PIT AND FISSURE

SEALANTS

INTRODUCTION:
Caries potential is directly related to shape &
depth of the pit and fissures.
The cariostatic properties of sealants are
attributed to the physical obstruction of the pit
and grooves.
Sealants are the effective caries protective
agents to the extent they remain bond safe &
their effectiveness should justify their routine
use as a preventive measure.

Definition:
According to simonsen:
Material that is introduced into the pits and fissures
of caries susceptible teeth, thus forming
micromechanically
Bonded protective layer cutting access of caries
producing bacteria from their source of nutrients.

HISTORY:
IN 1905: application of silver nitrate by miller
IN 1923: Hyatt reported a technique named
prophylactic odontomy.
IN 1929: Bodecker introduced fissure eradication.
IN 1955: Buanocare introduced a method of
adhering resin to an acid etched enamel surface.
IN 1965: Bowen & associates developed BIS- GMA
resin.
IN 1970 & EARLY 1980S: UV light with a
wavelength of 365 nm was used to initiate the
setting reaction.

CLASSIFICATION:
According
to
chemical
monomers used:

structure

of

MMA-methyl methacrylate,{ NUVASEAL}

TEGDMA-triethylene glycol dimethacrylate,{KERR
PITT AND FISSURE SEALANTS}
BPD-bisphenol dimethacrylate
BIS-GMA
PMU-propyl methacrylate urethane

According to generations:
1st generation

UV light cured at Eg:alphaseal,nuvalit

e,alphalite
356 nm

2nd generation

Self cured

Eg:concise white
sealant,delton

3rd generation

Blue visible light

cured at 490 nm

Eg:stephen K.W
strang

4th generation

flouride releasing

Eg: Toma l.morphis ,

Jack toumba

Based on filler content:

UNFILLED
Better flow
More retention
Abrade rapidly
FILLED
Resistance to wear
Need occlusal adjustments

Based on color
Color: esthetic but difficult to detect in recall
visits.
White tinted/opaque: contain opaquing agent
titanium dioxide
Colored: easy to see during placement and
recall.eg: Helioseal{ white color changes to green}

MORPHOLOGY OF PITS AND FISSURES

ACCORDING TO NANGO 1961:
V shaped fissure: wide at top, narrow at bottom
I shaped fissure : quite constricted and may
resemble a bottle neck
U shape fissure: same width from top to bottom
K shape fissure: extremely narrow slit with larger
space at bottom
H shape fissure: seen mostly in premolars

V
shaped

U shaped

K shaped
I shaped

ACCORDING TO GALIL & GWINETT, 1975

V shape
U shape
Tear drop shape

DIAGNOSIS OF PIT AND FISSURE CARIES:

When the explorer catches or resists removal
after insertion into a pit and fissure with
moderate to firm pressure.
softens at the base of area
Opacity adjacent
to the pit & fissure as
evidence of demineralization.
Softened enamel adjacent to the pit & fissure
that can be scraped away with the explorer.
By xeroradiographic & digital radiography, dye
preparation,fiberoptictransillumination,ultrasoni

PROCEDURE OF APPLICATION
OF SEALANT

PROCEDURE OF PIT AND FISSURE SEALANT

APPLICATION:
CLEAN THE TOOTH SURFACE:
Remove plaque & debris from enamel and pits &
fissures of the tooth.
Debris interfere with proper etching process
Simply use a toothbrush prophylaxis with
toothpaste or pumice followed by copious water
rinsing.
If sodium bicarbonate slurry has been used, it is
necessary to neutralize the retained slurry with
phosphoric acid for 5-10 sec.

ISOLATE & DRY THE TOOTH SURFACE

Rubber dam provides best isolation.
Cotton roll isolation with adequate suctioning is
also preferred method of isolation for many
practioners.

ETCH THE TOOTH SURFACE

Etch with 37% conc. Of orthophosphoric acid for
15-30 sec. for primary teeth and 15 sec. for
permanent teeth.
additional time is required for fluorosed teeth.
Gently rub etchant applicator over a tooth surface
including 2-3 mm of the cuspal inclines.
Periodically add fresh etching agent.
Donot allow the etchant to come into contact with
the soft tissue.

APPLY BONDING AGENT

Apply a hydrophilic bonding agent , prior to
sealant application may improve retention with
teeth that cannot be isolated properly.
Then cure it.

MATERIAL APPLICATION
Sealant material is then applied to the tooth
according to manufacturer direction.
Be careful not to corporate air bubbles in the
material.
with mandibular teeth apply the sealant at the
distal aspect and allow it to flow mesially and with
maxillary teeth vice versa.
After the sealant has set, the operator should
wipe the sealant surface with a wet cotton pellet.
With autopolymerising sealants working time
varies from 1-2 min & with photoactive sealants,
10-20 sec. for complete setting.

EVALUATE THE SEALANT

Sealant should be evaluated visually and
tactically.
Take the explorer & attempt to dislodge it.
Any deficiences in the material, more sealant
material should be applied.
Remove the rubber dam and cotton rolls.

CHECK OCCLUSION
If occlusal high points are present, correct them.
Occlusion checked and adjusted if needed

RETENTION AND PERIODIC MAINTAINENCE

Re-evaluate the sealant at recall visits.
See for any exposure in the voids in the material
and caries development.
Re-application is highest during six months
after placement.

RINSE AND DRY ETCHED TOOTH SURFACE

Rinse the etched tooth surface with an air spray
for 30 sec.
Dry the tooth surface for atleast 15 sec. with
uncontaminated compressed air.
Dried etched enamel should have frosted white
appearance.
Repeat the etching step if necessary.
Moisture contamination- most common cause of
sealant failure.

AGE RANGES FOR SEALANT APPLICATION:

3-4 YEARS- PRIMARY MOLARS
6-7 YEARS- 1ST PERMANENT MOLAR
11-13 YEARS- 2ND PERMANENT MOLAR AND
PREMOLARS.

REQUIREMENTS:
Reduced water absorption and solubility
Increased hardness and abrasion resistance
after curing
Good flow
Suitable short setting time
Same thermal conductivity as tooth
Good bond strength with enamel
Chemically inert
Anti-cariogenic
Reduced polymerization shrinkages

INDICATIONS:
Deep retentive pit & fissures
No radiographic/ clinical evidence of proximal
caries
Patient with high risk of caries
patient suffering from xerostomia
Patient undergoing orthodontic treatment
Stained pit and fissure with numerous
appearance of decalcification.

CONTRA-INDICATIONS
Well-coalesced , self cleansing pit and
fissures
Radiographic/clinical evidence of proximal
caries
Tooth not fully erupted
Isolation not possible
Life expectancy of tooth is limited
Dental caries

SEALANTS WILL BE LONG LASTING IF:

The case is selected properly
The tooth is selected properly
An appropriate placement technique is followed
Adequate maintenance is provided

SEALANT APPLICATION ON
TOOTH

FACTORS AFFECTING SEALANT RETENTION IN

MOUTH
Type of sealant
Position of teeth in mouth
Clinical skill of the operator
Age of child
Eruption status of teeth
Better sealant retention reported more for the
anterior and in mandibular than maxillary arch
Retention compromised in children due to
difficulty in maintaining a dry field resulting from
the behavior problems and depending on the
eruption status of the teeth.

FLOURIDE CONTAING SEALANTS

2 methods of fluoride application has been used:
Soluble fluoride added to unpolymerised resin.
After a sealant is applied to a tooth, the salt
dissolves and fluoride ions are released.
Other method involves an organic fluoride
component which is chemically bound to the resin
which enhances the fluoride release while
maintaining the physical properties of resin
material.
E.g.:
methcrylol
fluoride
methyl
methacrylate, acrylic amine hydrogen fluoride salt.

SEALANTS
IN
CARIES
MANAGEMENT
PROGRAMME:
Identification of a patient at risk of decay.
A thorough assessment of all aspect of a patients
life affecting the development of caries.
Appropriate examination to determine the tooth
surface at risk.
Appropriate
technique
and
manufacturers
guidelines need to be followed.
Step need to be taken to ensure reversal of the
decay
balance
from
demineralization
to
remineralization.
Monitoring and repair just like any other caries
management programme.

PARENT EDUCATION:
Educating parents and patients on
importance of dental sealants is critical.

the

Dental sealants are cost effective treatment

modalities when placed on the teeth of children at
high risk for dental caries.

SUMMARY
Sealant will be adopted as a standard of care for
prevention of pit and fissure caries. To make
significant gains in caries reduction in child and
adult population is necessary for the dental
profession to educate and inform the general
public.

Thank you.