Minimal Intervention Dentistry has brought a paradigm shift in the field of dentistry. Here I am introducing Pre-fissure sealants.

1. GOOD MORNING

2. Glass ionomer cements as fissure sealing
materials: yes or no?
Presented by : Dr. Madhuri M. Nikam.
2nd MDS
20-8-2019

3. Along with proper diet, fluoride therapy & biofilm control, the most
efficient way to prevent pit and fissure caries is fissure sealing
treatment .
It provides a favorable environment for the oral microorganisms to
thrive and convert the carbohydrates to acids, leading to
demineralization of the enamel.
Deep pits & fissures favor food retention & are difficult to clean by
routine brushing.
Begins shortly after eruption of the deciduous teeth & continue to
increase in their school age.
Dental caries is one of the most widespread disease in children.

4. 1895 Wilson
Placement of
zinc phosphate
cement
1905 Miller
Application of
silver nitrate
1922-23 Hyatt
‘Prophylactic
odontomy’
1929 Bodecker
‘Fissure
Eradication’
1942 Kline and
Knutson
ammoniacal
silver nitrate
1955 Buonocore
bonded resin
material
1971 Pit and
fissure sealant
recognized by
ADA
1986 Garcia-Godoy
Preventive glass
ionomer
restoration
History

5. Indications & contraindications
The disease susceptibility of the tooth should be considered when
selecting teeth for sealants.

6. Occlusal fissures are classified into U, V, Y, I, IK, inverted Y type.

7. Classification of Pit and Fissure Sealant

8. Mechanism
A physical barrier
Isolates the covered surfaces of teeth
From microorganisms and food
particle accumulation
Prevent caries in pits and
fissures

9.  Prevention of caries is the main goal of the fissure
sealant treatment.
 But the sealant retention rate is a more easy and
applicable outcome that investigators have used in the
studies.
Choice of
sealant type

10. Retention of RBS is higher than that of most of the GIC-based
sealants :
- Higher wear resistance & compressive strength
- Micro-mechanical bonding to tooth

11. Imagine a World Without Occlusal Caries:
Are Glass Ionomer Sealants the Answer?

12.  There were no limitations regarding the type of glass ionomer
or resin fissure sealants
 20 studies on caries prevention
 28 studies on retention

13. > 20
clinical
trials
Better retention of RBSs than of GIC-based
sealants
The higher wear resistance and compressive
strength of RBSs
Their micromechanical bonding after etching
In addition, most of the operators had many
years of experience in applying RBSs, whereas
the application of GIC-based sealants may have
been new to them.

14.  Only 4 studies indicated similar retention of RBS & GIC-based
sealants.
 The use of a mechanically stronger high-viscosity
glass ionomer
 A different application procedure that pushes the
glass ionomer into the pits and fissures with a finger.

15. Lower retention rate of the RBS - lower quality of
isolation with the RBS
Some researchers used resin-modified GICs instead of
conventional low-viscosity GICs as sealants
 The resin in their formulation improved viscosity, physical &
mechanical properties
 But they did not find better retention performance than that of
RBSs.

17. Similar
retention
rates for
RBS & GI
sealants.
Use of a bond
surface
conditioner
(Cavity
Conditioner)
with the glass
ionomer
sealant.
Polyacrylic
acid
produces a
chelation
reaction with
the calcium
of the
enamel
Hybrid layer
for the glass
ionomer to
establish a
more stable
bonding
surface.
Also acts
as a
wetting
agent.
Retention

18. Al-Jobair evaluated the microleakage of a glass ionomer sealant
(GC Fuji Triage) in saliva-contaminated pits and fissures and
compared it RBS .
The GI sealnt was insensitive to moisture contamination, showed
no difference in its leakage scores under dry or wet
contamination protocols.
When comparing the GI sealant with the RBS, GI sealant showed
less leakage under wet contamination conditions, whereas the
RBS exhibited less leakage under dry conditions
microleakage

19. In vitro study, Ashwin and Arathi reported no difference in
microleakage
Moreover, the GI has the additional benefit of fluoride release.
Increased
resistance to
microleakage
Chemical
adherence to
the tooth
Absence of resin -
no polymerization
shrinkage
Conditioning
before
application

20. caries
caries developed in two patients in the RBS group & the
caries was present in teeth with sealant lost.
No caries with glass ionomer group, which probably
is related to high fluoride release or to the glass
ionomer particles remaining in the bottom of fissures
Conversely, some authors reported that GI & RBS
were equally effective in preventing caries.
However, there is no evidence that either resin-based or
glass ionomer sealant material is superior to the other
in preventing caries.

21. Glass ionomer sealants preferable & better for
 Sealing partially erupted permanent molars
 When salivary contamination is expected

22. There was no difference between the percentage of caries
development with use of GICs as fissure sealing material and
that for conventional RBSs. However, the retention rate of
the conventional RBSs was much higher than that of the
GICs.

23.  Despite the better retention of RBSs vs GIC-based sealants,
no difference between % of the caries prevention.
 Sealant retention has been used for decades as a surrogate
endpoint for determining its caries-preventive
effectiveness.
 To what extent the retention of a sealant is a prerequisite
for its preventive effect has not been reported.
 Using retention survival rates as a surrogate endpoint to
determine sealant effectiveness is questioned.

24. Mickenautsch & Yengopal indicated that the risk of loss of
complete retention of sealant materials was associated with the
risk of developing caries occurrence for RBSs but not for GIC-
based sealants.
Small particles remained in the
bottoms of fissures
Acted as a fluoride reservoir
Enamel remineralization & no
marginal discrepancies
RBS mostly lost in bulk leads to
uneven margins

25. Hydrophobic
products that are
easy to apply
Have proper flow
Unlimited working
time
Require no mixing
Their effectiveness
may be jeopardized
by the difficulty in
obtaining ideal
isolation during
application.
RBS

26. Moisture-friendly s0
less technique
sensitive
Chemical bond to
dental tissue
Have anticariogenic
properties because of
the fluoride
reservoir.
No etching - reduce
chair time
GIC based
sealant

27. WHITE SHADE

28.  Prevention of caries is the main goal of the fissure sealant treatment.
 Since there was no difference between the percentage of caries
development & the retention rate of the conventional RBSs was much
higher than that of the GICs
 As retention is not a surrogate / valid prediactor – choice is RBS / GI
based sealant.
- Choice of PFS is RBS when there is no difficulties in
obtaining isolation
 GIC-based sealant is efficient & preferable choice of material
1. When there is difficulties in obtaining isolation.
- Limited equipment
- No chairside assistant
- In partially erupted permanent molars where salivary
contamination is expected.
2. Children at high risk of developing caries.
CONCLUSION

29. • George B,Shanthala M, Bobby W, Chandru P. Pit and fissure sealants in
pediatric dentistry: Review Article SRM Journal of Research in Dental
Sciences 2014;5(4):253-257.
• Alirezaei et. al. Glass ionomer cements as fissure sealing materials: yes or no?
A systematic review and meta-analysis. JADA 2018
• Antonson SA, Antonson DE, Brener S, et al. Twenty-four month clinical
evaluation of fissure sealants on partially erupted permanent first molars:
glass ionomer versus resin-based sealant. JADA. 2012;143(2): 115-122.
• Barlean L, Coman M, Bobu L, et al. Comparative evaluation of a glass ionomer
cement and a resin composite used as dental sealants. Mater Plastice.
2015;52(4): 542-545.
• Al-Jobair A, Al-Hammad N, Alsadhan S, Salama F. Retention and caries-
preventive effect of glass ionomer and resin-based sealants: an 18-month-
randomized clinical trial. Dental Mater J. 2017;36(5):654-661.
• Mickenautsch S, Yengopal V . Validity of sealant retention as surrogate for
caries prevention – a systematic review . J Minimum Interv Dent 6: 30–37.
• Hilgert LA, Leal SC, Freire GML, Mulder J,Frencken JE. 3-year survival rates
of retained composite resin and ART sealants using two assessment criteria.
Braz Oral Res. 2017;31:e35.
REFERENCES

30. THANK YOU…