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Pit and fissure sealants

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Pit and fissure sealants

  1. 1. PIT AND FISSURE SEALANTS Department of Pedodontics SDC, Sri Ganga Nagar Submitted By Ramneek kaur
  2. 2. Healthy sealed tooth
  3. 3. Pit and fissure sealants
  4. 4. 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.
  5. 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.
  6. 6. HISTORY: IN 1905: application of silver nitrate by miller IN 1923: Hyatt reported a technique named “prophylactic odontomy”. IN 1929: Bodecker introduced fissure eradication. IN 1955: Buanocare introduced a method of adhering resin to an acid etched enamel surface. IN 1965: Bowen & associates developed BIS- GMA resin. IN 1970 & EARLY 1980’S: UV light with a wavelength of 365 nm was used to initiate the setting reaction.
  7. 7. CLASSIFICATION: According to chemical structure of monomers used: MMA-methyl methacrylate,{ NUVASEAL} TEGDMA-triethylene glycol dimethacrylate,{KERR PITT AND FISSURE SEALANTS} BPD-bisphenol dimethacrylate BIS-GMA PMU-propyl methacrylate urethane
  8. 8. According to generations: 1st generation UV light cured at Eg:alphaseal,nuvalit 356 nm e,alphalite 2nd generation Self cured Eg:concise white sealant,delton 3rd generation Blue visible light Eg:stephen K.W cured at 490 nm strang 4th generation flouride releasing Eg: Toma l.morphis , Jack toumba
  9. 9. Based on filler content: •UNFILLED Better flow More retention Abrade rapidly •FILLED Resistance to wear Need occlusal adjustments
  10. 10. Based on color •Color: esthetic but difficult to detect in recall visits. •White tinted/opaque: contain opaquing agent titanium dioxide •Colored: easy to see during placement and recall.eg: Helioseal{ white color changes to green}
  11. 11. MORPHOLOGY OF PITS AND FISSURES ACCORDING TO NANGO 1961: •V shaped fissure: wide at top, narrow at bottom •I shaped fissure : quite constricted and may resemble a bottle neck • U shape fissure: same width from top to bottom • K shape fissure: extremely narrow slit with larger space at bottom • H shape fissure: seen mostly in premolars
  12. 12. Morphology of pits & fissures
  13. 13. ACCORDING TO GALIL & GWINETT, 1975 • V shape •U shape •Tear drop shape
  14. 14. Diagnosis of pits and fissures
  15. 15. DIAGNOSIS OF PIT AND FISSURE CARIES: •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. •By xeroradiographic & digital radiography, dye preparation,fiberoptictransillumination,ultrasoni
  17. 17. PROCEDURE OF PIT AND FISSURE SEALANT APPLICATION: •CLEAN THE TOOTH SURFACE: Remove plaque & debris from enamel and pits & fissures of the tooth. Debris interfere with proper etching process Simply use a toothbrush prophylaxis with toothpaste or pumice followed by copious water rinsing. If sodium bicarbonate slurry has been used, it is necessary to neutralize the retained slurry with phosphoric acid for 5-10 sec.
  18. 18. •ISOLATE & DRY THE TOOTH SURFACE Rubber dam provides best isolation. Cotton roll isolation with adequate suctioning is also preferred method of isolation for many practioners.
  19. 19. •ETCH THE TOOTH SURFACE •Etch with 37% conc. Of orthophosphoric acid for 15-30 sec. for primary teeth and 15 sec. for permanent teeth. •additional time is required for fluorosed teeth. •Gently rub etchant applicator over a tooth surface including 2-3 mm of the cuspal inclines. •Periodically add fresh etching agent. •Donot allow the etchant to come into contact with the soft tissue.
  20. 20. •APPLY BONDING AGENT Apply a hydrophilic bonding agent , prior to sealant application may improve retention with teeth that cannot be isolated properly. Then cure it.
  21. 21. Material application
  22. 22. •MATERIAL APPLICATION Sealant material is then applied to the tooth according to manufacturer direction. Be careful not to corporate air bubbles in the material.  with mandibular teeth apply the sealant at the distal aspect and allow it to flow mesially and with maxillary teeth vice versa. After the sealant has set, the operator should wipe the sealant surface with a wet cotton pellet. With autopolymerising sealants working time varies from 1-2 min & with photoactive sealants, 10-20 sec. for complete setting.
  23. 23. •EVALUATE THE SEALANT Sealant should be evaluated visually and tactically. Take the explorer & attempt to dislodge it. Any deficiences in the material, more sealant material should be applied. Remove the rubber dam and cotton rolls.
  24. 24. Evaluation of sealant
  25. 25. •CHECK OCCLUSION If occlusal high points are present, correct them. Occlusion checked and adjusted if needed
  26. 26. •RETENTION AND PERIODIC MAINTAINENCE Re-evaluate the sealant at recall visits. See for any exposure in the voids in the material and caries development. Re-application is highest during six months after placement.
  27. 27. •RINSE AND DRY ETCHED TOOTH SURFACE Rinse the etched tooth surface with an air spray for 30 sec. Dry the tooth surface for atleast 15 sec. with uncontaminated compressed air. Dried etched enamel should have frosted white appearance. Repeat the etching step if necessary. Moisture contamination- most common cause of sealant failure.
  28. 28. Review of sealant application
  29. 29. Failing sealant
  31. 31. REQUIREMENTS: Reduced water absorption and solubility Increased hardness and abrasion resistance after curing Good flow Suitable short setting time Same thermal conductivity as tooth Good bond strength with enamel Chemically inert Anti-cariogenic Reduced polymerization shrinkages
  32. 32. INDICATIONS: Deep retentive pit & fissures No radiographic/ clinical evidence of proximal caries Patient with high risk of caries patient suffering from xerostomia Patient undergoing orthodontic treatment Stained pit and fissure with numerous appearance of decalcification.
  33. 33. CONTRA-INDICATIONS Well-coalesced , self cleansing pit and fissures Radiographic/clinical evidence of proximal caries Tooth not fully erupted Isolation not possible Life expectancy of tooth is limited Dental caries
  34. 34. SEALANTS WILL BE LONG LASTING IF: The case is selected properly The tooth is selected properly An appropriate placement technique is followed Adequate maintenance is provided
  36. 36. FACTORS AFFECTING SEALANT RETENTION IN MOUTH Type of sealant Position of teeth in mouth Clinical skill of the operator Age of child Eruption status of teeth Better sealant retention reported more for the anterior and in mandibular than maxillary arch Retention compromised in children due to difficulty in maintaining a dry field resulting from the behavior problems and depending on the eruption status of the teeth.
  37. 37. Fluoride releasing sealants
  38. 38. FLOURIDE CONTAING SEALANTS 2 methods of fluoride application has been used: Soluble fluoride added to unpolymerised resin. After a sealant is applied to a tooth, the salt dissolves and fluoride ions are released. Other method involves an organic fluoride component which is chemically bound to the resin which enhances the fluoride release while maintaining the physical properties of resin material. E.g.: methcrylol fluoride methyl methacrylate, acrylic amine hydrogen fluoride salt.
  39. 39. Caries management programmes
  40. 40. SEALANTS IN CARIES MANAGEMENT PROGRAMME: Identification of a patient at risk of decay. A thorough assessment of all aspect of a patients life affecting the development of caries. Appropriate examination to determine the tooth surface at risk. Appropriate technique and manufacturers guidelines need to be followed. Step need to be taken to ensure reversal of the decay balance from demineralization to remineralization. Monitoring and repair just like any other caries management programme.
  41. 41. PARENT EDUCATION: Educating parents and patients on the importance of dental sealants is critical. Dental sealants are cost effective treatment modalities when placed on the teeth of children at high risk for dental caries.
  42. 42. Parent education
  43. 43. SUMMARY Sealant will be adopted as a standard of care for prevention of pit and fissure caries. To make significant gains in caries reduction in child and adult population is necessary for the dental profession to educate and inform the general public.
  44. 44. Thank you…..