3. • Dental caries is defined as the microbial
disease of the calcified tissues of teeth that
are characterized by demineralization of
the inorganic substance and destruction of
organic substance of tooth.
- Newbrun
4.
5. Definitions
• Pit: Pits are pinpoint depressions at the junction of
developmental grooves or at terminals of those
grooves.
• Fissure: It is defined as deep clefts between
adjoining cusps.
6. • According to SIMONSEN R.J, 1978: Pit & Fissure sealant term is used to describe a
material that is introduced into the occlusal pit & fissure of caries susceptible teeth, thus
forming a micromechanically bonded, protective layer.
• EAPD 2004: “A fissure sealant is a material that is placed in the pits and fissures of teeth
in order to prevent or arrest the development of dental caries”.
7. Epidemiology of pit & fissure
caries:
• RIPA [1973] observed that although the
occlusal surfaces represented only 12.5% of
the total surfaces of the permanent dentition,
they accounted for almost 50% of the caries in
school children.
• BELL et al, 1984 – Pit & Fissure caries account
for 80% of total caries in all children &
adolescent.
8. • In 1987, NIDR Survey showed that caries
involving occlusal surfaces account for 60% of
total caries in children & adolescent.
• NIDR, 1989 – Over 90% of dental caries occur in
occlusal, buccal & lingual surfaces in fluoridated
communities.
9. Development of Pit and Fissure:
• Black, 1987 pit & fissures don’t cause caries
process.
• They act as warm, moist richly provided
incubator which acts as sanctuary to those
agents which cause caries.
• Pit & fissure produces greater cavitations than
proximal smooth surface.
10. DEVELOPMENT OF PITS AND FISSURES
Shallow areas between adjacent cusps
of molars and premolars
ameloblasts suffer from crowding -
cell death
“weak spot”
11. Histopathology of Caries in Pits & Fissures
• Inclines forming the walls
of the fissures are affected 1st
by the caries process.
12. According to Nango(1960)
• There are 4 types of fissures based on the alphabetical description of
shape they are
• V type
• U type
• I type
• K type
13. • The typical fissure usually contains an organic plug composed of reduced enamel
epithelium, microorganisms forming dental plaque, and oral debris.
16. Explorer Wedging Explorer Catch
• Engages fissure with no clinical
evidence
• Action may or may not be
reproducible
• Explorer penetrates enamel only
• Probing may elicits slight
discomfort or pain on probing.
• Engages fissure with clinical evidence
• Action is reproducible
• Explorer penetrates enamel & dentin
• Probing elicits slight discomfort or
pain on probing.
17. Classification
• Mitchell and Gordon(1990)
Based on polymerization methods
• Self activation(mixing two components)
• Light activation
First generation : UV light
Second generation: Self cure
Third generation: Visible light
Fourth Generation: Flouride releasing
Based on resin systems
• BIS-GMA
• Urethane acrylate
18. Based on Fillers
•Filled
•Unfilled
Based on Color
•Tinted – Coloured sealants are more easily
appreciated by the patient and monitored by
the dentist at subsequent visits.
•Clear - better flow than tinted.
19. Recommendations (AAPD):
1. Bonded resin sealants are safe and effective in
preventing pit & fissure caries..
2.Sealant benefit is increased by placement on
surfaces at high caries risk or surfaces that
already exhibit incipient carious lesions
3.Sealant placement is benefited at any age
including primary teeth of children and
permanent teeth of children & adults.
20. 4. Sealant placement methods should include careful
cleaning of the pit & fissure without removal of any
appreciable enamel.
5. Placement of a low viscosity, hydrophilic material
bonding layer as a part or under the sealant enhances
long term retention & effectiveness.
21. Indications
• for children and adults
• moderate or high risk of developing dental
caries;
• have incipient caries (limited to enamel of pits
and fissures);
• anatomically susceptible to caries;
• have sufficiently erupted permanent teeth with
susceptible pits and fissures
• Deep, narrow pits & fissures.
22. • Recently erupted tooth.
• Sound proximal tooth surface.
• General caries activity – many occlusal
lesions and few proximal lesion.
• Tooth type – Molar.
• Patient receiving appropriate systemic
or topical fluoride therapy and are still
caries active.
23. Contraindications:
• Wide and self cleansable pits & fissures.
• Teeth remains caries free for 4 or more than 4 years.
• Carious proximal surface.
• General caries activity – many proximal lesions.
• Carious pits & fissures.
• Tooth that can not be isolated or partially erupted teeth
• Life expectancy of primary tooth is limited.
24. Advantages:
• It is a non-invasive technique. Sealing of pits &
fissures prevents tooth decay.
• Fluoride release from fluoridated sealants can
confer protection to adjoining areas.
• Sealants can be used at the community level for
prevention of caries.
25. Disadvantages:
• Caries susceptibility of etched enamel.
• Economic feasibility.
• Inadvertent placement over carious sites.
• Detection of lost sealant.
• Technique sensitivity.
26. Caries status of the occlusal surface
• caries status is uncertain or surfaces where the caries is
confined to the enamel can be sealed,
• since early lesions will not progress but will arrest as long as the
sealant remains intact.
27. Eruption status
• sufficiently erupted for the risk of contamination by saliva during
sealant placement to be eliminated.
Overall caries activity
• If susceptible to pit and fissure caries, any caries-free pit and fissures
of the teeth at greatest risk should be sealed.
• Susceptibility is usually indicated by the occurrence of one or more
caries lesions per year.
28. Technique for resin sealants
• Time to seal: There is good evidence that teeth sealed very early after eruption require
more frequent reapplication of the FS than teeth sealed later [Dennison et al., 1990;
Walker et al., 1996].
• Therefore, FS placement may be delayed until the teeth are fully erupted, unless high caries
activity is present.
• Placement of FS even in the absence of regular follow up is beneficial [Cueto and
Buonocore, 1967; Chestnutt et al., 1994].
29. Surface cleaning:
• Raadal et al., 2001 suggests careful removal of plaque and pellicle by the use of pumice or air-
polishing instruments in order to obtain optimal acid-etch pattern of the enamel,
• [Harris and Garcia-Godoy, 1999] maintains that the effect of acid etching alone is sufficient for
surface cleaning provided obvious soft material has been removed.
30. • The use of rubber dam
• but in young and newly erupted teeth this
is usually not practical as it demands the
use of local analgesia for placement of the
clamp.
• there is sufficient evidence that careful
isolation with cotton rolls gives similar
retention results [Lygidakis et al., 1994].
Isolation
31. Etchants:
• The goal of etching is to produce an
uncontaminated, dry, frosted surface [Manton
and Messer, 1995].
• The most frequently used etchant
Different acid concentration by different authors:
• Buonocore - 85% phosphoric acid, 60 sec
• Pinkham - 35 to 40% phosphoric acid, 15 - 60 sec
• Silverstone - 30 to 40 % phosphoric acid
32. Etching time:
• Damle – 15 to 20 sec
• McDonald – 15 sec for permanent teeth, 15 –
30 sec for primary teeth
• Pinkham – 20 sec for permanent teeth, 30
sec for primary teeth.
33. Washing and drying:
• The tooth is usually irrigated vigorously with air and water for about 30
seconds and then dried with uncontaminated compressed air for 15 seconds
[Manton and Messer, 1995].
• However, Waggoner and Siegal [1996] consider that exact washing and
drying times are not as important
34. Apply the sealant material :
• With mandibular teeth, apply the sealant at the
distal aspect and allow it to flow mesially.
• should prevent incorporation of air into the
material and creation of voids.
35. • Add material as necessary to seal all pits and
fissures.
• Using a fine brush, minisponge, or applicator
provided by the manufacturer, carry a thin
layer of sealant up the cuspal inclines to seal
secondary and supplemental fissures, and flow
the sealant material into buccal or lingual pits
and grooves.
36. • While curing tip of the rod is held 2 mm from the tooth surface
approximately for 30 seconds.
• Tags of resin, between 20 to 50 µm in length, have been noted from the
resin bulk after the enamel has been demineralized.
37. Explore the Sealed Tooth Surface:
• Explore the entire tooth surface for pits and fissures that may not have been
sealed and for voids in the material
• Evaluate the Occlusion of Sealed Tooth Surface:
to determine whether excessive sealant material is present and must be
removed.
38. • Periodically Reevaluate and Reapply Sealant as Necessary: During
routine recall examination, it is necessary to reevaluate the sealed tooth
surface for loss of material, exposure of voids in the material, and caries
development.
• The need for reapplication of sealant material is usually highest during the
first 6 months after placement.
39. Follow-up and review:
• All sealed surfaces should be regularly monitored clinically and radiographically.
• Bitewing radiographs should be taken --- where there has been doubt as to the caries
status of the surface prior to sealant placement.
40. Retention of the sealants:
• Numerous clinical trials, ranging from 6 months to 20 years, have been carried
out to assess retention rates, caries incidence, and the effectiveness of sealants
in preventing pit & fissure caries.
• The effectiveness of single application of sealant material in preventing caries
ranged from 83% after 1 year to 53% after 15 years.
Notas do Editor
Dc is an infectious dis, identifying the risk factors and controlling them s impt in prevent tooth demineralisation. Early recognition of risk factors allows dentist o implement preventive regim. Prevention include rebalancing the oral environment to its natural state and preventing orsl dis progression..once cavitation occurs minial intervention technique shall minimize tooth loss and restore function.
Deep pits and fissures favor food retention and are difficult to clean by routine brushing. It provides a favorable environment for the oral microorganisms to thrive and convert the carbohydrates to acids, leading to demineralization of the enamel. [1] The most efficient way to prevent pit and fissure caries is by effectively sealing the fissures using resins called pit and fissure sealants.
he National Institute of Dental Research (NIDR)
The ameloblasts, move outward from the dentino-enamel junction
The areas between adjacent cusps of molars and premolars are concave
Ameloblasts -crowding.
The result is cell death of the affected ameloblasts and incomplete maturation of the enamel matrix
Presence of a “weak spot”
The incompletely calcified areas are readily attacked by caries.
Remnants of the enamel organ leaves a deep, narrow groove .
Sound coalescence- groove,
faulty coalescence-fissures
The shallow wide V and U shaped fissures tend to be self cleansing and some what caries resistant
On smooth enamel surfaces, the earliest visible changes are usually manifested as a loss of transparency, resulting in opaque chalky region.
Smooth surface lesion when sectioned longitudinally, are cone shaped with apex directed towards the dentin.
In pit & fissure caries, the carious lesion more often starts at both sides of the fissure wall rather than at the base, penetrating nearly perpendicular toward DEJ.
Visual changes such as chalkiness or yellow, brown or black discoloration may be seen.
The lesion is commonly described as cone shaped with the base directed towards the dentin and apex towards the enamel surface.
Pit and fissure probed vertically
1.Effectiveness is increased with good technique and appropriate follow up and resealing as necessary
Sealants may be indicated for children and adults
who for a variety of reasons, may be at moderate or high risk of developing dental caries;
have incipient caries (limited to enamel of pits and fissures);
have existing pits and fissures that are anatomically susceptible to caries;
have sufficiently erupted permanent teeth with susceptible pits and fissures
Deep, narrow pits & fissures.
Such tooth surfaces should be assessed at regular intervals to ensure the complete retention of the sealant. Where caries has progressed to dentine the tooth should be restored. Preventive restorations involving sealant materials or composites may be indicated.
Since adequate isolation is needed for sealant retention to be ensured, it is generally recommended that sealants not be placed until the tooth is
The need for surface cleaning and the method of cleaning pits and fissures prior to FS placement may seem to be controversial.
as ensuring that both washing and drying are thorough enough to remove all etchant from the surface of the tooth to give a chalky, frosted appearance.
to the etched tooth surface and allow the material to flow into the pits and fissures
. If deficiencies are present, apply additional sealant material.
