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Pit and fissure sealants

The document discusses pit and fissure sealants, emphasizing their importance in preventing caries, particularly on occlusal surfaces of teeth. It covers the history, types, indications, contraindications, and criteria for ideal sealants, as well as materials used and application procedures. Public health programs for sealants are also highlighted, with data supporting their effectiveness over non-use and fluoride varnishes in reducing caries risk.

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Pit and Fissure Sealants Presenter : Dr. AASHNA DHINGRA P.G. Student First Year Dept. of Public Health Dentistry
I N T R O D U C T I O N Although only 12.5% of all tooth surfaces are occlusal, these surfaces develop more than two-thirds of the total caries experience of children. Caries potential is directly related to the shape and depth of the pits and fissures. Narrow isolated crevices and grooves are the most important anatomical features leading to development of occlusal caries.
CONTENTS …. Introduction definitions types of fissures indications contraindications purpose rationale criteria for ideal sealants classification materials used as sealants procedure prr public health programs
HISTORY1835 – Robertson – caries depth of Pits and fissures 1895 - Wilson - zinc phosphate 1905 - silver nitrate by Miller 1923- HYATT : “PROPHYLACTIC ODONTOTOMY” (Ag and Cu Oxyphosphate cements) 1929 - Bodecker - Enameloplasty (enamel fissure eradication) 1939- Gore – use of ploymers- sol. of cellulose 1942 - Kline and Knutson- ammonical silver nitrate 1951 – Miller J – copper amalgam 1955- Buonocore – Acid Etching (concentrated phosphoric acid solution) Cyanoacrylates were the first materials to be used as sealants, but never marketed. 1972 – NUVA SEAL(L.D Caulk) –UV P&F sealant – BOWEN 1976- first colored sealant- CONCISE WHITE SEALANT – chemical cure (3M dental products.
Pits and fissures are enamel faults, narrow shafts or cracks at some length whose blind ends are directed more or less towards the DEJ.
PIT : defined as a small pin point depression located at the junction of developmental grooves and at terminals of those grooves. FISSURE : defined as deep clefts between adjoining cusps.
“to describe a material that is introduced into the occlusal pit and fissure of caries susceptible teeth, thus forming a micro-mechanically bonded, protective layer cutting access of caries producing bacteria from their source of nutrients” •(Simonsen)
“Fissure sealants are materials designed to prevent pit and fissure caries when they are applied to the occlusal surfaces of teeth in order to obliterate occlusal fissures and remove the sheltered environment in which caries may thrive.” •(Gordon-1962)
TYPES OF FISSURES NAGANO 1960:
INDICATIONS : Ekstrand and Christiansen, 2005 active fissure caries has been diagnosed. a high risk had been established. fissures are deep and the patient or parent either cannot, or will not remove plaque effectively.
INDICATIONS : • presence of deep occlusal pits and fissure on newly erupted teeth. • presence of lingual pits or palatal pits in relation to upper lateral incisors and molars. • presence of incipient lesion in pit and fissure. • children and young people with medical, physical, or intellectual impairment with high caries risk. • children and young adults with signs of high caries activity coming from non-fluoridated areas.
CONTRA-INDICATIONS : • shallow pits and fissures. • open occlusal carious lesions with extension into dentin. • presence of large occlusal restoration. • presence of proximal caries extending on to occlusal surface. • partially erupted tooth where isolation is problem. • un-cooperative children.
PURPOSE : • To provide physical barrier to seal off the pit or fissure. • To prevent the bacteria and their nutrients from collecting within the pits or fissures to create the acid environment necessary for initiation of dental caries.
RATIONALE : Very high proportion of dental decay occurs in pits and fissures. Recent data shows that relative proportion of pit and fissure lesions has increased to 84% of total new caries experience. Pits and fissures remain at risk of caries for long periods of time, not just within the first few years of eruption. Fluoride has limited effect in preventing pit and fissure caries. Fissure sealants are effective at preventing pit and fissure caries and are best used as a part of overall preventive program. (British society of pediatric dentistry 2000)
1. A viscosity allowing penetration into deep and narrow fissures. 2. Adequate working time. 3. Rapid cure 4. Good and prolonged adhesion/bonding to enamel. 5. Low sorption and solubility. 6. Resistance to wear. 7. Be compatible with oral tissues. 8. Cariostatic action CRITERIA FOR THE IDEAL SEALANT -Brauer
Based on Curing Based on fillers 1) First G 2) Second G 3) Third G 4) Fluoride containing 1) Unfilled 2) Filled 3) Fluoride-releasing
FIRST GENERATION Polymerised with UV Light 350nm SECOND GENERATION FOURTH GENERATION THIRD GENERATION Self cured or Chemically cured Mostly unfilled. Visible light cured 430-490nm Filled/unfilled Addition of fluoride for added benefit
B. Filled - Need for occlusal adjustments - More resistant to wear - may need occlusal adjustments e.g.. Prisma shield, Helioseal, Delton plus. A. Unfilled [ free of fillers ] -Flow is better - more retention - abrade easily - e.g. . Concise White, Delton
MATERIALS USED AS SEALANTS
CYANOACRYLATES Discovered in late 1950’s. Surgical adhesives and tooth sealants. moisture - polymerize rapidly : hard and brittle. Mechanical durability : unsatisfactory Initially methyl cyanoacrylate used. : toxic potential. Replaced by Butyl and Isobutyl ester.
POLY URETHANES Eg: EPOXYLITES Contain 10% sodium mono fluorophosphate with liquid polyurethane and utilize citric acid as etchant. Not regularly used due to poor mechanical properties and oral durability and toxicity.
DIMETHACRYLATES Methyl Methacrylate (MMA) : highly volatile and lacks penetration. Enamite, a new sealant utilizes MMA- PMMA system initiated by butyl boron. Binds better and is less affected by immersion in water. BISGMA : viscous amber liquid of low volatility diluted with MMA. (3:1)
GLASS IONOMER Mc Lean and Wilson Hydrophilic Good adhesion Biocompatibility Fluoride release Used for fissure orifice exceeding 100µm
3-4yrs : Primary molar sealant application. 6-7yrs : First permanent molar . 11-13yrs : Second permanent molars and the premolar. Simonsen 1983. Group 1 – Caries free patients judged at no risk to decay. Group 2 – Patients judged to be at moderate risk to decay. Group 3 – Patients with rampant caries at a high risk to decay. WHO…??
PREPARE THE TEETH Plaque and debris interfere with etching -Clean the surfaces - Dry tooth brush/prophy cup with pumice/air abrasion. - Explorer to remove debris. - Rinse for 20-30seconds.
ISOLATE THE TOOTH Most critical aspect. Saliva contamination during or after acid etching can have deleterious effects on bond. Best : Rubber dam. Cotton rolls, dry angles Vac-ejector moisture control system. DRY THE SURFACE Dry the teeth with air for 20-30 seconds. Ensure no moisture.
ETCH THE SURFACES 37% Ortho-Phosphoric acid Liquid/gel form. 30-60seconds On all susceptible pits and fissures Extend up the cuspal lines, well beyond (at least 2mm) the anticipated margin of sealant.
RINSE AND DRY THE TEETH Rinse surfaces for 60 seconds. Surface should appear “Chalky- White” Dry teeth with air for 20-30 seconds.
APPLICATION OF SEALANT MATERIAL 1. Self-Curing Mix equal parts of the 2 components Polymerisation: 60-90 seconds. 2. Light curing Apply with syringe. Apply curing light to material. Polymerisation: 20-30seconds.
EVALUATION THE SEALANT - for complete coverage - for absence of voids or bubbles - small voids can be repaired. OCCLUSAL EVALUATION - Articulating paper. - Adjustments : filled resins. Re- EVALUATION
PREVENTIVE RESIN RESTORATIONS • a natural extension of the use of occlusal sealants. • integrates the preventive approach of sealant therapy for caries susceptible pit and fissure with therapeutic restoration of incipient caries with composite resin. • “extension for prevention”
PREVENTIVE RESIN RESTORATIONS
PREVENTIVE RESIN RESTORATIONS SIMONSEN (1978) TYPE A • where caries removal is limited to enamel. • slow speed round bur. • sealant placed. TYPE B • incipient lesion in dentin. • Base is placed in areas of dentin remaining covered with sealant. TYPE C • more extensive. • After base placement. • Requires posterior composite material for restoration.
PUBLIC HEALTH SEALANT PROGRAMS School - based American Association of Community Dental Programs has developed a manual “Seal America : The Prevention Invention” 1990: US Public Health Service published a national health objective for the year 2000, stating that 50% children should have sealants on 1 or more permanent teeth.
Define the community  School system  Municipality  Neighborhood  State  Homebound  Institutions
Assess community need  High pit and fissure caries level and low proximal caries level.  Low sealant prevalence  Poor access to dental care  Low income
Weigh support constraints for sealant program development  human resources  fiscal resources  Community values on oral health SUPPORTS CONSTRAINTS Adequate Lack
Select approaches for increasing sealant prevalence  Direct service  Sealant promotion  Policy development (Medicaid rules, state practice acts)
Define specific population  school children  specific populations :  head start  residential care  military  managed care organization  people with disabilities  geography
Identify individuals to be evaluated for sealants  All people  Low SES  Lack of dental care
Identify teeth/tooth surfaces  Risk assessment of individual
recent advancements WetBond Pit and Fissure Sealant Bonds chemically and micro mechanically to moist tooth surfaces. 1st PnF sealant resin that can be applied in moist field. Unique Resin Acid-Integrating Network. Pit and Fissure Sealant with ACP (Amorphous Calcium Phosphate) Resilient and flexible. Chemical and thermal barrier that protects tooth enamel. “smart material” : slowly releases Ca and Phosphate ions when the pH drops. Illuminating Pit and Fissure Sealant Use of UV pen light. Seal-N-Glo Fluoresces a blue/white color. Visual verification of sealant margins.
• Compared sealed and unsealed teeth in the same mouth. • Teeth which were initially sound had caries rate 13% at 5 years when unsealed and 8
Comparison 1. Sealants versus nonuse of sealants. The results of 9 studies (3,542 participants). Participants who received sealants reduced their risk of developing new carious lesions by 76% compared with participants who did not receive sealants. Comparison 2. Sealants versus fluoride varnishes. The results of 3 studies (1,715 participants) Participants who received sealants had a 73% reduction in the risk of developing new carious lesions compared with participants who received fluoride varnishes.
CONCLUSION …
REFERENCES…
Pit and fissure sealants