PIT AND FISSURE SEALANT

INTRODUCTION
DEFINITION PITS are small pinpoint depression located

at the junction of developmental grooves or at terminals of these grooves. FISSURE is defined as deep clefts between adjoining cusps.they provide areas for retention of caries producing agent.

MORPHOLOGY OF FISSURES
NANGO(1960)

in a study of crown section described four princile type of fissures. V type U type I type K type

PIT AND FISSURE SEALANT

ACCORDING TO SIMONSEN the term pit and fissure sealant is used to describe: A material that is introduced into the pits and fissures of caries suspectible teeth,thus forming a micromechanically bonded,protective layer cutting access of caries producing bacteria from their source of nutrient.

CLASSIFICATION OF PIT AND FISSURE SEALANT

They

are differentiated in the following ways:

CHEMICAL

STRUCTURE OF MONOMER RESIN SYSTEM BASED ON GENERATION FILLER CONTENT ON COLOR ON CURING

ACCORDING TO CHEMICAL STRUCTURE OF MONOMER

MMA-methy

methacrylate TEGDM-triethylene glycol dimethacrylate BISGMA BPD-Bis phenol dimethacrylate

BASED ON GENERATION
FIRST

GENERATIONS SEALANT-polymerized with UV light. Wavelength of 360um.eg nuvalite SECOND GENERATION-self cure or chemical cure resins based on accelator or catalyst.eg concise white THIRD GENERATION-Light cured with visible(blue) light of 430-490um.eg helioseal FLOURIDE GENERATION-flouride relising sealant.eg pulpdent

BASED ON FILLER CONTENT

UNFILLED-better

flow and more retentive but abrade rapidly. FILLED-resistance to wear

BASED ON COLOR
CLEAR-esthetic

recall visit Tinted-can be identified Colored-easy to see during placement and recall

but difficult to detect in

BASED ON CURING
AUTOPOLYMERIZING

LIGHT

CURE

INDICATIONS OF SEALANT PLACEMENT

 Deep

retentive pits and fissures,which may cause wedging of explorer. Stained pits and fissure with minimum appearance of decalcification. No radiographic or clinical evidence of proximla caries. Possibility of adequate isolation Morphology of pits at risk of caries

Criteria
Tooth age

Seal
A tooth that has just come through into the mouth.

Do not seal
Teeth that have remained free of decay for 4 years or longer.

Tooth type

Molars (which are the teeth at the back of your mouth)

Deep, retentive, narrow pits and fissures, which are excellent at attracting plaque Teeth that are soft, or in a person who has had decay in two or more teeth Person is having fluoride in their diet and still has decay

Front teeth (very rarely is there a need to seal front teeth)

Wide, unretentive, shallow grooves that are easily cleaned by the person Teeth that have remained free of decay for 4 years or longer

depth of pits and fissures The risk of decay

Availabilit y of other preventive measures

Person is not following dentist's advice, and is continually getting more decay; this will require a filling rather than a sealant

CONTRAINDICATION
Well

colased ,self cleaning pit and fissures. Radiographic or clinical evidence of interproximal caries Tooth not fully erupted Dental caries

CLINICAL TECHNIQVE FOR PLACEMENT OF PIT AND FISSURE SEALANT

ISOLATION OF TEETH
The

tooth should be isolated from salivary contamination by use of rubber dam or by cotton rolls and suctioning. Rubberdam should be used in fully erupted teeth and cotton rolls can be used where that is not possible.

TOOTH PREPARATION
There

are different methods of enamel surface preparation prior to etching and sealant application. Early concept was to treat the surface with slurry of PUMICE and WATER. ZERVOV et al 2000 recommended ENAMELOPLASTY as it increases the surface area and decrease microleakage.

ACID ETCHING TOOTH SURFACE

 Applying

the etching agent to the tooth surface using a fine brush or a mini spone according to manufacturer recommendations Initially 80% phosphoric acid is used but nowdays 37%phosphoric acid is recommended. Gently rub the etchant applicator over tooth surface. Be careful to avoid spillage of etchant on the interproximal area as it leads to gingival irritation and sealing of adjacent interproximal spaces together. Stchant can be either in liqvid form or gel form but gel is preferred.

TOOTH SURFACE IS CLEANED BEFORE FISSURE SEALANT IS APPLIED

ETCHING TIME

 Earlier

it was recommended that the etching time for primary teeth be double that of permanent teeth. Many studies have used different etching times ranging from 15sec to 60 sec. Acid etching on the surface enamel has shown to produce a degree of porosity.

STEPS Acid etch Wash Dry

PRIMARY TEETH 30 sec 30 sec 15 sec

PERMANENT TEETH 20 sec 30 sec 15 sec

RINSE AND DRY ETCHED TOOTH SURFACE

Rinse

the etched tooth surface with air water spray for 30seconds.this removes the etching agent and reaction products from etcing agent and reaction products from etched enamel surface.dry the tooth for 15 sec with uncontaminated compressed air.

APPLICATION OF BONDING AGENT

Application

of halogenated bonding agent after etching displaces saliva from enamel therby improving sealant wetting of surface and increases the bond strength both in saliva contaminated enamel and in uncontaminated enamel.

Application of SEALANT
Apply

the material and allow it to flow into pits and fissures. In mandibular teeth,apply the sealant distally and allow it to flow mesially with the converse being true for maxillary teeth. Allow the sealant to flow in the etched pits and fissures to avoid incorporating air into material and creating voids. using a fine brush or applicator carry a thin layer up the cuspal inclines to seal secondary and supplemental fissures.

CURE THE SEALANT

According

to the manufactures recommended time for curing. Hicks eet al 2000 found the argon laser curing of sealant material may enhance caries resistance.

EXPLORE THE SEALED TOOTH SURFACE

Explore

the entire tooth surface for pits and voids that may have not been sealed

EVALUATION OF OCCLUSION
Evaluate

occlusion of sealed tooth surface with articulating paper to determine if any excessive sealant is present and needs to be removed.

RECALL AND RE-EVALUATION

Recall

visits.

and check the patient at subseqvent

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