Pit and fissure sealants

1. Muhammad Rafay Imran
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2. Pit and Fissure Sealants
 According to American Dental Association (ADA) dental sealant is an adhesive
material that is applied to pits and fissures of teeth in order to isolate from rest of
the oral cavity.
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3. Why fissure sealants are needed?
 From a primary prevention perspective, anatomic grooves or pits and fissures on occlusal
surfaces of permanent molars trap food debris and promote the presence of bacterial
biofilm, thereby increasing the risk of developing carious lesions. Effectively penetrating
and sealing these surfaces with a dental material—for example, pit-and-fissure
sealants—can prevent lesions and is part of a comprehensive caries management
approach
 From a secondary prevention perspective, there is evidence that sealants also can inhibit
the progression of noncavitated carious lesions. The use of sealants to arrest or inhibit
the progression of carious lesions is important to the clinician when determining the
appropriate intervention for noncavitated carious lesions.
 Reference: Use of Pit and fissure sealants
 American Academy of Pediatric Dentistry and American dental association
 2016
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4. Mechanism of Action
 They eliminate the geometry that harbors bacteria and to prevent nutrients
reaching bacteria in the base of pit or fissure.
 Reference: Chapter#14 Art and Science of Operative Dentistry By
 Harald O Heymann
 Edward J Swift Jr
 Andre V Ritter
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5. Types of Pit and fissure sealants
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6. Resin based sealants versus Glass ionomer
sealants
 Background/Purpose
 Atraumatic restorative treatment (ART) was developed primarily for use in under-served areas of the world. This study was
designed to compare caries prevention with high-viscosity glass ionomer cement (GIC) sealants placed according to the ART
procedure and light-cured composite resin sealants after 3 years.
 Methods
 The study was conducted in a boarding school in the city of Kırıkkale. Four experienced dentists placed a total of 207
sealants (91 GIC and 116 composite resin), without chair-side assistance, on the school premises.
 Results
 A total of 137 sealants were available after 3 years. 55.3% of the GIC and 93.8% of the composite resin sealants were lost
completely, and the difference between the two groups was statistically significant. Only six of 56 teeth in the GIC group and
eight of 81 in the composite resin group showed caries.
 Conclusion
 Under field conditions in which moisture control was not effective, a high-viscosity and less technique-sensitive glass
ionomer material can be used as an effective sealant material, rather than resin.
 Reference: Comparison of Caries Prevention With Glass Ionomer and Composite Resin Fissure Sealants 2009
 Aylin Akbay Oba
 , Türksel Dülgergil
 , Işıl Şaroğlu Sönmez
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7. Indications for Pit and Fissure Sealants
 Patients with a low need for sealants:
 Indications :
 Absence of new dental caries in the last year;
 Absence of dental caries in primary dentition;
 Absence of dental caries in permanent molars erupted;
 Good exposure to fluorides;
 Non-cariogenic diet;
 Good oral hygiene
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8. Patients with a moderated need for
sealants
 Indications:
 A new dental caries in the last year;
 Dental caries in primary dentition;
 Some permanent molars affected by dental caries;
 Low exposure to fluorides;
 Cariogenic diet;
 Poor oral hygiene
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9. Patients with a high need for sealants
 Indications:
 Two or more new dental caries in the last year;
 People whose parents have high dental caries experience;
 Rampant dental caries;
 Medications that cause xerostomia;
Anti Histamines: For example: Diphenhydramine
Anti Depressants: For example: Buproplon, Fluoxentine ,Paroxentine
Anti Psychotic Agents: For example: Haloperidol
Sedatives and anxiolytic agents: Diazepam, Loraxipam Alpraxolam
Anti Hypertensives: Furosemide, Metaprolol, Calcium Channel Blockers
Anti Cholinergic drugs: Atropine , Scopolamine
 Reference:Fissure Sealants: A Review of their Importance in Preventive Dentistry Nélio
J. Veiga1 , Paula C. Ferreira
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10.  Systemic Diseases that cause Xerostomia:
Sjogren Syndrome
Diabetes Militus
Diabetes Insipidious
Sarcoidosis
HIV
Psychogenic Disorders
 High cariogenic diet;
 Zero or nearly zero exposure to fluorides;
 Very poor oral hygiene.
 Reference:Fissure Sealants: A Review of their Importance in Preventive Dentistry Nélio J.
Veiga1 , Paula C. Ferreira
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11. Advantages
 Prevention from caries
 Cost effectiveness : At the 10‐year point of a 15‐year study, it was found that it is 1.6 times as
costly to restore the carious lesions in the first permanent molars in an unsealed group of 5‐
to 10‐year‐old children
 Anti Bacterial effect
 Better oral hygiene
 Better periodontal status
 Reference: A review of the clinical application and performance of pit and fissure sealants
 RJ Simonsen
 RC Neal
 Fissure Sealants: A Review of their Importance in Preventive Dentistry Nélio J. Veiga1 , Paula
C. Ferreira
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12. Disadvantages of Pit and fissure sealants
 A key problem of fissure sealants is microleakage. This microleakage may lead to
bacterial plaque accumulation, which in contact with enamel, can turn into a
carious lesion
 Mouth´s pH constant variations, as well as the action of bacterial plaque and
salivary enzymes, that can cause their chemical degradation. This limitation
explains the need for regular appointments to the dentist.
 Effect of sealants wear due to chewing forces applied on the occlusal surfaces of
the teeth. The constant force application on the sealant can lead to the material
fracture and microleakage
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13. Clinical Technique
 Step 1: The tooth is isolated by using a rubber dam or another effective isolation
method such as placing cotton rolls.
 Step 2: The area is cleaned with a bristle brush
 Step 3: The tooth surface I dried, and etched with 37% phosphoric acid gel for 15-
30 seconds. Properly acid etched enamel surface as a lightly frosted appearance.
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14.  Step 4: The sealant material is then applied with an applicator or small hand
instrument. The sealant is gently placed.
 Step 5: The sealant is light activated for 15 seconds
 Step 6: The occlusion is evaluated by using articulating paper.
 If too much sealant is applied, excess can be removed with a microbrush prior to
light activation or round carbide finishing bur can also be used for removing
excess.
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16. References:
-Chapter#14 : Art and Science of Operative Dentistry
By Harald O Heymann
Edward J Swift , Andre V Ritter
-A review of the clinical application and performance of pit and fissure sealants
RJ Simonsen
RC Neal
-Fissure Sealants:
A Review of their Importance in Preventive Dentistry
Nélio J. Veiga1 , Paula C. Ferreira
-Comparison of Caries Prevention With Glass Ionomer and Composite Resin Fissure Sealants 2009
Aylin Akbay Oba
, Türksel Dülgergil
, Işıl Şaroğlu Sönmez
-Use of Pit and fissure sealants
American Academy of Pediatric Dentistry and American dental association
2016
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