GOOD MORNING…

PIT AND FISSURE

SEALANTS…

Dr aruna
CONTENTS
 DEFINITIONS
 HISTORY
 CLASSIFICATION
 MATERIALS USED AS SEALANTS
 WHY PIT AND FISSURES ARE MORE PRONE TO
CARIES
 INDICATIONS AND CONTRAINDICATIONS.
 ADVANTAGES AND DISADVANTAGES.
 DIAGNOSIS
 CLINICAL PROCEDURES
 TREATMENT ALTERNATIVES
 RECENT ADVANCES
 ESTROGENICITY ISSUE
 REFERENCES
 CONCLUSION
DEFINITIONS:

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 producing agents.

SEALANT: is used to describe a material that is introduced into the
occlusal pit and fissure of caries susceptible teeth, thus
forming a micromechanically–bonded, protective layer
cutting access of caries producing bacteria from their
source of nutrients.
 EVOLUTION OF SEALANTS

 1835 Robertson caries ‹ depth of pit n fissures

 1895 Wilson used zinc phosphate

 1923- “PROPHYLACTIC ODONTOTOMY”-Hyatt

 1929- Bodecker enameloplasty

• 1951 Miller J --- Copper amalgam

• 1955- Buonocore – use of concentrated phosphoric acid solution

• 1965- FIRST PAPER on PFS published (Cueto and buonocore)

• 1968- Roydhouse used BIS-GMA monomer using methyl

methacrylate as diluent with peroxide amine polymerization
system.
• 1971- Buonocore

• 1976- First colored sealant- CONCISE WHITE SEALANT

(3M dental products)

• 1984- Burt reported- “first and second molars should be

sealed as soon as possible after eruption because of their
susceptibility to occlusal caries”

• 1989- Eccles noted- “fissure sealant should be used

preventively for caries prone patient, and
therapeutically for suspect or early carious lesion

• 2001- Colored sealants

 PREVALENCE OF OCCLUSAL
CARIES IN CHILDREN
• Bossert 1937 deep fissures & steep cusps
• 84 % of caries in 5 to 17 year-olds involved
pits and fissures--National Dental Caries
Prevalence Survey, 1979-80
• Brunelle & carlos 1982
• Swango&Brunelle 1983
20% by 8 years
70% by 20 years
ANATOMY :

Pit and fissures are formed when the union

of lobes of enamel in the calcification
process entraps the organic elements of the
enamel forming organ, a natural pit or thin
film of organic material is dissolved by
enzymatic and bacterial action, a natural
passage way into the recess of enamel is
created.
This natural fissure become a nature
culture tube for bacterial dissolution of the
remaining enamel.
 Why pit n fissure are more prone to caries
• Slack in 1973: stated that it takes approximately 3 years

• Bacterial and nutrient harboring capacity of pit and fissures

• Close proximity of its base to DEJ.

• Total inaccessibility of this area to mechanical debridement.

INEFFECTIVENESS OF FLUORIDE:
Systemic fluoride ingestion- selective benefit on smooth surface
caries

Thus, in fluoridated community- so there is Decrease in smooth

surface caries and relative increase in caries.

Ingestion of fluorides in pre eruptive phase: enhances coalescence of

occlusal pit and fissure and reduces steepness of cuspal inclines : so

decrease in caries.
THICKNESS OF ENAMEL:

Backer – Dirks 1974

Bohannan 1983

SEALANTS + FLUORIDE = MAXIMUM PROTECTION AGAINST CAVITIES

 MORPHOLOGY OF SURFACES WITH PITS AND
FISSURES:
• Caries in pit and fissure- related to form and depth of these
P and F
• Two main type of pits and fissures are usually described
– 1)Shallow, wide v-shaped fissures-self cleansing and CARIES
RESISTANT

– 2)Deep, narrow I-shaped CARIES SUSCEPTIBLE

• pit and fissure vary in shape- 0.1 mm wide and tortuous

NANGO 1960 (14%)

(34%) (19%)

(7%)

(26%)
• Fissure contains an organic plug composed of reduced
enamel epithelium, microorganisms forming dental
plaque and oral debris

• Fissure provides a niche for plaque accumulation

• Morphology of occlusal surfaces varies from one

tooth to another-
– 1)Premolar-prominent primary fissure with 3 or 4 pits
– 2) Molar-as many as 10 separate pits may be present in primary, secondary and
supplemental fissures

• Dental caries in fissures:

Enamel rods flare laterally in bottom of pit and fissure

Caries occur

Follow direction of enamel rods

Triangular lesion with base toward DEJ

Greater no. of dentinal tubules involved

Caries (occlusal surfaces) involve greater cavitation than

proximal lesions.
 MICROFLORA OF PIT AND FISSURES

Cocci constitute – 75% to 95% of microorganisms

S.Sanguis – Predominant viable microorganisms

S.Mutans and Lactobacilli – low in newly formed plaque in

fissures over time

Fusiforms, Spirillae and Spirochetes are absent

 HISTOPATHOLOGY OF CARIES IN PIT AND FISSURES

• Initially, caries progress in fissures-thought to

begin at base of fissure

• Inclines forming walls of fissure are affected next by

caries process
 First evidence of lesion formation occurs at orifice
of fissure- two independent bilateral lesions

Depth of fissure walls become involved

Coalescence of two independent lesions into single,

contiguous lesion

Once caries involves dentin-progress is enhanced

Cavitation of fissure-loss of mineral and structural support

Clinically detectable lesion

UNIQUE PROCESS OF CARIES FORMATION IN
FISSURE-

– Presence of organic plug in fissure acts as a buffer

against acid byproduct of plaque and provides lessened
acid attack at fissural base during initial phase of caries
formation

• Base of fissure may be close to or lie within dentin dentin

involvement is rapid frank cavitated lesion (Rohr et al
1991,)
 BUT ON SMOOTH SURFACES

At least 1mm of enamel present superficial to DEJ in

smooth surfaces

Sufficient enamel has to become involved to reach dentine

3-4 yrs required -dentinal involvement

Remineralization of caries may occur on exposure to

fluorides

Reversal of lesion may occur

HOW DO SEALANTS WORK ?

• Keep substrates out of pits, fissures and grooves

• Create an anaerobic environment  eliminating the aerobic bacteria

and other decaying matter residing in this area of the tooth.
 REQUIREMENTS FOR OCCLUSAL SEALANTS
• NON-TOXIC and NON IRRITATING to the tissues.

• Should ADHERE to the tooth as a thin layer and for an extended period of
time.

• Adequate consistency and viscosity to permit flow and penetration

• Sufficient mechanical compressive and tensile properties

• Minimum Shrinkage and expansion of the material avoid marginal leakage.

• The material should have optimal properties that allow it to be seen but be
harmonious with tooth structure.

• Low solubility in oral fluids.

• Cariostatic action
CLASSIFICATION OF SEALANTS
BASED ON GENERATION
A. First generation sealants:
- Polymerized by UV-light at a wavelength 356 μm.
Disad.: - Excessive fluid absorption
- Incomplete flow of sealant at its depth.
- variable output intensity
Ex: Nuva-seal
B. Second generation Sealants/Self curing resins
- Based on catalyst – accelerator system
- Most are unfilled.
- May be transparent, tinted or opaque by inclusion of
white pigment or a tint for better visualization.
Eg . Concise [3M] white sealant system, Delton
C. Third generation sealants:
-Light cured by visible light at wavelength 430 nm-490nm.
-May be classified as filled or unfilled, and with or with out
tint or opaquer.
-Most of the unfilled resins are colored white.
-Filled resins are either clear, yellowish white or tan
Ex: Prisma shield, Tan (Estiseal LC)

D. Fourth generation sealants:

Are those containing fluorides.
FLUORIDES INCORPORATION IN FISSURE SEALANTS

1) Fluoride is added to unpolymerized resin in form of soluble salt

- Releases fluoride for extended period: 24 hrs. to 30 days
Ex: Fluoro shield, Delton plus

2) Anionic exchange system:

An organic fluoride compound is chemically bound to resin
- An ion from saliva diffused into resin , exchanged with fluoride ion –
which then is diffused out and is released
FLUORIDE REPLACED RATHER THAN LOST
BASED ON FILLER CONTENT:

1. Unfilled [ free of fillers ]

-flow is better
-retention is more
-abrade rapidly
eg . Concise White , Delton

2. Filled
- need for occlusal adjustments
- more resistant to wear
eg. Prisma shield ,Nuva cote
BASED ON TRANSLUCENCY :

1. CLEAR
-Esthetic, but difficult to detect at recall
examination.
-Better flow than tinted or opaque
-More easily appreciated by the patient.

2. TINTED / OPAQUE
-Can be easily identified
– COLOURED

-Easy to see during placement

-Easy to see during recall check up
BASED ON CURING:

1. AUTOPOLYMERIZING .
- Better retention 88%
- Sets by exothermic
reaction

2. LIGHT CURE
- 75% retentive
MATERIALS USED AS PIT AND FISSURE SEALANT RESINS:

POLYURETHANES :
• Di-isocyante + high mol. wt glycol

• Urethane prepolymer

• Disadvantages :
-Adhesion of these polyurethanes to enamel is not
satisfactory
-poor mechanical properties
-Low oral durability(2-3 months)
SEPPAL -1982

• Eg. EPOXYLITE 9070, ELMEX PROTECTOR

CYANOACRYLATES

• Took longer time to disintegrate than polyurathenes

• Material sticks to the skin

• Poor mechanical durability

• Hydrolysis led to toxic materials

• Cyanoacrylates with fluoride were also available

 BIS-GMA

• BOWEN : INTRODUCED BIS-GMA-SEALANT OF CHOICE

• Addition of BIS-PHENOL A and GLYCIDYL METHACRYLATE

BIS-GMA

• In 1972, Nuva-Seal was the first successful commercial sealant to

be used.

• Hydroxyl group in BIS-GMA is responsible for viscosity.

• Some of these contain fillers, which make the sealant more resistant to
abrasion
MATERIALS USED AS PIT
AND FISSURE SEALANTS
 GLASS IONOMER AS
SEALANTS
Br Dent J. 1996 Feb 10;180(3):104-8.
WILLIAMS B et al Stated that glass
polyalkenoate cement & bis glycidyl
methacrylate resin sealants had similar
cariostsis but polyalkenoate cement had a
very poor retention rate & therefore stated
that Polyalkenoate cements probably should
be regarded as 'fluoride depot' materials
rather than fissure sealants.
Int J Paediatr Dent. 1996 Dec;6(4):235-9.
RAADAL M et al retention rates for resin-
based sealant after 3 years was (97%) & for
glass-ionomer cement was 9% It was
concluded that the resin-based sealant is
superior to the glass-ionomer cement in
preventing caries, and that the superior
retention of the resin probably is an
important factor for this.
• It was assumed that fluoride release from
GIC provided added benefit to the retentive
blocking of the fissure.

• Boksman et al, reported 92% and 2%

retention rates for Concise white sealant
and Fuji III GIC sealant respectively over a
period of 6 months.110

• Torppa – Saarinen reported that after 4

months 75% of the Fuji III sealants were
totally present, 22% partially lost and 3%
totally lost.
• Mejare and Mjor reported that 61% of the GIC
sealant were lost within 6 – 12 months and 84%
after 30 - 36 months whereas retention rates for
resin based sealants showed an average of 90%
after 5 years. Caries was recorded in 5 % of the
resin based and in none of the GIC sealed
surfaces.

• The clinical performance of RMGI sealants

showed 0% complete retention, 38% complete loss
over a duration of 2 years.

• Seppa et al, suggested that fissure sealed with GI

are more resistant to demineralization than
control fissures, even after macroscopic sealant
loss.
FLUORIDE RELEASING PIT AND FISSURE
SEALANT :
 Split mouth trial
(Lygidakis et al, 1999)
F vs non-F sealants: retention rates and caries
after 4 years
% sealants % teeth
retained decayed

F sealant 77% 9%

Non-F sealant 89% 10%

 FLUORIDE APPLICATION AND SEALANT
PLACEMENT
• Fluoride application is thought to render the enamel more
resistant to acid-etching procedures and there by affects the
bonding of sealant to tooth structure.

• Kho et al, in 1998 stated that topical fluoride treatment has no

clinical effect on retention of pit and fissure sealants.

• Warren et al, in 2001 confirmed that sealant retention may not

be affected by a topical fluoride treatment prior to sealant
placement.
EFFECTIVENESS OF SEALANTS:

Conservative preventive measure

When utilized in conjunction with water

fluoridation, its effectiveness increases by 20%

100% effective in protecting tooth surface

Retention varies for sealant coverage:

96% after 1 yr.
82% after 5 yrs
57% after 10 yrs
52% after 15 yrs
(JCPD Vol. 6: no.3: 2005)
EFFECTIVENESS OF PIT AND FISSURE
SEALANTS :
• The success of this treatment is measured by
degree to which treated teeth do not develop
occlusal caries and how long after the
placement the sealants are retained on the
teeth.
• Caries reduction from 1-5 years after the initial
placement of sealants have been reported &
found occlusal caries reduction of 80-100%
after 1 and 2 years
(Ripa 1980).
 AGE FOR APPLICATION

• 3-4 years
• 6-7 years
• 11-13 years

SIMONSEN 1983

Group 1- Caries free patients, no risk at decay

Group 2- Patients judged at moderate risk of decay
Group 3- Patients with rampant caries, high risk group
ADDITIONAL CONSIDERATIONS

• Age

• Fluoride environment

• Tooth morphology

• History of previous caries

• Dietary habits

• Oral hygiene
 Newly erupted .

 Minimum decalcification or opacification .

 The tooth in question - erupted less than four years ago.

  No evidence of proximal caries.

 No previous caries experience.

 Evidence of proximal caries.

 Wide and self cleansable .

 Cannot be isolated or partially erupted .

 PF - remained carious free for four years or longer.

 ADVANTAGES

• Non-invasive technique

• Fluoridated sealants

• Effective at community level

DISADVANTAGES
 DIAGNOSIS

• Conventional
a) Visual
b) Probing
c) Bitewing radiographs
• Xeroradiography
• Digital radiography
• Fibre optic transillumination
• Laser fluorescence
• Caries detecting dyes
TECHNIQUE OF SEALANT APPLICATION

• PREPARATION OF TOOTH

• ISOLATION

• CONDITIONING /ETCHING OF TOOTH SURFACE

• RINSING AND DRYING OF TOOTH

• PLACEMENT AND POLYMERIZATION OF SEALANT

• OCCLUSAL EVALUATION
TOOTH PREPARATION

• Earlier - cleaning enamel surface with pumice

and water mixture using rotary brush

• By patient - Direct bristles of dry brush in

pit and fissure

• Use of explorer (Donnan & Ball)

• Use of Prophy-Jet : air polishing system

• Air abrasion system with 50 um alumina particles

• Mechanical preparation of fissure with

tapered fissure diamond bur
 Julie A Blackwood in 2002 stated that
pumice prophylaxis followed by acid
etching resulted in similar sealing of sealant
to enamel when compared to that of air
abrasion or enameloplasty followed by acid
etching.
GARCIA-GODOY stated that using dry
bristles to clean the fissures resulted in good
retention rates.
ISOLATION OF TEETH

• Saliva contamination avoided to prevent

pption of glycoproteins on etched surfaces
which results in decreased bond strength.
(Silverstone 1984)

• FERGUSON AND RIPA – rubber dam

isolation provides better retention rates for
UV-light activated sealants.

• Use of cotton rolls – when using

auto polymerized resins.

• Rubber dam isolation - used when a

quadrant is to be isolated
 CONDITIONING

ETCHING
• Phosphoric acid -Concentration used – 30 – 40%
(Silverstone 1974)

• Etchant available as – liquid, gel or semi-gel form

• Applied using – small sponge, cotton pellet or

brush may be used

• “SKIPPING EFFECT”- USE OF GEL ETCHANT

• Technique of application : continuous but gentle

dabbing or agitation of sol on enamel surface

• Rubbing
• Site of application – 2/3 rd way up cuspal slopes

• Etch approx. 2 mm on either side of an exposed groove

• Shorter etching time for primary molars - chances of

contamination, during etching (acceptable for 3-4 yr old
children)

• Etching time has no effect on sealant retention

• Etching time has no effect on sealant microleakage (Shaffe

et al )
WHY IS PROLONGED ETCHING
TIME NECESSARY FOR PRIMARY TEETH ???

PRIMARY ENAMEL has

• Low mineral content
• High internal pore volume
• More exogenous organic material
• More prismless enamel Ripa (1966)

According to ADA symposium in 1991

Etching time for:
Primary teeth is 30seconds
Permanent teeth is 20 seconds

Tandon 1989
Duggal 1997

• Primary enamel has prismless structure

but it is not found on occlusal surface
 ZONES OF ETCHING
• NARROW ZONE OF ENAMEL/ETCHED ZONE – 10u deep that is
lost by etching

• QUALITATIVE POROUS ZONE – 20u deep, rendered porous- as

seen in polarizing microscope

• QUANTITATIVE POROUS ZONE/DEEPER ZONE – 20u thick –

indistinguishable from sound enamel, but is slightly porous due to acid
 PATTERNS OF ETCHING (Silverstone 1975)
• TYPE 1 :

• TYPE 2 :

• TYPE 3 :
 BONDING INTACT ENAMEL?
Self etch adhesives:

Study Group (n=10) Range Mean Median

Self Etch 11.06 - 15.03 13.39 13.4
Pre Etching 16.03 - 28.95 24.70 25.4
 ENAMELOPLASTY SEALANT TECHNIQUE
{ EST }

• Garcia-Godoi, et al demonstrated that EST allows a deeper

sealant penetration and a superior sealant adaptation than the
conventional sealant treatment without any mechanical
enlargement of the fissures.

• The reason was reported to be the increase in surface area.

• Kugel et al, in 2000 stated that enameloplasty reduces the

microleakage of sealants, especially when load was applied to
the teeth.
AIR ABRASION AND SEALANT :

• Some manufacturers air abrasion with aluminium oxide

roughened the enamel surface and could be a substitute for
acid etching prior to sealant placement.

• Kanellis et al, in 2000 stated that air abrasion without acid

etching was superior to that of acid etching prior to sealant
placement.

• Wright et al in 1998 stated that minimum microleakege was

obtained when bur preparation was done prior to sealant
placement, when compared to that of conventional cleaning
and air abrasion.

• Ellis et al, in 1989 stated that combined use of 50um alumina

and phosphoric acid treatment significantly enhances the long
term bond of a sealant to enamel.
 WASHING AND DRYING

REMOVE ALL ACID AND REACTIONARY PRECIPITATES

• Rinse with water for 10-20 seconds and dried for additional 10
sec

• Water under pressure in air-water spray + high power

evacuation
• If cotton rolls are being used- replaced after becoming saturated during
etching and washing

IF CONTAMINATION OCCURS . . . .

• If saliva contamination does occur – re-etching for 10 sec before washing

once again

• If etched enamel is exposed to saliva for 1 to 60 sec , re-etching

• Minimal saliva exposure for less than 10 sec, immediate washing

performed
USE OF DENTIN BONDING AGENTS

FEIGAL et al.. hydrophilic bonding materials

may, when applied under sealant, minimize
the bond strength normally lost -- when a
sealant is applied in a moist environment..
• It also reduces microleakage

• In primary teeth- use of sealants in moisture contaminated

areas gave better results than sealant alone on non-
contaminated areas

• Single bottle agents- protect sealant survival :

SEALANT APPLICATION

• Sealant applied with disposable bristle brush

• For auto polymerizing resins – cover etched areas on each tooth as

quickly as possible with sealant and then bulk can be added

• For light curing resins – no mixing necessary and hence reduced

bubbles

• THUS TOTAL TIME FOR SEALANT APPLICATION SHOULD

TAKE 3 ½ MIN
 2. Apply sealant        

1. Etch enamel           

3. Light cure     

Courtesy of 3M Dental
Products
ADJUSTMENT AND RECALL

Surface wiped off to remove surface film –

inspection of surface

Occlusion checked with articulating papers

Occlusal interferences removed

Filled sealants adjusted with green stone

Sealants should be evaluated every 6 months

Bite-wing RG: detect caries progression under sealants
LAST STEP OF SEALANT APPLICATION INVOLVES

• Education of patient and the parents about

the importance of periodic re-evaluation of

the sealants
 AUTOCURED Vs LIGHTCURED SEALANTS

• Handelman (1987) reported 84% complete retention of

autocure sealants when compared to 75% complete retention
rates of UV cured sealants over a duration of 2 years.

• Fuks A (1990) reported no significant differences in retention

of visible light cured and autocured over a duration of 31
months.

• De Craene et al in 1989, showed that visible light cured

sealant to be as good as self cured sealants.
 FILLED Vs UNFILLED

• Advantages

• Disadvantages

• Tilliss et al, showed that with a filled sealant, nearly all

subjects experienced a perceptible occlusal change and
discomfort.
 FILLED Vs UNFILLED

• Unfilled light cure resin retention was better than that of filled
light cure resin.

• Wright et al reported that microleakeage of unfilled sealant

was less than that of filled sealant.

• Kay (1990) stated that over a duration of 2 years 81% of the

Prisma shield sealant { filled }was completely retained
compared with 88% of the unfilled Concise white sealant.
 SEALANT and AMALGAM RESTORATIONS
• For the general dentist the question is to whether the
sealant or restorative approach is better or more
appropriate?

• The sealant technique involves minimal, loss of surface

enamel through acid-etching & lasts over atleast 5 years

• Re-etching and replacement of lost material is easily

carried out with minimal further effects on the tooth.

• The difficulty of proper placement of an acid etch resin

sealant in the posterior area of the mouth in a child
obviously causes many practitioners to turn towards
amalgam.
-The operative procedures and the removal

of tooth substance weakens the tooth

mechanically and contributes to marginal
breakdown.
-Amalgam, the most frequently used
restorative material, shows marginal
breakdown and corrosion leading to
leakage and secondary caries.
-The use of dental amalgam introduce
• The real issue in the minds of many general
dentists is cost effectiveness. The belief is
widespread that amalgam restorations are
more durable and more grateful in terms of
investment in time and money.
• Time of initial placement of sealant
averaged 6 minutes, 29 seconds with
necessary reapplication, increasing to 10.02
min after 4 years whereas limited amalgam
placement averaged 13.51 with refinishing.
• Overall, sealant took 29% less time.
 COLOURED Vs CLEAR SEALANTS

• The first coloured sealant introduced in 1977 was 3M’s

Concise white sealant.

• Advantages

• Disadvantages

• Rock reported the identification error rate for opaque resin

sealant was only 1% whereas, for clear resin it was 23% .
LATEST TREND :

• Incorporation of the colour change in the curing phase or in

the polymerised phase.
Ex: Clinpro from 3M ESPE, Helio seal clear chroma from
IVOCLAR VIVADENT.
SEALANT PLACEMENT OVER CARIOUS SITES ?

• Not recommended over detectable carious lesion- unless marginal

integrity can be maintained

• Handelman in 1972 was a first to report effects of sealant over

caries. Preliminary clinical and radiographic findings suggested
that there was no progression of disease.

• Reduction in viable organisms cultured from sealed fissures

(HANDLEMAN AND WASHBURN 1976)
 SEALANT OVER CARIES

• Going et al, stated that limited number of cultivable

organisms persist in some lesions, but their numbers
was so few that they incapable of continuing the
destruction of tooth structure.

• Inactivity was also seen by- lack of Radiographic

progression observed over time (FERERSKOV 1977)
• Calson et al suggested that pit and fissure sealant with
resin based material does not affect S.mutans levels.

• Mass et al studied the continuous effect of pit and

fissure sealing on S.mutans and reported a prolonged
reduction in the S.mutans count.
 CLINICAL PROBLEMS

• Lack of universal usage

• Technique sensitivity
• Caries susceptibility of etched enamel
• Placement over carious sites
• Loss of sealant
ADVERSE REACTION TO A FISSURE SEALANT :

Allergic reactions of various substances are reported to be

increasing in children.

One such allergic reaction to a Delton pit and fissure

sealant containing TEGDMA, Bis-GMA monomer systems
has been reported. In this formaldehyde is a potential
allergen.

Benzoic acid is known to be an elicitor of

nonimmunological contact urticaria.
 ESTROGENECITY ISSUE

• Olea and co-workers in Granada shattered a controversy

regarding the pit and fissure sealants.

• BIS-GMA, UDMA, TEGDMA, are the main ingredients of

resin composites.

• The conversion of monomers during the curing process of a

sealant is incomplete, thus residual monomers can leach out of
the cured resin.

• Olea study confirmed the estrogenecity of BPA and also

implicated BIS-DMA as a estrogenic factor.
• Olea (1996) detected these monomers in the saliva of
human subjects 1 hour after sealants had been placed.

• Soderholm and Mariotti revealed that short term

administration of BISGMA or BPA in animals or cell
cultures can induce changes in estrogen sensitive
organs or cells, but the short term risk of estrogenic
effects was insignificant.

• Schafer (2000) reported that BPA released orally from

a dental sealant may not be absorbed or may be
present in non-detectable amount in systemic
circulation.
• Manabe (2000) stated that BPA released from
dental materials would be less than 1/1000 of
the reported dose required for
xenoesterogenicity in vivo ( 2ug/kg/day ).

• Ergle (1999) suggested the use of abrasive

such as pumice on the sealant surface to
minimize the exposure of uncured
components.
 ALTERNATIVE TREATMENT
MODALITIES FOR PIT AND FISSURES

• Observation
• Conservative adhesive restorations / PRR
(Simonsen and Stallard 1978)
• ART
CONCLUSIONS AND RECOMMENDATIONS :

• The fissure sealants if properly applied and maintained are

effective in preventing dental caries in pits and fissures.
• Fissure sealant materials should be opaque or coloured to
facilitate subsequent inspection and maintenance.
• Fissure sealants should be introduced as primary preventive
measure under the general dental service for children with
special needs.
• The use of fissure sealant is recommended as an alternative to
amalgam filling to treat questionable or early carious lesions
in pits and fissures.
• Further research in to the sealant restoration technique should
be encouraged.
 PREVENTIVE RESIN RESTORATION
FISSURE SEALANT OR SEALANT RESTORATION (SIMONSEN 1978)
• First introduced in the early 1970’s.

• The technique was titled sealant restoration because it was a

restoration using sealant as integral part of the procedure.

• The original 3 types of PRR (A,B & C ) from 1977 were

modified slightly and updated in 1985 as type 1, 2 and 3.

• Type 1:
• Type 2:
• Type 3:
 PREVENTIVE RESIN RESTORATIONS (PRR)

• INDICATIONS…
 Tooth can be isolated.
 No, or only minimal staining.
 Minimal “catches” in the grooves, or areas with distinct
incipient enamel caries.
 No evidence of radiographic caries.
LOSS OF SEALANT
THREE TYPES OF PRR – based on extent and depth of
carious lesion as determined by exploratory preparation.

• TYPE 1: suspicious pit and fissure where caries removal

limited to enamel (UNFILLED SEALANT)
• TYPE 2: incipient lesion in dentin that is small and confined
(DILUTE COMPOSITE)
• TYPE 3: is characterized for greater exploratory preparation in
dentin (FILLED RESIN COMPOSITE)
 PROCEDURE OF TYPE 1:

PRR indicated - clinical “catching” on probing. Unsound enamel removed.

Flowable composite placed.

PROCEDURE OF TYPE 2:
Procedure of Type 3:
• Isolation
• Cleaning of fissures and areas
• Removal of carious tooth structure
• Application of bonding agent
• Restorative resin composite
• Application of sealant to adjacent pits and fissures
• Removal of rubber dam and correction of occlusion
 Demineralized
enamel removed.
Decay evident on Caries detection dye placed
maxillary first molar. on exposed dentin.

• BURS USED:
-no.330, 1/2, 1, 33
1/2
-Fissurotomy
burs
• AIR ABRASION

Decayed dentin Occlusal relationship.

identified & removed
Restored with
Conventional composite.
• Feigal in 1998 reported that PRR had a proven record but were
susceptible to failure as the overlying sealant field.

• Mc Combe in 2001, noted that the weak link in the later PRR is
the overlying fissure cement which requires adequate ongoing
maintainance.

• Lyons in 2003, reported that PRR should be placed to restore

deep pits and fissures with incipient caries or developmental
defects in primary and permanent teeth.
 RECENT ADVANCES
sealants
GC FUJI TRIAGE ADVANTAGES
-No isolation required & works in a
moist field.
-No bonding agent required.
-Sealing over immature enamel or non-
cavitated lesions

.Six Times More Fluoride Than Any Other Sealant

.Releases Fluoride for up to 24 Months to Help Prevent Decay

from Acid and Bacteria

.TRIAGE WHITE is for fully erupted teeth;

.TRIAGE PINK offers a visual indicator that is ideal

for newly erupted molars
HELIOSEAL CLEAR CHROMA
Light-cured transparent fissure sealant with reversible colour
changes.

Advantages
•Reversible colour change - check seal and retention via
polymerization lamp at every recall
•Transparent - aesthetic results
•Changes under the sealant can be checked
•Excellent flow properties - optimal wetting of fissures
•Luer-Lock syringe - precise application
DELTON® SEAL-N-GLO ILLUMINATING PIT &
FISSURE SEALANT

• 38% filled, syringe delivered,

• Opaque sealant with fluoride

• With use of a UV pen light, Seal-

N-
Glo fluoresces a blue/white color.

• This fluorescent technology is

valuable throughout the lifetime of
the sealant
 EMBRACE, WETBOND

WET-BONDING resin technology

LESS MICROLEAKAGE

MARGIN-FREE. No chipping. No staining.

FEWER STEPS. Saves time and money.

NO DRYING OR BONDING AGENTS REQUIRED

AEGIS® PIT & FISSURE SEALANT

.Pit & Fissure Sealant with ACP

.Is more resilient and flexible

.Can be used with any light-curing

device
AIR ABRASION IN PREVENTING AND TREATING
EARLY PIT AND FISSURE CARIES Chris L.
 The Role of Air Abrasion in Preventing and Treating
Early Pit and Fissure Caries ?
• Air abrasion units allow the clinician to focus a stream of
aluminum oxide particles on a specific area of the tooth.
The restorative capabilities of this technique are wide-
ranging and dependant on how the operator controls the
following variables.

PRESSURE
• For fissure surface cleansing prior to sealant application, a
brief exposure at 40 p.s.i. is sufficient, while more
extensive decay removal may require nozzle pressures of
80 p.s.i or more.

TIP SIZE
• Tip aperture ranges from 0.015” to 0.027” in diameter.
TIP DISTANCE :
• By keeping the tip less than 2 mm from the target
surface, the clinician maximizes the focus of the
abrasive stream.

PARTICLE SIZE :
• While 27 µ aluminum oxide powder is the norm
for intraoral preparation, some units are capable
of carrying the much larger 50 µ powder.
 CONCLUSION

When in doubt SEAL rather than fill…

-Bodecker
 REFERENCES
 FUNDAMENTALS OF PEDIATRIC DENTISTRY.- R.MATHEWSON

 DENTISTRY FOR CHILD AND ADOLESCENT – MC DONALD

 PEDIATRIC DENTISTRY – STEWART

 TEXTBOOK OF PEDODONTICS – SHOBHA TANDON

 PEDIATRIC DENTISTRY: INFANCY THROUGH ADOLESCENCE-

PINKHAM

 TEXTBOOK OF PEDIATRIC DENTISTRY. – BRAHAM MORRIS

 SEALANTS: REVIEW OF LITERATURE (PEDIATRIC DENTISTRY

2002)

 GOOGLE SEARCH
THANK YOU…
Have a great day!