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Pit and fissure sealants


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pit and fissure sealants

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Pit and fissure sealants

  1. 1. PIT AND FISSURE SEALANTSDepartment of Pedodontics SDC, Sri Ganga NagarSubmitted By Ramneek kaur
  2. 2. Healthy sealed tooth
  3. 3. Pit and fissure sealants
  4. 4. INTRODUCTION:• Caries potential is directly related to shape & depth of the pit and fissures.• The cariostatic properties of sealants are attributed to the physical obstruction of the pit and grooves.• Sealants are the effective caries protective agents to the extent they remain bond safe & their effectiveness should justify their routine use as a preventive measure.
  5. 5. Definition:According to simonsen:Material that is introduced into the pits and fissures of caries susceptible teeth, thus forming micromechanicallyBonded protective layer cutting access of caries producing bacteria from their source of nutrients.
  6. 6. HISTORY:IN 1905: application of silver nitrate by millerIN 1923: Hyatt reported a technique named“prophylactic odontomy”.IN 1929: Bodecker introduced fissure eradication.IN 1955: Buanocare introduced a method ofadhering resin to an acid etched enamel surface.IN 1965: Bowen & associates developed BIS- GMAresin.IN 1970 & EARLY 1980’S: UV light with awavelength of 365 nm was used to initiate thesetting reaction.
  7. 7. CLASSIFICATION:According to chemical structure ofmonomers used:MMA-methyl methacrylate,{ NUVASEAL}TEGDMA-triethylene glycol dimethacrylate,{KERRPITT AND FISSURE SEALANTS}BPD-bisphenol dimethacrylateBIS-GMAPMU-propyl methacrylate urethane
  8. 8. According to generations:1st generation UV light cured at Eg:alphaseal,nuvalit 356 nm e,alphalite2nd generation Self cured Eg:concise white sealant,delton3rd generation Blue visible light Eg:stephen K.W cured at 490 nm strang4th generation flouride releasing Eg: Toma l.morphis , Jack toumba
  9. 9. Based on filler content:•UNFILLEDBetter flowMore retentionAbrade rapidly•FILLEDResistance to wearNeed occlusal adjustments
  10. 10. Based on color•Color: esthetic but difficult to detect in recallvisits.•White tinted/opaque: contain opaquing agenttitanium dioxide•Colored: easy to see during placement Helioseal{ white color changes to green}
  11. 11. MORPHOLOGY OF PITS AND FISSURESACCORDING TO NANGO 1961:•V shaped fissure: wide at top, narrow at bottom•I shaped fissure : quite constricted and mayresemble a bottle neck• U shape fissure: same width from top to bottom• K shape fissure: extremely narrow slit with largerspace at bottom• H shape fissure: seen mostly in premolars
  12. 12. Morphology of pits & fissures
  13. 13. ACCORDING TO GALIL & GWINETT, 1975• V shape•U shape•Tear drop shape
  14. 14. Diagnosis of pits and fissures
  15. 15. DIAGNOSIS OF PIT AND FISSURE CARIES:•When the explorer catches or resists removalafter insertion into a pit and fissure withmoderate to firm pressure.• softens at the base of area•Opacity adjacent to the pit & fissure asevidence of demineralization.•Softened enamel adjacent to the pit & fissurethat can be scraped away with the explorer.•By xeroradiographic & digital radiography, dyepreparation,fiberoptictransillumination,ultrasoni
  17. 17. PROCEDURE OF PIT AND FISSURE SEALANTAPPLICATION:•CLEAN THE TOOTH SURFACE:Remove plaque & debris from enamel and pits &fissures of the tooth.Debris interfere with proper etching processSimply use a toothbrush prophylaxis withtoothpaste or pumice followed by copious waterrinsing.If sodium bicarbonate slurry has been used, it isnecessary to neutralize the retained slurry withphosphoric acid for 5-10 sec.
  18. 18. •ISOLATE & DRY THE TOOTH SURFACERubber dam provides best isolation.Cotton roll isolation with adequate suctioning isalso preferred method of isolation for manypractioners.
  19. 19. •ETCH THE TOOTH SURFACE•Etch with 37% conc. Of orthophosphoric acid for15-30 sec. for primary teeth and 15 sec. forpermanent teeth.•additional time is required for fluorosed teeth.•Gently rub etchant applicator over a tooth surfaceincluding 2-3 mm of the cuspal inclines.•Periodically add fresh etching agent.•Donot allow the etchant to come into contact withthe soft tissue.
  20. 20. •APPLY BONDING AGENTApply a hydrophilic bonding agent , prior tosealant application may improve retention withteeth that cannot be isolated properly.Then cure it.
  21. 21. Material application
  22. 22. •MATERIAL APPLICATIONSealant material is then applied to the toothaccording to manufacturer direction.Be careful not to corporate air bubbles in thematerial. with mandibular teeth apply the sealant at thedistal aspect and allow it to flow mesially and withmaxillary teeth vice versa.After the sealant has set, the operator shouldwipe the sealant surface with a wet cotton pellet.With autopolymerising sealants working timevaries from 1-2 min & with photoactive sealants,10-20 sec. for complete setting.
  23. 23. •EVALUATE THE SEALANTSealant should be evaluated visually andtactically.Take the explorer & attempt to dislodge it.Any deficiences in the material, more sealantmaterial should be applied.Remove the rubber dam and cotton rolls.
  24. 24. Evaluation of sealant
  25. 25. •CHECK OCCLUSIONIf occlusal high points are present, correct them.Occlusion checked and adjusted if needed
  26. 26. •RETENTION AND PERIODIC MAINTAINENCERe-evaluate the sealant at recall visits.See for any exposure in the voids in the materialand caries development.Re-application is highest during six monthsafter placement.
  27. 27. •RINSE AND DRY ETCHED TOOTH SURFACERinse the etched tooth surface with an air sprayfor 30 sec.Dry the tooth surface for atleast 15 sec. withuncontaminated compressed air.Dried etched enamel should have frosted whiteappearance.Repeat the etching step if necessary.Moisture contamination- most common cause ofsealant failure.
  28. 28. Review of sealant application
  29. 29. Failing sealant
  31. 31. REQUIREMENTS:Reduced water absorption and solubilityIncreased hardness and abrasion resistanceafter curingGood flowSuitable short setting timeSame thermal conductivity as toothGood bond strength with enamelChemically inertAnti-cariogenicReduced polymerization shrinkages
  32. 32. INDICATIONS:Deep retentive pit & fissuresNo radiographic/ clinical evidence of proximalcariesPatient with high risk of cariespatient suffering from xerostomiaPatient undergoing orthodontic treatmentStained pit and fissure with numerousappearance of decalcification.
  33. 33. CONTRA-INDICATIONSWell-coalesced , self cleansing pit andfissuresRadiographic/clinical evidence of proximalcariesTooth not fully eruptedIsolation not possibleLife expectancy of tooth is limitedDental caries
  34. 34. SEALANTS WILL BE LONG LASTING IF:The case is selected properlyThe tooth is selected properlyAn appropriate placement technique is followedAdequate maintenance is provided
  36. 36. FACTORS AFFECTING SEALANT RETENTION INMOUTHType of sealantPosition of teeth in mouthClinical skill of the operatorAge of childEruption status of teethBetter sealant retention reported more for theanterior and in mandibular than maxillary archRetention compromised in children due todifficulty in maintaining a dry field resulting fromthe behavior problems and depending on theeruption status of the teeth.
  37. 37. Fluoride releasing sealants
  38. 38. FLOURIDE CONTAING SEALANTS2 methods of fluoride application has been used:Soluble fluoride added to unpolymerised resin.After a sealant is applied to a tooth, the saltdissolves and fluoride ions are released.Other method involves an organic fluoridecomponent which is chemically bound to the resinwhich enhances the fluoride release whilemaintaining the physical properties of resinmaterial. E.g.: methcrylol fluoride methylmethacrylate, acrylic amine hydrogen fluoride salt.
  39. 39. Caries management programmes
  40. 40. SEALANTS IN CARIES MANAGEMENTPROGRAMME:Identification of a patient at risk of decay.A thorough assessment of all aspect of a patientslife affecting the development of caries.Appropriate examination to determine the toothsurface at risk.Appropriate technique and manufacturersguidelines need to be followed.Step need to be taken to ensure reversal of thedecay balance from demineralization toremineralization.Monitoring and repair just like any other cariesmanagement programme.
  41. 41. PARENT EDUCATION:Educating parents and patients on theimportance of dental sealants is critical.Dental sealants are cost effective treatmentmodalities when placed on the teeth of children athigh risk for dental caries.
  42. 42. Parent education
  43. 43. SUMMARYSealant will be adopted as a standard of care forprevention of pit and fissure caries. To makesignificant gains in caries reduction in child andadult population is necessary for the dentalprofession to educate and inform the generalpublic.
  44. 44. Thank you…..