Uses of pit and fissure sealants in dentistry

1. Pit and Fissure
Sealants
By:
Mohammed Kareem Radhi

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Table of contents
Introduction
Definition of Pit and
fissure sealants
classification of
occlusal fissure
Indications
5 Contraindications
6 Types of Sealants
7 Preparation & Equipment
8 Sealant Application

3. Introduction
Pits and fissures of the occlusal surfaces of the posterior teeth
are more prone to caries development than the smooth
surfaces due to their morphological complexity, making
dental hygiene more challenging leading to increased plaque
accumulation.
The use of pit and fissure sealants provides a physical barrier
that inhibits microorganisms and food particles accumulation,
preventing caries initiation, and arresting caries progression

4. classification of occlusal fissure
Nagano(1960) in study of crown sections classified occlusal fissure into
five types on the basis of fissure morphology: V, U, Y, I, K types.

5. Permanent first molars, followed by second
molars, show the highest caries prevalence.
The management of occlusal caries on
permanent molars represents a significant
challenge because the onset of caries occurs
soon after they erupt into the oral cavity.
The effectiveness of pit and fissure sealants
relays on their long-term retention

6. Definition
Pit and fissure sealants are defined as ‘a cement or a resin which
is introduced into unprepared occlusal pits and fissures of caries
susceptible teeth forming a mechanical and physical protective layer
against the action of acid producing bacteria and their substrates

7. Indications
Pit and fissure sealants can be utilized as a primary
prevention tool when the tooth or the patient is at an
increased risk of experiencing caries or as a
secondary prevention method interrupting the
progression of incipient caries.

8. The indications for placing a pit and fissure sealant are as follow:
1. Pits and fissures of deciduous teeth in children when the tooth, or the
patient, is at an increased risk of experiencing caries
2. Pits and fissures of permanent teeth in children and adolescents when the
tooth, or the patient, is at risk of experiencing caries
3. Pits and fissures of permanent teeth in adults when the tooth, or the patient,
is at risk of experiencing caries .
4. Incipient carious lesions (non-cavitated) of pits and fissures in children,
adolescents, and adults
5. Pit and fissures of primary and permanent teeth should be considered in
children and young people with medical, physical, or intellectual
disabilities, mostly when systemic health could be jeopardized by dental
disease or the need for dental treatment

9. Contraindications
Dental professionals should decide to place a pit and fissure sealant based on the
patient's risk, not the age or time lapsed since tooth eruption . If the patient does
not exhibit any risk factors or is at low risk of developing carious lesions, there is
no need to perform this preventive measure at that time. However, it is essential to
highlight that all children should be regularly monitored for any changes in
cariogenic risk factors or clinical or radiographic changes .
Generally its not used if :
1. Open occlusal carious lesion.
2. Caries exist on other surfaces of the same tooth.
3. A large occlusal restoration is already present

10. Types of Sealants
A. Based on generation
1. Generation 1 Sealant (photocured via UV light).
2. Generation 2 Sealant (auto or chemically-cured).
3. Generation 3 Sealant (photocured via visible light).
B. Based on fillers
1. Unfilled.
2. Filled sealant (fillers increase abrasion resistance strength).
3. Fillers: glass and quartz particles.
4. Fluoride -Releasing.

11. Types of Sealants
C. Based on Color Helps in quick identification for equation during maintenance
assessment:
1. Clear: Esthetic but difficult to detect in follow up.
2. Tinted/opaque sealant: easy to detect.
Three types of materials are utilized as sealants:
1. Resin
2. Glass ionomer (traditional and resin-modified)
3. Polyacid-modified resins.
The most commonly accepted material is the Resin-based sealant, as it has
shown superior retention rates compared with glass ionomer sealants

13. Preparation & Equipment
Preparation
The need and the method for surface cleansing of pits and fissures before placing a sealant may seem
controversial. Some authors have suggested using pumice or air-polishing instruments to obtain an
optimal acid-etch pattern of the enamel. At the same time, others believe that acid etching alone is
sufficient for surface cleaning
Equipment
• Air/water syringe
• Mouth mirror
• Explorer
• Excavator tip
• Two by two gauze squares
• Cotton rolls
• Cotton pellets
• Forceps/cotton
pliers
• Articulating paper
• Curing light
• Handpiece
• Dappen dish with pumice

14. Procedure of Pit and Fissure Sealant Application
1. Surface Cleanliness of the Tooth
Usually the acid etching alone is sufficient for surface cleaning. Pumice and water slurry
are used to the occlusal surface. Slurry must be non-fluoride, oil free mixture to avoid
contamination of the tooth surface. Hydrogen peroxide also been tried as a cleaning agent
but, it has the disadvantage that it produces a precipitate on the enamel surface. All heavy
stains, deposits, and debris should be off the occlusal surface before applying the sealant.
2. Dryness of the Tooth Surface
The teeth must be dry at the time of sealant placement. A dry field can be
maintained by several ways, such as by the use of rubber dam, applying cotton
rolls, bibulous pads over the opening of the parotid duct. Isolation of a tooth are
done mainly by using cotton rolls.

15. Procedure of Pit and Fissure Sealant Application
3. Preparing the Tooth for Sealant Application
Acid Etching
• Most frequently used: 37% orthophosphoric acid (gel)
• Gel applied either directly with special application tips or with a small disposable brush
• Should be applied to all the susceptible pits and fissures and extend up to cuspal inclines
• Etch for 15 seconds for permanent molars, 15 to 30 seconds for primary teeth. Teeth
with dental fluorosis require additional etching time
• If glass ionomer cement is being used, etching is not required, and a surface conditioner
may be used
• Rinse well with air-water spray
• Dry the tooth
• If the surface becomes contaminated, re-etching must be done

16. Procedure of Pit and Fissure Sealant Application
4. Sealant Placement and Curing
Many sealant kits have their own dispensers and instructions that must be
followed.
• Apply sealant, allow to flow into pits and fissures
• In mandibular teeth, apply the sealant from the distal aspect, allow flowing mesially
• In maxillary teeth, apply the sealant from the mesial aspect, allowing to flow distally
• Use a fine brush, mini sponge, and carry sealant material up to the cuspal inclines
Air bubbles should not be incorporated
Visible Light Cured Sealant
• 10 to 20 seconds: exposure to visible light

21. Retention of Sealants
• Plastic sealants are retained better on recently erupted
teeth.
• It is better on first molars than on second molars.
• It is better retained on mandibular than on the
maxillary teeth.

23. Thanks for
listening

24. REFERENCES
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