PIT AND FISSURE SEALANTS

THE BEST WAY TO PREVENT DENTAL CARIES

Pit and fissure sealents

• A pit is defined as a pinpoint depression located at the junction of grooves present over the grinding surfaces of the teeth.
• A fissure is defined as a deep cleft between adjoining cusps of a molar or premolar, usually located at the junction of developmental grooves.
• The term pit and fissure sealant is used to describe a material  that  is  introduced  into  the  occlusal  pits  and a micromechanically bonded, protective layer cutting access of caries-producing bacteria from their source of nutrients.
• The fissures and pits are normal anatomical findings in a dentition and caused by faults in dental enamel. Shallow fissures may not be problematic and be self cleansing and resistant to dental caries.
• However, deep and narrow fissures tend to lead to tooth decay. Both pit and fissures act as areas of initiation of caries due to food retention. To prevent dental caries. It is a safe, efficient and effective method of prevention of pits and fissure caries. .
•  It has been well documented that occlusal surfaces in young patients have a high caries susceptibility. The incidence of caries is relatively low on smooth, self cleansing surfaces (i.e., buccal, lingual, mesial, distal) where fluorides are highly effective in reducing decay.
•  Unfortunately, fluoride is not nearly as effective in the pits and fissures where approximately 50-85% of decay is found. The reason for this high rate of caries relates specifically to the pit and fissure morphology of occlusal and buccal/lingual surfaces.  Bacteria are able to breed in deep, narrow fissures where enamel did not completely form (called non coalescence of enamel). In many cases toothbrush bristles cannot reach to the depths of these spaces to remove bacteria
• History
  •  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
  •  Unfilled resin- BIS-GMA: Bowen (1965)
  • Glass ionomers – 1972
• Classification
  • Polymerization methods:
    •  First generation: UV light
    • Second generation: Self Cure
    •   Third generation: visible Light
    •   Fourth generation: fluoride releasing
  • Resin Systems
    • BIS-GMA (Bis phenol alpha-Glycidyl Methacrylate Adduct)
    •  Urethane acrylate
  • Depending on presence of filler
    • Filled
    • Semi-filled
  • Depending on color
    •  Clear
    •  Tinted
• GIC
  • The Glass Ionomer Cement were invented by Wilson and Kent in 1972 in London. Their use for pit and fissure sealing was advocated by McLean and Wilson in 1974.
  •  Characteristics which justify their use as pit and fissure sealant are:
    •  Physicochemical bonding with enamel and dentin.
    • Release of fluoride ions
    • Cariostatic and anti-microbial activity due to fluoride release.
    • Biocompatibility.
    • Resistance to oral fluids.
    • Ease of use.
  • Requirements
    • Should have high flow properties i.e. low surface tension,
    • low viscosity and low or zero angle of contact.
    • Adequate working time
    • Rapid cure
    • Good and prolonged adhesion to the enamel
    • Low sorption and solubility
    • COTE should be similar to tooth structure
    • Minimum irritation to tissues
    • Cariostatic action
    • Match the tooth color   
  • indications
    •  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
  • Contraindications
    •  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.
• procedures
  • Cleansing of tooth
  • Tooth isolation
  • Enamel etching
  • Application of sealant material
  • Curing of sealant material
  • Inspection of sealant
  • Re-evaluation of sealant
  • Cleansing of tooth
  •  Use a prophy cup and pumice with water (any non-fluoride paste can be used).