Contents:Introduction.Historical backgroundMorphology and diagnosis of pit and fissuresPit and fissures sealants

ClassificationRequirementsIndications and contraindicationsTooth preparations and techniquesSealant over cariesGlass Ionomer cement vs. sealant

Conclusion

Occlusal surface of teeth: 12% of total surface area. 80% of caries occurs on occlusal surface. 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.

Caries potential is directly related to shape & depth of the pits & fissures & caries seldom begins on smooth,& easily cleansed surfaces- (Robertson,1889)

43% to 45% of all carious surfaces in the permanent dentition are on the grinding surfaces-G.V.Black(1936).

The narrow isolated cervices & grooves that harbor food & micro-organisms are the singlemost important anatomical features leading to the development of Occlusal caries-Paynter & Grainger(1962).

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TYPES OF FISSURES

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

2. Types of pit & fissures have been described by Nogano [1961] based on an alphabetical description of shape.

a) Shallow, wide v-shaped fissures- Tend to be self-cleansing & somewhat Caries resistant.

b) U shape fissure. c) K shape or bottle neck fissure- Narrow at top and wide at

bottom.d) T shape fissure.

Wilson used zinc phosphate Kline and Knutson- use of ammoniacal silver nitrate Extension for prevention: G. V. Black Prophylactic odontotomy : Hyatt (1923) Fissure eradication: Bodecker (1929) Acrylic polymers introduced to dentistry – 1937 Acid etching: Buonocore (1955) Composites – 1960 FIRST PAPER on pit and fissure published (Cueto and

Buonocore)- 1965 Unfilled resin- BIS-GMA: Bowen (1965) Glass ionomers – 1972

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DIAGNOSIS OF PIT & FISSURE CARIES

• Diagnosis is made by :Visual assessment of the enamel appearance & tactile evaluation with an explorer using mouth mirror & adequate lighting.

(a) Softness at the base of area.

(b) Opacity or loss of the normal tooth translucency adjacent to the pit or fissure as evidence of undermining or demineralization.

(c) Softened enamel adjacent to the pit or fissure that can be separated away by explorer.

Plaque present, the decay rate, and history in

exposure to fluoride. Occlusal restorations on adjacent molars. Tooth on the opposite side of the mouth with

similar morphology has caries/decay or a filling.  Adults with low saliva secretion. Time Since Tooth Eruption. General condition of the mouth. Age of the patient. Attendance record of the patient. Medical conditions.

ALSO EVALUATE

The term pit and fissure sealant is used to

describe a material that is introduced into the

occlusal pits and fissures of caries susceptible

teeth, thus forming a micromechanically bonded,

protective layer cutting access of caries-

producing bacteria from their source of nutrients.

1) Polymerization methods: a. Self activation b. Light activation

2) i. First generation; UV light ii. Second generation: Self Cure iii. Third generation: visible Light iv. Fourth generation: fluoride releasing

3) Resin Systems a. BIS-GMA b. Urethane acrylate

4) Filled or unfilled

5) Clear or tinted

1. A viscosity allowing penetration into deep and

narrow fissures

2. Adequate working time

3. Rapid cure

4. Good and prolonged adhesion to the enamel

5. Low sorption and solubility

6. Resistance to wear

7. Minimum irritation to tissues

8. Cariostatic action

Carious occlusal anatomy- If pits or fissures are

separated by transverse ridge, a sound pit or

fissure may be sealed Carious pits or fissures- Deep, narrow pits and

fissures General caries activity-mild, Many occlusal

lesions; few proximal lesions Recently erupted teeth

Many proximal lesions General caries activity-high Sound Broad, well-coalesced pits and fissures Teeth without caries (free for 4years or longer) Rampant caries / decay.  Interproximal lesions .  Occlusal surface is already carious.  Tooth present in mouth for many years and there

is no evidence of decay. 

1. Cleansing of tooth

2. Tooth isolation

3. Enamel etching

4. Application of sealant material

5. Curing of sealant material

6. Inspection of sealant

7. Re-evaluation of sealant

Use a prophy cup and pumice with water (any non-fluoride paste can be used). 

Run explorer through the grooves to remove pumice. 

Thoroughly wash, dry, and re-examine. Mechanically prepare the tooth (optional ). There is no need for anesthesia.

To maintain a dry field, use rubber dams or

cotton rolls. If the tooth is contaminated with saliva, the

etching must be done over again.

37% phosphoric acid in gel form applied 2/3 way

the cuspal incline to create microporosities within

the enamel. Etch tooth 20-30 seconds. Fully rinse and dry tooth.

Apply the sealant material according to manufacturer’s direction.

A brush is used to allow it to follow the curvature of the tooth.

The sealant may be light-activated or self-curing. Avoid air bubbles

Visible light is used to cure (harden) the sealant material.

Use an explorer to ensure that all grooves are filled/sealed and smooth.

Verify that the sealant doesn’t extend over the marginal ridge of the tooth.

Check for occlusal interferences using articulating paper.

If necessary, remove excess. No contact points on sealants. There is no need for further polishing.

Observe the sealants at all future appointments. One may need to re-apply the sealant. Re-applications, along with fluoride, and other

preventative measures can provide a 100%

caries free and restorative free patient.

Air bubbles may be present between or under sealants: Sealant should be ground down to expose the air bubble, and the bubble should then be filled / repaired

Porosities may develop in the sealant:Reapply the sealant.  If this is delayed, decay may form around the edges.

Sealant may fall off :Reapply the sealant.  

Caries / decay left under the sealant :This is a contraindication for sealant placement. The sealant should be removed, and a filling should be placed.

Etching agent should be 35-37% orthophosphoric acid.

15 sec. of etching is sufficient. There is benefit in using a bonding layer,

which improves retention. Dry brushing, rotary brushing with pumis,

air polishing and air abrasion are all acceptable for cleaning the tooth.

Flouride-containing sealants show no superiority to regular sealant.

GI sealants show poor retention in comparison to resin based sealants.

Autocured vs. light cured sealants show similar performance, However, autocure have more retention.

Microleakage is greater in teeth that aren’t prepared before sealing, but if sealant falls, the preparation causes a higher chance of caries.

Sealant is not supposed to be applied once.

Argon laser curing: argon laser polymerization

provides further caries protection against a

cariogenic challenge over that afforded by fluoride-

releasing sealants

DIAGNOdent (KaVo): laser fluorescence system into

detecting caries under sealants.

Use of air abrasion 50 micron Alumina particles for

tooth preparation.