Fissure sealants DCP1 S2 Lecture 8 - part 1 By Dr A. Eldarrat & A. Uni

1. Fissure sealants DCP1 S2 Lecture 8 - part 1By Dr A. Eldarrat & A. Uni

3. Objectives To understand the following: • Role of fissure sealants in preventive dentistry. • Indications/contraindications; advantages and disadvantages of fissure sealants. • Different types of materials used as fissure sealants and their advantages and disadvantages.

4. Objectives • Acid etch technique and the mechanism of bonding of resin based sealants. • To be able to apply fissure sealants (Composite resin sealants and Glass ionomer sealants) on natural teeth in the laboratory situation. • To be able to critically evaluate the quality of composite resin fissure sealants after placement.

5. FISSURE CARIES

6. Early caries in fissure confined to enamel only [Incipient Caries]

7. Early caries in fissure Enamel spread [Incipient Caries]

8. Caries in fissure Spread to DEJ and involves dentine

9. Caries in fissure Dentine involvement – note: no cavitation

10. Why do pits and fissures decay? • Morphology of the pits (buccal/palatal) and fissures

11. Why do pits and fissures decay? • Two main types of pits and fissures: 1. Shallow, wide, V-shaped fissure

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

13. Diagnosis of pit/fissure caries Diagnosis of pit/fissure caries - can be very difficult 3 Possibilities • No caries • Definite caries • Questionable caries

14. Are these fissures carious or just stained ?

15. Are these fissures carious or just stained ?

16. Management of Questionable pit/fissure early caries • Monitor tooth surface over period of time in conjunction with other caries preventive measures. • Mechanically open up fissures with a bur/air abrasion and check if carious (invasive?) • Fissure seal with fissure sealant.

17. What is a Fissure sealant? Definition: A low viscosity material which is flowedinto pretreated pit or fissure on (occlusal, buccal, palatal surfaces) which fills the pits/fissures. • The Material polymerizes into a hard material. • Acts as a physical barrier between the sealed area of the tooth and the bacteria in the oral cavity. • Sealants are used as preventive and therapeutic treatment.

18. How does a Fissure sealantprevent caries? 1. Physical barrier in the pit/fissure of the tooth. 2. Eliminate the environment conducive to s.mutans. 3. Make pit/fissures easier to clean by tooth brushing and mastication

19. Indications for fissure sealing for children and adults • Caries risk status. • Tooth morphology. • Age of patient.

20. Contraindications to fissure sealing • Shallow, self cleansing pits/fissures. • Patient with low or negligible caries risk (eg. no new lesions or past restorations). • Partially erupted teeth in which all pits/fissures not exposed to oral cavity.

21. Cont. • If can not obtain excellent moisture control (for composite resin FS). • Occlusal caries has progressed into the dentine. • Tooth has proximal caries. • Uncooperative child/patient.

22. Sealing over early occlusal caries?[Advantages and disadvantages] Caries can be in-activated if • use a CR sealant that is well bonded. • use GIC Fuji 7 sealant. (Chemical adhesion & high Fluoride release) Caries can progress • If place a CR sealant which is poorly bonded or partially lost. (Use your own clinical judgement and assess each case carefully)

23. Partially erupted teethSeal or wait until fully erupted? For Composite Resin • If seal whilst partially erupted - Risk of sealant failure • Risk of caries development For Glass Ionomer Fissure sealant-Fuji 7 only • can be placed in situations where tooth can be partially erupted because of its ability to be placed in conditions where moisture control can not be optimally maintained. • More appropriate material to use in this clinical situation.

24. What type of sealant materials are available? 1. Composite resin (CR) 2. Glass ionomer (GI)

25. Composite resin sealants • BIS-GMA (Bowen’s resin) • low viscosity unfilled or partially filled resins. • Polymerised. 2 bottles (base and catalyst which are mixed together)

26. Composite resin sealants a. Self-cured sealant. (also known as auto-cured or chemically-cured). b. Light-cured sealant. [white light (wavelength 420-490nm) equipped with a blue filter]. Kidd and Smith 1996

27. Composite resin sealants • Advantages/Disadvantages • Clear/Opaque sealants

29. Composite resin fissure sealant - light cured opaque type

30. Glass ionomer sealants • Chemical bond to enamel. • Fluoride release. • New GIC material- Fuji 7 • high fluoride release (6 x more) than other restorative GICs. • has good flow properties and flow well into pits/fissures. • moisture tolerant. • has a strong fused layer which is acid resistant & continues to offer protection to occlusal surface even when it appears “visually” lost due to wear. • Restorative GICstend not to be suitedas fissure sealants as are thicker and do not flow well into narrow/deep pits & fissures

31. Fuji 7 GIC

32. Restorative Glass ionomer fissure sealant Mount & Hume, 2005

33. Summary • Effective primary preventive measure against pit and fissure caries. - prevent plaque accumulation - hence prevent pit & fissure caries. • arrest very early pit/fissure caries. • Can be used as part of patients’ overall caries prevention/management plan.

34. Summary • Conservative(Minimal Intervention). – non invasive • Relatively Painless.

35. Summary • Benefitschildren and adults- if at risk pit/fissures sealed. • Commonly used fissure sealants are light cured resin sealants but the new Fuji 7 GIC material gives us more options • Cost effective – if careful case selection.

36. Thank you