1

PIT & FISSURE SEALANTS

AND PRR
2

Dr.T .Balasri
Mds II yr
Dep of pediatric & preventive
dentistry
 Contents:
Introduction

Definition

Classification

History

Types of pit and fissure sealants

Indications & contraindications

Technique

Current sealants

AAPD guidelines of sealent application

Preventive resin restoration

Types of PRR

Procedure

Advantages

Conclusion 3
Introduction
Caries potential is directly related to shape & depth of the pit and
fissures.

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.
4
Definition
Pit:

A small pinpoint depression located at the junction of

developmental grooves or at terminals of those grooves.(ash &
nelson )

Fissures:

Deep clefts between the adjoining cusps They provide areas

for retention of caries producing agents (orbans )

5
Definition :
According to simonsen:
◦ Material that is introduced into the pits 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 pits and fissures of teeth in order
to isolate from rest of the oral cavity.

6
 Why fissures are caries
susceptible ???

1. NEWLY ERUPTED, IMMATURE TOOTH ENAMEL HIGH

ORGANIC CONTENT, MORE PERMEABLE CARIES

SUSCEPTIBLE

2. FISSURE MORPHOLOGY PROVIDE ENVIRONMENT

FOR PLAQUE RETENTION AND BACTERIA

PROLIFERATION.

3.ENAMEL IN PIT N FISSURES THINNER ACCELERATED

DEMINERALISATION 7
 MORPHOLOGY OF PIT & FISSURES
◦ Nagano(1961) described following principal types of fissures, based on
the alphabetical description of shape:

8
 DIAGNOSIS OF PIT & FISSURE
CARIES:
◦ Caries is present when the explorer catches or resists removal after
insertion into a pit or fissure with moderate to firm pressure and
when this is accompanied by one or more of the following signs of
caries:

1. Softness at base of the area.

2. Opacity or loss of normal translucency adjacent to a pit or fissure

as evidence of undermining or demineralization.

3. Softened enamel adjacent to the pit or fissure that can be

scraped away with the explorer.
9
◦ In 2005 Stookey , challenged that long held belief that probing an
occlusal groove with an explorer does not increase dentists ability to
make correct diagnosis and forceful use of explorer can actually
damage the tooth.

◦ In 2008, evidence based recommendations published state that th use

of explorers is not necessary for the detection of early lesions". Visual
examination alone is sufficient to detect early lesions.
10
HISTORY OF PIT AND FISSURE
SEALANTS

11
In 1970, Buonocore published its first article on pit and fissure
sealer, detailing the effective application of BIS-GMA resin
using UV light (Buonocore., 1970). The use of fissure sealant
materials containing bis-phenol A methacrylate (Bis-GMA)
resin monomer was authorized by the American Dental
Association (ADA) in the 1980s (Bowen., 1982)

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13
 TYPES OF PIT & FISSURE
SEALANTS

ACCORDING TO CHEMICAL STRUCTURES OF

MONOMERS
Methyl methacrylate MMA
Tri ethylene glycol dimethacrylate TEGDM
Bis phenol dimethacrylate BPD
Bis GMA— Reaction product of Bis phenol A & glycidyl methacrylate with a methyl
methacrylate monomer.
ESPE monomer
 Propyl methacrylate urethane PMU
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2.BASED ON GENERATIONS
FIRST GENERATION SEALANTS - UV light.
eg:Nuva-lite

SECOND GENERATION SEALANTS-self cure/

chemical cure. eg: Concise white.

THIRD GENERATION SEALANTS-light cured/

visible ( blue) light. eg:Helioseal.

FOURTH GENERATION SEALANTS-fluoride

releasing sealants. eg: Seal right (Pulodent)

FIFTH GENERATION- Glass ionomer cement as

pit and fissure sealants. Sealants with bonding
agents

SIXTH GENERATION Self-etching light cured

sealants.
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3. BASED ON FILLER
CONTENT
- may need
-- resistance
• UNFILLED Eg: clinpro occlusal
to wear
adjustments

- better
flow FILLED
-- more
retention Eg: helioseal

-- abrade
easily
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4. BASED ON COLOR

CLEAR COLOURED
Eg :ivoclar Eg: helioseal

TINTED/
OPAQUE
Eg: clinpro

17
5.Based on curing
SDI conseal
AUTOPOLYMERISIN
G

LIGHTCURE
Beautisealent

18
 Indications:
l. Stained pits and fissures with minimum appearance of
decalcification or opacification.
2. Deep, retentive pits and fissures, which may cause wedging
or catching of an explorer.

3. No radiographic or clinical evidence of interproximal caries .

4. Possibility of adequate isolation from salivary contamination.

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Contraindications:

• Well-coalesced, self-cleansing pits and

fissures.
• Radiographic or clinical evidence of
interproximal caries in need of restoration.
• Tooth partially erupted and no possibility of
adequate isolation from salivary
contamination.
• Life expectancy of tooth is limited.
• Lack of preventive practices.

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REQUISITES OF AN EFFICIENT
SEALANT
◦ Viscous enough to penetrate into deep pit & fissures

◦ Adequate working time

◦ Rapid cure

◦ Good & prolonged adhesion to enamel

◦ Low sorption & solubility

◦ Resistance to wear

◦ Minimum irritation to tissues

◦ Cariostatic action
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 ELIGIBILITY FOR SEALANT APPLICATION:
SELECTION OF PATIENT:-
I.BASED ON AGE: 2.BASED ON CLINICAL JUDGEMENT:

◦ 3-4 years of age for the primary molar ◦ Age

sealant application.
◦ 6-7 years of age for the first permanent
molar.
◦ 11-13 years of age for the second
permanent molars and the premolars.
◦ Oral hygiene
◦ Familial and individual history of dental
caries
◦ Fluoride environment and history
◦ Dietary habits
◦ Tooth type and morphology

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23
STEPS OF SEALANT
APPLICATION

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POST OPERATIVE INSTRUCTIONS

 Avoid chewing gums or sticky foods for 24hours

 May yellow with age
 Expected to last for 3-5years
 Chew right away after sealants placement
 It is not guaranteed that decay is 100% preventable.

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 Invasive technique
Garcia-Godoy and de Araujo, 1994
◦ demonstrated that the Enameloplasty Sealant Technique (EST) allows a deeper sealant
penetration and a superior sealant adaptation than the conventional sealant treatment
without any mechanical enlargement of the fissures with a bur .

An increased surface area for sealant retention is readily evident in all

samples treated with the EST.

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 Koh et al in 1995 showed that topical
fluoride treatment has no clinical effect
on retention of pit and fissure sealants.

Koh et al,1998
showed that exposure of enamel to NaF, SnF2 or APF prior to
placement of unfilled or filled sealants has no effect on in vitro bond
strength the and the sealants.

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Acid etching tooth surface
Silverstone in 1975 identified 3 basic patterns of etching:

Type 1:Generalised roughening of

enamel surface, but with distinct
hollowing of prism centers and
relatively intact peripheral regions.
Type 2:Prism peripheries appear to
be damaged. Prism cores are left
projecting towards original enamel
surface.

Type 3:Show neither type 1 or 2

etching pattern but appear as
generalised surface roughening

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The conventional 60 s etching was first used by Ripa and Cole.
Increased etching time for deciduous teeth is attributed to various
reasons like:
1. Deciduous teeth have less mineral and more organic material in the
enamel
2. Deciduous teeth have a larger internal pore volume and thus more
exogenous organic material.
3. Deciduous teeth have more prism less enamel on their surface the do
permanent teeth.
4. The prism rods in deciduous teeth approach the surface at a greater angle
and thus are more difficult to etch.

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 Despite this, early recommendations for etching primary
enamel were twice then accepted time for permanent
enamel (120 seconds vs 60 seconds) (Silverston and Dogon
1976).

The first report comparing the retention on primary

molars of the 120-second etching time vs 60 seconds
showed no difference in sealant retention.
Simonsen, 1978

A later reported noted that “decreasing the etch time ,for

primary molars has been found to decrease the chance of
contamination, during etching. Additionally the shorter etch
time was far more acceptable to 3- and 4- year-old children.“
(Simonsen, 1979)
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◦ Silverstone(1974) : found that 60 secs application of unbuffered solution of
37% phosphoric acid produced the most favourable conditions for bonding.

◦ Fuks et al(1 984) and Eidelman et al(1984) :showed respectively that a 20

sec etch provided similar resistance and retention rates when compared to a
60 sec etch.

◦ The most accepted times were given in IADR sealent symposium in 1991:

35
Retention and microleakage have shown improvement when
a bonding agent is used: A 2-year clinical study comparing
sealants done with intentional salivary contamination shows
that sealant retention is possible on wet enamel if a bonding
agent is used between enamel and sealant (Chestnutt et
al,1994)

In primary teeth, the effect of bonding agents on the

microleakage and bond strength of sealant has been studied.
The use of enamel-dentin bonding agents under sealant in
moisture- contaminated conditions gave better results than
applying sealant alone onto non contaminated
teeth(ToIunogIu et al,1999)
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 Boksman(1993) carried out a clinical trial of sealants with and
without bonding agent and found no benefit to the use of the
bonding agent. The retention rates for the sealants were 77%
for Concise with Scotchbond 2, 84% for Concise with no
bonding agent; 77% for Prisma Shield with Universal Bond;
and 77% for Prisma Shield with no bonding agent

A study by Arzu Pinar et al (2005) observed that the use of

bonding agent as an intermediary layer between enamel and
sealant did not affect sealant success during a 24-month period.

37
Based on the results observed in several
studies, the use of bonding agent as an
intermediary layer between enamel and
sealant did not affect sealant success.

In situations in which control of saliva and

isolation is impossible the use of bonding for
increasing the quality of fissure sealant
therapy is useful.

38
Now a days lasers are used for curing due to the following advantages :
Reduction in setting time.
 Control of specific radiation energy wavelengths.
Control of area of exposure.
Decrease in %age of unpolymerized

39
 Evaluation of occlusion:
◦ Evaluate occlusion of sealed tooth surface with articulating
paper to determine if an excessive sealant is present and needs
to be removed

◦ A small discrepancy in occlusion in case of unfilled sealant is

easily tolerated as the cement abrades away but in case of filled
resin sealant occlusal adjustment is must to avoid discomfort.

40
 CCC sealant evaluation system

◦ C — Colour: validity of sealant identification diagnosis.

◦ C — Coverage: effectiveness of the sealant.

◦ C— caries: caries status on the surface.

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Recall and re-evaluation

Sealants must The sealant is still firmly adherent to the

be thoroughly tooth and
checked at The sealant material has not been lost.
subsequent
recall Thus, if there is any of the sealant
appointments as material lost then it must be added
to ensure that: during this time.

42
 Effectiveness of sealants:
◦ For the sealants to be very effective, first of all it should be retained
which depends upon the following factors:

Technique of sealants application

The type of sealant material used and

 The morphology of the surface of the tooth to which the sealant is

applied to cover the pits and fissures.

43
Retention and caries
prevention:
Wendt and Koch (1988)
 reported on a tooth sealed over a IO-year period. They found that after
8 years, about 80% of the sealed fissures showed total sealant
retention and no caries.
 Another 16% of the sealed occlusal surfaces showed partial retention
and no caries.
After 10 years, only 6% of the sealed occlusal surfaces showed caries
or restorations

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Estrogenicity issue:
Olea and coworkers in Granada, 1996,Spain

 started a controversy that resulted in considerable confusion and

doubt in the minds of many dentists and consumers alike about the
safety of pit and fissure sealant.

Concern was raised about the safety of monomers leached out of

these materials.

45
◦ The conversion of monomers during the curing process of a sealant is
incomplete, thus residual monomers can leach out of the cured resin.

◦ BPA released orally from a dental sealant may not be absorbed or may
be present in non detectable amounts in systemic circulation. The
concern about potential estrogenicity of sealant may be Unfounded (Fung
et al 2000)

46
The parental concern about the
estrogenicity of sealants is unfounded
based on the presently-available
evidence. It should also be remembered
that none of the dental sealants that
carry the ADA Seal release detectable

47
Fluoride used with sealants and
fluoride-containing sealant:
◦ In an analysis of fluoride release from fissure sealants, Garcia-Godoy,
Summitt and Donly (1997) found that all the fluoridated sealants tested
released measurable fluoride.
◦ However, the greatest amount of fluoride was released in the first 24
hours after mixing, and the fluoride release fell sharply on the second
day and decreased slowly for the last days.

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filled vs unfilled; colored vs clear; autocure vs
light-initiated:

Penetration, is inversely proportional to the viscosity. Thus, it

could be reasoned that an unfilled resin penetrate deeper into
the fissure system, and, therefore, perhaps be better retained.

In a study comparing unfilled and filled sealant in the mouth, an

unfilled light-cured resin was significantly better retained than a
filled light-cured resin((Rock et al,1990)

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Colored vs clear:
◦ In March of 1977, the first colored sealant (3M’s Concise White Sealant) was
introduced

Advantages :
Easier to see the sealant during application, and faster to assess
retention with a white sealant.
Documentation of retention is much easier over long time periods with
a colored sealant.
Some have argued against use of an opaque color as it precludes
continual examination of the sealed fissure.

50
 Autocure vs light-initiated:

Autopolymerizing resins generally performed better than the early

ultraviolet light-initiated resin sealant—84% complete retention at 2 years
compared to 75% in one study. When the visible light-initiated resins were
introduced and compared to the autopolymerising sealant, no significant
difference was found in retention over 31 months.

51
Glass ionomer materials as
sealants:
The logical assumption that a material that releases fluoride, such as a
glass ionomer cement, would provide an added benefit to the retentive
blocking of the fissure by a resin sealant, has been tested many times
with various glass ionomer materials, sometimes in direct comparison
with resin materials.

52
◦ In a study reported by Boksman et al,
◦ comparison of the study's 6-month complete retention rates
of 92% for Concise white light- initiated sealant and 2% for
the Fuji Ill glass ionomer sealant, suggests, according to the
authors,that the routine use of the Fuji Ill glass ionomer as a
fissure sealant is unreliable.

53
resin-modified glass-ionomer (RMGI) can
challenge the resin sealants in terms of
retention remains to be seen.
 But early indications are that the RMGI wears
markedly more than the resin sealant-
winkler.et.al 1996

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Current status:
Fluorescing Pit and Fissure sealent :

• Use of UV pen light: fluoresces a blue/white color.

• Visual verification of sealent margins at time of placement and recall .

Eg Delton Seal-N-Glo

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Wetbond pit and fissure
sealent
◦ Bonds chemically and micromechanically to the moist tooth.
◦ First pit and fissure resin sealent that can be applied in moist field.

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Pit and fissure sealent
with ACP
◦ Light cured sealent that contains "smart material“ Amorphous Calcium
Phosphate(ACP).
◦ More resilient and flexible,creating stronger long lasting sealent. Eg:
Aegis pit and fisure sealent.

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Moisture tolerant pit & fissure sealants.
Eg: Pulpdent Embarce wet bond
Traditional sealents Embrace wet bond

◦ Hydrophobic ◦ Hydrophilc.

◦ They repel water and cannot be ◦ Embrace is activated by moisture.

applied where there is Moisture. ◦ Embrace WetBond contains no bis-GMA

and no bisphenol A.
◦ Bis-GMA is present(hydrophobic
◦ It contains fillers (aluminum powder,
monomer)
carbon fiber, graphite, calcium carbonate,
◦ Filled or un-filled sealants
silica, clay)

58
American Academy of Pediatric
Dentistry (AAPD) guidelines
Recommendations for Pit and fissure sealants (2008):

◦ Sealants should be placed into pits and fissures of teeth based the
patient’s caries risk, not the patient's age or time lapsed since tooth
eruption.
◦ Sealants should be placed on surfaces judged to be at high risk or
surfaces that already exhibit incipient carious lesions to inhibit lesion
progression. Follow up care As with all dental treatment, is
recommended.

59
◦ Sealant placement methods should include careful cleaning of the pits
and fissures without removal of any appreciable enamel. Some
circumstances may indicate use of a minimal enameloplasty technique.

◦ A low-viscosity hydrophilic material bonding layer, as part of or under the

actual sealant, is recommended for long-term retention and
effectiveness.

◦ Glass ionomer materials could be used as transitional sealants.

60
Are sealants recommended for both
adults and children …???
◦ Susceptibility to decay can exist in any tooth with pits and fissures

◦ This includes the primary teeth of children, and the permanent teeth of
children and adults

◦ The caries risk status of an individual can change over

◦ a period of time during both adolescence and adulthood

“Therefore sealants really aren't kids".

61
Features of Current Pit and Fissure
Sealents….
◦ Pit and fissure sealant applications are the most essential prophylactic
method against caries formation, aside from professional fluoride
treatments and regular oral hygiene habits.

◦ The choice of pit and fissure sealant material to be used may vary
depending on the age of the patient, the eruption time of the teeth, and
the child’s cooperation

62
Current Pit and Fissure Sealents

63
64
65
 Preventive resin restoration

◦ Are among the newer techniques which show

long term success.

◦ This treatment of resin restoration has various

distinct advantages over the traditional amalgam
restorations.

◦ But it requires an excellent isolation of moisture

and saliva contamination.
66
A PRR is a conservative treatment that involves limited excavation to
remove the carious tissue , restoration of the excavated area with a
composite resin , and application of a sealant over the surface of the
restoration and remaining, sound, contiguous pits and fissures (Ripa et al
1992)

Also called CONSERVATIVE ADHESIVE RESTORATION. First reported

by Simonsen and Stallard (1978)

67
◦ PRR utilizes 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 provides a valuable
treatment alternative to conventional restorations like amalgam

68
It integrates the preventive approach of the
sealant therapy for caries susceptible pits and
fissures with the therapeutic restoration of
incipient caries with composite resin that occurs
on the same occlusal table.

69
Deep pit and fissures on tooth surface

Require sealant therapy

If caries present in one area or part of the pits or fissures

that particular caries is restored and remaining pits and fissures

are protected with sealants

PREVENTIVE RESIN RESTORATION

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 Based on the extent and
depth of the carious lesions:

a) Type A - Suspicious pits c) Type C - Characterized by

b) Type B - Incipient lesion
and fissures where caries the need for greater
in dentin that is small and
removal is limited to exploratory preparation in
confined
enamel. dentin

71
 Simonson (1978) advocated an unfilled sealant --- type A

A diluted composite resin ---- type B

Filled composite resin ---- type C

Ulvested (1976) adopted the concept of diluted composite resin---- mixture of filled
composite resin and unfilled bonding agent over an unfilled sealant.

 Use of an intermediate unfilled resin layer.

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 TYPE A RESTORATION
 Enamel fissure caries are removed with slow speed round bur.

 Enamel surface is etched

 Completely with sealant.

73
PLACEMENT TECHNIQUE
I)CLEAN THE SURFACE

2)1SOLATION

3)REMOVE DECALCIFIED PITS AND FISSURE

4)PLACE ACID - ETCHED GEL - 20 TO 60 SEC

5)WASH AND DRY

6)APPLY THE SEALANT

7)POLYMERISE WITH VISIBLE LIGHT - 20 SEC

8)ADJUST THE OCCLUSION, IF NEEDED

74
TYPE B RESTORATION

75
PLACEMENT TECHNIQUE
Removal of caries

Application of acid — etching gel

Bonding agent application

Injection of filled composite resin

Condensation and smoothing

Filled sealant application

polymerization

76
TYPE C RESTORATION
Repeat all steps listed for type B

Type C is larger and deeper add additional polymerization time

(30sec).

In most cases local anesthesia will also be required.

77
Advantages:
Conservation of Tooth
Structure

Flexible preparation
design

Ease and speed of

placement

78
◦ PRR are an extension of the sealant technique that allow for caries
control with minimal loss of tooth structure.

◦ This method is indicated where caries within a fissure has just reached
the dentine.

◦ Under ideal circumstances the fissure sealants can successfully prevent

progression of caries

79
◦ For early decay, where space allows, glass ionomer veneered with
unfilled resin should be used. The main difficulty in determining the
optimal form of management for an early decay lesion is the diagnosis of
state of the fissure.

◦ Management of doubtful occlusal fissures, with use of air abrasion

techniques to open up all suspect fissures and grooves does not fit well
with current minimal intervention philosophy, even though it may be
easiest solution for the practitioner.

80
Literature
The purpose of this study was to systematically review the impact of nanofillers on the
physicomechanical properties of resin-based pit and fissure sealants (RBS).

The review was formulated based on the preferred reporting items for systematic review and
meta-analyses (prisma) guidelines and used the consolidated standards of reporting trials
(consort) guidelines and risk of bias cochrane tool for quality assessment.

Do nanofillers provide better physicomechanical properties to resin-based

pit and fissure sealants? A systematic review, Syed M. Yassin .et al ,
Journal of the Mechanical Behavior of Biomedical Materials,sep 2023

82
The inherent nature of the nanomaterial used, its morphology, concentration, and volume used
were the primary parameters that determined the nanomaterial's success as a filler in rbs. These
parameters also influenced their interaction with the resin matrix, which influenced the final
physicomechanical properties of RBS

 The use of nanofillers that were non-agglomerated and well dispersed in the resin matrix
enhanced the physicomechanical properties of RBS.

Do nanofillers provide better physicomechanical properties to resin-based

pit and fissure sealants? A systematic review, Syed M. Yassin .et al ,
Journal of the Mechanical Behavior of Biomedical Materials,sep 2023

83
Purpose: The purpose of this study was to review the in vitro literature on shear bond strength
(SBS) and microleakage of pit and fissure sealant materials in contaminated (water, human, or
artificial saliva) and non-contaminated conditions

Methods: PubMed®, Web of Science™, Scopus®, Embase™, and Cochrane Library databases
were used as data sources. Of the 974 studies identified, 56 were considered eligible for full-text
screening and 32 were selected for data extraction.

Conclusion: Surface contamination decreases the bond strength between contaminated enamel
and both unfilled and filled resin-based sealants, which affects the clinical effectiveness of
sealants.
Shear Bond Strength and Microleakage of Fissure Sealant to Contaminated and Non-
Contaminated Enamel: A Systematic Review and Meta-Analysis of In Vitro Studies, Memarpour,
.et.al , : American Academy of Pediatric Dentistry,sep ,2023

84
◦ This study evaluates the microleakage levels of a new and colored flowable composite
applied as a sealant after three preparation techniques
◦ A total of 24 non-carious mandibular permanent molars with deep pits and fissures
were included in the study. Pit and fissures were prepared with 37% phosphoric
acid,tungsten carbide bur and fissurotomy burs using conventional, enameloplasty
and fissurotomy techniques.
◦ .The present study reports no difference between the microleakage level of a colored
flowable composite material used as a pit and fissure sealant following three fissure
preparation techniques and supports the clinical use of this material.

Evaluating the effect of three fissure preparation techniques on microleakage of a colored

flowable composite used as a fissure sealant Basak.et .al journal of clinical pediatric
dentistry ,2023
85
AIM :
◦ This study examined if reducing the recommended 15 s etching time of primary teeth
enamel affects the micro-shear bond strength (µSBS) of pit-and-fissure sealants.
METHOD
◦ The cusps of forty non-carious, extracted human primary molars were separately
etched for 8, 15 or 30 s. Then, a pit-and-fissure sealant was placed and light-cured.
The µSBS values were evaluated and compared among the three groups
CONCLUSION
◦ No statistically significant differences in µSBS were observed among the three test
groups. In this study, we showed for the first time that the recommended etching time of
primary teeth enamel may be reduced from 15 to 8 s without compromising the µSBS
of the sealant
Effect of Different Etching Times on Pit-and-Fissure Sealant Micro-Shear Bond
Strength to the Enamel of Primary Teeth, Kharouba J.et.al ,MDPI.2023

86
Conclusion
One of the best preventive measures we can offer patients

Cost effective ,simple & fast

When properly placed and maintained

Sealents have proven longevity

Will aid in the prevention of caries

Patients appreciate the preventive efforts

87
 References :
◦ Pediatric dentistry Infancy through Adolescence. 5th edition by:
CASAMASSIMO. 2013

◦ Richard J. Simonsen.Pit and fissure sealant: review of literature. Pediatr

Dent.

◦ James J.C, Kevin J.D.Dental sealants guidelines development: 2002-2014.

Pediatr Dent

◦ Essentials of preventive and community dentistry. 4th edition by Soben

Peter.2010 88
References
◦ International studies in health sciences 2023
◦ Yassin SM, Mohamad D, Togoo RA, Sanusi SY, Johari Y. Do nanofillers
provide better physicomechanical properties to resin-based pit and
fissure sealants? A systematic review. Journal of the mechanical
behavior of biomedical materials. 2023 Jul 21:106037.
◦ Memarpour M, Baghdadabadi NA, Bardideh E. Shear Bond Strength
and Microleakage of Fissure Sealant to Contaminated and Non-
Contaminated Enamel: A Systematic Review and Meta-Analysis of In
Vitro Studies. Pediatric Dentistry. 2023 Sep 15;45(5):30E-47E.

89
References
◦ Eliacik BK, Karahan M. Evaluating the effect of three fissure preparation
techniques on microleakage of a colored flowable composite used as a
fissure sealant. Journal of Clinical Pediatric Dentistry. 2023 Nov 1;47(6).

◦ Kharouba J, Gonoratsky AA, Brosh T, Masri M, Iraqi R, Blumer S. Effect

of Different Etching Times on Pit-and-Fissure Sealant Micro-Shear
Bond Strength to the Enamel of Primary Teeth. Children. 2023 Feb
26;10(3):461.
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