Pit and Fissure Sealants Dr: Abdelmonem Altarhony

1. Pit and Fissure Sealants Dr: Abdelmonem Altarhony

2. Why do pits and fissures decay? Morphology of the pits &fissures

3. Pits and fissures are the fossa and grooves that failed to fuse during development

4. Pits and fissures • Two main types of pits & fissures: 1. Shallow, wide, V-shaped fissures

5. Why do pits and fissures decay? 2. Deep, narrow I-shapedor bottle neck shaped fissures • Plaque retention • Mechanical plaque removal is difficult • Depth of fissure is in close proximity to the DEJ

6. Why do pits and fissures decay? • Bacteria accumulate in the narrow pits & fissures • Even a single Toothbrush Bristle is too large to enter & clean pits and fissures

7. Historical Efforts To PreventOcclusal Caries 1. Extension for prevention Although developed over years ago, this concept is still practiced

8. Historical efforts to preventOcclusal Caries 2. Prophylactic odontotomy Hyatt (1923) advocated: Placing a small amalgam restoration beforecariesdevelop in deep pits fissures

9. Historical efforts to preventOcclusal caries 3. Fissure Eradication Bödecker(1929) suggested: Modifying Deep fissure anatomy by using alarge round bur into Wide non-retentive grooves

10. Historical efforts to preventOcclusal caries 4. Application of Impregnatingsolutions byapplying Silver nitrate & zinc chloride

11. Historical efforts to preventOcclusal caries 5. Application of non-adhesive material • Zinc phosphate cement • copper cement But with High solubility & poor retention

12. Historical efforts to preventOcclusal caries 6. Development of occlusal sealant pit and fissure sealants Introducedinto clinical dentistry in 1967 by Michael Buonocore

13. What is a Fissure sealant? Definition Alow viscosity material flowedinto pretreated Pits and Fissures (on occlusal, buccal orpalatal surfaces) • The Material polymerizes to become hard

14. How does a Fissure SealantPrevent Caries ? 1. Acts as a physical barrier between the sealed area (tooth) & Bacteria in the oral cavity

15. How does a Fissure Sealant Prevent Caries ? 2. Eliminate the Environment ( conducive to caries) by Depriving Bacteria from Nutrients

16. How does a Fissure Sealant Prevent Caries ? 3. The Microorganisms Covered by the sealant become Static due to: • lack of air • lack of nutrition

17. How does a Fissure Sealant Prevent Caries ? 4. Make pits/fissures Easierto clean by - toothbrushing &mastication

18. Is it necessary to fill the entire depth of the fissure? The sealant is not necessarilyrequired to: Fill the Entire DepthOf The Fissure But Must extend along itsentire length

19. Requirements of Sealant material • Adhesion to enamel for extended time. • Simple clinical application. • Biocompatible. • Free flowing (capable of enteringnarrow fissures). • Rapidly polymerized. • Low solubility in oral fluids. • Enough compressive strength.

20. Types of Sealant Material 1- ACCORDING TO METHOD OF POLYMERIZATION • Autopolymerized. • Light-polymerized . 2- ACCORDING TO MATERIAL • Resin based • Glass ionomer based

21. Types of Sealant Material 3- ACCORDING TO FILLER CONTENT • Filled • Unfilled 4-ACCORDING TO COLOR • Transparent – clear sealant • Colored sealant

22. Types of Sealant Material 5- ACCORDING TO FLUORIDE CONTENT • Fluoridated Sealants. • Un fluoridated sealants.

23. 1-ACCORDING TO METHOD OF POLYMERIZATION • Autopolymerizing • Less expensive • Supplied as base and catalyst • Operator has no control over polymerization initiation • Light-polymerized • High cost • Need light curing machine • Supplied as single liquid (no need for mixing) • Operator has control over polymerization initiation

24. 2-ACCORDING TO MATERIAL Glass ionomer sealants Advantages Compared to Resin-Based Sealants: • Chemical bonding to enamel. • Do not require acid etching of the tooth surface. • Not as moisture-sensitive. • Generally are easier to place.

25. Restorative GICs Are Not suitable as fissure sealants: • Thicker than the Glass ionomer sealants. • Do not flow well into Narrow/Deep Pits & fissures

26. 3- According To The Filler Content • Filled • More resistant to abrasion & wear. • Need to be adjusted after placement • UnFilled • Wear quicker • Usually do not need occlusal adjustment

27. 4- ACCORDING tocolor Transparent or clear sealant Moreesthetically acceptable • Colored sealant The increased visibility: - More precise placement. - Retention can be more accurately monitored

28. INDICATIONS 1. Caries free, deep or irregular fissures, fossa, or pits in Newly erupted teeth. 2. Fully erupted fossa. 3. Ifa fossa is well isolated from another fossa with a restoration present. 4. where the contra-lateral tooth surface is carious or restored. 5. Incipient carious lesions. 6. Patient with high caries susceptibility.

29. INDICATIONS

30. INDICATIONS

31. Partially erupted teeth ? • To seal or not to seal? Operculum (gum flap) leaks crevicular fluid Apply Fluoride Varnish

32. Proper Age ? • For Deciduous Teeth 3 - 4 years • For First Permanent Molars 6 - 7 years • For Second Permanent Molars 11-13 years & Premolars

33. Sealants in adults Should be considered if Evidence of impending caries Such as: - Excessive intake of sugar - Xerostomia cases

34. CONTRAINDICATIONS • If pits and fissures are well coalesced & self-cleansing. • Patient behavior does not permit isolation • There is an open occlusal or proximal carious lesion. • A large occlusal restoration is already present.

35. Fissure Sealants The Clinical Procedure

36. Armamentarium Mouth mirror Explorer Evacuator Tip Cotton rolls Cotton roll holder Prophy brush Prophylactic Paste (without fluoride) Acid etch syringe Sealant applicator with dispensing tip Curing light Articulating paper Handpiece Round Bur

37. Armamentarium

38. Step 1- Clean the Tooth Surface • The tooth surface must be thoroughly cleaned prior to the placement of the sealant. • Cleaning can be accomplished by using • A Prophylactic Paste (without fluoride) & Prophy Cup or Brush • A Toothbrush • Hydrogen Peroxide

39. Clean the Tooth Surface • Use products containing No Fluoride orGlycerin • After cleaning The tooth surface is rinsed for 20 seconds

40. An Exploreris used to remove any debris in the pitsorfissures

41. Step 2 -Isolate the Tooth Surfaces The most critical issue For the proper placement of sealants 1. Rubber dam The ideal method But it is not always possible or appropriate for young children. 2. Cotton Rolls are alsoused with success .

42. Isolation of Tooth Surfaces

43. Step 3 -Etch the Tooth Surface • Etching the surface(conditioning) by using 37% orthophosphoric acid ( liquid / gel). • Etching time 20 seconds (primary /permanentteeth)

44. ACID ETCHING

45. ACID ETCHING • The Etchant Produces Selective dissolution of the enamel Opening pores into which the resin can flow

46. Retention of the sealant The Sealant Penetrates into these Surface Irregularities To form : Resin “Tags” approximately 15-25microns (in length).

47. Step 4 -Rinse & Dry the Tooth Surface • Rinse surfaces with water ( to remove the acid ) • Thoroughly dry the etched tooth surface. • Check for effectiveness of etching (by drying with air) The surface should appear“chalky white” If not, repeat etching procedure

48. Step 4 -Rinse and Dry the Tooth Surface • Avoid Salivary Contamination If the tooth surface is contaminated by Saliva Repeat The Etching Process

49. Step 5- Apply the Sealant Material • Place Sealant material on the prepared tooth using A Syringe • The sealant material should be placed in the pits & fissures up to 2/3 of cusp slopes • Use the correct amount Too much material can result in Occlusal Interferences

50. Step 5- Apply the Sealant Material • Chemically cured sealant material ( two components mixed just ) before placement • Light cured sealant material (without any mixing)