Pit and fissure sealant

1. PIT AND FISSURE
SEALANTS
PRESENTED BY: DR ADITYA
PARAMPILL
GUIDED BY: DR RUPINDER
BHATIA
DR KIRAN GHULE.

2. INDEX
Introduction Cost effectiveness
Definition Other materials as sealants
History Sealant of primary teeth
Morphology Adverse effects
Histopathology Conclusion
Classification References
Requisites of efficient sealant
Indication Contraindication
Rationale for sealants
Steps of Sealant application

3. INTRODUCTION
oCaries occurs more commonly on the occlusal surfaces when compared to
the smooth surfaces.
oThe high susceptibility of pit and fissures to caries presents a major dental
problem and provides the rationale for caries control of these areas
oWhile occlusal surfaces represent approximately 10% of the enamel surface
at risk, they account for almost 50% of the caries in human dentition.
oThe use of pit and fissure sealants has been considered as effective
preventive method in blocking the development of carious lesions on occlusal
surfaces.

4. DEFINITIO
N

5. PIT: It is defined as a small pinpoint depression located at the junction of
development grooves or at terminals of those grooves. The central pit describes
a landmark in the central fossae of the molars where developmental groves join.
(Ash 1993)
FISSURE: It is defined as deep clefts between adjoining cusps. (Orbans,1990)
PIT AND FISSURE SEALANT:
1. It is the term to describe the material that is introduced into the occlusal pits &
fissures of caries susceptible teeth , thus forming micromechanically- bonded,
protective layer ,cutting access of caries- producing bacteria from their source
of nutrients. (Simenson RJ 1978)
2. It is the material that is placed in the pits & fissures of teeth in order to prevent
or arrest the development of dental caries. (R Welbury, M Raadal, N Lygidaks,
EAPD Policy documents, 2003)

6. HISTORY

7. 1867 Arthur Obliteration of fissure may prevent caries
1905 MIller Used silver nitrate for fissure restoration
1922 Hyatt “prophylactic odontomy”- filling of fissures with silver or copper
oxyphosphate cement.
1939 Gore The use of polymers as a fissure sealant.
1955 Buonocore After treatment of enamel with phoshoric acid, attachement of
acrylic resin to tooth increases.
1965 Gwinnett &
Buonocore
50 % phosphoric acid solution etched enamel produced strong
bond by cyanoacrylate
1965 Browen BIS-GMA was developed from adducts of bisphenol A & glycidyl
methacrylate.
1966 Cueto &
Buonocore
Studies on fissure sealing using methyl methacrylate filled with
silicate filler that had potential of bonding & fluoride release

8. 1968 Rodyhouse
Reported on use of the BIS-GMA monomer using methyl
methacrylate as diluents together with peroxide amine
polymerization system.
1970 Buonocore
Utilized BIS-GMA system but employed UV – sensitive
polymerization initiator( benzoin methyl ether) which
allowed more flexibility in the clinical application of the
material.
1971 Nuva-Seal
First pit & fissure developed & commercially introduced
by LD Caulk company.
Textbook of Pediatric dentistry Nikhil Marwah 3r

9. MORPHOLOG
Y OF PIT AND
FISSURES

10. Classificatio
n by
Nagano
(1961)

11. HISTOPATHOLOGY OF FISSURE
CARIES
At the orifice of the fissure & represented as 2 bilateral
lesions in enamel on opposing cuspal inclines
The lesion progresses & depth of fissure wall becomes
involved
Two lesions coalesce into one at the base of fissure.
The enamel at the base is affected & lesion spreads
laterally towards DEJ.
Cavitation occurs owing to loss of minerals & structural
support from affected enamel & dentin.
Textbook of Pediatric dentistry Nikhil Marwah 3rd

12. CLASSIFICATION OF
PIT AND FISSURE
SEALANTS

13. Based on
Composition:
• Cyanoacrylate
s.
• BISGMA resin
materials.
• Urethane
dimethacrylate
resin
materials.
• Glass ionomer
sealants.
Based on
setting method
or method of
polymerization:
• Auto
Polymerizatio
n
• Photo
activated
Polymerizatio
n-UV light
cured.
-Visible light
cured.
- Laser cured.
Based on Filler
Composition:
• Unfilled
BISGMA
sealant
• Filled
BISGMA
sealant
Based on
Transluceny
• Opaque.
• Tinted.
• Clear.
Based on
Fluoride
Release:
• Non-
fluoride
releasing.
• Fluoride
releasing.
E.g. G.I.
Sealants.
MITCHELL AND GORDON (1990) STATED THAT SEALANTS COULD BE
DIFFERENTIATED IN THE FOLLOWING WAYS

14. Based on
chemical
structures
of
monomers
• MMA
• TEGDMA
• BPD
• Bis-GMA
with MMA
• PMU
Based on
generation
1st-Nuva-
lite
2nd-Concise
white
3rd-
Helioseal
4th-Seal
right
Based on
filter content
Unfilled
Filled
Based on
colour
Clear-
Helioseal
Tinted/opaq
ue-Delton
Coloured-
Clinpro pink
Based on
setting
Autopolyme
rizing
Light cure
Textbook of Pediatric dentistry Nikhil Marwah 3r

15. First generation
sealant-U V light.
Eg Nuva lite
• Introduced in
the mid 1960’s
and was a
cyanoacrylate
(CA) substance
• Nuva Seal® was
the first
successful
commercial
sealant in
market, in 1972
• bacterial
degradation of
the material in
the oral
Second generation
sealant-Self
cure/chemical cure:
concise white
• Dimethacrylates,
which represent
the reaction
product
of BIS-GMA
• Second generation
sealants are auto
polymerizing
• generally self-
cured or chemically
cured
Third generation
sealant-Light
cure/visible light:
helioseal
• Photo activated
resins which
contain a
diketone
initiator such as
• Camphoroquino
ne reducing
agent such as
tertiary amine to
initiate
polymerization.
Fourth generation-
Fluoride releasing
sealant: Helioseal F
• release fluoride
on the enamel
surface for an
extended period
of 24 h to 30
days.
• After the sealant
is applied to the
tooth, salt
dissolves and
fluoride ions are
released
GENERATION OF SEALANTS

16. Over a period sealants undergo
abrasive wear and hence filler
particles have been added to
sealants to increase their wear and
abrasion resistance
Addition of filler particles lowers the
sealant’s ability to penetrate into
fissures and microporosities of etched
enamel.
FILLED VS UNFILLED SEALANTS
Advantage includes better flow and
more
retention but abrade rapidly
Advantages include resistance to wear
but may need occlusal adjustment
A study by Reddy V et al in 2015 compared retention of filled and unfilled resin
based sealants concluded that the difference in the retention rate was not
statistically significant but unfilled sealant showed slightly higher retention rates
and clinically better performance than filled sealants
Retention of resin-based filled and unfilled pit and fissure sealants: A comparative clinical study V. Rajashekar Reddy,
Nagalakshmi Chowdhary, K. S. Mukunda, N. K. Kiran, B. S. Kavyarani M. C. Pradeep Contemporary Clinical Dentistry March

17. COLORED VS CLEAR
In 1977, the first coloured sealant (3M Concise White Sealant) was introduced.
The advantage of colored over clear is that, for the operator, it is easier to see the sealant during
application, and it is much faster to assess retention with a white sealant than with a clear sealant
at later time intervals.
The latest trend is to incorporate color change in their polymerisation phase
Clinpro----pink to opaque white
Helios----- clear to green
A review of the clinical application and performance of pit and fissure sealants ADA,RJ Simosen et al 2011

18. Auto cure vs light initiated sealant
De Craene and co-workers showed that a visible-light-
cured sealant (Helioseal) appeared to be as good as the
self-cured sealants and better than the UV-light-cured
sealants.
Thus, both self-cured and visible-light-cured materials
should provide equal clinical effectiveness both in terms
of retention and caries prevention.
According to a meta-analysis of 24 studies, the overall
effectiveness of autopolymerised fissure sealants in
preventing dental decay was 71 percent.
Clinical evaluation of light cured fissure sealant(Helioseal) De Craene ,Martin LC, Surmount PA ASDC J Dent Child 1990 March

19. PROPERTIES OF AN IDEAL
SEALANT
Property Ideal
penetration High
Working time Medium
Setting time Short
Water sorption Low
Thermal expansion Low
Wear resistance High
Brauer
(1978)

20. REQUISITES
OF EFFICIENT
SEALANT

21. A viscosity allowing penetration into deep and narrow fissures
even in the maxillary teeth.
Adequate working time.
Rapid cure.
Good and prolonged adhesion to the enamel.
Low sorption and solubility.
Resistance to wear
Minimum irritation to tissues.
Cario-static action.
Brauer
(1978)
Textbook of Pediatric dentistry Nikhil Marwah 3r

22. Indications
• Deep & retentive P&F
• Stained P&F with
minimum
decalcification
• No radiographic or
clinical evidence of
caries.
• Possibility of
isolation
• Indicative caries
pattern
• Morphology
• Patients desire
• Dental care with
active preventive
Contraindications
• Well coalesced, self-
cleansing pits &
fissures
• Radiographic or
clinical evidence of
caries
• Tooth not fully
erupted
• Isolation not possible
• Limited life
expectancy of tooth
• Dentinal caries
• Lack of preventive
practice
Textbook of Pediatric dentistry Nikhil Marwah 3r

23. Fissure Sealants: A Review of their Importance in Preventive Dentistry
Nélio J. Veiga, Paula C. Ferreira, Ilidio J. Correia, Carlos M. Pereira OHDM 2014
Pit and fissure sealants in pediatric dentistry George Babu, Shanthala Mallikarjun,
Bobby Wilson, JRDS 2014

24. AAPD GUIDELINES FOR PIT AND
FISSURE SEALANTS
Sealants should be placed on
pit and fissure surfaces
judged to be at risk for dental
caries or surfaces that already
exhibit incipient, non-
cavitated carious lesions to
inhibit lesion progression.
Sealant placement methods
should include careful
cleaning of the pits and
fissures without mechanical
tooth preparation.
Resin-based sealants require
placement in a moisture
controlled environment,
often facilitated by four-
handed technique.
Low-viscosity hydrophilic
material bonding layer, as
part of or under the actual
sealant, is better for long-
term retention and
effectiveness.
Resin-based materials achieve
better retention and, therefore,
may be preferred as dental
sealants, but glass ionomer
sealants could be used as
transitional sealants when
moisture control is not possible.

25. RATIONALE
FOR USE OF
SEALANTS

26. Bonded resin sealants placed by appropriately trained dental personnel are safe,
effective and underused in preventing pit and fissure caries on at-risk surfaces.
Benefit is increased by placement on surfaces judged to be at high risk or
surfaces that already exhibit incipient carious lesions
The best evaluation of risk is made by an experienced clinician using
indicators
Caries risk and therefore potential sealant benefit may exist in any tooth
with pit or fissure at any age
Sealant placement methods should include careful cleaning of the pits and
fissures without removal of appropriate enamel
Placement of low viscosity, hydrophilic material bonding layer as part of or
under the actual sealant has been shown to enhance the long term retention
and effectiveness
GIC have been shown to be ineffective as pit and fissure sealants but can be used
as transitional sealants
American academy of pediatric dentistry’s pediatric restorative dentistry consens

27. AGE PERIOD FOR SEALANT
PLACEMENT
1.Ages 3 and 4 years
are the most
important times for
sealing the eligible
deciduous teeth.
Ages 6-7 years for
the first permanent
molars.
Ages 11-13 years for
the second
permanent molars
and premolars
Brown LJ, Selwitz RH. The impact of recent changes in the epidemiology of dental caries on guidelines
for the use of dental sealants. J Public Health Dent 1995;55:274-91.

28. STEPS OF
SEALANT
APPLICATION

29. PREPARING THE TOOTH
oTooth surface is cleaned to remove plaque and debris from
the enamel and pit and fissure or both.
oVarious methods have been used:
1. No tooth preparation
2. Preparation with only a toothbrush
3. Rubber cup with pumice slurry
4. Rotation brush with pumice slurry
5. Enameloplasty with a bur
6. Prophy-jet or Cavi-jet unit preparation
7. Air Abrasion Preparation

30. Author Year Method Result
Gray et al 2009 Tooth brushing vs
Handpiece prophylaxis
Levels of sealant
retention after surface
cleaning with
toothbrush prophylaxis
were at least as high as
those associated with
hand- piece
prophylaxis.
Paul et al 2009 Tooth brushing vs
Handpiece prophylaxis
Supervised tooth-
brushing of tooth
surfaces before sealant
application results in a
similar level of
retention as associated

31. Author Year Method Result
Ansari et al 2004 Pumice
prophylaxis vs no
pumice
prophylaxis (In
vitro)
Prophylaxis has a
role in improving
sealant retention.
Removing this step
may cause an
increase in
microleakage.
Bhagarian et
al
2013 Pumice
prophylaxis vs
fissurotomy bur
(in vitro)
Teeth in fissurotomy
bur and pumice
prophylaxis groups
had significantly
reduced level of
microleakage than

32. Author Year Method Result
Ansari et al 2005 To check
sealant
retention with
Tooth
brushing with
pumice vs no
brushing (in
vivo)
Brushing with
pumice did
not have a
great effect on
clinical sealant
retention after
6 month and
removing this
step seems
not interfering
with sealant
retention

33. The fissurotomy system gives a viable alternative to be conservative and protect
as much healthy
tooth structure as possible. The fissurotomy bur tip is extremely small(0.33mm)
and fast. It cuts a
smooth, minimally invasive groove in suspicious fissures to allow for explorer
access.
Exact drilling depthPain free use
Ideal cavity form and ability to explore
Restore in just 3-5 mins

34. Autho
r
Yea
r
Method Result
Geiber SB
et al
2000 Tapered fissure
diamond bur vs
round carbide bur
(in vitro)
Preparation with a tapered fissure
diamond bur was superior to the round
carbide bur.
Khanna et
al
2009 Fissurotomy bur vs
no preparation (in
vitro)
(i) The surface area available for
sealant placement on the occlusal
surface was significantly increased
following enameloplasty. (ii)
Fissure width following
enameloplasty was significantly
increased. (iii) Extent of sealant
penetration was significantly
greater with enameloplasty sealant
technique as compared to
conventional sealant

35. Author Yea
r
Method Result
Askarizadeh
et al
2012 Fissurotomy bur vs
no preparation (in
vivo)
No significant difference
Atefeh et al 2014 Fissurotomy bur
vs no preparation
(in vitro)
Enamel preparation reduces
marginal leakage in pit and
fissure sealant therapy.
Ferrazano et
al
2017 Ultrasound tip vs
conventional bur
(in vitro)
Conventional bur surface
treatment showed a better
performance when compared to
ultrasound preparation and could
probably ensure superior sealant

36. ENAMELOPLASTY SEALANT TECHNIQUE- TWO
CASE REPORTS BALA PRASANNA KUMAR C AED 2011

38. Author Year Method Result
Kofman et
al
1998 Air abrasion vs ¼
round bur (in
vitro)
superior results were
obtained when the tooth
surfaces were prepared
by a bur
Kofman et
al
2001 Air abrasion vs ¼
round bur
Air abrasion with acid
etch showed
significantly less
microleakage than bur
with acid etch
Maria et al 2001 Air abrasion vs
Er:YAG laser (in
vitro)
No significant difference

39. Author Year Method Result
Yazici et al 2006 Retention of
sealant with and
without air
abrasion (in vivo)
Sealant retention after 12 and
24 month was higher with air
abrasion followed by acid
etching
Khouroshi et
al
2016 Air abrasion
Aluminium oxide
particles vs
Bioactive glass
particles (in vitro)
Sealant retention rate in alumina
group was higher than those in
the bioactive glass particle
Bhusan et al 2017 With and without
air abrasion (in
vivo)
Combining air abrasion pre-
treatment with subsequent acid
etching did not result in
statistically significant
difference in sealant retention
compared to acid etching alone
in both primary and permanent

40. ENAMEL DEPROTENIZTION
Autho
r
Year Method Result
Gandhi
et al
2012 Etch and FS vs 5%
NaOCl, etched and
fissure sealed vs 5%
NaOCl and fissure
sealed with no etch
(in vitro)
no significant difference in the tag
quality between the conventional
technique (Control) and the ‘bleach-
etch-seal’ technique. There was no
benefit in pre-treating with NaOCl
alone (without etch) before sealing
Rangel
et al
2015 With and without
deprotenization prior
to acid etching (in
vitro)
The rate of sealant retention was
similar between the two study
groups but the rate of sealant
microleakage was significantly lower
in the enamel deproteinisation

41. Author Year Method Result
Blackwoord
et al
2001 Pumice prophylaxis
and acid etching vs
fissure
enameloplasty and
acid etchng vs air
abrasion and acid
etching. (in vitro)
Neither air abrasion nor
enameloplasty followed by acid
etching produced significantly
less microleakage than the
traditional pumice prophylaxis
with acid etching technique.
Meligy et al 2015 Pumice vs
enameloplasty vs
dentin adhesive vs
air abrasion (in
vitro)
Neither air abrasion and
enameloplasty followed by acid
etching nor the self etching
adhesive system produced
significantly less microleakage
than the traditional pumice
prophylaxis with acid etching

42. Author Year Method Result
Maria et al 2015 No prophylaxis vs
pumice prophylaxis
vs chlorhexidine
gluconate vs
fluoridated paste vs
air prophy (in vitro)
A higher tensile strength was
observed in groups treated with
fluoridated paste and air prophy.
Hegde et
al
2016 Brushing vs pumice
slurry vs surface
conditioning vs
control (without any
preparation) (in vivo)
The pumice slurry group and
surface conditioning group
showed a significantly higher
retention when compared to the
brushing group, whereas the
control group showed the least
retention when compared to all
the other groups.

43. Sealant Retention in Pits and
Fissures: Preparation and
Application Techniques. A
Literature Review
V. Tzifa, A. Arhakis Balk J Stom,
2013; 17:9-17

44. ACID ETCHING OF TOOTH SURFACE
Buonocore in 1955 stated 85%, phosphoric acid for etching
but it was then reduced in his early clinical studies to 50%
Nowadays, 35% and 37% are the commonly used concentrations.
Acid-etching times have also been reduced from 60 s down to 20 s
(Zero DT et al 2013)
Earlier etching time
was double in primary
teeth than that of
permanent
Tondon et al(1989)-15
sec for primary teeth
Duggal et al(1997)-
used 15,30,45,60sec.
No difference in
retention
A rinsing time of 30 s
and drying the tooth for
15 s should be sufficient
to remove
all acid etchant residues
and achieve the
characteristic chalky
white enamel frosty
appearance (Santini et al
2013)

45. Silver stone in 1973 identified 3 basis pattern of etching
Type 1 : generalized roughing of enamel surface.
Type 2: prism peripheries are damaged.
Type 3: show neither type 1 or type 2 pattern
Muller-Bolla M, 2006
With regard to self-etch bonding agents that do not involve a
separate step for etching, a systematic review found that self-etch
bonding agents may not provide as good retention as acid etch
technique.
Maher MM 2013
Randomized clinical trial reported similar retention rates of self-
etch system compared to acid etch group.

46. ISOLATION
oResin based sealants are moisture sensitive.
oRubber dam should be used for fully erupted teeth and cotton rolls can be
used where that is not possible.
oAccording Muller-Bolla (2003), isolation of the tooth is an important aspect of
sealant placement and use of rubber dam improves the retention rates of light-
cured resin based sealants.
o Moisture control systems (IsoliteTM, VacuEjectorTM) produce sealant
retention rates comparable to cotton roll isolation or rubber dam, while
decreasing procedure time.

47. Autho
r
Year Method Result
Lygidakis
et al
1994 16- Cotton roll and
bristle brush
26- Rubber dam and
round bur
36- Rubber dam and
bristle brush
46- Cotton roll and
bristle brush (in vivo)
Success rate were 1) 81% 2)
89% 3) 91% 4) 93%
Only marginal statistical
difference between the 4
groups. There was a statistical
significance between group 1
and 4
Muller-
Bolla et al
2006 Rubber dam vs cotton
roll (in vivo)
Increase in retention with
rubber dam as compared to
that with cotton roll

48. Author Year Method Result
Layman T et al 2013 Isolite vs cotton
roll (in vivo)
Equally effective
for sealant
placement
Nuntiya et al 2016 Dry shield vs
cotton roll (in
vivo)
Dry shield was
comparatively
showed slightly
better retention
than cotton roll.

49. BONDING OF TOOTH SURFACE
The idea of using a bonding agent under the sealant came from Feigal et al.
in 1993 when they used hydrophilic bonding materials to aid the bond
strength when the sealant is applied in a moist environment
Bonding agent under sealant on wet contamination yielded bond strength equivalent to bond
strength obtained when sealant was bonded directly to etched enamel surface. Bonding agent
used without contamination yielded bond strength greater than the bond strengths obtained
when using sealant with contamination.(Feigal and Hitt, 1992)

50. A systematic review by Muller-
Bolla in 2006 found that self-
etch bonding agents may not
provide as good retention as
acid etch technique
2013 evaluated the retention
rate of fissure sealants in
primary molars using a 6th
generation adhesive
compared to the
conventional phosphoric
acid-etching technique with
no bonding agent
application. They found no
statistically significant
difference in sealant
retention
Sakkas in 2013 in a
clinical trial compared 3
adhesive generations(4th
5th 6th ) with
conventional
technique(etching but
no adhesive) and found
that highest retention of
sealant was seen with
4th and 5th generation
A systematic review by
Bagharian 2013
compared the retention
rate of sealants,
combined with self-etch
adhesive systems(6th
7th generation), with
that of etch-and-rinse
adhesive systems(4th 5th
Bagharain 2016 evaluated the fissure
sealant retention rate with or without
the use of an adhesive system and
also compared the retention rate of
sealants when using etch-and-rinse
adhesive systems (4th or 5th
generations) versus the rate achieved
when self-etching adhesive systems
(6th or 7th generations) were used.
The above-mentioned studies indicated that
the use of adhesive systems prior to fissure
sealant application had a positive effect on
increasing penetration and improving the
retention rate.
It also appears that the use of bonding-agents that involve a separate acid-etching step
(4th and 5th generations) provides better sealant retention than self-etching adhesives
(6th and 7thgenerations). Etch- and-rinse adhesive systems produce better penetration of th
enamel surface than self-etch adhesive systems, and this may result in a better bond strengt
The Use of Pit and Fissure Sealants—A Literature Review Reem Naaman Azza A. El-Housseiny Najlaa

51. APPLICATION OF SEALANT
In mandibular teeth, place the sealant distally and allow it to flow mesially.
In maxillary teeth, place the sealant mesially and allow it to flow distally.
Care should to be taken to prevent incorporation of air.

52. Pit and fissure sealant with Amorphous calcium phosphate
Clear pit and fissure sealants
Coloured pit and sealants
Flouride releasing sealants
Flourescing sealants
Hydrophilic sealants
Moist bonding sealants

53. PIT AND FISSURE SEALANT WITH
ACP

54. S.no Title Author
and Year
Conclusion/Result
s
1
In situ study –To evaluate the
remineralizing potential of pit and
fissure sealants containing amorphous
calcium
phosphate (ACP) in artificially induced
carious lesions on smooth enamel
surfaces.
Garcia Silva
et al
2010
The sealants containing ACP
presented a higher remineralizing
capacity than that of the control
group. Aegis provided either more
efficient or similar remineralization
than the other sealants.
2
Evaluation of the remineralization
potential of amorphous calcium
phosphate and fluoride containing pit
and fissure sealants using scanning
electron microscopy
Prashant
Choudhary et al
2012
Aegis and Teethmate F1 have the
potential to remineralize. Release
of Amorphous Calcium Phosphate
molecules in Aegis group and
formation of Fluoroapetite in
Teethmate F1 group, were probably
responsible for the
remineralization.

55. S.no Title Author
and Year
Conclusion/Result
s
3 Comparative evaluation of retention
ability of amorphous calcium
phosphate containing and illuminating
pit & fissure sealants in 6-9 year
old age group
Amit Kishore
et al
2013
Statistically no significant
difference was observed
between the two
groups, sealant with ACP
showed better retention
than the illuminating sealant.
4 To evaluate the effect of amorphous
calcium phosphate
(ACP)-containing pit and fissure
sealant on inhibition of enamel
demineralization in vitro.
Feda I
Zawaideh et al
2016
The ACP-containing pit and
fissure sealant has
the potential to inhibit enamel
demineralization

56. Clear ,Invisible Sealants
Helioseal, IVOCLAR VIVODENT
Clear sealants allow visual examination of carious
lesions beneath the sound enamel, they seem to be
the best option to clinically detect the caries
The Effects of Opaque and Clear Pit and Fissure Sealants on Infrared Laser Fluorescence
Measurements
Z. Bahrololoomi,2014

57. FLOURIDE RELEASING SEALANTS
3M™ ESPE™ Clinpro™ Sealant is a light-cure, low viscosity, fluoride releasing pit and fissure
sealant with a unique patented colour change feature.
Clinpro™ sealant is pink when applied to the tooth surface, and changes to an opaque off white
colour when exposed to light.
The pink color helps the dental professional with the accuracy and amount of material placed
during the sealant procedure.
•Contains and releases fluoride
•Long-lasting protection against caries

58. S.no Title Author
and Year
Conclusion/Result
s
1 Comparison of antibacterial
properties of two fluoride-
releasing and a non-fluoride
releasing pit and fissure sealants
Menon
Preetha et al
2007
The study proved that
Helioseal-F and Helioseal did
not possess antibacterial
properties and Teethmate-F
was the only sealant that
showed antibacterial
properties.
2 Evaluation of the Fluoride
Releasing and Recharging
Abilities of Various Fissure
Sealants
Khudanov et
al
2018
Fluoride release of Fisskhim
and Fissulight was negligible,
while Helioseal F and
Argecem noticeably released
fluoride and thus can enhance
the caries preventive effect of
fissure sealants.

59. FLUORESCING PIT AND FISSURE
SEALANTS
This sealant eliminates the guesswork involved with placing sealants and
confirming placement during recall appointments
Through the use of UV pen light, this sealant fluoresces a blue/white color
The fluorescent glow provides clinicians with a visual verification of the sealant
margins at the time of placement and offers the easiest way to verify retention
and inspect margins during recall
Exmples- Delton Seal N Glo(Dentsply)
Author Yea
r
Method Result
Amit kishor
et al
2013 Compare retention of ACP sealant vs
illuminating pit & fissure sealants
No significant
difference
Comparative evaluation of retention ability of amorphous calcium phosphate containing and illuminating pit & fissure sealants in 6-9 year
old age group Amit Kishor, Mousumi Goswami, Seema Chaudhary, Naveen Manuja, Rachita Arora, Mandeep Rallan JISPPD Sept 2013

60. MOIST TOLERANT RESIN SEALANTS
Embrace WetBond sealant is a unique moisture-tolerant resin-based sealant that contains no
BisGMA and no Bisphenol A and uses hydrophilic resin chemistry.
Embrace incorporates di-tri and multifunctional acrylate monomers into an advanced acid-
integrating chemistry that is activated by moisture.
The advantages are wet-bonding, tooth-integrating, better retention, superior marginal seal,
smooth margins, less technique sensitive, and increased fluoride release
Kane B, Karren J, Garcia-Godoy C, Garcia-Godoy F
Strassler HE, O’Donnell JP, Inside Dentistry 2008
Embrace is the first pit and fissure sealant that bonds to the moist tooth.
The margins are undetectable, and the long-term success has been reported in the literature.
Embrace releases and recharges phosphate and fluoride, and it has longer lasting antibacterial
activity compared to other leading brands, especially against S. mutans.

61. S.no Title Author
and Year
Conclusion/Result
s
1 Moisture-tolerant resin-based
sealant: A boon
Prasanna
Kumar Bhat
et al
2013
The result from the present
study indicated that moisture-
tolerant resin-based sealant
could be successfully used as
a pit and fissure sealant
because its hydrophilic
chemistry makes it less
technique sensitive and
simplifies the sealant
application procedure.

62. FILLING LEVEL OF THE FISSURE
oGeiger et al. 2000 demonstrated in an in vitro study, that overfilled fissures
seem to suffer greater sealant loss than those that are border filled
oThe general consensus seems to be that all pits and fissures should be
covered to obtain good retention and that the thickness of the material is of
less importance
oThere are also suggestions that better penetration occurs when material is
left to flow for 20 seconds before curing than when it is left for a shorter
time (Waggner 1996) or left as long as possible (Irinoda et al 2000)
Sealant Retention in Pits and Fissures: Preparation and Application Techniques. A Literature Review V. Tzifa,
A. Arhakis Balk J Stom, 2013; 17:9-17

63. CURING OF SEALANT
Curing is done according to the manufacturers direction
Chosak & Eidelman found that longer the sealants were allowed to sit on
etched surface before being polymerized, more the sealant penetrate into
microporosities,creating longer resin tags which are critical for
micromechanical retention.
Hicks et al (2000) found that argon laser curing of sealant may enhance
caries resistance.
Strang R et al 1986 If curing time is insufficient, the bonding is poor &

64. EVALUATION OF OCCLUSION
oEvaluate occlusion of any sealed with articulating paper to determine if
any excessive sealant is present and needs to be removed.
oEvaluate the interproximal regions for inadvertent sealant placement by
tactile examination with an explorer and passing dental floss in the contact
areas

65. RE CALL AND RE EVALUATION
The average sealant loss from permanent molars is between five to ten percent
per year( Feigel 2000)
A study conducted by Romcke et al 1990 evaluated more than 8000 sealants over
10 years. sealant success rate of 85% after 8 to 10 years, due to the incorporation
recall and repair program. Complete sealant retention without any need for resea
at 10 years
Horowitz landmark Kalispell study (1977)
In the 5yr long term study, he reported 42% complete retention at the end of 5yrs. Horowitz
also noted that in teeth with sealant partially missing had a lower incidence of caries (7%) than
paired unsealed control teeth that were not sealed(41%).

66. Wendett and Koch (1988) reported for teeth sealed over 10yrs. They found that after 8yrs,80%
of the sealed fissures showed complete sealant retention and no caries. After 10yrs only 6% of
the sealed occlusal surfaces showed caries or restoration.
Simonsen in 1991 conducted 15yr study of single application of a colored autopolymerising pit
and fissure sealant found 28% complete retention and 35% partial retention on permanent first
molars. In a matched pair analysis, carious or restored surfaces made up 31% of the surfaces in
the sealed group and 83% in the unsealed group.
Griffin 2009 systematic review aimed to evaluate if the risk of developing
caries in previously
sealed teeth with fully or partially lost sealant surpasses the risk in teeth that
have never been
sealed. participants were aged between 5- and 14-year-old.
It was found that the risk of caries development in previously sealed teeth

67. Cost effectiveness
At a 10yrs point in a 15yr
study, it was found that it
is 1.6 times as costly to
restore the carious lesion
in the first permanent
molar in an unsealed group
of 5-10yrs old children
living in a fluorinated area
than it is to prevent, with a
single application of pit
and fissure sealant.
(simonsen 1989)
62.Quinonez 2005
systematic review
showed that risk-
based sealing
improves clinical
outcomes and saves
money over never
sealing
16.Ahovuo-Saloranta
2013 Cochrane review
concluded that sealing
primary molars
reduces restorations
and extractions, but is
more expensive than
not sealing
$

68. OTHER
MATERIA
LS AS
SEALANT
S

69. FLUORIDE VARNISH
Hirri A et al 2010 ,Cochrane review
concluded that there is only a low
quality of evidence that pit and
fissure sealants have a superior
outcome, when compared to
fluoride varnish application, in the
prevention of occlusal caries.
American Academy of Pediatric
Dentistry (AAPD), recommend the
use of sealants in preference to no
sealant or fluoride varnish
Chestnutt et al 2017 recent
randomized clinical trial that
compared the clinical effectiveness
for caries prevention of fluoride
varnish and fissure sealants at a
three year follow-up among a 6 to
7 years old population.

70. GLASS IONOMER CEMENT
oGlass ionomer sealants offer similar caries-preventive effects as resin-based sealants
o Easier manipulation and without the use of acid etching.
o The glass ionomer may be valuable as a sealant in cases of difficult operating .
o The ease of application, reduction in operating time, and the adherence of these materials to
moist teeth favours their placement.
oThey are biocompatible and have a coefficient of thermal expansion slightly lower than that
of tooth structure.
oGlass ionomer sealants exhibited good short term retention comparable with resin sealants at
one year, and they may be used as an interim preventive agent when resin-based sealant
cannot be placed as moisture control may compromise such placement.

71. Autho
r
Year Method Result
Herle et al 2004 GIC And Resin Based
Fissure Sealant Using
Noninvasive And
Invasive Techniques
It was seen that minimal
microleakage was seen in Group IV.
Considering the recent
controversies using resin based
sealants, it can be said that GC VII
can be a viable alternative for pit
and fissure sealants
Steffen et
al
2011 Systematic review No difference between the caries-
preventive effects of GIC- and
resin-based fissure sealants.
Shirin et
al
2014 compare the marginal
integrity of resin
no significant differences were
found. It can be concluded that use

72. Author Year Method Result
Effat et al 2015 compare the
microleakage of flow
able resin reinforced
glass ionomer
(Ionoseal) with other
materials used as
fissure sealants.
No significant difference but
ionoseal without etching had
greater microleakage compared to
the other groups
Graciano et
al
2015 To compare the
retention and
superficial
characteristics
between a new resin-
modified glass
ionomer sealant and
resin sealant
Both sealants, Fluroshield® and
Clinpro TM Varnish® XT were
effective in preventing caries lesion
within 6 months, although
Fluroshield sealant showed better
clinical retention.

73. Goncalves
et al
2016 Retention of glass
ionomer cement (GIC)
used as fissure sealant
with a resin- based
sealant.
GIC and resin-based sealants
achieved similar results with
regards to retention during a one-
year follow-up period.

74. COMPOSITE FLOW
oConventional composites were not supposed to be as good pit and
fissure sealant as they had high viscosity
ohowever now, the newer low viscosity composites such as flowable
composites and nanocomposites have shown sufficient flow
oThe results of some studies have shown lower retention rate of
flowable composite compared to the retention rate of resins
oThe high retention rate of flowable composite when used with adhesive
system has been confirmed (Garcia Godoy 2001, Cornona SA 2005,
Dukic W 2006)
Clinical Comparison of Flowable Composite to Other Fissure Sealing Materials – A 12 Months Study Walter
Duke,Olga Luli Duki, Sla|ana Milardovi} Coll. Antropol. 31 (2007) 4: 1019–1024

75. Author Year Method Result
P Francescut
et al
2006 Non-invasive approach
using a conventional
unfilled sealant and a
flowable composite
Those pre- pared with the bur
showed statistically signifi- cantly
greater microleakage rates when
sealed with X-flow than when sealed
with Delton.
Walter Dukic
et al
2007 Flow vs other sealing
materials (Teethmate
F1, Admira Seal,
Helioseal Clear
Chroma, Fissurit FX )
over a period of 12
months
Flowable composites used with
adhesive system are equal to other
sealing materials in terms of
prevention of occlusal caries
Chitra et al 2010 microleakage of a
flowable resin used as
a sealant on molars
There was significantly lesser
microleakage in EST when compared
with CST and FT, which showed

76. Author Yea
r
Method Result
Singh et al 2011 Evaluate the
microleakage and
penetration depth of
CPF, flowable and
nanocomposite
flowable
Microleakage was found to be
highest for the flowable
composites, and least for the
conventional sealant. The
nanocomposite values were
intermediate.
Hatirli et al 2017 Microleakage and the
penetration-depths of
different fissure-
sealant materials
applied with/ without
enameloplasty
Flowable composites showed the
best and the glass-ionomer-based
sealant showed the worst
penetration and microleakage.

77. SEALANT OF PRIMARY TEETH
oOn the basis of caries risk assessment, primary teeth can be judged to be at
risk due to fissure anatomy or patient caries risk factors, and would therefore
benefit from sealant application
oSealing should be considered particularly for children and young people with
medical, physical, or intellectual impairment.
oPit-and-fissure sealants were found to be retained on primary molars at a rate
of 74 to 96.3% at one year and 70.6–76.5% at 2.8 years (Beauchamp, J 2008)
oRathnam and Madan 2010 maintain that it is difficult to conduct clinical
studies on primary teeth due to several confounding factors,

78. oTo simplify the clinical procedure and make fissure sealant application more
acceptable to young children, a shorter etching time may be used to decrease
the chance of saliva contamination (Duggal et al 1997)
oAnother measure that can be used with young children in an attempt to
shorten the procedure time is to use self-etching bonding agents as an
alternative to the conventional acid etching technique
oStudies have shown that using a GI sealant may be a good interim option
when salivary contamination is expected because it has a higher toleration to
moisture compared to resin-based sealants (Antonson 2012)

79. Autho
r
Year Method Result
Houtman
et al
1998 Retension of sealant in
primary teeth
Retention rate of 76.5 percent for light
polymerized fissure sealants in the follow
up time of 2.8 years.
Chadwick
et al
2005 GIC sealants in primary
molars in preschool
children (18 to 30 months
of age) reduce fissure
caries incidence rate in
either first molars or
across the entire
dentition, and to establish
sealant retention over
time.
Retention rate as low as 18.7 percent in
1.38 years and no statistically significant
caries reduction.

80. Autho
r
Year Method Result
Honkala
et al
2015 Sealant versus Fluoride
in Primary Molars
Sealing fissures seems to be better
in preventing occlusal caries lesions
in primary molars than applying
only fluoride varnish after 1 year
Unal et al 2015 Comparing 3 sealant
materials on primary teeth
24 month result
RBS containing ACP or fluoride
may be more effective than
conventional RBS for caries
prevention
Wright et
al
2016 Preventing and Arresting
Pit-and-fissure Occlusal
Caries in Primary and
sealants are effective and safe to
prevent or arrest the progression of
noncavitated carious lesions

81. Autho
r
Year Method Result
Jehan et
al
2017 Effect of Erbium Laser on
Microtensile Bond
Strength
(Er, Cr:YSGG)
Pretreatment with 3.5 W Er,
Cr:YSGG laser alone results in
microtensile bond strengths
similar to that produced by acid
etching

82. ADVERSE EFFECT
oBisphenol-A (BPA) is the precursor chemical component of bisphenol-a
dimethacrylate (Bis-DMA) and bisphenol-a glycidyl dimethacrylate (Bis-GMA)
oIt is known for its estrogenic property with potential reproductive and
developmental human toxicity(Elidas 2014)
oBPA is not present in monomers as a raw material but as BPA derivatives
that can sometimes be hydrolyzed and found in saliva (Ahovuo-Saloranta et
al 2017)
o
The Use of Pit and Fissure Sealants—A Literature Review Reem Naaman Azza A. El-Housseiny Najlaa

83. oKloukos et al 2013 in a systematic review that high levels of BPA were
found in saliva samples that had been collected immediately or one hour
after resin-based sealant placement.
oHowever a report by ADA and AAPD in 2016 did not support the
occurrence of adverse effects after sealant placement and described the
BPA effect as a small transient effect
oKloukos et al 2013 reported techniques, such as the immediate cleaning
of the sealed surface, or the removal of the oxygen inhibition layer of the
unreacted monomer, which is present on the outer layer of the sealant
surface to reduce the amount of unreacted monomer. This can be done
using a pumice or a rotating rubber cup to reduce the potential BPA
exposure.
The Use of Pit and Fissure Sealants—A Literature Review Reem Naaman Azza A. El-Housseiny Najlaa
Alamoudi Dent. J. 2017

84. CONCLUSION
Pit and fissure sealant is an effective means of preventing pit and fissure caries
in primary and permanent teeth.
Dentists should therefore be encouraged to apply pit and fissure sealants in
combination with other preventive measures in patients at a high risk of caries
Selection of sealant material is dependent on the patient’s age, child’s
behavior, and the time of teeth eruption. Teeth that present with early non-
cavitated carious lesions would also benefit from sealant application to prevent
any caries progression.

85. REFERENCES
Pediatric dentistry Infancy through adolescence Casamassimo 5th edition
Textbook of Pediatric dentistry Nikhil Marwah 3rd edition
Retention of resin-based filled and unfilled pit and fissure sealants: A
comparative clinical study V. Rajashekar Reddy, Nagalakshmi Chowdhary, K. S.
Mukunda, N. K. Kiran, B. S. Kavyarani M. C. Pradeep Contemporary Clinical
Dentistry March 2015 Vol 6
A review of the clinical application and performance of pit and fissure sealants
ADA,RJ Simosen et al 2011
Clinical evaluation of light cured fissure sealant(Helioseal) De Craene ,Martin
LC, Surmount PA ASDC J Dent Child 1990 March;56(2):97-102

86. Fissure Sealants: A Review of their Importance in Preventive Dentistry Nélio J. Veiga,
Paula C. Ferreira, Ilidio J. Correia, Carlos M. Pereira OHDM 2014
Pit and fissure sealants in pediatric dentistry George Babu, Shanthala Mallikarjun,
Bobby Wilson, JRDS 2014
American academy of pediatric dentistry’s pediatric restorative dentistry consensus
conference
Brown LJ, Selwitz RH. The impact of recent changes in the epidemiology of dental
caries on guidelines for the use of dental sealants. J Public Health Dent
1995;55:274-91.
Enameloplasty sealant technique- Two case reports Bala prasanna
kumar C AED 2011
Sealant Retention in Pits and Fissures: Preparation and Application Techniques. A
Literature Review V. Tzifa, A. Arhakis Balk J Stom, 2013; 17:9-17
The Use of Pit and Fissure Sealants—A Literature Review Reem Naaman Azza A. El-
Housseiny Najlaa Alamoudi Dent. J. 2017
The Effects of Opaque and Clear Pit and Fissure Sealants on Infrared Laser
Fluorescence MeasurementsZ. Bahrololoomi,2014

87. Comparative evaluation of retention ability of amorphous calcium phosphate
containing and illuminating pit & fissure sealants in 6-9 year old age group
Amit Kishor, Mousumi Goswami, Seema Chaudhary, Naveen Manuja, Rachita
Arora, Mandeep Rallan JISPPD Sept 2013
Kane B, Karren J, Garcia-Godoy C, Garcia-Godoy F Strassler HE, O’Donnell JP, Inside
Dentistry 2008
Sealant Retention in Pits and Fissures: Preparation and Application
Techniques. A Literature Review V. Tzifa, A. Arhakis Balk J Stom, 2013; 17:9-
17
Clinical Comparison of Flowable Composite to Other Fissure Sealing Materials
– A 12 Months Study Walter Duke,Olga Luli Duki, Sla|ana Milardovi} Coll.
Antropol. 31 (2007) 4: 1019–1024

88. THANK YOU