The term pit and fissure sealant is used to describe a material that is introduced into the occlusal pits and fissures of caries susceptible teeth, thus forming a micromechanically bonded, protective layer cutting access of caries-producing bacteria from their source of nutrients.

1. Pits and Fissure Sealants
Vishesh Jain

3. Pit & Fissures
A pit is defined as a pinpoint depression located at the junction
of grooves present over the grinding surfaces of the teeth.
A fissure is defined as a deep cleft between adjoining cusps of
a molar or premolar, usually located at the junction of
developmental grooves.

4. Pit and Fissure Sealants
The term pit and fissure sealant is used to describe a
material that is introduced into the occlusal pits and
fissures of caries susceptible teeth, thus forming a
micromechanically bonded, protective layer cutting access
of caries-producing bacteria from their source of nutrients.

5. Why Sealant?

6. Why Sealants?
The fissures and pits are normal anatomical findings in a dentition and caused
by faults in dental enamel. Shallow fissures may not be problematic and be self
cleansing and resistant to dental caries.
However, deep and narrow fissures
tend to lead to tooth decay. Both pit
and fissures act as areas of initiation
of caries due to food retention.
To prevent dental caries. It is a safe,
efficient and effective method of
prevention of pits and fissure caries.

7. Dental caries are defined as a progressive irreversible microbial disease
affecting the hard parts of tooth exposed to the oral environment, resulting
in demineralization of the inorganic constituents and dissolution of the
organic constituent, thereby leading to a cavity formation.
Dental Caries

8.  It has been well documented that occlusal surfaces in young patients
have a high caries susceptibility. The incidence of caries is relatively
low on smooth, self cleansing surfaces (i.e., buccal , lingual, mesial,
distal) where fluorides are highly effective in reducing decay.
 Unfortunately, fluoride is not nearly as effective in the pits and
fissures where approximately 50-85% of decay is found.
 The reason for this high rate of caries relates specifically to the pit
and fissure morphology of occlusal and buccal/lingual surfaces.
 Bacteria are able to breed in deep, narrow fissures where enamel did
not completely form (called non coalescence of enamel).
 In many cases toothbrush bristles cannot reach to the depths of
these spaces to remove bacteria.

9. Susceptibility
Upper and lower first molar  95%
Upper and lower second molar  75%
Upper second bicuspid  45%
Upper first bicuspid  35%
Lower second bicuspid  35%
Upper central and lateral incisor  30%
Upper cuspids and lower first bicuspid  10%
Lower central and lateral incisor  3%
Lower cuspids  3%
Caries susceptibility of individual tooth surface
 occlusal > mesial > buccal > lingual

10. Sealants are the most effective clinical technique to prevent pit and fissure
caries. The cost effectiveness of sealants, naturally, is based upon sealant
retention.
While the rates of sealant retention on occlusal surfaces are relatively high
at five years, sealant retention for buccal and lingual pits and fissures of
molars is considerably lower.
There was 88% complete sealant retention of the self-cure sealant on the
occlusal surface but only 35% retention on the buccal/lingual surfaces.
The light-cure sealant had a retention rate of 81% for the occlusal surfaces
compared to a 39% rate of retention on the buccal/lingual surfaces.
These data indicate that, while the loss of sealant from occlusal surfaces
averages 5-10% a year, for buccal and lingual surfaces the percentage of
sealant loss increases to 30% per year, rendering this procedure less
reliable.
Thus, based on sealant retention rates, it follows that the occlusal surfaces
should be easier to protect from caries than buccal/lingual surfaces.

11.  Wilson used zinc phosphate
 Kline and Knutson- use of ammoniacal silver nitrate
 Extension for prevention: G. V. Black
 Prophylactic odontotomy : Hyatt (1923)
 Fissure eradication: Bodecker (1929)
 Acrylic polymers introduced to dentistry – 1937
 Acid etching: Buonocore (1955)
 Composites – 1960
 Unfilled resin- BIS-GMA: Bowen (1965)
 Glass ionomers – 1972
Historical Background

12. Classification
1) Polymerization methods:
 First generation: UV light
 Second generation: Self Cure
 Third generation: visible Light
 Fourth generation: fluoride releasing
3) Resin Systems
 BIS-GMA (Bis phenol alpha-Glycidyl Methacrylate Adduct)
 Urethane acrylate
4) Depending on presence of filler
 Filled
 Semi-filled
5) Depending on color
 Clear
 Tinted

13. Glass Ionomer Cement

14.  The Glass Ionomer Cement were invented by Wilson and Kent in 1972
in London. Their use for pit and fissure sealing was advocated by
McLean and Wilson in 1974.
 Characteristics which justify their use as pit and fissure sealant are:
 Physicochemical bonding with enamel and dentin.
 Release of fluoride ions
 Cariostatic and anti-microbial activity due to fluoride release.
 Biocompatibility.
 Resistance to oral fluids.
 Ease of use.

15.  Studies of the use of GIC and resin modified glass ionomers as fissure
sealants indicate significantly lower retention rates than resin-based pit
and fissure sealants.
 However, several studies have found that GIC's exert a cariostatic effect
even after they had disappeared macroscopically, and that this effect
might be based on remnants of the cement in the fissure as well as
increased levels of fluorides on the enamel surface, have been shown to
be specifically beneficial in reducing occlusal caries.
 The use of GIC has been suggested for erupting teeth where isolation is a
problem, especially in the high caries risk individuals.
 In this situation they can be considered more a fluoride vehicle than a
traditional fissure sealant.

16. Requirements
1. Should have high flow properties i.e. low surface tension,
low viscosity and low or zero angle of contact.
2. Adequate working time
3. Rapid cure
4. Good and prolonged adhesion to the enamel
5. Low sorption and solubility
6. COTE should be similar to tooth structure
7. Minimum irritation to tissues
8. Cariostatic action
9. Match the tooth color

17. Indications
 Carious occlusal anatomy- If pits or fissures are
separated by transverse ridge, a sound pit or fissure
may be sealed
 Carious pits or fissures- Deep, narrow pits and fissures
 General caries activity-mild, Many occlusal lesions; few
proximal lesions
 Recently erupted teeth

18. Contraindications
 Many proximal lesions
 General caries activity-high
 Sound Broad, well-coalesced pits and fissures
 Teeth without caries (free for 4years or longer)
 Rampant caries / decay.
 Interproximal lesions .
 Occlusal surface is already carious.
 Tooth present in mouth for many years and there is no
evidence of decay.

19. Setup for Sealants

20. STEP BY STEP PROCEDURE
1. Cleansing of tooth
2. Tooth isolation
3. Enamel etching
4. Application of sealant material
5. Curing of sealant material
6. Inspection of sealant
7. Re-evaluation of sealant

21. 1. CLEANSING OF TOOTH
Use a prophy cup and pumice with water (any non-
fluoride paste can be used).
Run explorer through the grooves to remove pumice.
Thoroughly wash, dry, and re-examine.
Mechanically prepare the tooth (optional ).
There is no need for anesthesia.

22. 2. TOOTH ISOLATION
To maintain a dry field, use rubber dams or cotton
rolls.
If the tooth is contaminated with saliva, the etching
must be done over again.

23. 3. ENAMEL ETCHING
37% phosphoric acid in gel form applied 2/3 way the
cuspal incline to create microporosities within the enamel.
Etch tooth 20-30 seconds.
Fully rinse and dry tooth.

25. 4. APPLICATION OF SEALANT
MATERIAL
 Apply the sealant material according to manufacturer’s
direction.
 A brush is used to allow it to follow the curvature of the
tooth.
 The sealant may be light-activated or self-curing.
 Avoid air bubbles

26. 5. CURING OF SEALANT MATERIAL
Visible light is used to cure (harden) the sealant
material.
Don’t touch tip of cure light to sealant material.

27. 6. INSPECTION OF SEALANT
 Use an explorer to ensure that all grooves are
filled/sealed and smooth.
 Verify that the sealant doesn’t extend over the marginal
ridge of the tooth.
 Check for occlusal interferences using articulating paper.
 If necessary, remove excess.
 No contact points on sealants.
 There is no need for further polishing.

28. 7. RE-EVALUATION OF SEALANT
Observe the sealants at all future appointments.
One may need to re-apply the sealant.
Re-applications, along with fluoride, and other
preventative measures can provide a 100% caries
free and restorative free patient.

29. PROBLEMS AND SOLUTIONS
 Air bubbles may be present between or under
sealants:
Sealant should be ground down to expose the air bubble,
and the bubble should then be filled / repaired
 Porosities may develop in the sealant:
Reapply the sealant. If this is delayed, decay may form
around the edges.
 Sealant may fall off :
Reapply the sealant.
 Caries / decay left under the sealant :
This is a contraindication for sealant placement.
The sealant should be removed, and a filling should be
placed.

30. Perfect isolation and
maintenance of a dry field
are essential!

31. Points to remember
 Etching agent should be 35-37% orthophosphoric acid.
 15 sec. of etching is sufficient.
 There is benefit in using a bonding layer, which improves retention.
 Dry brushing, rotary brushing with pumice, air polishing and air
abrasion are all acceptable for cleaning the tooth.

32.  Flouride-containing sealants show no superiority to regular
sealant.
 GI sealants show poor retention in comparison to resin based
sealants.
 Autocured vs. light cured sealants show similar performance,
However, autocure have more retention.
 Microleakage is greater in teeth that aren’t prepared before
sealing, but if sealant falls, the preparation causes a higher
chance of caries.
 Sealant is not supposed to be applied once.

33. NEW DEVELOPMENTS AND PROJECTIONS
Argon laser curing: argon laser polymerization provides
further caries protection against a cariogenic challenge
over that afforded by fluoride-releasing sealants
DIAGNOdent (KaVo): laser fluorescence system into
detecting caries under sealants.
Use of air abrasion 50 micron Alumina particles for tooth
preparation.