opaque
 REQUISITED OF AN EFFICIENT SEALANT
1. Adequate working time
2. Adequate viscosity
3. Rapid cure
4. Good and prolonged adhesion to the enamel
5. Low sorption and solubility
6. Resistance to wear
7. Minimum irritation to tissues
8. Cariostatic action
 AGE RANGES FOR SEALANT APPLICATION
 3-4 year age for the primary molar sealant application
 6-7 year of age for the first permanent molar
 11-13 years of age for the second permanent molars and premolars
 Simonsen in 1983 classified patients in to 3 groups

Group 1 Caries free patients judged at no risk to decay

Group 2 Patients judged to be at moderate risk to decay
Group 3 Patients with rampant caries at a high risk to decay
 INDICATIONS

 Newly erupted primary molars and permanent premolars and molars with complete recession of pericoronal
operculum with an open pit and fissure
 Stained pit and fissure with minimum decalcification
 CONTRAINDICATION
 Individual with no previous caries experience and well coalesced pit and fissure
 Wide and self cleansable pit and fissure
 Tooth that cannot be rotated to partially erupted
 Pit and fissure that have remained caries free for 4 years or longer
 TECHNIQUE OF APPLICATION
 Cleaning: the surface of the tooth selected for sealant placement should be cleaned first with a slurry of pumice and water

 Washing and drying: immediately following cleaning, the tooth is washed with water and air dried

 Etching: occlusal surface is then etched with a 30-50% solution of phosphoric acid liquid or gel for 60 seconds
Etching produces microscopic porosities in the enamel. The resin extends into there microporosities and forms tags which
attach it firmly to the tooth surface.

 Washing and drying: following etching, the tooth surface is washed with water for 30 sec to remove are the etchent and thin
air dried (A properly etched tooth have a dull frosted appearance).

 After etching the tooth, the surface be remain dry and free of any moisture contamination until the resin is applied and
cured if the surface becomes contaminated, it must be re-etched for an additional 10 seconds
 Application of material: care must be taken when applying the material
to avoid incorporating air bubble
 Curing: material is cured according to the manufacturer’s directions.
Once the material has been fully cured, it is carefully examined with in
explorer to make certain that
- All pits and fissures are covered
- All excessive materials has been removed
- Material is firmly adhere to the enamel surface
 Recall: as with other forms of dental care, the sealants should be
checked at subsequent recall appointment to ensure.
- It is still firmly adherent
- No sealant materials has been lost
 RECENT PIT AND FISSURE SEALANTS
1. ACP releasing pit and fissure sealant
2. Enamel locum
The first self curing light etching pit and fissure sealant with following properties:
 Fluoride release
 One step application natural white colour
 Low viscosity
 Filled resin
3. Embrace tm wet band tm pit and fissure sealant
 FLUORIDE RELEASING SEALANT
 Garcia goday found that are the fluoridated sealants had a greatest amount of fluoride release by 24 hours
 Cooley et al and hicks et al conducted laboratory studies on a fluoride sealant material composed of
modified urethane bis-gma resin.
 Examples: seal- rite, fluorished, conceal f
 CLEAR PIT AND FISSURE SEALANT
 This type of sealant is aesthetic
 Difficult to detect in recall visit
 Examples: helioseal- changes from green to white
 COLOURED PIT AND FISSURE SEALANT
 The sealant is close to begin with but after polymerization it changes its colour.
 Examples: clinpro- changes pink on setting
 FLUORESCING PIT AND FISSURE SEALANTS
 With the use of a UV pen light, thin sealant fluorescence a blue/ white colour.
 The fluorescent glow provides clinicians with a visual verification of the sealant margins at the time of
placement.
 Examples: Delton sweal-n-glo
 Moist bonding pit and fissure sealants
- First pit and fissure sealants that can be applied in a moist field
E.g.: embrace wet bond pit and fissure sealant
 PIT AND FISSURE SEALANT WITH ACP
 It is a light cured sealant that contains the “smart material” amorphous calcium phosphate that is more
resilient and flexible creating a stronger, longer sealant
 Examples: aegis pit and fissure sealant
 HYDROPHILIC FLUORESCENT BPA FREE PIT AND
FISSURE SEALANT
 Combination of best properties of nearly all sealant
 Some of the major properties are hydrophilic chemistry, advanced adhesive technology, fluorescent
properties, thixotropic viscosity, BPA free formula.
 Example: Ultra seal XT hydro
 PREVENTIVE RESIN RESTORATIONS
 Preventive resin restoration utilize the invasive and non invasive treatment of borderline or questionable
caries.
 The resin placed in the carious areas and adjacent caries susceptible areas, seals them from the oral
environment and provide a valuable treatment alternative to conventional restoration like amalgam
 TYPES OF CARIOUS SURFACE TREATED

 Three types of preventive resin restorations are performed depending up on the carious lesion

Group a Deep pit and fissure susceptible to caries

Group b Minimal exploratory carious lesion
Group c Isolated carious lesion
 TECHNIQUE
 Placement of preventive resin restoration utilizes principle of acid etch technique similar to those of sealant
placement with the exception of caries removal from isolated pits and fissures

CLINICAL PERSPECTIVE
 PRR has shown to improve the long term health of teeth
 Materials like glass ionomer cement have been tried as “ glass ionomer rest a seal” to incorporate their various
advantages which are:
Fluoride release benefits
True adhesion to enamel and dentin
 However, they have inherent disadvantages such as:
Techniques sensitive
Poor wear resistance
 ADVANTAGES
 Minimal cavity preparation is required, thus preventing unnecessary removal of healthy tooth structure for
retention
 Seals caries thereby halting the destruction of tooth. Examples: teeth with pit and fissure, dens invaginatus
 Loss of restoration and subsequent replacement proves to be less invasive than that of conventional
restoration like amalgam
 PRECAUTION
 Early loss of PRR similar to pit and fissure sealant has been attributed to insufficient etching
 Thus it is very important to maintain excellent indication from moisture contamination for the long term
success of PRR
 CONCLUSION
 Pit and fissure sealants can be used effectively as part of a comprehensive approach to caries prevention
 White sealants have been used for primary caries prevention. Current evidence indicates that sealants also
are an effective preventive approach when placed on early noncavitated carious lesions
THANKYOU