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Pits and fissure

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sealants

sealants

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  • 1. PITS AND FISSURE SEALANTS
  • 2. MUJTABA NADEEM BDS 2nd year  Roll number 124 
  • 3. Annuit coeptis Novus Ordo Seclorum
  • 4. WHAT ARE PITS AND FISSURE SEALANTS? Defined as  A material applied to occlusal surfaces of the teeth in order to obliterate the occlusal fissures and remove the sheltered environment in which caries may thrive.
  • 5. WHY PIT & FISSURE ARE SEALANTS NEEDED?
  • 6. TOOTH MORPHOLOGY  Why fissures are caries susceptible
  • 7. CLASSIFICATION OF SEALANTS
  • 8. GENERATIONS OF PITS AND FISSURE SEALANTS  First Generation   Second Generation   Chemically cured (auto polymerized), Third Generation   Ultraviolet Light cured Visible Light cure Fourth Generation  Those containing Fluorides
  • 9. A. TYPES OF FISSURE SEALANTS  Plastics based Sealants Polyurethanes  Cyanoacrylates  Bisphenol a glycidyl methacrylae (BIS-GMA)  Resin based Sealants  Glass Ionomer Sealants  Fluoride containing Sealants 
  • 10. B. TYPES OF FISSURE SEALANTS Filled and Unfilled  Light cured and Chemically cured  Clear and Tinted 
  • 11. A. TYPE CLASSIFICATION SEALANTS Plastic Sealants (Bis-GMA) Bisphenol A-glycidyl methacrylate resins  Urethane-based resin  Sealant of choice 
  • 12. A. TYPE CLASSIFICATION SEALANTS Glass Ionomer Cement Clinical advantage of chemically bonding to dentine and enamel without the acid-etch technique.  Less vulnerable to moisture  Fluoride release  Active fissure system  Not for long term.  Exerts a cariostatic effect even after removal of GIC. 
  • 13. B. TYPE CLASSIFICATION SEALANTS Filled and Unfilled Addition of fillers make the sealants more resistant to abrasion.  Fillers are coated with products such as silane, to facilitate combination with the BIS-GMA plastic. 
  • 14. TYPES OF CURING FOR SEALANTS Chemical cured – “Autopolymerization”  Base and catalyst Monomer & Initiator + Diluted monomer & 5% Organic Amine Accelerator = Sealant Visible light cured – “photopolymerization”  Pre-mixed Dimethacrylate + Diluent + Activator + Light = Sealant
  • 15. CHEMICAL CURE SEALANT MATERIALS Advantages  No cure light or risk of eye damage  Can apply sealants to several teeth Disadvantages  Variation in setting time (appx 2 min)  Voids from mixing material  Changes in viscosity over time
  • 16. LIGHT CURED SEALANT MATERIALS Advantages  Short setting time (appx 20 seconds)  No mixing required  Won’t set-up – longer working time  Does not get thick Disadvantages  Potential eye damage due to light cure  Additional cost of cure light  Cure time increased with number of teeth sealed  Difficult to manipulate cure light for posterior teeth
  • 17. CURING UNITS Conventional cure light with halogen bulb = 20 seconds cure for each surface  Plasma arc or laser = 5-10 seconds 
  • 18. Clear and tinted Depends on induvidual preferences.  Vary form translucent to white,pink and yellow.  Coloured pemits a more precise placement of the sealant.  On the other hand clear may be considered more aesthetically acceptable. 
  • 19. SEALANT SHADES  Clear  Tinted  Opaque
  • 20. REQUISITES FOR SEALANTS RETENTION
  • 21. The tooth surface must have  Maximum surface area   Pits and fissure depth    Deep irregular pits and fissure offer a much more favorable surface contour for sealant retention. Deep fissures protect the plastic sealant from shear forces as a result of mastication. Surface cleanliness    Surface area can be increased by tooth conditioners or etchants(30-50%phosphoric acid). Thorough prophylaxis paste should be applied. All heavy strains, debris and deposits be removed before application. Dryness    Saliva interposes between the tooth and sealant. Air stream be checked for moisture contamination. Directing the air stream onto a cool mouth mirror.
  • 22. APPLICATION PROCEDURE
  • 23. INDICATIONS Deep fissures  Incomplete or ill formed pits  Newly erupted teeth  High caries rate  Children  Molars 
  • 24. CONTRAINDICATIONS Shallow fissures  Well coalesced pits  Fluoride rich enamel  Low caries rate  Occlusal or proximal caries  Adults 
  • 25. ACID ETCH  Gel  Liquid
  • 26. ACID ETCH Phosphoric acid 35%-40%-50%  Dissolves organic portion of enamel  “micromechanical retention” 
  • 27. ACID ETCH - CONTINUED  Creates more surface area for better adhesion
  • 28. ACID ETCH - PRECAUTIONS  Avoid contact with adjacent teeth or soft tissues  Can use mylar strips or matrix bands
  • 29. DRYING AGENT  Acid etching and Primadry (alcohol based) allows enamel to be easily “wetted”
  • 30. ACCEPTED SEALANT MATERIALS ADA COUNCIL ON SCIENTIFIC AFFAIRS             3M ESPE – Clinpro Sealant Confi-Dental Products Company Dental Technologies Dentsply International - FluroShield Ivoclar Vivadent, Inc. - Helioseal Kuraray America Inc. – Teethmate F-1 PracticeWares Dental Supply Pulpdent Corporation Southern Dental Industries Tru-Tain Prime Dental Ultradent Products, Inc. - Ultraseal Zenith/DMG Dental Manufacturing
  • 31. ISOLATE TOOTH/TEETH  Rubber dam  Cotton rolls  Cotton roll holders
  • 32. DRY TOOTH Test air/water syringe before applying blast of air
  • 33. APPLY ACID ETCH  15-20 seconds  Use blue micro tip or brush tip  Apply only in pit and fissures  For liquid – dab but do not rub  Re-etch 10 seconds if saliva contamination
  • 34. APPLY ACID ETCH  Etch pit and fissures  Extend 1-2 mm beyond pit and fissures  Avoid cusp tips
  • 35. ACID ETCH - CONTINUED Etch longer  Deciduous teeth  Saliva contamination  Air abrasion or prophy jet used  Highly mineralized teeth Do not use explorer
  • 36. RINSE TOOTH/TEETH  Use HVE and a/w syringe  Proper – usually 20 seconds rinse  Avoid saliva contamination  Re-isolate
  • 37. DRY TOOTH/TEETH  Should appear chalky or frosty white if etched  If not, re-etch for another 10 seconds if not contaminated with saliva
  • 38. APPLY DRYING AGENT  Use brush tip  Apply and leave for 5 seconds  Gently blow air to dry  DON’T RINSE
  • 39. APPLY BOND AGENT A bond agent will improve retention
  • 40. APPLY SEALANT MATERIAL       Most posterior tooth first Extend 1-2 mm beyond pit and fissures Gently work into pits and fissures Avoid lifting off tooth Don’t overfill “pop” bubbles in sealant with explorer or brush tip before curing
  • 41. LIGHT CURE FOR 20 SECONDS  20 seconds each tooth  Don’t touch tip of cure light to sealant material  Don’t let saliva contaminate the field…..yet
  • 42. LIGHT CURE FOR 20 SECONDS – AIR INHIBITION THEORY Sealant will appear shiny/wet
  • 43. CHECK SEALED TEETH  Use explorer  Tooth should be smooth but not soft  Re-apply sealant, if necessary (Remove uncured sealant with wet cotton roll)
  • 44. GIVE 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  We will keep checking the sealant at subsequent appointments (if using unfilled corposite sealant the bite will self adjust in 2-3 days) 
  • 45. FAILURE OF SEALANTS cause – moisture contamination  Maxillary and mandibular 2nd molars  Early loss means less retention of the resin  Main