pits and fissure

PITS AND FISSURE SEALANTS

MUJTABA NADEEM

BDS 2nd year Roll number 124

Annuit coeptisNovus Ordo Seclorum

WHAT ARE PITS AND FISSURE SEALANTS?

Defined as

A material applied to occlusal surfaces of the teeth in order to obliterate the occlusal fissures and remove the sheltered environment in which caries may thrive.

WHY PIT & FISSURE ARE SEALANTS NEEDED?

TOOTH MORPHOLOGY Why fissures are

caries susceptible

CLASSIFICATION OF SEALANTS

GENERATIONS OF PITS AND FISSURE SEALANTS

First Generation Ultraviolet Light cured

Second Generation Chemically cured (auto polymerized),

Third Generation Visible Light cure

Fourth Generation Those containing Fluorides

A. TYPES OF FISSURE SEALANTS

Plastics based Sealants Polyurethanes Cyanoacrylates Bisphenol a glycidyl methacrylae (BIS-GMA)

Resin based Sealants Glass Ionomer Sealants Fluoride containing Sealants

B. TYPES OF FISSURE SEALANTS

Filled and Unfilled Light cured and Chemically cured Clear and Tinted

A. TYPE CLASSIFICATION SEALANTS

Plastic Sealants

(Bis-GMA) Bisphenol A-glycidyl methacrylate resins

Urethane-based resin

Sealant of choice

A. TYPE CLASSIFICATION SEALANTS

Glass Ionomer Cement Clinical advantage of chemically bonding to

dentine and enamel without the acid-etch technique.

Less vulnerable to moisture Fluoride release Active fissure system Not for long term. Exerts a cariostatic effect even after removal

of GIC.

B. TYPE CLASSIFICATION SEALANTS

Filled and Unfilled Addition of fillers make the sealants more

resistant to abrasion. Fillers are coated with products such as

silane, to facilitate combination with the BIS-GMA plastic.

TYPES OF CURING FOR SEALANTS

Chemical cured – “Autopolymerization” Base and catalyst

Monomer & Initiator + Diluted monomer & 5% Organic Amine Accelerator = Sealant

Visible light cured – “photopolymerization” Pre-mixed

Dimethacrylate + Diluent + Activator + Light = Sealant

CHEMICAL CURE SEALANT MATERIALS

Advantages No cure light or risk of eye damage Can apply sealants to several teeth

Disadvantages Variation in setting time (appx 2 min) Voids from mixing material Changes in viscosity over time

LIGHT CURED SEALANT MATERIALS

Advantages Short setting time (appx 20 seconds) No mixing required Won’t set-up – longer working time Does not get thick

Disadvantages Potential eye damage due to light cure Additional cost of cure light Cure time increased with number of teeth

sealed Difficult to manipulate cure light for posterior

teeth

CURING UNITS

Conventional cure light with halogen bulb = 20 seconds cure for each surface

Plasma arc or laser = 5-10 seconds

Clear and tinted Depends on induvidual preferences. Vary form translucent to white,pink and

yellow. Coloured pemits a more precise placement of

the sealant. On the other hand clear may be considered

more aesthetically acceptable.

SEALANT SHADES

Clear Tinted Opaque

REQUISITES FOR SEALANTS RETENTION

The tooth surface must have Maximum surface area

Surface area can be increased by tooth conditioners or etchants(30-50%phosphoric acid).

Pits and fissure depth Deep irregular pits and fissure offer a much more

favorable surface contour for sealant retention. Deep fissures protect the plastic sealant from shear

forces as a result of mastication. Surface cleanliness

Thorough prophylaxis paste should be applied. All heavy strains, debris and deposits be removed

before application. Dryness

Saliva interposes between the tooth and sealant. Air stream be checked for moisture contamination. Directing the air stream onto a cool mouth mirror.

APPLICATION PROCEDURE

INDICATIONS

Deep fissures Incomplete or ill formed pits Newly erupted teeth High caries rate Children Molars

CONTRAINDICATIONS

Shallow fissures Well coalesced pits Fluoride rich enamel Low caries rate Occlusal or proximal caries Adults

ACID ETCH

Gel Liquid

ACID ETCH Phosphoric acid 35%-40%-

50% Dissolves organic portion of

enamel “micromechanical

retention”

ACID ETCH - CONTINUED Creates more

surface area for better adhesion

ACID ETCH - PRECAUTIONS

Avoid contact with adjacent teeth or soft tissues

Can use mylar strips or matrix bands

DRYING AGENT

Acid etching and Primadry (alcohol based) allows enamel to be easily “wetted”

ACCEPTED SEALANT MATERIALSADA COUNCIL ON SCIENTIFIC AFFAIRS 3M ESPE – Clinpro Sealant Confi-Dental Products Company Dental Technologies Dentsply International - FluroShield Ivoclar Vivadent, Inc. - Helioseal Kuraray America Inc. – Teethmate F-1 PracticeWares Dental Supply Pulpdent Corporation Southern Dental Industries Tru-Tain Prime Dental Ultradent Products, Inc. - Ultraseal Zenith/DMG Dental Manufacturing

ISOLATE TOOTH/TEETH Rubber dam Cotton rolls Cotton roll holders

DRY TOOTHTest air/water

syringe before applying blast of air

APPLY ACID ETCH

15-20 seconds Use blue micro tip

or brush tip Apply only in pit

and fissures For liquid – dab

but do not rub Re-etch 10

seconds if saliva contamination

APPLY ACID ETCH Etch pit and fissures Extend 1-2 mm

beyond pit and fissures

Avoid cusp tips

ACID ETCH - CONTINUED

Etch longer Deciduous teeth Saliva

contamination Air abrasion or

prophy jet used Highly mineralized

teethDo not use explorer

RINSE TOOTH/TEETH

Use HVE and a/w syringe

Proper – usually 20 seconds rinse

Avoid saliva contamination

Re-isolate

DRY TOOTH/TEETH

Should appear chalky or frosty white if etched

If not, re-etch for another 10 seconds if not contaminated

with saliva

APPLY DRYING AGENT

Use brush tip Apply and leave

for 5 seconds Gently blow air to

dry DON’T RINSE

APPLY BOND AGENT

A bond agent will improve retention

APPLY SEALANT MATERIAL

Most posterior tooth first

Extend 1-2 mm beyond pit and fissures

Gently work into pits and fissures

Avoid lifting off tooth Don’t overfill “pop” bubbles in

sealant with explorer or brush tip before curing

LIGHT CURE FOR 20 SECONDS 20 seconds each

tooth Don’t touch tip of

cure light to sealant material

Don’t let saliva contaminate the field…..yet

LIGHT CURE FOR 20 SECONDS – AIR INHIBITION THEORY

Sealant will appear shiny/wet

CHECK SEALED TEETH

Use explorer Tooth should be

smooth but not soft

Re-apply sealant, if necessary(Remove uncured sealant with wet cotton roll)

GIVE PATIENT INSTRUCTIONS The sealant is hard so you don’t have any

restrictions on eating If it feels “high” after you go home – you can

come in to get it adjusted We will keep checking the sealant at

subsequent appointments(if using unfilled corposite sealant the bite will self adjust in 2-3 days)

FAILURE OF SEALANTS

Main cause – moisture contamination

Maxillary and mandibular 2nd molars

Early loss means less retention of the resin