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fissure sealant Presentation

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fissure sealant Presentation

  1. 1. In the name of GOD Pit and fissure sealants Narges shojaei 1
  2. 2. the Centers for Disease Control and Prevention (CDC): profession is dental caries, a chronic disease affecting more than 90% of adults aged 20 to 64 years.1 Although chronic diseases are among the most common and costly of all health problems, they are also among the most preventable 2
  3. 3. Epidemiology of Pit and Fissure Caries dramatic improvements in the prevention of caries have occurred : I. fluoride exposure II. enhanced awareness of the benefits of early care III. increased access to dental care IV. increased financial coverage by insurance companies V. group plans, and government-funded programs of preventive and restorative dental procedures for children 3
  4. 4. According to the National Institute for Dental and Craniofacial Research, 20% of the population bears at least 60% of the caries • Dental caries :children living in poverty • five time • Minority populations • specific tooth surfaces • almost 25% of the decayed, missing, filled surfaces (dmfs) index • 90% of caries in permanent • two thirds of caries 4
  5. 5. Why The occlusal surface is prone to caries ?? • immature tooth enamel high organic content • pit and fissure morphology • the molars take along time to fully erupt:1.5_2 years • fluoride is less effective in preventing caries on the occlusal surfaces 5
  6. 6. in 1955, Dr. Michael Buonocore revolutionized dentistry with the first reserch on adhesive dentistry a physical barrier over susceptible pits and fissures and, in effect, “seal” out caries, preventing the carious process In 1971 the first dental sealant, Nuva-Seal the theory of sealing the occlusal surfaces of teeth in an effort to maximize “the power of prevention.” 6
  7. 7. Sealant Effectiveness Unquestionably, dental sealants prevent pit and fissure caries in both primary and permanent teeth Healthy People 2010 set a goal for the prevalence of sealants in children and adolescents to increase to 50% Low usage : 1. lack of confidence in the bonding of sealants to enamel 2. concern for sealing over caries 3. difficulty of achieving isolation 4. lack of reimbursement for sealant placement 7
  8. 8. Current sealant utilization: 8
  9. 9. How Sealants Work: 1. Resin 2. glass ionomer 3. polyacid-modified resins 1. most commonly accepted material 2. by micromechanical retention 3. tooth must be clean and remain dry 4. enamel is etched with 35% to 37% phosphoric acid, • different bonding mechanism • retention, chemcial bonding, and chelation • hydrophilic 1. tooth is cleaned, and a tooth conditioner of polyacrylic acid is applied 2. rinsed and dried 3. Aply gi 9
  10. 10. Types of sealants: variety of materials, colors, and viscosities Resin-based sealants : • unfilled, filled • clear, colored • visible light–polymerized, autopolymerizing (chemically cured • fluoride-releasing materials earliest sealants :autopolymerizing but now replaced by self cured sealants 10
  11. 11. Why? 1. sets in 10 to 20 seconds 2. No mixing and air bubble 3. the viscosity of the sealant remains constant 4. sealant material does not set until it is light activated 5. similar retention rates and similar strengths. 11
  12. 12. Color: available as clear or opaque white: Advantage of an opaque sealant: 1. easy to see during application 2. easy to monitor its retention at a recall visit 3. . Assessment of a clear sealant requires tactile 4. No apparent difference in the clinical efficacy of either type of sealant being able to quickly and correctly assess sealant retention is clinically important. 12
  13. 13. newer materials 1.color properties:Clinpro (3M ESPE, St. Paul, Minn.) • that is pink upon application and turns white when cure • . This color change provides no clinical advantage and has been described as a “perceived marketing benefit 2:(Ivoclar Vivadent, Amherst, N.Y.). • containing a photochromic dye • correct wavelengths :change from clear/yellow to green • is clinically relevant because it may assist a provider in assessing the sealant’s retention upon recall examination • But:using a polymerizing lamp • have similar properties andcaries-protective as other resin- based sealants 13
  14. 14. 1 Filler Content: physical characteristics unfilled sealants deeper into the fissures : • low viscosity:longer resin tags, and therefore be better retained • other studies have found similar retention rates with unfilled and filled sealants • clear advantage of the unfilled sealant : 1. lower rates of microleakage 2. better penetration into the fissures 3. occlusal adjustment is not necessary(necessity to adjust the occlusion increases the time and cost of the procedure) Viscosity flowability, and resistance to wear 14
  15. 15. flowable composite:  inferior retention and microleakage  utilizing a bonding agent improves fissure penetration and decreases microleakage need for a bonding agent and occlusal adjustment the conventional unfilled resin-based sealant appears to be the most appropriate preventive therapy. Fluoride-Releasing Sealants:salivary fluoride levels are the same before and after no long-lasting release of fluoride marketing benefit by manufacturers 15
  16. 16. Glass Ionomer: as an alternative to resin-based 1. fluoride-releasing 2. recharging ability 3. moisture toleration 4. easy application But poor retention rates the use of resin-based sealant usage:  ART(high-viscosity sealants placed with “finger pressure)  compromise sealant placement  Preventin of caries resin baced sealant  Retention resin based sealant 16
  17. 17. Polyacid-Modified Resin Composites (Compomers): • the esthetic property of composite • fluoride-releasing property and adhesion of glass ionomer similar to composites Similar to GI:release fluoride( GI ) poor marginal integrity,retention and occlusal wear • contain no water hydrophobic • polymerization • lack the ability to bond to tooth • require bonding agents 17
  18. 18. Who Really Needs Sealants? 18
  19. 19. 19
  20. 20. Age at Placement: • caries incidence occurring shortly after tooth eruption and then tapering • occlusal surface was most vulnerable(first few years after eruption ) • that fluorides may have caused a delay in pit and fissure caries resulting in occlusal surfaces that decay at a later age • adults should receive sealants when the tooth or the patient is at risk of experiencing caries • place a sealant should not be based on how long ago the tooth erupted but on the clinical impression of whether a sealant is necessary to prevent caries 20
  21. 21. Which Teeth Should Be Sealed? Traditionally: non carious first and second permanent molars with deep fissures now any tooth at risk of developing caries • including primary teeth • permanent molars with incipient, noncavitated lesions, and/or premolars. 21
  22. 22. Indications :  deep, retentive pits and fissures”(cause wedging or catching of an explorer)  stained pits and fissures with minimal appearance of decalcification or opacification (no cavitation)  no RG or clinical evidence of interproximal  use of other preventive treatment, such as fluoride therapy  possibility of isolation 22
  23. 23. Contraindications : well-coalesced, self-cleaning pits and fissures interproximal caries in need of restoration interproximal lesions or restorations with no preventive plan/treatment to inhibit caries formation life expectancy of the primary tooth is limited no possibility of isolation from salivary (due to either eruption status or patient behavior.) 23
  24. 24. Diagnosing Occlusal Caries dentists correctly diagnose only 42% of cases Usage of expelorer : yes or no ? No : Yes :  eliminate plaque in the fissures  determine surface roughness of incipient lesions  time-tested tool  Tactile diagnosis :specific criteria for detection and diagnosis of pit and fissure lesions  does not increase dentists’ ability  tactile examination unreliable  enamel defects(cavitation 24
  25. 25. Caries is present when : 1. explorer catches or resists removal after the insertion into a pit or fissure 2. when this is accompanied by one or more of the fallowing • A softness at the base of the area • Opacity adjacent to the pit or fissure • Softened enamel adjacent to the pit or fissure 25
  26. 26. the use of explorers is not necessary for the detection of early lesions Visual examination alone (of a clean, dry tooth) is sufficient to detect early lesions 26
  27. 27. Sealing Over Incipient Caries: If sealants are applied properly and are monitored periodically, caries arrest beneath a sealant sealant placement greatly reduces the number of carious lesions that progress  decreases the viable bacteria  Acid etching eliminates 75% of the viable microorganisms  100% reduction in total viable bacteria 27
  28. 28. . Whenever a situation occurs in which the practitioner is certain that a restoration is not yet warranted but is unsure of whether the fissure is simply stained or is exhibiting signs of incipient caries, the practitioner should err on the side of placing a sealant rather than monitoring the lesion. 28
  29. 29. Cleaning the tooth: For flow in the fissures it must be cleand:several method: historically:pumice ,prophy cap ,bristle brush Other method: explorer ,air water spray or dry bristle brush Sup cleaninig method: cavitron prophy-jet(air polishing) Advantage: remove more debry ,increase resin tags but not standard equipment cost and complication No difference in retention 29
  30. 30. Mechanical preparation: Invasive technique minimally described: Enameloplasty and fissurotomy:  Better penetration  Increase surface area fore etching  Dosent decrease microleakage Air abrasion : another technique but cant substitute etching Some studies show that air abrasion in combination with Etching improved retention 30
  31. 31. Disadvantage : • limits delegation of sealant placement to axilliaries • Decrease cost effectiveness • Expose child to handpiese the plaque should be removed but removal of tooth structure by bur unnecessary Effect of fluoride treatment Multiple studies confirm sealant bond strength and retention Are not affected by fluoride treatment before sealant application 31
  32. 32. Factors affecting sealant success:  Etching  Drying agent and time  Curing  Isolation  Time of sealant placement  Auxiliary application  Four-handed delivery 32
  33. 33. Etchant : Phosphoric acid , self etching system , liquids and gel  Historically:ething:60 s and rinsing time :at least 10 s  Etching time for fluoride tooth should be increased  Usual recommendation : etching:30 s rinsing :20 -30 s  It is important that removal of all etching agent from surface No difference between liquids or gel system in bond strength And retention Self etching needs a separate etching step Not recommended 33
  34. 34. Drying agent and time : Applying alcohol or acetone Because of Resins that are hydrophobic agent : Don’t decrease microleakage or increase retention No recommended drying time : occlusal surface should have chalky Or frosted appearance No chalky : etching again 34
  35. 35. Curing : Phothoiniatiator (camphoroquinone) absorb energy from blue light (479 nm) that cause low viscosity monomer to matrix polymer  Sealant must be adequately cured to obtain purported physical properties  Most widely used: 1: QTH curing light: 1. Reguire cooling fan 2. Low cost 3. Easy to maintain and repair 4. Curing composite in 20 s 35
  36. 36. 2: LED : First LED curing had low energy output ,recent LED increase out put intensity Latest LED s advertise 5s curing in<torbo> or <plasma> method May be concerns with such quick cures: 1. Significant rise temperature(pulp injuries) 2. May cause undesirable physical properties 3. Increase polymerization contraction 4. More internal stress 5. Reduced flexural fatigue Highest level of cure:40 s exposure with the tip of the Light source placed directly over sealant 36
  37. 37. Several factors affect level of cure : 1. Shade of the materials 2. Filler content 3. Thickness of material 4. Intensity of light curing 5. Distance between light source and sealant surface clear sealant can be cured to deeper level than opaque sealant in same curing time 37
  38. 38. Isolation Resin based sealant are moisture sensitive: Saliva prevent the formation resin tag decrease retention Isolation is a critical step to the success of sealant Considered a key concept in clinical procedures Rubber dam: Some studies show increased retention Whenever possible especially if cocorurrent Operative treatment is provided rubberdam should be used 38
  39. 39. Timing of sealant placement : • Correlated with overall retention: • Partially erupted teeth require repair or replacement more than other • When operculum extended over distal marginal ridge:50% of teeth to be resealed • When it was at level of marginal ridge : reseal 26% • When achieving isolatoin is difficult or precooperative :using Glass ionomer 39
  40. 40. Use of intermediate bonding agent : An intermediate layer between tooth and sealant advantage  Increase retention rate  Decreased microleakage  Increased penetration of sealant into fissures  Not only permanent tooth : primary as well  Hypomineralized teeth(at higher risk than normal) disadvantage  Proper sealant placement technique  Increased chair time  Cost whould inhance sealant retention on clinical Situation 40
  41. 41. Auxiliary application : No difference in retention of sealant when applied by dentist or trained dental auxiliary Four-hand delivery :  No difference in retention  Expert opinion support use of trained dental assistant  Improve quality and efficiency of sealant placement  Isolation  Shorten placement time  Reduce fatigue and enhance patien care 41
  42. 42. School based sealant program: Increase sealant using Reduceing careis Provide prevention service to child less likely to receive dental care It is important and effective public health approach that complements clinical care systems in promoting oral health 42
  43. 43. Other uses of sealant: 1. Sealing over the restoration 2. Repairing margin of restoration 3. Preventing demineralization around orthodontic brackets Reduce microleakage Decreased incidences of recurrent caries Increase longevity of restoration through repair of marginal defect No loss of tooth structure and low cost 43
  44. 44. Clinical procedure: 1:Isolation: Most common method :cotton roll For maxillary isolation :  tri angular buccal shield :angle posterior  Cotton roll : maxillary vestibule  Mirror is used during entire procedure mandibular isolation :  Cotton roll : two vestibule  Cotton roll holder or hand may be used  Triangular shield on buccal 44
  45. 45. Etching :  With 37% phosphoric acid  Including pit and fissure and lingual groove of max molars and buccal pit of man molars  Etching should extend up cuspal line ,2 -3 mm beyond anticipated margin of sealant 45
  46. 46. Rinsing and drying :  Air-water spray and high volume suction  Most manufactors recommended :20-30 s  The goal of rinsing is removal all of etchant from surface Sealant application and polymerization:  Should be applied to all pit and fissures  With : expelorer ,PICH, or small brush  Shouldn’t be over filled • Does not extend past the etched area • Limit occlusal interence • Ensure adequate depth of cure Small bubbles should be teased out of the material before polymerization • Exposure time of 40 s is more appropriate 46
  47. 47. Evaluating the sealant :  Visually an tactilely examine the sealant before removing isolation  Void or bubble : material can be directly added  Sealant retention :examine by attempting to dislodge by expelorer If sealant dislodge :  Fissure inspected for Remaining debri :re etched…  Sealant pooled on distal margin created ledge tht should be removed  Sealant misplaced on inter proximal should be removed  Un polymerized layer(BPA):removed by pomice or rinsing Occlusion Adjustment : Yes:filled sealant and flowable composite With:com finishing bur(high spead ,round bur,stone(low spead) MC:centric stop on enamel 47
  48. 48. Periodic evaluation:  It should be evaluated at every recall visit  Partial or complete loss of material failure  If only part of sealant remain : attempts can be made to dislodge with expelorer ,if it remain :no no need to remove this  MC :  5% -10% of sealant need to repaired or replaced yearly  Partialy or completely,discolored or defective old sealant should be removed 48
  49. 49. Troubleshooting sealant placement : If sealant debonds upon immediate evaluation: 1. Debris remains on the fissure Cleaning,re etching and apply material 2 .Saliva contaminated the enamel Re etched ,dry and resealant 3. The tooth wasnot completely dry after the rinsing step 49
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