Pits and fissure

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Pits and fissure

  1. 1. PITS AND FISSURE SEALANTS
  2. 2. MUJTABA NADEEM BDS 2nd year  Roll number 124 
  3. 3. Annuit coeptis Novus Ordo Seclorum
  4. 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. 5. WHY PIT & FISSURE ARE SEALANTS NEEDED?
  6. 6. TOOTH MORPHOLOGY  Why fissures are caries susceptible
  7. 7. CLASSIFICATION OF SEALANTS
  8. 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. 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. 10. B. TYPES OF FISSURE SEALANTS Filled and Unfilled  Light cured and Chemically cured  Clear and Tinted 
  11. 11. A. TYPE CLASSIFICATION SEALANTS Plastic Sealants (Bis-GMA) Bisphenol A-glycidyl methacrylate resins  Urethane-based resin  Sealant of choice 
  12. 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. 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. 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. 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. 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. 17. CURING UNITS Conventional cure light with halogen bulb = 20 seconds cure for each surface  Plasma arc or laser = 5-10 seconds 
  18. 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. 19. SEALANT SHADES  Clear  Tinted  Opaque
  20. 20. REQUISITES FOR SEALANTS RETENTION
  21. 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. 22. APPLICATION PROCEDURE
  23. 23. INDICATIONS Deep fissures  Incomplete or ill formed pits  Newly erupted teeth  High caries rate  Children  Molars 
  24. 24. CONTRAINDICATIONS Shallow fissures  Well coalesced pits  Fluoride rich enamel  Low caries rate  Occlusal or proximal caries  Adults 
  25. 25. ACID ETCH  Gel  Liquid
  26. 26. ACID ETCH Phosphoric acid 35%-40%-50%  Dissolves organic portion of enamel  “micromechanical retention” 
  27. 27. ACID ETCH - CONTINUED  Creates more surface area for better adhesion
  28. 28. ACID ETCH - PRECAUTIONS  Avoid contact with adjacent teeth or soft tissues  Can use mylar strips or matrix bands
  29. 29. DRYING AGENT  Acid etching and Primadry (alcohol based) allows enamel to be easily “wetted”
  30. 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. 31. ISOLATE TOOTH/TEETH  Rubber dam  Cotton rolls  Cotton roll holders
  32. 32. DRY TOOTH Test air/water syringe before applying blast of air
  33. 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. 34. APPLY ACID ETCH  Etch pit and fissures  Extend 1-2 mm beyond pit and fissures  Avoid cusp tips
  35. 35. ACID ETCH - CONTINUED Etch longer  Deciduous teeth  Saliva contamination  Air abrasion or prophy jet used  Highly mineralized teeth Do not use explorer
  36. 36. RINSE TOOTH/TEETH  Use HVE and a/w syringe  Proper – usually 20 seconds rinse  Avoid saliva contamination  Re-isolate
  37. 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. 38. APPLY DRYING AGENT  Use brush tip  Apply and leave for 5 seconds  Gently blow air to dry  DON’T RINSE
  39. 39. APPLY BOND AGENT A bond agent will improve retention
  40. 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. 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. 42. LIGHT CURE FOR 20 SECONDS – AIR INHIBITION THEORY Sealant will appear shiny/wet
  43. 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. 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. 45. FAILURE OF SEALANTS cause – moisture contamination  Maxillary and mandibular 2nd molars  Early loss means less retention of the resin  Main

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