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Pits and Fissure sealants
Definition:
Fissure sealants are materials that are designed to prevent pits and fissures
caries by removing areas of stagnations of micro-organisms and food debris on
these areas.
Sealant is a clear or opaque plastic material that is applied to the pits and
fissures of teeth where decay occurs most often. The purpose of the sealant is to
provide a physical barrier to occlude pits and fissures and to protect them from
bacteria and food. Because the sealant obliterates the deep pits and fissures
anatomy, it also facilitates oral hygiene efforts because the sealed tooth is easier to
clean.
Ideal properties
1- Should flow over the surface of clean enamel.
2- Should be inert in the mouth.
3- Should have low viscosity on mixing so that surface spreading is rapid.
4- Should penetrate the etched enamel surface.
5- Should exhibit adequate mechanical properties on setting (strength,
abrasive resistance).
Classification
A- Depending on the type of curing:
1- First generation sealants (ultra violet light).
2- Second generation sealant (auto polymerization or chemical cure).
3- Third generation sealant (visible light cured).
B- According to color:
1- Transparent- clear, pink, amber.
2- opaque-tooth colored, white.
C- According to fluoride content:
1- fluoridated.
2- non- fluoridated.
E- According to filler content:
1- filled.
2- unfilled.
3- semi-filled.
أ.م. ساهر سامي
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Age of application for pit and fissure sealant.
3-4 years - primary molars.
6-7 years - first permanent molars.
11-13 years - second permanent molars and premolars.
Advantages
1- It is non-invasive technique, prevent tooth decay.
2- Fluoride released from fluoridated sealant can confer protection to
adjoining area.
3- Sealant can be used at the community level for prevention of caries.
Disadvantages
1- Lack of universal usage.
2- Inadvertent placement over carious lesion.
3- Technique sensitivity.
4- Caries susceptibility of etched enamel.
5- Economic feasibility.
Indications
1- Recently erupted teeth.
2- Molars and premolars.
3- Deep narrow retentive pits and fissures.
4- Sound proximal surfaces.
5- Patients receiving appropriate systemic or topical fluoride therapy and are
still caries active.
Selection of teeth
Considerations
Patient age
Oral hygiene
Caries risk
Diet
Fluoride history
Tooth type
Morphology
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Contraindications
1. Teeth remain caries free for 4 or more than 4 years.
2. Wide self-cleansing pit and fissures.
3. Proximal caries present.
4. Patient is not cooperating in child preventive program. The restoration is
preferred.
Light cured sealant materials
Advantages:
Short setting time (about 20 seconds).
No mixing required.
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.
Sealant kits
• Drying and/or bonding agent (optional)
• Acid etch
• Sealant material
Steps of application
1-Prepare the tooth
Bristle brush or rubber cup and plain pumice.
Sharp explorer to clean out debris
Rinse.
2- Check occlusion
By using articulating paper. Avoid placing acid etch and sealant on marked
areas from articulator paper.
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3- Isolation:
Rubber dam isolation. (If restoration is planned for the quadrant in which
teeth are to be sealed).
Cotton roll. (maxillary teeth, both covers the parotid duct and isolates the
tooth. Mandibular teeth, also retract the tongue and cheek ).
4- Etching tooth surface:
Acid etch either Gel or Liquid
The tooth is etched with 30-50% solution of phosphoric acid.
It dissolves inorganic portion of enamel and causes micro porosities.
Avoid contact with adjacent teeth or soft tissues. Can use mylar strips or
matrix bands.
Etch pit and fissures only, extend 1-2 mm beyond pit and fissures.
Avoid cusp tips.
The etching time is 30 seconds for permanent teeth.
For primary teeth an etching time of 30-60 seconds is recommended as
primary teeth possess a layer of prismless enamel which is difficult to etch,
also the organic content of primary enamel is more due to lower mineral
content and higher internal prism volume which may contribute to lower
sealant retention.
Acid conditioning enhances enamel porosity.
Increases the surface area and further cleans the enamel surface.
Acid conditioning should be limited to the tooth surfaces that will be sealed
and care should be taken to keep the acid away from all soft tissues.
5-Washing and drying
The surface must be washed with water for 10-20 seconds and dried for 10
seconds finally must have opaque appearance.
If the tooth does not have this appearance, it should be re-etched for another
30 seconds.
6- Applying bond agent to improve retention.(optional)
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7- Sealant’s application.
When using a light-polymerization system, the sealant material is placed on
all susceptible pits and fissures and a few seconds are allowed for the
material to flow into the deep pits and fissures.
The sealant is next cured with the light source according to the
manufacturer's recommendations. Generally this will be at minimum a 20-
seconds cure time for each surface that is being sealed.
8-Occlusal adjustment and finishing.
Occlusion is adjusted using articulating paper to check the presence of high
spots. If they are present, remove them carefully using round diamond bur
with high speed hand piece.
9-Recall:
Inform the patient or parents of the need for six-month recall appointments
to monitor sealant retention.
If the sealant has been lost or only partially retained, more sealant can be
added by repeating the steps in the application technique already described.
SEALANT FAILURE
Contamination.
Inadequate surface preparation.
Incomplete or slow mixing of self-cure sealants affects polymerization.
Too slow application of the material results in a less viscous (thicker) mix
that cannot flow easily into the pits and fissures, causing an incomplete seal.
Air entrapment due to whipping or vigorous mixing can occur during the
mixing of self-cured sealants.
Over-extension of the material beyond the conditioned tooth surface.