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Pit & fissure sealants

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HISTORY
‰.. Buonocore (1955) described
the technique of acid etching as a
simple method of increasing the
adhesion of self-curing methyl
methacrylate resin materials to
dental enamel.
‰.. Bowen et al (1965) developed the
BIS-GMA resin, Which is the chemical
reaction product of
BISPHENOL A + GLYCIDYL
METHACRYLATE.
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DEFINITIO
N
‰..Pits:-- small pinpoint depressions
located at the junction of
developmental grooves or at
terminals of those
‰..Fissures:-- grooves
fissures are shallow
lines or grooves between primary
parts of the Crown on the occlusal
surface.
‰..Grooves having non-coalesced
enamel are termed as fissures &
non-coalesced enamel in fossae is
termed as awww.FourthMolar.com
pit. 3
TYPES OF FISSURES

1. - Shallow
- Medium deep
- Deep
- Very deep

2. Three main types of pit & fissures have


been described by Nogano [1961] based on
an alphabetical description of shape.

i) Shallow, wide v-shaped fissures


- Tend to be self-cleansing & somewhat
Caries- resistant.
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ii):-- DEEP, NARROW I-SHAPED FISSURES
- QUITE CONSTRICTED & MAY RESEMBLE
A BOTTLE NECK HAVINGAN EXTREMELY
NARROW SLIT-LIKE OPENING WITH A
LARGE
BASE AS IT EXTENDS TOWARDS THE
DEJ.
- CARIES- SUSECPTIBLE
- MAY HAVE A NUMBER OF DIFFERENT
BRANCH.
III:-- U TYPE FISSURE.

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CLASSIFICATION OF FISSURES

‰..V-TYPE : WIDE AT THE TOP & GREDUALLY


NARROWING TOWARDS THE BOTTOM ( 34%).
‰..U-TYPE : ALMOST THEA SAME WIDTH FROM
TOP TO BOTTOM (14%).
‰..I-TYPE : AN EXTREMELY NARROW SLIT (19%).

‰..IK-TYPE : EXTREMELY NARROW SLIT


ASSOCIATED WITH A LARGER SPACE AT THE
BOTTOM (26%).

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EPIDEMIOLOGY OF PIT & FISSURE CARIES
‰.. IN THE PERMENANT DENTITION,OCCLUSAL
CARIES ACCOUNTS FOR ALMOST 60% OF THE
TOTAL CARIES EXPERIENCE IN CHILDREN
& ADOLASCENTS.
‰..PIT & FISSURE CARIES (INCLUDING THAT OF
BUCCAL & LINGUAL SURFACES) ACCOUNT FOR
ATLEAST 80% OF THE TOTAL CARIES
EXPERIENCE IN CHILDREN & ADOLASCENT.
‰..CARIES POTENTIAL IS DIRECTLY RELATED TO
SHAPE & DEPTH OF THE PITS & FISSURES &
CARIES SCLDOM BEGINS ON SMOOTH,& EASILY
CLEANSED SURFACES.-ROBERTSON(1889)
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‰..43% TO 45% OF ALL CARIOUS SURFACES IN
THE PERMENT DENTITION ARE ON THE GRINDING
SURFACES-G.V.BLACK(1936).

‰..THE NARROW ISOLATED CERVICES & GROOVES


THAT HARBOURFOOD & MICRO-ORGANISMS ARE
THE SINGLEMOST IMPORTANT ANATOMICAL
FEATURES LAEDING TO THE DEVELOPMENT OF
OCCLUSAL CARIES-PAYNTER & GRAINGER(1962).

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DIAGNOSIS OF PIT & FISSURE
CARIES
CRITERIA FOR DETECTION & DIAGNOSIS OF PIT &
FISSURE LESIONS ARE AS FOLLOWS:

(A) SOFTNESS AT THE BASE OF AREA .


(B) OPACITY OR LOSS OF THE NORMAL
TOOTH
TRANSLUCENCY ADJECENT TO THE PIT OR
FISSURE AS EVIDANCE OF
UNDERMINING OR DEMINERALIZATION.

(C) SOFTNED ENAMEL ADJECENT TO THE PIT OR


FISSURE THAT CAN BE SERAPED AWAY BY
EXPLORER. www.FourthMolar.com 9
%..DIAGNOSIS IS MADEBY :

-VISUAL ASSESSMENT OF THE ENAMEL


APPEARANCE & TECTILE EVALUATION
WITH AN EXPLORER USING MOUTH
MIRROR & ADEQUATE LIGHTING.

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REQUIREMENTS FOR OCCLUSAL
SEALENTS:

-ADHESION TO ENAMEL FOR EXTENDED


PERIODS
-ADEQUATE RETANTION
-NONINJERIOUS TO ORAL TISSUES
-FREE FLOWING & CAPABLE OF ENTERING
NARROW FISSURES BY
CAPILLARY ACTION
-RAPID POLIMARIZATION
-LOW SOLUBILITY IN ORAL FLUIDS
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INDICATION:
‰..DEEP, RETENTIVE PITS & FISSURES, WHICH MAY CAUSE WEDGING
OR ETCHING OF AN EXPLORER.

‰.. STAINED PITS & FISSURES WITH MINIMUM APPEARANCE OF


DECALCIFICATION OR OPACIFICATION.

‰.. PIT & FISSURE CARIES OR RESTORATION OF PITS & FISSURES IN OTHER
PRIMARY OR PERMANENT TEETH.

‰.. NO RADIOGRAPHIC OR CLINICAL EVIDENCE OF INTERPROXIMAL CARIES


IN NEED OF RESTORATION ON TEETH TO BE SEALED.

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‰..USE OF OTHER PREVENTIVE TREATMENT SUCH AS SYSTEMIC OR
TOPICAL FLOURIDE THERAPY TO INHIBIT INTERPROXIMAL CARIES
FORMATION.

‰.. POSSIBILITY OF ADEQUATE ISOLATION FROM SILAVERY CONTAMINATION.

‰.. TOOTH CONSIDER FOR SEALENT APPLICATION ERAPTED LESS THAN 4


YEARS AGO.

‰.. PATIENTS WITH CONSIDERABLE PREVIOUS OCCLUSAL CARIES EXPERIENCE


/ CARIES IN THE PRIMARY TEETH (dmfs=2 OR MORE) SHOULD HAVE ALL
SUSPETIBLE SITES ON PERMANENT TEETH SEALED.

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‰..CHILDREN WHOSE LIFE STYLE, DEVELOPMENTAL OR BEHAVIOURAL
PATTERNS, OR LACK OF FLORIDE EXPOSURE PUT THEM AT HIGH RISK
FOR DENTAL CARIES.

‰.. CHILDREN & YOUNG PEOPLE WITH IMPAIRMENTS IN WHOM THE GENERAL
HEALTH WOULD BE JEOPARDIZED BY DEVELOPMENT OF ORAL DISEASES OR
THE NEED FOR DENTAL TREATMENT.

‰.. INDICATIONS FOR USE IN COMMUNITY BASED CARIES.

‰.. PRIORITY 1 :-- PERMANENT I MOLAR FOR CHILDREN AGES FROM 6 TO 8


& PERMANENT II M,OLARS FOR AGES 11 TO 13.C

‰.. PRIORITY 2 :-- PREMOLARS IN HIGH-RISK CHILDREN & PRIMARY MOLARS.


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Glass inomer cement
INDICATION
only when the fissure is wide enough for entry
y a probe

When fissures are not patent , either a very sm


ered dimond bur should be used To open the
or to fissures sealing or a resin sealant should
chosen .
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 Ability to realese fluoride
 G.I. cements are formed by reacting calcium
alumino silicate with poly acrylic acid in the
presence of a fluoride flux. The resulting
material may contain as much as 19%
fluoride by weight . This fluoride is readily
exchanged for hydroxyl and chloride ions
from the adjacent enamel and dentin .

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 The tooth to be sealed is isolated
 The feasure is cleaned with 10 % poly acrylic acid conditioning
agent supplied by the manufacturer for 30 to 60 seconds
 The tooth is washed and dried .
 GI material , mixed to a consistency which will just flow, is applied
along the fissure and firmly burnished in to the positions. Excess
material is easily removed with the burnishers.
 A layer of unfilled BISGMA resin is applied to GIC and light cured
to prevent it drying out while it completes its setting reaction .
 The occlusion is checked and should “ a high spot “ required a
reduction , the further layer of varnish is applied to protect the
freshly set material .

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DENTIN BONDING AGENTS AS
SEALENTS
 Low viscosity resins used for adhesion of a
restoration enamel &/or dentin are generally
referred to as bonding agents
 Acid etching of enamel results in numerous
microscopic undercuts and irregular surface
features into which a fluid resin can be
applied and cured to produce a
micromechanical bond.

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CLASSIFICATION OF
SEALANTS
 FIRST GENERATION SEALANTS – [ nuva-seal ]
 Polymerised with UV light at a wavelength of 356
nm
 Classified as ‘ provisionally accepted ‘ by ADA in
1972 and ‘ accepted ‘ 1976 .
 Failed due to 1) poor clinical technique [ moisture
contamination , in adequate post - etch washing
and drying ] , 2) inconsistency of wavelength from
the UV light source and 3) the potential for retinal
damaged with long term exposure to UV light .

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 Second generation sealants
 Better formulations
 May be self cured chemically cured
 Mostly unfilled resin
 Better retension clinically then first
generation sealants [ ripa , 1993 ]

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 THIRD GENERATION SEALANTS-
 Light cured by visible ( blue ) light at a
wavelength of 430 nm & 490 nm
 May be unfilled or filled
 Have similar retention rates in the second
generation once

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DEPENDING ON COLOUR :
 Clear – detection requires tactile exploration
of the seal surface
 Opaque
 Tinted

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DEPENDING ON FILLER
 Filled – much higher wear and abrasion
resistance then unfilled resins with the same
bond strength ,setting times and retention
rates as unfilled resins( clear , yellowish –
white or tan ).
 Unfilled – white

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DEPENDING ON METHOD OF
POLYMERIATION
 SELF – CURING
 Light – curing UV light

Visible light

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SURFACE CLINICAL DO SEAL DONOT
DIAGNOSIS CONSIDER SEAL
ATION
CARIOUS OCCLUSAL IF PITS & FISSURES CARIOUS PITS OR
ANATOMY ARE SEPERATED BY FISSURES
TRANSVERSE
RIDGE ,SOUNDS,PIT
OR FISSURE MAY
BE SEALED.

QUESTIONABLE STATUS OF SOUND CARIOUS


PROXIMAL
SURFACES .

MANY OCCLUSAL MANY PROXIMAL


GENERAL CARIES LESIONS,FEW LESIONS
ACTIVTIY PROXIMAL LESIONS.

SOUND OCCLUSAL DEEP NARROW PIT BROAD, WELL


MORPHOLOGY & FISSURES COALESEED PIT &
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SURFACE CLINICAL DO SEAL DONOT SEAL
CONSICERATI
ON
SOUND TOOTH ACHE RECENTLY TEETH CARIES FREE
ERRUPTED TEETH FOR 4 YEARS OR
LONG

STATUS OF SOUND CARIOUS


PROXIMAL SURFACE

GENERAL CARIOUS MANY OCCLUSAL MANY PROXIMAL


ACTIVITY LESIONS & FEW LESIONS
PROXIMAL LESIONS

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1.POLISH THE TOOTH SURFACE
IT IS ABSOLUTELY NESESSARY TO REMOVE PLAQUE &
DEBERIS FROM THE ENAMEL & THE PIT FISSURESBOF
THE TOOTH.

ANY DEBRIES THAT IS NOT REMOVED WILL INTERFERE


& THE PROPER ETCHING PROCESS &THE SEALANT
PENITRATION INTO THE FISSURE & PITS.

POLISHING CAN BE CARRIED OUT BY USING


PROPHYLAXIS CUP & PUMICE.

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2.ISOLATE & DRY THE TOOTH SURFACE
RUBBER DAM PROVIDES THE BEST ISOLATION .
HOWEVER, IT MAY BE IMPRECTICCAL TO APPLY IN ALL
CIRCUMSTENCES.

IT IS ABSOLUTELY IMPERATIVE TO KEEP THE TOOTH FREE


FROM SALIVARY CONTAMINATION .

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3.ETCH THE TOOTH SURFACE;

THE TOOTH SHOULD BE ETCHED WITH A 37%


CONCENTRATION OF ORTHOPROSCOPIC ACID
FOR 15-30 SECONDS.
THE ETCHED SHOULD BE APLIED TO ALL
THE PIT & FISURES

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4.RAINSE THE TOOTH SURFACE

THE TOOTH SHOULD BE RAINSD FOR APPROXIMATELY


15 SECONDS.

5.ISOLATE & DRY THE TOOTH


THE TOOTH SHOULD BE DRIED WITH COMPRASSED AIR .
IT IS NECESSARY TO MAKE SURE THAT 3-WAY SYRINGE
IS FREE OF OIL & WATER
THE TOOTH IS DRIED UNTIL IT HAS CHALKY,FROSTED
APPERENCE

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7.MATERIAL APPLICATION

• THE SEALANT MATERIAL IS THEN APPLIED TO THE


ACCORDING TO THE MANUFACTURER’S DIRECTION.

• BE CAREFUL NOT TO INCORPORATE AIR BUBBLES IN


THE MATERIAL .

• AFTER THE SEALANT HAS SET ,THE OPRATER


SHOULD WIPE THE SEALED SURFACE WITH A WET
COTTON PELLET.

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8.EVALUATE THE SEALANT

THE SEALANT SHOULD BE EVALUATE VISSUALLY & TACTICALLY.

9.CHECK OCCLUSION

CHECK FOR OCCLUSAL HIGH POINTS & IF PRESENT CORRECT THEM

10. RECORD & PERIODIC MAINTENANCE


IT IS NECESSARY TO RE-EVALUATE THE SEALANT AT RECALL VISITS.

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