This document discusses fissure sealing, which involves using sealing materials to fill pits and fissures on tooth surfaces in order to prevent decay. It describes the anatomy of tooth enamel and how enamel mineralization occurs over time. Deep and narrow fissures are most in need of sealing. The document outlines the indications, contraindications, types of sealants and sealing methods, including both invasive and non-invasive techniques. Key steps for successful sealant application include adequate enamel etching and drying prior to application of the sealant. Fissure sealing is effective at preventing decay for 5-8 years.

1. Fissure sealing

2. Anatomical background
The process of enamel mineralization begins
long before teething. Immediately after eruption
and over the next 2 years, the mineralization of
the teeth proceeds quite quickly, then it slows
down. In the process of "ripening" occurs first
rapid and then slower saturation of the enamel
with macro- and microelements. The
composition of enamel includes hydroxyapatites,
fluorapatites, carboxyapatites and chlorapatites.

3. Anatomical background
The enamel of an immature tooth is characterized
by greater porosity and a lower crystal packing
density. Immature enamel contains fewer
fluorapatite-like crystals, which are less soluble in
acids than hydroxyapatites, making it more
vulnerable to acids.
With a decrease in the level of health and the
presence of local risk factors for the development of
caries, spontaneous fissure sealing does not occur.

4. Anatomical background
Often there is a spontaneous sealing of fissures
in a natural way. In such cases, dense, highly
mineralized formations, heterogeneous in
structure, are found in the fissures. Mineral
formations are located at the very bottom of the
fissures - this is the only anatomical zone where
the centrifugal currents of cerebrospinal fluid
coming from neighboring tubercles and folds are
concentrated at one point, i.e. natural mineral
sealing of fissures occurs mainly due to enamel
liquor.

5. Types of fissure structure
A. funnel-shaped
B. conical
C. teardrop
D. polypoid
A. open
B. deep
C. "Ampoule" type
D. "Ampoule" type

6. Fissure depth 0.25-3.0 mm
Bottom width 0.1-1.2 mm Orifice
width 0.005-1.5 mm

7. The method of obturation of fissures and other
anatomical recesses of healthy teeth with special
sealing materials in order to create a barrier for
external cariogenic factors.

8. Fissure sealing functions:
Creates a barrier to cariogenic bacteria
It has a remineralizing effect on the enamel, if
the sealant contains active ions

9. Indications for sealing:
Presence of deep fissures
Intact fissures, absence of fissure caries
Incomplete mineralization of the chewing
surface of the tooth
Minimum period since tooth eruption
Initial caries

10. Contraindications for sealing:
Presence of intact wide, well-communicating
fissures
Teeth with healthy pits and fissures but carious
lesions on proximal surfaces
Pits and fissures that have remained healthy for
4 years or more do not require sealing
Poor oral hygiene

11. Fissure sealants
Types of composite sealants:
Self-polymerizing or chemo-curing: "Concise
White Sealant" (3M, USA), "Delton" (Johnson
and Johnson), "Delton", "Fis Seal" (Russia)
Photopolymerizable: Estisial LC (Kulrer), Sealant
(Bisco), Fissurit, Fissurit F (Voco), Delton-S, Fis
Seal-S (Russia)

12. Fissure sealants
Opaque (opaque)
Transparent:
Painted
Unpainted
Transparent sealants are used to monitor the
progress of caries, but are more difficult to
detect on the surface of the tooth.

13. Fissure sealants
Fluorine containing (Fissurit)
Fluorine free (Fissurit F)
In recent years, GIC has been used as a sealant.
Due to the F, Al, Zn, Ca contained in the GRC,
these materials have a pronounced cariesstatic
effect. However, their safety, in comparison with
composites, is reduced.

14. Sealing materials

15. Sealing methods
non-invasive
invasive

16. Stages of an invasive sealing method
Cleaning of the occlusal surface of the tooth,
walls and bottom of the fissure.
Rinsing and drying of cleaned surfaces.
Isolation of teeth from saliva.
Fissure opening. Expansion of the fissure
entrance with a needle-shaped diamond bur for
visual inspection.

17. Stages of an invasive sealing method
If caries is limited to the enamel zone, then the
base of the cavity and the entire fissure are
etched within 15 seconds.
The tooth is rinsed with water for 30 seconds
and dried. In case of unsatisfactory results of
etching or ingress of saliva, repeat the
procedure.
A suitable composite is placed in the cavity, a
contour is created, light curing occurs within 60
seconds.
The composite filling and the entire fissure are
covered with a sealant.
Occlusion check, correction.
Fluorine preparation.

18. Stages of an invasive sealing method
 In the presence of cavity carious lesions with a small
diameter (no more than 1/3 of the distance between the
buccal, lingual, palatine tubercles), the fissure is sealed
with a lining. SIC is used as a lining.
 If, during the opening of the fissure, it is found that
caries has affected the dentin, and its lateral location
leads to the fact that the edges of the filling will be in
the zone of occlusal contacts, one CIC cannot withstand
chewing loads. It is used as a lining for an occlusal
composite filling.

19. Stages of a non-invasive sealing method
 Thorough cleaning of the occlusal surface of
the tooth, walls and bottom of the fissure,
removal of soft plaque, food debris using
circular brushes and special products that do
not contain fluoride and oils (keint paste
(voco)). Cleaned surfaces should be rinsed
and dried to ensure there is no carious
lesion.
 Isolation of teeth to be sealed with a rubber
dam or cotton rolls.
 Acid surface preparation. Etching of enamel
with special gels (“Vokocid” - Voco, Unietch,
All-etch-“Bisco”), or others based on
phosphoric acid for 15-20 seconds. Rinse
with water for 15-20 seconds.

20.  Re-isolation of the tooth from saliva.
 Application of sealant on the prepared
enamel surface, distributing a thin layer over
the entire surface of the fissure without
voids, repeating the contours of the fissure
with a probe or brush.
 For self-curing sealants, wait 3-5 minutes.
For light-cured sealants, direct the light
source for 15-20 seconds for opaque and
filled.

21.  After curing, it is necessary to wipe off the
surface inhibition layer with a cotton ball,
and then check the occlusal contacts using
carbon paper and, if there are
supercontacts, polish them using ball-
shaped carbide or diamond burs.
 The final stage is the application with a
fluorine-containing varnish or gel (Fluoride
varnish, Fluocal-gel, Fluoridin gel).

22. Factors for Successful Sealant Application
Adequate acid treatment of enamel.
Thorough subsequent flushing of the acid.
Preservation of the prepared enamel prior to
sealant application with dry and unmoistened
saliva.
Adequate light intensity and penetration for
complete polymerization.

23. Fissure sealing is effective for 5-8 years!

24. Thank you for your attention
!