This document provides information on dental pit and fissure sealants, including their definition, history, properties, rationale for use, indications, contraindications, and application technique. Pit and fissure sealants are protective materials applied to the pits and grooves of teeth to prevent decay by isolating them from bacteria. They were first developed in the 1960s using bis-GMA resin and are now most commonly applied to posterior primary and permanent teeth judged to be at high risk of decay. Proper technique involves cleaning, etching, application of sealant, and curing either chemically or with visible light. Sealants are effective at preventing decay when applied correctly.
2. Definition
• According to ADA:
An adhesive material that is
applied to pits and fissures of
teeth in order to isolate from
rest of the oral cavity
• According to simonsen:
Material that is introduced into
the pits and fissures of caries susceptible teeth,
thus forming micromechanically bonded
protective layer cutting access of caries
producing bacteria from their source of
nutrients.
3. HistoryThe first materials used
experimentally as sealants
were based on cyanoacrylates
but were not marketed.
By 1965 Bowen et al had developed
the bis-GMA resin,
which is the chemical reaction
product of bisphenol A
and glycidyl methacrylate. This is the
base resin to most of the current
commercial sealants. Urethane
dimethacrylate and other
dimethacrylates are alternative
resins used in sealant materials.
4. Properties
Some sealants contain
filler, usually silicon
dioxide microfill or even
quartz
Sealant materials may be
transparent or opaque.
The cariostatic properties
of sealants are attributed
to the physical obstruction
of the pits and grooves
Activating or Curing
Self-cured(chemically)
Light-cured(Ext energy sourrce):
uv
Visible light-curing
5. Properties
Sealants are most effective in children when they are applied
to the pits and fissures of permanent posterior teeth
immediately on eruption of the clinical crowns(Art & Science
2013)
Sealant materials(self-cured and light cured) are based on
urethane dimethacrylate or BIS-GMA resins. Tints frequently
are added to sealants to produce color contrast for visual
assessment.
6. • Using Glass Ionomer As Sealant:
1. deeply fissured primary molars that are difficult to isolate
due to the child's precooperative behavior
2. in partially erupted permanent molars that the clinician
believes are at risk for developing decay
• In such cases, glass ionomer materials must be
considered a provisional sealant to be
reevaluated and probably replaced with resin-
based sealants when better isolation is
possible
7. RATIONALE FOR USE
OF SEALANTS
• 1. Bonded resin sealants, placed by appropriately trained dental
personnel, are safe, effective, and underused in preventing pit and fissure
caries on at-risk surfaces. Effectiveness is increased with good technique
and appropriate follow up and resealing as necessary.
• 2. Sealant benefit is increased by placement on surfaces judged to be at
high risk or surfaces that already exhibit incipient carious lesions. Placing
sealant over minimal-enamel caries has been shown to be effective at
inhibiting lesion progression. Appropriate follow-up care is recommended,
as with all dental treatment.
• 3. Presently, the best evaluation of risk is made by an experienced clinician
using indicators of tooth morphology, clinical diagnostics, past caries
history, past fluoride history, and present oral hygiene.
• 4. Caries risk, and therefore potential sealant benefit, may exist in any
tooth with a pit or fissure, at any age, including primary teeth of children
and permanent teeth of children and adults.
8. • 5. Sealant placement methods should include careful cleaning
of the pits and fissures without removal of any appreciable
enamel. Some circumstances may indicate use of a minimal-
enameloplasty technique.
• 6. Placement of a low-viscosity, hydrophilic materialbonding
layer as part of or under the actual sealant has been shown to
enhance the long-term retention and effectiveness.
• 7. Glass ionomer materials have been shown to be ineffective
as pit and fissure sealants but can be used as transitional
sealants.
• 8. The profession must be alert to new preventive methods
effective against pit and fissure caries. These may include
changes in dental materials or technology.
9. Indications for Sealants
• Sealants may be indicated for either preventive or therapeutic uses, depending on the
patient’s caries risk, tooth morphology, or presence of incipient enamel caries.(art &
science)
• The sealant restoration is indicated primarily on the occlusal surfaces of permanent
molars and premolars and may also be indicated for primary
molars. (www.nature.com)
• Only caries-free pits and fissures or incipient lesions in enamel not extending to the
dentinoenamel junction (DEJ) currently are recommended for treatment with pit-and-
fissure sealants. (art & science)
•A history of dental caries
•Deep retentive pits and fissures
•Early signs of dental caries
•Poor plaque control
•Enamel defects, such as enamel hypoplasia
•Orthodontics appliances
10. Contraindications
• Active caries lesion
• Interproximal caries
• Chalky view,soft,changing color to brown-gray
• Dentin caries
• And much caries….
11. SEALANT TECHNIQUE
After selection, the tooth is washed and dried
and the deep pits and fissures are reevaluated .If
caries is present, restoration or a combination of
restoration and sealing may be indicated
STEPS: (McDonald) (Pinkham)
– CLEANING ISOLATION
– ISOLATION CLEANING
– ETCHING ,……
– WASHING
13. CLEANING
• Pamis past
– Rubber cap or brush mounted on angle
– Teeth brush
Or polish with air pressure(NaHCo₃)
• Eching
• Quarter round bur
14.
15. ECHING
• Create Microporosities in the enamel surface
• Generally, 30% to 50% acid solutions or gels are now
recommended.(phosphoric acid)
• Placment by:
– Slender brush
– Cotton pellet
– Small sponge
16.
17. • If a solution is used, one should gently agitate and
replenish it, making an effort to avoid rubbing and
breaking the enamel rods
• If gel is used ( skipping )
– Gel better than solution (control)
• 2-3 mm cusp slope and whole pits & fissures exist in lingual
and buccal
• Not infiltrate to proximal
18. Eching(time)
• 15 seconds for permanent
• 15-30 s for primary
– be resistant to etching and may require a longer
etching time
• More time for flurosis teeth
• no increase in bond strength with 120-second etching on
primary teeth compared with 15-, 30-, or 60-second etching
times.24 Their in vitro study showed that the etch depth
increased between 60 and 120 seconds, but there was no
corresponding increase in bond strengths.
19.
20. WASHING
• Most of Most manufacturers' instructions advocate a
thorough washing and drying of the etched tooth surface
but do not specify a time interval. Phillips advocated a 40
second washing time.25 Norling has advocated 20 seconds
• The etched enamel is dried using a compressed air stream
that is free of oil contaminants (frosty appearance)
21. Dentin Bonding Agent
• increased sealant retention in teeth even
when salivary contamination occurred
• Use in Hard isolation:
– Partially eraupted tooth
– precooperative behavior
• must be thoroughly air-dried across the
surface to be sealed to avoid a thick layer of
adhesive residue.
23. Chemically Cured Sealant
• mixing without vigorous agitation can help to
prevent the formation of air bubbles.
• catalyst to the base
• Short working time
24. Visible Light Cured Sealant
• is not completed without the exposure of the material to the
curing light ( operating and ambient light )
• Long working time
• Placement Variety of putting sealant by different aplicator
• Method:
– Putting
– Gently teased with a brush or probe into the pits and grooves
• curing just on surface area requires polymerization
• Porating Air bubble less than chemically type
• the unpolymerized surface layer should be removed by
washing and drying the surface to avoid an unpleasant taste.
26. CHECK OF OCCLUSAL INTERFERENCES
• Articulating paper
• filled sealant => adjusting the occlusion before
the patient is dismissed.
• Before removing rebberdam, the excess
should be removed before detaching that:
– A small round bur
– Sharp instrument
