pit and fissure sealants, preventive dentistry

1. GOOD MORNING

2. PIT & FISSURE
SEALANTS
DR.S.ASWINI
2ND YEAR POSTGRADUATE STUDENT
DEPARTMENT OF PUBLIC HEALTH DENTISTRY

3. CONTENTS
• Introduction
• Definition
• Morphology of Pits and fissures
• History of sealants
• Types of Pit and fissure sealants
• Indications
• Contraindications
• Steps of sealant application
• Factors affecting retention
• Cost effectiveness
• Preventive resin
restorations
• Public health sealant
programs
• Conclusion
• References

4. INTRODUCTION
• Dental caries - widespread disease of mankind.
• shortly after eruption of the deciduous teeth and continue to increase at
a remarkable rate in their school age.
• Fluoride’s great success in preventing tooth decay on smooth surfaces
has made dental caries largely a disease of rough irregularities.

5. • Deep pits and fissures favor food retention and are difficult to clean
by routine brushing.
• The most efficient way to prevent pit and fissure caries is by
effectively sealing the fissures using resins called pit and fissure
sealants.
INTRODUCTION

6. DEFINITIONS
PITS :
small pinpoint depressions located
at the junction of developmental
grooves or at terminals of those
grooves.
(Ash and Nelson)
FISSURE:
Deep clefts between adjoining cusps.
These defects occur on occlusal surfaces
of the molars and premolars, with
tortuous configurations that are difficult
to assess from the surfaces. (Orbans)

7. MORPHOLOGY OF PITS & FISSURES
Nagano(1961)
• V type – 34%
• U type – 14%
• I type – 19%
• IK type – 26%
• Inverted Y type – 7%

8. • Shallow, wide V & U shaped fissures –
a. self cleansing
b. somewhat caries resistant.
• Deep, narrow I shaped fissure –
a. constricted
b. resemble bottle neck
c. narrow slit like opening
• K- shaped and inverted Y shaped fisssures –
a. large base
b. caries susceptible.
MORPHOLOGY OF PITS & FISSURES

9. WHY PIT AND FISSURES ARE CARIES SUSCEPTIBLE?
• Enamel in pit and fissures are thinner- accelerated demineralization
• Newly erupted tooth-high organic content, more permeable
• Morphology provide environment for plaque

10. PIT AND FISSURE SEALANTS
“Pit and Fissure sealants are materials designed to prevent pit and fissure
caries when they are applied to the occlusal surfaces of teeth in order to
obliterate occlusal fissures and remove the sheltered environment in
which caries may thrive.”

11. International Caries Detection and Assessment System (ICDAS)
for caries
ADA guidelines-the use of fissure sealant is recommended with ICDAS II codes 1 and 2.

12. HISTORY OF SEALANTS
• 1895- Wilson reported the placement of dental cement in pits and
fissures.
• 1905- Silver nitrate by Miller.
• 1923 and again in 1936, Hyatt - Prophylactic odontotomy.
• 1929- Bodecker- Enameloplasty (Fissure eradication).
• 1942 - Klein and Knutson- ammonical silver nitrate

13. • 1951 – Miller J – copper amalgam
• 1955- Buonocore – Acid Etching (concentrated phosphoric acid
solution) (PMMA)
• Cyanoacrylates were the first materials to be used as sealants
• 1972 – NUVA SEAL –UV P&F sealant – BOWEN
• 1976- first colored sealant- CONCISE WHITE SEALANT – chemical
cure.
HISTORY OF SEALANTS

14. POLYMERIZATION OF SEALANTS
• The common sealant is a resin called a monomer (a molecule that can
be bound to similar molecules to form a polymer, which contains two
or more monomers).
• When the catalyst acts on the monomer, repeating chemical bonds
begin to form, as the hardening process - polymerization proceeds .
• Finally, the resultant hard product is known as a polymer.

15. Two methods have been used to catalyze polymerization
• Light curing with the use of a visible blue light (camphoroquinone)
• Second method is self-curing (initiator usually benzoyl peroxide )

16. TYPES OF SEALANTS
BASED ON CHEMICAL STRUCTURE OF MONOMER
• Methyl methacrylate(MMA)
• Triethylene glycol dimethylacrylate(TEGDMA)
• Bis Phenol dimethacrylate(BPA)
TYPES OF SEALANTS

17. TYPES OF SEALANTS
BASED ON CURING METHODS
TYPES OF SEALANTS

18. BASED ON FILLERS
A) UNFILLED
• better flow
• more retention
• abrade easily
B) FILLED
• Need for occlusal adjustments
• More resistant to wear
• May need occlusal adjustments
TYPES OF SEALANTS

19. BASED ON COLOR
• Tinted
• Clear
• Opaque
• Pink
TYPES OF SEALANTS

20. TYPES OF SEALANT MATERIALS
a) Cyanoacrylates:
• Discovered in late 1950's
• Used as surgical adhesive and tooth sealants
• In presence of traces of moisture they polymerize rapidly to hard
and brittle polymers on etched tooth surface.

21. b)Poly urethanes:
• Eg: EPOXYLITES
• Contain 10% sodium mono fluorophosphate with liquid polyurethane
and utilize citric acid as etchant.
• Not regularly used due to poor mechanical properties and oral
durability and toxicity.

22. c)Dimethacrylates
• highly volatile and lacks penetration.
• Enamite, a new sealant utilizes MMA-PMMA system initiated by butyl
boron.
• Binds better and is less affected by immersion in water.
• BISGMA : viscous amber liquid of low volatility diluted with MMA.
(3:1)

23. d) Glass Ionomer Cement
• Mc Lean and Wilson
• Hydrophilic
• Good adhesion
• Biocompatible
• Used for fissure orifice exceeding 100μm

24. • Fluoride-Releasing Sealants
• Because fluoride uptake increases the enamel's resistance to caries, the
use of a fluoridated resin-based sealant may provide an additional
anticariogenic effect if the fluoride released is incorporated into the
adjacent enamel.

25. • Fluoride-releasing sealants have shown antibacterial properties as well
as a greater artificial caries resistance compared with a non-fluoridated
sealant.
• However, recent reviews revealed that, compared with resin-based
sealants, fluoride-containing sealants have a poor retention rate after 48
months; they also have not proven to act as a fluoride reservoir with
long-term release of fluoride into the oral environment.

26. • Alpha-Dent Light Cure Pit and Fissure Sealant
• Baritone L3
• Concise Light Cure White Sealant
• Concise White Sealant
• Helioseal F
• Helioseal
• 3M Clinpro Sealant
• Prisma Shield Compule Tips Tinted Pit and Fissure Sealant
• e Prisma Shield YLC Filled Pit and Fissure Sealant
• Seal-Rite
• Seal- Rite Low Viscosity
Pit & Fissure Sealant Products in Market:

27. ELIGIBILITY FOR SEALANT APPLICATION-
PATIENT SELECTION
BASED ON AGE
• 3-4 years of age for the primary molar 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.
The disease susceptibility of the tooth should be considered when
selecting teeth for sealants, not the age of the individual.

28. BASED ON CLINICAL JUDGEMENT
• Oral hygiene
• Familial and individual history of dental caries
• Fluoride environment and history
• Dietary habits
• Tooth type and morphology

29. OTHER INDICATIONS
• Stained pits and fissures with minimum appearance of decalcification
or opacification.
• Deep, retentive pits and fissures, which may cause wedging or catching
of an explorer.
• No radiographic or clinical evidence of interproximal caries.
• Possibility of adequate isolation from salivary contamination.

30. CONTRAINDICATIONS
• Patient behavior does not permit use of adequate dry-field techniques
throughout the procedure.
• An open carious lesion exists.
• Caries exist on other surfaces of the same tooth in which restoring will
disrupt an intact sealant.
• A large occlusal restoration is already present

32. STEPS IN SEALANT
APPLICATION

33. ASSEMBLE THE ARMAMENTARIUM
• Mouth mirror
• Probe
• Explorer
• Tweezer
• Cotton rolls
• Suction tip
• Etchant
• Sealant
• Articulating paper
• Handpiece

34. POLISH/DRY THE TOOTH SURFACE
• Remove plaque and debris from the enamel and the pits and fissures of
the tooth.
• Clean the surfaces - Dry tooth brush/prophy cup with pumice/air
abrasion for 10seconds.
• Explorer to remove debris.
• Rinse for 20-30seconds.

35. ISOLATION OF THE TEETH
Rubber dam provides the best isolation.
salivary contamination allows rapid precipitation of glycoprotein's onto the etched
enamel, greatly decreasing the bond strength.
in which retention was tested using a rubber
dam versus cotton rolls, the sealant retention
was approximately equal

36. ACID ETCHING
• 30-50% Ortho phosphoric acid is used in liquid form for 30-60 seconds
using hairbrush/cotton pledget held with cotton pliers
• On all susceptible pits and fissures
• Extend up the cuspal lines, well beyond (at least 2mm) the anticipated
margin of sealant.
• Another 15 seconds of etching is indicated for fluorosed teeth to
compensate for the greater acid resistance of the enamel.

37. RINSING
• At the end of the etching period, the aspirator tip is positioned with the
bevel interposed between the cotton roll and the tooth.
• For 10 seconds the water from the syringe is flowed over the occlusal
surface.

38. ISOLATION & DRYING
• The tooth is dried until it has a chalky, frosted appearance. If it does
not, the tooth should be re-etched.
• This is because the etching will remove approximately 5 to 10 µm of
the original surface, although at times interrod penetrations of up to 100
µm may occur
• In any event, the surface area is greatly increased by the acid etch.
comparing the Vac-Ejector versus the cotton
roll for maintaining dryness, the two were
found to be equally effective.

39. APPLICATION OF SEALANT
• The material should first be placed in the fissures where there is the
maximum depth.
• The sealant should not only fill the fissures but should have some bulk
over the fissure.
• The light-emitting device consists of a high-intensity white or blue
light , usually between 400 to 500 nm.

40. • The end of the rod is held a few millimeters above the sealant during
the first 10 seconds, after which it can be rested on the hardened surface
of the partially polymerized sealant.
• The time required for polymerization is usually around 20 to 30
seconds.
• Even after cessation of light exposure, a final, slow polymerization can
continue over a 24-hour period.

41. • Staring at the lighted operating field is uncomfortable
• This problem is circumvented by the use of a round, 4-inch dark-yellow
disk.

42. • If any voids are evident, additional sealant can be added without the
need for any additional etching.
• The hardened sealant has an oil residue on the surface.
• This is unreacted monomer that can be either wiped off with a gauze
sponge or can be left.

43. EVALUATION
SEALANT
• for complete coverage
• for absence of voids or bubbles
• small voids can be repaired.
OCCLUSION
-checked visually or
articulating paper
- round cutting bur
INTERPROXIMAL SPACES
-dental floss.
-the use of scalers.

44. 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
• Made to wear on biting within 1-2days
• It is not guaranteed that decay is 100% preventable.

45. RECALL AND RE-EVALUATION
• Should be done after 6months
• The sealant is still firmly adherent to the tooth and
• The sealant material has not been lost.
• Thus, if there is any of the sealant material lost then it must be added
during this time.

46. CCC SEALANT EVALUATION SYSTEM

47. RETENTION
• When the resin sealant flows over the prepared surface, it penetrates the
finger-like depressions created by the etching solution.
• projections of resin into the etched areas are called tags.
Teeth that have been sealed and then have lost the sealant have had fewer lesions than
control teeth- due to tags.

48. REQUISITES FOR SEALANT RETENTION
For sealant retention the surface of the tooth must
(1) have a maximum surface area,
(2) have deep, irregular pits and fissures,
(3) be clean,
(4) be absolutely dry at the time of sealant placement and
uncontaminated with saliva residue.

49. COST EFFECTIVENESS
• The number of sealants that need to be placed in order to prevent one
surface restoration.
• 5 - 10 sealants must be placed to save one molar surface from becoming
carious.

50. TO MINIMIZE THE COST
1. Selective application on teeth with the greatest caries risk.
2. Delegating treatment to auxiliary personnel where legally permitted.
3. Selecting commercial products that have the highest proved success
rates and are approved.
4. Following meticulous application protocol.
5. Applying sealants in conjunction with optimal fluoride therapy

51. ESTROGENICITY ISSUE
• Leaching of monomers from unpolymerized material
• Olea et al. (1996) reported that BPA was identified in the saliva of
patients treated with a commercially available dental sealant, and
confirmed the estrogenicity of this resinous material by proliferation
tests of human breast cancer cells.
• It also affects reproductivity.

52. CURRENT STATUS
EMBRACE WETBOND
• Bonds to moist tooth
• Easy to dispense
• Avoids cross contanimation

53. ACP releasing sealant
• light cured sealant
• resilient and flexible, creating a stronger long
lasting sealant.
• neutralize the acid and buffer the pH.
• reinforcement to the tooth’s natural defense
system only when it is needed.
Aegis Pit and Fissure Sealant (Bosworth)

54. Hydrophillic Fluorescent BPA Free Pit and Fissure Sealant
• combines the best properties of nearly all sealants.
• hydrophillic chemistry, improved adhesive property, fluorescent
properties, BPA-free formula

55. LASERS IN PIT AND FISSURE SEALANT TECHNIQUE
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 percentage of unpolymerized resin

56. PREVENTIVE RESIN RESTORATIONS
• 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.

57. According to Simonson(1978)
TYPE A
• where caries removal is
limited to enamel.
• slow speed round bur.
• sealant placed.
TYPE B
• Incipient lesion in dentin
that is small & confined
• 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

58. TYPE A RESTORATION
1)clean the surface
2)isolation
3)remove decalcified pits and fissure
4)place Etchant – 20 to 60 sec
5)wash and dry
6)apply the sealant
7)polymerize with visible light – 20 sec
8)adjust the occlusion, if needed

59. TYPE B RESTORATION
• Removal of caries
• Application of acid – etching gel
• Bonding agent application
• Injection of filled composite resin
• Condensation and smoothing
• Filled sealant application
• polymerization

60. TYPE C RESTORATIONS
• Repeat all steps listed for type B
• Type C is larger and deeper add additional polymerization time (30
sec).
• In most cases local anesthesia will also be required.

61. PUBLIC HEALTH SEALANT PROGRAM
• School – based American Association of Community Dental Programs
has developed a manual “Seal America : The Prevention Invention”
1990: US Public Health Service published a national health objective
for the year 2000, stating that 50% children should have sealants on 1
or more permanent teeth.

65. CONCLUSION
• The use of fissure sealants as a key primary prevention method is
well documented and it is scientifically proved to have good results.
• sealing pit and fissures of primary and permanent teeth is safe and
effective both in preventing and in arresting caries.
• Although the application of a pit and fissure sealant is a non-invasive
and less time-intensive procedure compared to restorative therapies, it
is very technique sensitive.