Fissure sealant pdf - د.ساهر

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 deeper and more tortuous 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……..etc).

Classification

A- Depending  on the type of curing:
    1- First generation sealants (ultra violet light).
    2- Second generation sealant (auto polymerization).
    3- Third generation sealant (visible light cured).

Now a day lasers  are used for curing due to the  following:

  Reduction in setting time .
  Control of specific radiation.
  Control of area of exposure.
  Decrease in the percentage of unpolymerized resin.

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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.

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.  Inadvertent placement over carious lesion.
2.  Technique sensitivity.
3.  Caries susceptibility of etched enamel.
4.  Economic feasibility.

Indications

1- Recently erupted teeth.

2- Molars and premolars.
3- Deep narrow retentive pit 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

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.

Chemical cure sealant materials

Advantages:

 No cure light or risk of eye damage.
 Can apply sealants to several teeth at same time.

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.
  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

Give the patient communication before treatment

Verbal instructions: I will be placing a dental sealant on your teeth – it’s like a
thin plastic coating on top of the tooth and will help prevent cavities. If you
have any problems then raise your left hand.

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
  Avoid placing acid etch and sealant on marked areas from articulator paper.

3- Isolation:
  Rubber dam isolation.
  Cotton roll. (maxillary teeth, both covers the parotid duct and isolates the

tooth).

 Anti-sialagogue treatment.
 good moisture control is the issue, not the particular method used.

4- Etching tooth surface:
Acid etch is available as gel or liquid. The tooth is etched with 30-40% solution of
phosphoric acid to dissolves inorganic portion of enamel and produce micro
retentive holes.

Acid etch Precautions:
Avoid contact with adjacent teeth or soft tissues, by use mylar strips or matrix
bands.

Apply acid etch

  Etch pit and fissures, Extend 1-2 mm beyond pit and fissures.
  Avoid cusp tips
  Phosphoric acid concentrations available as 30%-40
  It dissolves in organic portion of  enamel and leads to the formation of

micro-retentive porosity or holes “micromechanical retention”

  Creates more surface area for better adhesion
  The etching time is 30 sec. for permanent teeth.
  While for primary teeth an etching time of 30-60 sec 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 sec. and dried for 10 sec.

finally must have opaque appearance.

 If the tooth does not have this appearance, it should be re-etched for

another 30 sec.

6- Applying bond agent to improve retention (optional).

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 10-second cure time for each surface that is being sealed

8-Occlusal adjustment and finishing.

9-Recall :

 Inform the patient or parent 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.

Incipient Caries

Studies have shown that sealants can be placed over incipient caries which arrests
the caries process.