PIT AND FISSURE
⋇ High caries susceptibility of pit & fissure is a major dental
problem and provides the rationale for caries control of these
⋇ It accounts for 50% of caries in human dentition.
CARIES OF PIT & FISSURE:
⋇ Caries process particularly in 1st & 2nd molar starts as soon
as it erupts. Pit and fissure is an important factor in determining
the presence of caries.
⋇ According to BLACK - P&F don’t cause caries instead provide
a sanctuary to caries causing agents.
⋇ P&F caries follows the direction of the enamel rods & forms
a shaped lesion with its apex at the outer surface and its base
⋇ It produces greater cavitations than proximal caries.
MILESTONES OF PIT AND FISSURE:
⋇ HYATT – Prophylactic odontotomy – fissures filled with silver
or copper oxy phosphate cement . (1923)
⋇ BODECKER – Fissure eradication – deep retentive fissure into
self cleansable one.(1929)
⋇ BUNOCORE - Acid etching – phosphoric acid for 30 seconds.
⋇ BOWEN – BISGMA – base resin for sealants.(1965)
PIT & FISSURE:
PIT: Small pin point depression located at the junction of developmental
FISSURE: Deep clefts between adjoining cusps.
MORPHOLOGY OF FISSURES: (NANGO - 1960)
V – type U – type I – type K - type
shallow & self cleansable deep , narrow & retentive
(non invasive technique) (invasive technique)
PIT & FISSURE SEALANTS
CLASSIFICATION: (MITCHELL & GORDON - 1990)
polymerization method filled / unfilled clear / tinted resin system
Self activation Light activation Urethane BIS-GMA
I generation II generation III generation IV generation
UV light self cure visible light fluoride releasing
EFFECTIVENESS OF SEALANTS:
⦿ Technique of application.
⦿ Type of sealant used.
⦿ Morphology of tooth surface to which it is applied.
REQUISITES OF AN EFFICIENT SEALANT:
Viscous enough to penetrate into deep pit & fissures
Adequate working time
Good & prolonged adhesion to enamel
Low sorption & solubility
Resistance to wear
Minimum irritation to tissues
AGE RANGE: 3-4 yrs for primary molar, 6-7yrs for I permanent
molar, 11-13yrs for II permanent molar.
GROUP 2: Moderate caries risk patients.
CLINICAL JUGDEMENT CRITERIA:
Tooth type & morphology
Familial & individual history of dental caries
Fluoride environment & history
Newly erupted 1⁰ M & permanent PM & M – with
complete recession of pericoronal operculum & with
open / sticky P&F.
Stained P&F with minimum decalcification / opacification
& no softness at the base of the fissure.
Tooth in ? – erupted less than 4 yrs
No previous caries experience , coalesced P&F.
Proximal caries – clinically & radiographically
Wide & self cleansable P&F
Partially erupted tooth / that which cant be isolated.
P&F caries free for > 4 yrs.
TECHNIQUE OF APPLICATION
With slurry of pumice & water.
Fluoride containing paste not used – interferes
with acid etching.
2) ISOLATE THE TOOTH:
Using rubber dam
3) ACID ETCHING:
30-50% phosphoric acid liquid / gel - 30 sec
Microscopic porosities in the enamel
4) WASHING & DRYING
Wash with water – 30 sec & air dried
If contaminated re-etch for 10 sec
5) APPLICATION OF RESIN:
Apply the material.
Avoid incorporation of air bubble
Done according to the manufacturer.
Examine – all P&F covered, excessive material removed,
7) RECALL VISIT:
Check loss of material
If needed sealant may be added
ACP releasing Enamel LocTM
Embrace TM WetbondTM
natural white colour
Bonds to moist tooth
Easy to dispense
Snip off the tip & squeeze
Avoids cross contamination
Neutral / high pH remains
in its original form.
pH < 5.8, ACP → HAP
Replaces the HAP lost by the
Non reliant on patient
Long life – not washed away
Neutralize acid & buffer pH