Report for Community Dentistry. Preventive Restorative Treatment, Pit and Fissure Sealant (PFS)

1. Date: 01.22.16 Community Dentistry
PREVENTIVE RESTORATIVETREATMENT
JOSEPH RUSSELL N. GORDA

2. PIT AND
FISSURE
SEALANTS
JOSEPH RUSSELL N. GORDA

3. FIT AND FISSURE SEALANTS

5. 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.

6. 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.

7. ✤ ACCORDING TO ADA
✤ AN ADHESIVE MATERIAL APPLIED TO PITS
AND FISSURES OF TEETH IN ORDER TO
ISOLATE FROM THE REST OF THE ORAL
CAVITY.

8. CLASSIFICATION
✤ According to chemical structure of monomers used:
✤ MMA-methyl methacrylate,{NUVASEAL}
✤ TEGDMA-triethylene glycol dimethacrylate,{KERR PIT
AND FISSURE SEALANTS}
✤ BPD-bisphenol dimethacrylate
✤ BIS-GMAPMU-propyl methacrylate urethane

9. ✤ According to generations:
1st generation
UV light cured at
356 nm
Eg: alphaseal, nuvalite, alphalite
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

11. ✤ Based on filler content:
✤ UNFILLED
✤ Better flow
✤ More retention
✤ Abrade rapidly
✤ FILLED
✤ Resistance to wear
✤ Need occlusal adjustments

12. ✤ 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}

13. MORPHOLOGY OF PITS AND
FISSURES
✤ ACCORDING TO NANGO 1961:
✤ V shaped fissure: wide at top, narrow at bottom
✤ I shaped fissure : quite constricted and mayresemble a bottle
neck
✤ U shape fissure: same width from top to bottom
✤ K shape fissure: extremely narrow slit with largerspace at bottom
✤ H shape fissure: seen mostly in premolars

14. ✤ ACCORDING TO GALIL & GWINETT, 1975
✤ V shape
✤ U shape
✤ Tear drop shape

16. 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,
fiberoptic transillumination, ultrasonic imaging

17. PROCEDURE OF APPLICATION
OF SEALANT
✤ 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.

18. ✤ 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.

19. ✤ 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 cusp inclines.
✤ Periodically add fresh etching agent.
✤ Do not allow the etchant to come into contact with the
soft tissue.

20. ✤ RINSE AND DRY ETCHED TOOTH SURFACE
✤ Rinse the etched tooth surface with an air spray for 30
sec.
✤ Dry the tooth surface for at least 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.

21. ✤ 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.

22. ✤ 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.
✤

24. ✤ 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.

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

27. ✤ 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 monthsafter
placement.

30. FAILING SEALANT

31. AGE RANGES FOR SEALANT
APPLICATION
✤ 3-4 YEARS- PRIMARY MOLARS
✤ 6-7 YEARS- 1ST PERMANENT MOLAR
✤ 11-13 YEARS- 2ND PERMANENT MOLAR AND
PREMOLARS.

32. 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

33. 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.

34. 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

35. ✤ 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

36. 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.

37. 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
methylmethacrylate, acrylic amine hydrogen fluoride salt.

38. 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.