this topic is of public health dentistry

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Pit & Fissure Sealants
Presented By Dr. Swarenima Khichi
PG Public Health Dentistry

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Pit: is defined as small pin point depression
located at the junction of developmental
grooves or at terminals of those grooves.
Fissure: is defined as deep clefts between
adjoining cusps.
They provide areas
for retention of caries.

4. History of Pit & Fissure Sealant
• 1905: Application of Silver nitrate by Miller.
• 1922: Hyatt- “Prophylactic Odontomy”. Filling the
fissures of erupting teeth with silver or copper
oxyphosphate cement. After full eruption, small occlusal
cavity is prepaperd and filled with silver amalgam.
• 1929: Bodecker, widening the fissure ‘Fissure
Eradication’.
• 1955: Buonocore, adhering resin to an acid etched enamel
surface.
• 1962: Bowen & associates, developed Bis-GMA resin.
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Types of fissures
“V” Type “U” Type Inverted – “Y” Type
“IK” Type/ Hour glass Type “I” Type/ Narrow slit Type

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Morphology of pit and fissure

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Pit and Fissure Sealant:
Defined as “a cement or resin material which is
introduced into unprepared occlusal pit and fissure
of caries susceptible teeth forming a mechanical and
physical protective layer against the action of acid
producing bacteria from their substrates”

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BASED ON TYPES CHARACTERSITICS
I. GENERATIONS 1. First Generation
Sealants.
Activated by UV light
No more used
2. Second Generation
Sealants.
Chemical curing
resins.
3. Third Generation
Sealants.
Activated by visible
light
4.Fluoride containing
Sealants
Fluoride releasing
light activated resin
CLASSIFICATION OF SEALANTS

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BASED ON TYPES CHARACTERSITICS
II. FILLER 1. Unfilled Flow is better.
2. Filled More resistant to wear.
III. COLOUR OF THE
SEALANTS
1. Clear Esthetic but difficult to
identify.
2. Tinted Can be easily identified.
3. Opaque Can be easily identified.
CLASSIFICATION OF SEALANTS

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TYPES OF SEALANTS
• Cyanoacrylate
• Polyurethanes
• BIS-GMA – Bisphenol-A-glycidyl
methylacrylate

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INDICATIONS
• Presence of deep occlusal pit and fissures of
newly erupted teeth.
• Suspected or initial enamel caries in Pits &
Fissures.
• In children who are susceptible to occlusal
caries.
• In those susceptible areas of teeth palatal aspect
of upper lateral Incisors, upper 1st molars
palatal groove, buccal pits of lower molars.

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CONTRAINDICATIONS
• Presence of shallow pit and fissures of molars
and premolars.
• Low caries risk.
• Teeth with proximal decay or occlusal caries
involving dentine
• Semi-erupted teeth where isolation is a
problem.
• In uncooperative children

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Technique for sealant application
• Preparation Of Tooth
Polish the tooth surface
- By using prophylactic cup and Pumice with water.

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Technique for sealant application
• Isolation
Can be best done by rubber dam
application.
• Dry The Tooth
• Etching Of Tooth Surface
The tooth should be etched with 37%
orthophosphoric acid for 30-60 seconds

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• Rinse the Tooth
The tooth should be rinsed for approximately
30 sec.
• Isolate and dry the tooth
Should be dried with compressed air until it
has a white, chalky frosted appearance.
Moisture contamination at this stage is the
most common cause of sealant failure.
Technique for sealant application

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Technique for sealant application
• Apply bonding agent and cure it.
• Material application
The sealant is applied according to the
manufacture’s direction.
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Technique for sealant application
• Evaluate the sealant visually and
tactically
• Occlusal Evaluation
• Follow up- Retention and periodic
maintainance.

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FACTORS AFFECTING RETENTION
• Types of Sealant
• Position of Teeth in the mouth
• Clinical skill of the Operator
• Age of the Child
• Eruption Status of Teeth

19. • It involves use of dental hand piece to remove only those
areas of the tooth affected by caries.
• Then bonding resin restorative material into them.
• Covering all restorative material and any remaining
fissured anatomy with sealant.
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PREVENTIVE RESIN RESTORATION
(PRR)

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PREVENTIVE RESIN RESTORATION
(PRR)

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SEALANT V/S AMALGAM
S. no. Sealants Amalgam
1. Preventive technique where
tooth loss is minimal.
Restorative technique with
considerable loss of tooth
structure.
2. With sealant loss,
reapplication of material on
intact tooth.
Replacement of defective
amalgam results in greater
tooth loss.
3. Time taken to place sealant
is less.
More
4. Highly technique sensitive Less technique sensitive.
5. Cost effective on longer
duration
Cost effective on shorter
duration

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ART
Atraumatic
Restorative
Treatment

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Introduction
The Atraumatic Restorative Treatment(ART) is a
procedure based on removing carious tooth tissues using
hand instruments alone and restoring the cavity with an
adhesive restorative material (Glass ionomer cement).
Was first pioneered in the mid 1980’s in Tanzania
by Jo Frencken.

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Principles of ART
• This procedure is based on the principles
 Removing caries using hand instruments only.
 Restoring the tooth with an adhesive filling
material - glass ionomer .

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Applications of ART
 Introducing oral care to very young not
previously exposed to dentistry.
 For patients with extreme fear/anxiety.
 For mentally and / or physically handicapped
patients.
 For home – bound elderly and those living in
nursing homes.
 In patient with multiple carious lesions- as an
intermediate treatment to stabilize conditions.

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Contraindications
• Presence of abscess
• Exposed pulp
• Teeth which is painful since long time.
• Clear signs of cavity, such as proximal caries
which cannot be entered from the proximal nor
the occlusal direction.

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Instruments and Materials used
Mouth mirrors
Explorers
Pair of tweezers
Carvers
Glass slab
Spatula

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•Dental hatchets,
•Small and
medium sized
spoon excavators

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Materials for ART
• The essential materials are
gloves.
• Cotton wool rolls and pellets.
• Glass ionomer restorative
material and conditioners.
• Petroleum jelly (Vaseline)
wedges, plastic strips.

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Operating Positions

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The principle steps of ART
 Isolate the tooth with
cotton rolls
Rationale: Easier to work
in a dry environment than in
wet one.

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The principle steps of ART
Clean the tooth surface to be
treated with a wet cotton
pellet
Rationale: The wet cotton
wool pellet remove debris and
plaque from the surface, thus
improving visibility of the extent
of the lesion.

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The principle steps of ART
 Widen the entrance of the lesion
Rationale: The hatchet replaces the bur. By
rotating the tip, unsupported enamel will break
off, making an opening large enough for the
small excavator to enter.

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The principle steps of ART
• Remove the caries: Depending
on the size of the cavity, use either
the small or medium sized
excavator.
Rationale: All soft caries should
be removed to prevent caries
progression.

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The principle steps of ART
 Clean the occlusal surface: All
pits and fissures should be clear of
plaque and debris.
Rationale: The remaining pits
and fissures will be sealed with the
same material used for filling the
cavity.
Conditioning increases the bond
strength of glass ionomers.

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The principle steps of ART
• Provide pulpal protection if necessary
Rationale: Calcium hydroxide stimulates repair of
dentin and glass ionomers are biocompatible.
• Mix glass ionomer
according
to manufacturer’s
instructions

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The principle steps of ART
• Insert mixed glass ionomer into
the cavity and overfill slightly
• Press coated gloved finger on top
of the entire occlusal surface and
apply slight pressure so that
Glass Ionomer reaches the
deeper parts of the pits and
fissures

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The principle steps of ART
• Remove excess material with the
carvers.
• Cover filling or sealant with petroleum jelly
(Vaseline) or apply varnish.
• Instruct the patient not to eat for at least one
hour.

39. Reasons for using hand instrument
• Conserves sound tooth structure.
• Low cost of hand instrument.
• Limitation of pain.
• Simplified infection control.
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40. • It sticks chemically to both enamel and dentin.
• Fluoride is released from restoration which will prevent and
arrest caries.
• Similar to hard oral tissue and does not inflame pulp or
gingiva.
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Reasons for using glass ionomer

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Advantages of ART
• Accessible for all population
• Minimal cavity preparation and less trauma to teeth.
• Cost effective
• Simplified infection control
• Glass ionomer adheres chemically to both enamel and
dentine.
• Fluoride is released from the cement to prevent and
arrest caries

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