DENATAL PROCEDURE

1. GOOD MORNING

2. PIT AND
FISSURE
SEALANTS
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3.  Introduction
 Milestones of p & f
 Morphology of p & f
 Diagnosis
 Classification of p & f
 Ideal requirements
 Indications and Contraindications
 Technique of application
 Factors affecting retention
 Other sealant materials
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5. The caries susceptibility in the
permanent dentition can be
ranked in the following order
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6.  Although the eight occlusal surfaces
of permanent molars (3rd molars
excluded) represent only about 6%
of the 128 permanent tooth surfaces
at risk, it is estimated that they
exhibit about 60% of the total
number of decayed or filled surfaces
 This is mainly attributed to
extremely plaque retentive
morphology of the pit and fissure
system they have.
 To prevent the development of this
fissure caries, so-called Pit and
Fissure Sealants were introduced. 6

7. 7

8. GROOVES
Shallow linear depressions
formed by the perfect
joining of the different
lobes.
PIT:-
A small pin point depression
located at the junction of
developmental grooves or at
terminals of those grooves.
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9. FISSURE:-
Defined as deep clefts between adjoining
cusps that provide areas for retention of
caries producing agents. Commonly occur
on the occlusal surfaces of molars and
premolars
PIT AND FISSURE SEALANT
“An agent used for sealing off an
anatomically deficient region of the tooth
to supplement the regular professional
care in a program of preventive dentistry”
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10.  Is a material that is placed in the pits & fissure of
teeth in order to prevent or arrest the development
of dental caries
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11. In 1895, Wilson reported the placement of dental cements
in pits and fissures to prevent caries.
Prophylactic odontotomy:
 Proposed by HYATT (1923)
 Consists of filling the fissures with silver or copper oxy-
cement as soon as teeth erupted into oral cavity and later,
when they are fully erupted, preparing a small occlusal
cavity and filling it with amalgam.
 No longer advocated as preventive measure.
Fissure Eradication (Enameloplasty)
 Proposed by Bodecker (1929)
 Involves mechanical eradication of fissures which are deep
and retentive into self cleansable areas.
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12.  Two disadvantages, requires a dentist and in the process
of modifying a deep fissure, it is often necessary to
remove more sound tooth structure that would require
insertion of small restoration
Bowen (1963)
 Reported BIS-GMA material development which is
reaction product of Bisphenol A and glycidyl-methacrylate.
BIS-GMA is the base resin to most of the commercial
sealants.
Bunocore: (1970)
 acid etching of enamel increases attachment of acrylic to
the tooth surface.
 Advocated the filling of pit and fissure with bonded resin.12

13.  The fissure patterns varies among population groups and
even racial groups rendering teeth more or less
susceptible to dental caries.
 It has been found that more than 90% of teeth have
normal fissures, which have a relatively wide opening,
followed by a narrow. The caries lesion is visible and
accessible to a probe.
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14.  Fewer than 10% of teeth contain atypical or
risk fissures with a narrow opening and a
bulbous widening at the base. The lesion can
start at the entrance as well as at the base
of the fissure.
 Nango (1960) in a study of crown sections
described four principal types of fissures,
based on the alphabetical description of
shape.
V type
U type Caries resistant
 I type
 K type Caries susceptible 14

15. MORPHOLOGY OF PITS AND FISSURES
34 %
14%
Self cleansing

16. Not
self cleansing
19 % 26 %
7 %
7%

17.  There is a consistent
evidence that explorers
do not improve the
accuracy of caries
diagnosis.
 Applied with slight force
also, an explorer could
damage a tooth surface,
converting white lesion
into a cavity.
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18.  When required a blunt periodontal probe should be used
to remove plaque and debris from the tooth surface prior
to examination and to check the surface texture of a
lesion atraumatically.
 A rule of thumb in diagnosis of caries is to use sharp eyes
and a blunt probe (or no probe at all).
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19. According to Mitchell and Gordon (1990)
 Based on the generations
1. First generation (UV Light activated composites)
i) Curing occurs due to activation of Benzoin methyl ether
when exposed to UV light.
ii) Contains Potential health hazard to clinician and patient as
UV light causes retinal and soft tissue damages. So no more
used.
2. Second generation (self cure composites)
i) Supplied in two pastes. Base paste contains the initiator
Benzoyl peroxide. Accelerator paste contains tertiary
amine (N-dimethyl-P- toluidine) as activator.
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20. 3. Third generation (visible light activated composites)
i) Consist of a single paste
Initiator - Camphoroquinone
Activator - Diethyl-amino-ethyl methacrylate (amine) or
Diketone.
ii) Most popular composites used today .
iii) They interact when exposed to light at wavelength range of
400 - 500nm i.e., blue region of visible light spectrum,
predominantly at 474nm.
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21. iv) Heath hazard is virtually eliminated.
v) Requires a minimum of 20 secs. for adequate curing.
viii) Shrinkage occurs towards the light source.
xi) The advantages of light cure over self cure are -
- the operator can initiate polymerization at any suitable time.
- Reduced porosities
- Better wear and abrasion resistance
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22. 4. Fourth generation (fluoride releasing)
i) Offers double protection
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23.  Based on fillers
 Free of fillers
 Semifilled
 Increases strength, reduces solubility, and water absorption.
 Based on the colour of sealants
 Clear
 Tinted
 Opaque
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24. 1. Low Viscosity
2. Adequate working time
3. Biocompatible
4. Minimum irritation to tissues
5. Good and prolonged adhesion to the enamel
6. Low sorption and low solubility
7. Resistance to wear
8. Cariostatic action
9. Economical
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25.  Indicated in teeth with deep occlusal fossae, fissure or
incisal lingual pit is present
 In an intact occlusal tooth surface if the contralateral tooth
surface is carious (because the opposite side of mouth is equally
prone to caries)
 An incipient lesion exists in the pit and fissure
 Can be used over class I composite or amalgam to increase the
marginal integrity and into the remaining pits and fissures.
 Newly erupted teeth both primary molars and permanent
premolars and molars
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26.  Wide and self cleansable pit and fissures.
 Patient behaviour does not permit use of adequate dry-
field techniques
 An open carious lesion exists
 A large occlusal restoration is already present.
 Caries exist on other surfaces of same tooth in which
restoring will disrupt an intact sealant.
 Individual with no caries experience and well coalesced pit
and fissures.
 Pit and fissures that have remained caries free for 4 yrs
or longer
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27.  3-4 yrs of age for the primary molar sealant application
 6-7yrs of age for the permanent 1st molar
 11-13 yrs of age for the permanent 2nd molar.
 The tooth in question should have erupted less than 4 yrs
ago.
 The disease susceptibility of the tooth should be
considered when selecting teeth for sealants, not the age
of the individual.
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28. 1. Maintaining dryness:
- The teeth must be dry because sealants are hydrophobic
- Can be maintained by rubber dam or cotton rolls or bibulous pads
- In a three year study Straffon , L.H and Dennison, in which
sealant retention was tested using a rubber dam versus cotton
rolls, the sealant retention was found to be approximately equal.
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29. 29

30. 1a. Cleaning of tooth surface
- tooth cleaned with a rotating pointed
brush and pumice
2. Washing and drying
- tooth is washed with water and air
dried for at least 10 secs.
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31. 3. Etching
Occlusal surface is then etched
with 30-50% solution of
phosphoric acid liquid or gel for
60 secs. The gel form is easy to
apply.
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32.  Etching produces microscopic porosities in the enamel
into which the resin extends and forms tags which attach
it firmly to tooth surface. ( bond strength is 60- 100
N/m2)
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33. Fluoride treated teeth and primary teeth require longer
time (15 secs more) due to the presence of more
aprismatic enamel.
The etched area should be rinsed with water for 20
seconds.
Acid conditioning removes old and fully reacted enamel,
increases the surface area up to 2000 times that of
original untreated surface and enhances surface porosity.
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34. 4. Washing and drying:
- the tooth is washed for 30 sec to remove the
etchant, then air dried
- Etched tooth surface has a dull frosted appearance.
- if the surface is contaminated it must be re-etched
for an additional 10 secs.
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35. 5. Application of sealant material
- the sealant should not only fill
the fissures but should be some bulk
over fissures.
- after the fissures are adequately
covered, the material should be
brought to a Knife edge
approximately halfway up the
inclined plane
-air bubbles should not be
incorporated. If any voids are
evident, additional sealant can be
added without the need for any
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36. 6. Curing
The time required for
polymerization is set by
manufacture and it is usually around
20 – 30 secs.
 Even after cessation of light
exposure a final, slow polymerization
can continue over 24-hr period
 usually any minor discrepancies in
occlusion are rapidly removed by
normal chewing. unacceptable
discrepancies can be removed with a
bur.
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37. Evaluating retention of sealants
 The fissure sealant should be checked for retention
without using undue force.
 If the sealant does not adhere, the placement
procedures should be repeated with only about 15 secs of
etching.
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38. 7. Recall:
should be thoroughly checked at subsequent recall
appointments to ensure:
- it is still firmly adherent
- no sealant material has been lost
- if needed sealant material should be added first.
Because the most rapid falloff of sealants occurs in the
early stages, an initial 3-month recall following
placement should be routine for determining if sealants
have been lost.
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39.  The rapid loss of sealants over the first 3 months is
probably caused by faulty technique in placement.
 due to abnormal masticatory stresses.
 After a year, the sealants become very difficult to see
especially if they are abraded to the point that they fill
only the fissures.
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40.  Teeth that have been sealed and then have lost the
sealant have had fewer lesions than control teeth. This is
possibly due to presence of tags that are retained in the
enamel after the bulk of sealant has been sheared from
the tooth surface.
 More recent studies reported 82% of sealants placed are
retained for 5yrs.
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41. Eruption status
 Less retention in partially erupted teeth (difficulty in
moisture control)
 Bette retained on recently erupted teeth than in teeth
with mature surface.
Teeth
 Better retained on 1st molars than 2nd molars
Type of arch
 Better retained on mandibular teeth. This finding is due
to that the lower teeth are more accessible, direct sight
is possible; also gravity aids the flow of the sealant into
fissures. 41

42. Efficiency of clinical moisture control
 Because acid etching is very sensitive to salivary
contamination and sealants are hydrophobic in nature.
Experience of the operator.
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43.  In an office setting, it is estimated that it costs 1.6
times more to treat a tooth than to seal.
 Hence sealants would be considered cost effective if
they could be placed in only those pits and fissures that
are destined to become carious.
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44. The majority of all carious lesions that occur in the
mouth occur on the occlusal surfaces. Which teeth will
become carious cannot be predicted; however, if the
surface is sealed with a pit-and-fissure sealant, no caries
will develop as long as the sealant remains in place. Also
recent studies indicate an approximately 90% retention
rate of sealants 1-year after placement.
Whenever sealant is placed, a topical application of
fluoride should follow if at all possible. The conclusion
was that caries could be almost completely eliminated by
the combined use of these two preventive measures.
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45. THANK YOU
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