DR.

PRIYA
PG STUDENT
 CONTENTS
 INTRODUCTION
 ANATOMY OF PIT AND FISSURES
 DEFINITION
 HISTORY
 CLASSIFICATION- PIT AND FISSURE SEALANTS
 INDICATIONS
 CONTRAINDICATIONS
 ADVANTAGES AND DISADVANTAGES
 PROCEDURES
 CONCLUSION
 INTRODUCTION
o Caries potential directly related to the shape and depth of pits and
fissures.
o Narrow isolated crevices, grooves- harbor food and microorganism
– important anatomical features leading to -occlusal caries.
o Over 85% of children (5-17 years old) in world have caries in the
pits and fissures.
o Fluoride is least effective on pit and fissures.
 DEFINITIONS

 Pit: Small pinpoint depression - junction of development grooves

or at terminals of the grooves. (Ash 1993).
 Fissure: Deep clefts between adjoining cusps.
 Pit and Fissures are of two types mainly: V shaped and I shaped fissures
MORPHOLOGY OF PIT AND FISSURES

Nagano (1960) - types of fissures

1. V type (34%)
2. U type (14%)
3. I type (19%)
5. IK type (26%)
6. INVERTED Y type (7%)
 Pit and Fissure Sealants
“The application and mechanical bonding of a resin material
to an acid etched enamel surface, thereby sealing pit and fissures
from the oral environment. This mechanism prevents bacteria from
colonizing in the pit and fissure and nutrient from reaching the
bacteria already present.”

MATHEWSON
HISTORY OF PIT AND FISSURE SEALANTS

1905- application of silver nitrate by Miller

1923 – Hyatt- “Prophylactic Odontotomy”

1929- Bodecker- “Fissure Eradication”

1955-M.G. Buonocore acid etching and resin

restorative material

1962- Bowen and associates developed Bis-

GMA
 CLASSIFICATION OF PIT AND FISSURE SEALANTS

PIT AND FISSURE SEALANTS

I. Based on IV. Based on

Filler particles II. Polymerization III. Visibility/ generations
1. Filled methods Color
2. Unfilled 1. Self activated 1. Clear 1. First Generation
2. Light activated 2. Colored 2. Second
Generation
3. Third Generation
4. Fourth
Generation
I. Based on Filler particles

Unfilled sealants
 Low viscosity
Filled sealants
 Greater penetration  Require occlusal
 Better flow adjustment
 Abrade rapidly probably  Increase the time
within 24-48 hrs  Increased cost of the
procedure
 Resistant to wear
II. Polymerization methods

1. Auto polymerizing.
• Better retention 88%
• Sets by exothermic reaction

2. Light cure
• 75% retentive
III. Visibility/ Color/ Translucency

CLEAR
• Esthetic, but difficult to detect
at recall examination.
• Better flow than tinted or
opaque
• More easily appreciated by
the patient.
TINTED / OPAQUE
• Can be easily identified
COLOURED
• Easy to see during placement
• Easy to see during recall check
up
IV. Based on generations
TYPES OF MATERIALS USED AS PIT AND FISSURE
SEALANT:

Cyanoacrylates

Polyurethanes

Dimethacrylates

GIC
POLYURETHANES
• Adhesion of these
polyurethanes to enamel is not
satisfactory
• Poor mechanical properties
• Low oral durability(2-3
months)
CYANOACRYLATES
 Bond to unetched enamel is poor
 Material sticks to skin
 Mechanical durability poor
 Biodegradable
 Hydrolysis of cyanoacrylates to
toxic materials
• Recent cyanoacrylates – butyl and
isobutyl esters
• Cyanoacrylates with fluoride -also
available
REQUIREMENTS OF AN OCCLUSAL
SEALANTS
• Non-toxic & Non irritating to the tissues.
• Should Adhere to the tooth as a thin layer and for an extended period of time.
• Adequate consistency and viscosity to permit flow and penetration.
• Sufficient mechanical compressive and tensile properties.
• Minimum Shrinkage and expansion of the material avoid marginal leakage.
• The material should have optimal properties that allow it to be seen but be
harmonious with tooth structure.
• Low solubility in oral fluids.
• Cariostatic action
INDICATIONS

Newly erupted primary molars & permanent bicuspids and

molars - with open and sticky grooves.

Minimum decalcification or opacification and no

softness at the base of fissures.

Erupted less than 4 years age.

Patients with high caries rate.

CONTRAINDICATIONS

Caries on Individual no previous

proximal caries experience & well
surfaces coalesced pit and fissures.

Wide and self-

Partially
cleansable pit &
erupted tooth.
fissures.

Remained carious
free for 4 years or
longer.
ADVANTAGES AND DISADVANTAGES

ADVANTAGES
DISADVANTAGES
• Non-invasive
technique  Lack of universal usage.

• Fluoridated sealants  Inadvertent placement

• Effective at placement over carious sites.

community level  Technique sensitivity.

 Caries susceptibility cannot be
accurately diagnosed
 Economic unfeasibility.
Age ranges for sealant applications:

3-4 years: Primary molar sealant application.

6-7 years: 1st permanent molar.
11-13 years: 2nd permanent molar and premolar.
Equipment
Equipment typically includes:
•Air/water syringe
•Mouth mirror
•Explorer
•Excavator tip
•Cotton rolls
•Cotton pellets
•Forceps/cotton pliers
•Articulating paper
•Curing light
•Hand piece
•Dappen dish with pumice
Tray set-up: the tray should be set up before the procedure,
and set up to the practitioner's preferences.
 TECHNIQUE OF APPLICATION

1 POLISH THE 2 ISOLATE AND 3

ACID ETCHING
TOOTH SURFACE DRY THE TOOTH

6 MATERIAL 5 ISOLATE AND 4 RINSE THE

APPLICATION DRY THE TOOTH TOOTH

7 8 CHECK 9 PERIODIC
CURING
OCCLUSION MAINTENANCE
1. POLISH THE TOOTH SURFACE

Plaque and debris should be

removed from the enamel
and the pits and fissures.

Debris will interfere with the

proper etching process and
sealant penetration.

Polishing can be done using

pumice, prophylactic
paste/fluoride paste.
2. ISOLATE AND DRY THE TOOTH SURFACE

• Using rubber dam or cotton rolls.

• Saliva contamination avoided to prevent precipitation of glycoproteins on
etched surfaces which results in decreased bond strength.

3. ACID ETCHING (CONDITIONING)

 30-50% Orthophosphoric acid in liquid form for 30-60 seconds using brush.
 Removes organic materials and debris and produces micropores.
 Etchant available as – liquid, gel or semi-gel form
 MECHANICAL RETENTION

 Physical adherence of one substance to another.

 Sealant adheres to the enamel.
 Acid etching (conditioner) leaves micro spaces between the enamel rods -
sealant locks into spaces.
4. RINSE THE TOOTH

• Rinse appro. for 30 seconds.

• REMOVE ALL ACID and REACTIONARY precipitates.

5. ISOLATE AND DRY THE TOOTH

• Air dried for 10 sec.

• Kept dry, eliminate contamination from saliva
• This can be isolated by rubber dam or cotton rolls.
• Chalky , frosted appearance. If it doesn’t –re-etch.
• Moisture contamination at this stage- sealant
failure.
6. MATERIAL APPLICATION/SEALANT APPLICATION

 Sealant placed according to the manufacture’s directions.

 Not to incorporate air bubbles.

7. CURING
• Curing 30-45 sec.
• Recheck all pits and fissures are sealed
• Check for the adherence to enamel surface
• Excessive material to be removed
• Check occlusion
8. CHECK OCCLUSION

• Check for occlusal high points and if present

correct them.

• Use explorer

• Tooth should be smooth but not soft

• Re-apply sealant, if necessary

• Remove uncured sealant with wet cotton roll

9. RECALL/ PERIODIC MAINTENANCE

• Sealants should be evaluated every 6 months.

.
• Integrity of the sealants are evaluated. If any loss, new sealant can be applied
over the old sealant.

PATIENT INSTRUCTIONS

• The sealant is hard so you don’t have any restrictions on eating.

• If it feels “high” after you go home – you can come in to get it
adjusted.
• Education of patient and the parents about the importance of
periodic re-evaluation of the sealants
TECHNIQUE OF APPLICATION
PIT AND FISSURE SEALANTS
REQUIREMENTS

GOOD
CLEAN
MOISTURE
SURFACES
CONTROL

APPROPRITE APPROPRIATE
ETCHING AND COVERAGE OF
DRYING TIME TOOTH SURFACE

CHECKING REGULAR
OCCLUSIONS MONITORING
FACTORS AFFECTING SEALANT RETENTION IN MOUTH

 Type of Sealant

 Position of teeth in the mouth

 Clinical skill of the operator

 Age of the child

 Eruption status of teeth.

COMPLICATIONS

Moisture Improper
Contamination cleaning

Air Outdated
entrapment materials

Over Incomplete
extension curing
• They are the natural extension of the use of occlusal sealants.

Integrates

Preventive approach of Therapeutic restoration of

sealant therapy for caries incipient caries with
susceptible pit and composite resin that occur on
fissures. the same occlusal surface.
Simonsen (1978) has classified them as:

TYPE B TYPE C
TYPE A
• Suspicious pit and • Incipient lesion • More extensive
fissures where in dentin that is dentinal involvement
caries removal is small & confined & requires restoration
limited too enamel. • No LA is needed. with posterior
• LA is not required. • Base is applied composite material.
• Sealant is placed. on areas of dentin • Appro. Base is
• A slow speed ¼ or exposure, placed over dentin.
½ round bur is used composite resin • P&F are covered
to remove is placed and with sealants.
decalcified enamel. remaining P&F • LA is required.
are covered with
a sealant.
 Conclusion

• The pit and fissure sealants are a proven, safe and effective preventive
material.
• Fissure sealant materials should be opaque or colored to facilitate
subsequent inspection & maintenance.
• The use of fissure sealant is recommended as an alternative to amalgam
filling to treat questionable or early carious lesions in pits & fissures.
• Further research in sealant restoration technique should be encouraged.
 Answer these questions?
1. -----------are more prone to caries development than smooth
surfaces of the tooth. Reason?
2. Which is the method of curing of third generation
sealants?
3. Using pit and fissure sealant comes under which section in
the prevention of dental caries?
4. PRR is a ----------- and -------------- approach.
 REFERENCES
1. Axelsson. Preventive materials, methods and programs.
2. Ralph E. Mc Donald, david R. Avery. Dentistry for the child and adolescent.
3. John J. Murray, June H. Nunn, James G. Steele. Prevention of oral diseases.
4th edition.
4. McDonald “Dentistry for the child and Adolescent” Eighth
5. Shobha Tandon, Textbook of Pedodontics, First edition

6. Mark D. Siegal, Jayanth V. Kumar. Workshop on Guidelines for sealant use:

preface. Journal of Public Health Dentistry 1995;55(5):261-72.

7. Soben Peter-5th edition