made by narges shojaei

1. In the name of GOD
Pit and fissure sealants
Narges shojaei
1

2. the Centers for Disease Control and
Prevention (CDC):
profession is dental caries, a chronic disease
affecting more than 90% of adults aged 20 to
64 years.1 Although chronic diseases are
among the most common and costly of all
health problems, they are also among the
most preventable
2

3. Epidemiology of Pit and Fissure Caries
dramatic improvements in the prevention of caries
have occurred :
I. fluoride exposure
II. enhanced awareness of the benefits of early care
III. increased access to dental care
IV. increased financial coverage by insurance
companies
V. group plans, and government-funded programs of
preventive and restorative dental procedures for
children 3

4. According to the National Institute for Dental and
Craniofacial Research, 20% of the population bears at least
60% of the caries
• Dental caries :children living in poverty
• five time
• Minority populations
• specific tooth surfaces
• almost 25% of the decayed, missing, filled surfaces (dmfs)
index
• 90% of caries in permanent
• two thirds of caries
4

5. Why The occlusal surface is prone to caries ??
• immature tooth enamel high organic content
• pit and fissure morphology
• the molars take along time to fully erupt:1.5_2 years
• fluoride is less effective in preventing caries on the occlusal surfaces
5

6. in 1955, Dr. Michael Buonocore revolutionized dentistry with the first
reserch on adhesive dentistry
a physical barrier over susceptible pits and fissures and, in effect, “seal”
out caries, preventing the carious process
In 1971 the first dental sealant, Nuva-Seal
the theory of sealing the occlusal surfaces of teeth in an effort to
maximize “the power of prevention.”
6

7. Sealant Effectiveness
Unquestionably, dental sealants prevent pit and fissure caries in both
primary and permanent teeth
Healthy People 2010 set a goal for the prevalence of sealants in
children and adolescents to increase to 50%
Low usage :
1. lack of confidence in the bonding of sealants to enamel
2. concern for sealing over caries
3. difficulty of achieving isolation
4. lack of reimbursement for sealant placement
7

8. Current sealant utilization:
8

9. How Sealants Work:
1. Resin
2. glass ionomer
3. polyacid-modified resins
1. most commonly accepted
material
2. by micromechanical
retention
3. tooth must be clean and
remain dry
4. enamel is etched with
35% to 37% phosphoric
acid,
• different bonding mechanism
• retention, chemcial bonding,
and chelation
• hydrophilic
1. tooth is cleaned, and a tooth
conditioner of polyacrylic acid
is applied
2. rinsed and dried
3. Aply gi
9

10. Types of sealants:
variety of materials, colors, and viscosities
Resin-based sealants :
• unfilled, filled
• clear, colored
• visible light–polymerized, autopolymerizing (chemically cured
• fluoride-releasing materials
earliest sealants :autopolymerizing but now replaced by self cured
sealants
10

11. Why?
1. sets in 10 to 20 seconds
2. No mixing and air bubble
3. the viscosity of the sealant remains constant
4. sealant material does not set until it is light activated
5. similar retention rates and similar strengths.
11

12. Color:
available as clear or opaque white:
Advantage of an opaque sealant:
1. easy to see during application
2. easy to monitor its retention at a recall visit
3. . Assessment of a clear sealant requires tactile
4. No apparent difference in the clinical efficacy of either type of
sealant
being able to quickly and correctly assess
sealant retention is clinically important.
12

13. newer materials
1.color properties:Clinpro (3M ESPE, St. Paul, Minn.)
• that is pink upon application and turns white when cure
• . This color change provides no clinical advantage and has been
described as a “perceived marketing benefit
2:(Ivoclar Vivadent, Amherst, N.Y.).
• containing a photochromic dye
• correct wavelengths :change from clear/yellow to green
• is clinically relevant because it may assist a provider in assessing the
sealant’s retention upon recall examination
• But:using a polymerizing lamp
• have similar properties andcaries-protective as other resin-
based sealants
13

14. 1
Filler Content:
physical characteristics
unfilled sealants deeper into the fissures :
• low viscosity:longer resin tags, and therefore be better
retained
• other studies have found similar retention rates with unfilled
and filled sealants
• clear advantage of the unfilled sealant :
1. lower rates of microleakage
2. better penetration into the fissures
3. occlusal adjustment is not necessary(necessity to adjust the
occlusion increases the time and cost of the procedure)
Viscosity
flowability,
and resistance to wear
14

15. flowable composite:
 inferior retention and microleakage
 utilizing a bonding agent improves fissure penetration and
decreases microleakage
need for a bonding agent and occlusal adjustment
the conventional unfilled resin-based sealant appears
to be the most appropriate preventive therapy.
Fluoride-Releasing Sealants:salivary fluoride levels are the same before and
after
no long-lasting release of fluoride
marketing benefit by manufacturers
15

16. Glass Ionomer:
as an alternative to resin-based
1. fluoride-releasing
2. recharging ability
3. moisture toleration
4. easy application
But poor retention rates the use of resin-based sealant
usage:
 ART(high-viscosity sealants placed with “finger pressure)
 compromise sealant placement
 Preventin of caries resin baced sealant
 Retention resin based sealant
16

17. Polyacid-Modified Resin Composites
(Compomers):
• the esthetic property of composite
• fluoride-releasing property and adhesion of glass ionomer
similar to composites
Similar to GI:release fluoride( GI )
poor marginal integrity,retention and occlusal wear
• contain no water
hydrophobic
• polymerization
• lack the ability to
bond to tooth
• require bonding
agents
17

18. Who Really Needs Sealants?
18

19. 19

20. Age at Placement:
• caries incidence occurring shortly after tooth eruption and then
tapering
• occlusal surface was most vulnerable(first few years after
eruption )
• that fluorides may have caused a delay in pit and fissure caries
resulting in occlusal surfaces that decay at a later age
• adults should receive sealants when the tooth or the patient is at
risk of experiencing caries
• place a sealant should not be based on how long ago
the tooth erupted but on the clinical impression of
whether a sealant is necessary to prevent caries
20

21. Which Teeth Should Be Sealed?
Traditionally: non carious first and second permanent molars
with deep fissures
now any tooth at risk of developing caries
• including primary teeth
• permanent molars with incipient, noncavitated lesions, and/or
premolars.
21

22. Indications :
 deep, retentive pits and fissures”(cause wedging or
catching of an explorer)
 stained pits and fissures with minimal appearance of
decalcification or opacification (no cavitation)
 no RG or clinical evidence of interproximal
 use of other preventive treatment, such as fluoride
therapy
 possibility of isolation
22

23. Contraindications :
well-coalesced, self-cleaning pits and fissures
interproximal caries in need of restoration
interproximal lesions or restorations with no preventive
plan/treatment to inhibit caries formation
life expectancy of the primary tooth is limited
no possibility of isolation from salivary (due to either eruption
status or patient behavior.)
23

24. Diagnosing Occlusal Caries
dentists correctly diagnose only 42% of cases
Usage of expelorer : yes or no ?
No :
Yes :
 eliminate plaque in the fissures
 determine surface roughness of incipient lesions
 time-tested tool
 Tactile diagnosis :specific criteria for detection and diagnosis of pit
and fissure lesions
 does not increase
dentists’ ability
 tactile examination
unreliable
 enamel defects(cavitation
24

25. Caries is present when :
1. explorer catches or resists removal after the insertion into a pit or
fissure
2. when this is accompanied by one or more of the fallowing
• A softness at the base of the area
• Opacity adjacent to the pit or fissure
• Softened enamel adjacent to the pit or
fissure
25

26. the use of explorers is not necessary for the detection of
early lesions
Visual examination alone (of a clean, dry tooth) is
sufficient to detect early lesions
26

27. Sealing Over Incipient Caries:
If sealants are applied properly and are monitored periodically, caries
arrest beneath a sealant
sealant placement greatly reduces the number
of carious lesions that progress
 decreases the viable
bacteria
 Acid etching eliminates
75% of the viable
microorganisms
 100% reduction in total
viable bacteria
27

28. . Whenever a situation occurs in which the
practitioner is certain that a restoration is not yet
warranted but is unsure of whether the fissure is
simply stained or is exhibiting signs of incipient
caries, the practitioner should err on the side of
placing a sealant rather
than monitoring the lesion.
28

29. Cleaning the tooth:
For flow in the fissures it must be cleand:several method:
historically:pumice ,prophy cap ,bristle brush
Other method: explorer ,air water spray or dry bristle brush
Sup cleaninig method: cavitron prophy-jet(air polishing)
Advantage: remove more debry ,increase resin tags
but not standard
equipment cost and complication
No difference in retention
29

30. Mechanical preparation:
Invasive technique minimally described:
Enameloplasty and fissurotomy:
 Better penetration
 Increase surface area fore etching
 Dosent decrease microleakage
Air abrasion :
another technique but cant substitute etching
Some studies show that air abrasion in combination with
Etching improved retention
30

31. Disadvantage :
• limits delegation of sealant placement to axilliaries
• Decrease cost effectiveness
• Expose child to handpiese
the plaque should be removed but removal of tooth
structure by bur unnecessary
Effect of fluoride treatment
Multiple studies confirm sealant bond strength and retention
Are not affected by fluoride treatment before sealant
application
31

32. Factors affecting sealant success:
 Etching
 Drying agent and time
 Curing
 Isolation
 Time of sealant placement
 Auxiliary application
 Four-handed delivery
32

33. Etchant :
Phosphoric acid , self etching system , liquids and gel
 Historically:ething:60 s and rinsing time :at least 10 s
 Etching time for fluoride tooth should be increased
 Usual recommendation : etching:30 s rinsing :20 -30 s
 It is important that removal of all etching agent from surface
No difference between liquids or gel system in bond strength
And retention
Self etching needs a separate etching step
Not recommended
33

34. Drying agent and time :
Applying alcohol or acetone Because of Resins that are hydrophobic
agent :
Don’t decrease microleakage or increase retention
No recommended drying time : occlusal surface should have chalky
Or frosted appearance
No chalky : etching again
34

35. Curing :
Phothoiniatiator (camphoroquinone) absorb energy from blue light
(479 nm) that cause low viscosity monomer to matrix polymer
 Sealant must be adequately cured to obtain purported physical
properties
 Most widely used:
1: QTH curing light:
1. Reguire cooling fan
2. Low cost
3. Easy to maintain and repair
4. Curing composite in 20 s
35

36. 2: LED :
First LED curing had low energy output ,recent LED increase out put
intensity
Latest LED s advertise 5s curing in<torbo> or <plasma> method
May be concerns with such quick cures:
1. Significant rise temperature(pulp injuries)
2. May cause undesirable physical properties
3. Increase polymerization contraction
4. More internal stress
5. Reduced flexural fatigue
Highest level of cure:40 s exposure with
the tip of the Light source placed directly
over sealant
36

37. Several factors affect level of cure :
1. Shade of the materials
2. Filler content
3. Thickness of material
4. Intensity of light curing
5. Distance between light source and sealant surface
clear sealant can be cured to deeper level than opaque sealant in same
curing time
37

38. Isolation
Resin based sealant are moisture sensitive:
Saliva prevent the formation resin tag decrease retention
Isolation is a critical step to the success of sealant
Considered a key concept in clinical procedures
Rubber dam:
Some studies show increased retention
Whenever possible especially if cocorurrent
Operative treatment is provided rubberdam
should be used
38

39. Timing of sealant placement :
• Correlated with overall retention:
• Partially erupted teeth require repair or replacement more than
other
• When operculum extended over distal marginal ridge:50% of teeth to
be resealed
• When it was at level of marginal ridge : reseal 26%
• When achieving isolatoin is difficult or precooperative :using
Glass ionomer
39

40. Use of intermediate bonding agent :
An intermediate layer between tooth and sealant
advantage
 Increase retention rate
 Decreased microleakage
 Increased penetration of sealant into fissures
 Not only permanent tooth : primary as well
 Hypomineralized teeth(at higher risk than normal)
disadvantage
 Proper sealant placement technique
 Increased chair time
 Cost
whould inhance sealant retention on clinical
Situation
40

41. Auxiliary application :
No difference in retention of sealant when applied by dentist or
trained dental auxiliary
Four-hand delivery :
 No difference in retention
 Expert opinion support use of trained dental assistant
 Improve quality and efficiency of sealant placement
 Isolation
 Shorten placement time
 Reduce fatigue and enhance patien care
41

42. School based sealant program:
Increase sealant using
Reduceing careis
Provide prevention service to child less likely to receive dental care
It is important and effective public health approach that
complements clinical care systems
in promoting oral health
42

43. Other uses of sealant:
1. Sealing over the restoration
2. Repairing margin of restoration
3. Preventing demineralization around orthodontic brackets
Reduce microleakage
Decreased incidences of recurrent caries
Increase longevity of restoration through repair of marginal defect
No loss of tooth structure and low cost
43

44. Clinical procedure:
1:Isolation:
Most common method :cotton roll
For maxillary isolation :
 tri angular buccal shield :angle posterior
 Cotton roll : maxillary vestibule
 Mirror is used during entire procedure
mandibular isolation :
 Cotton roll : two vestibule
 Cotton roll holder or hand may be
used
 Triangular shield on buccal
44

45. Etching :
 With 37% phosphoric acid
 Including pit and fissure and lingual groove of max molars
and buccal pit of man molars
 Etching should extend up cuspal line ,2 -3 mm beyond anticipated
margin of sealant
45

46. Rinsing and drying :
 Air-water spray and high volume suction
 Most manufactors recommended :20-30 s
 The goal of rinsing is removal all of etchant from surface
Sealant application and polymerization:
 Should be applied to all pit and fissures
 With : expelorer ,PICH, or small brush
 Shouldn’t be over filled
• Does not extend past the etched area
• Limit occlusal interence
• Ensure adequate depth of cure
Small bubbles should be teased out of the material before
polymerization
• Exposure time of 40 s is more appropriate 46

47. Evaluating the sealant :
 Visually an tactilely examine the sealant before removing isolation
 Void or bubble : material can be directly added
 Sealant retention :examine by attempting to dislodge by expelorer
If sealant dislodge :
 Fissure inspected for Remaining debri :re etched…
 Sealant pooled on distal margin created ledge tht should be removed
 Sealant misplaced on inter proximal should be removed
 Un polymerized layer(BPA):removed by pomice or rinsing
Occlusion Adjustment :
Yes:filled sealant and flowable composite
With:com finishing bur(high spead
,round bur,stone(low spead)
MC:centric stop on enamel
47

48. Periodic evaluation:
 It should be evaluated at every recall visit
 Partial or complete loss of material failure
 If only part of sealant remain : attempts can be made to dislodge with
expelorer ,if it remain :no no need to remove this
 MC :
 5% -10% of sealant need to repaired or replaced yearly
 Partialy or completely,discolored or defective old sealant should be
removed
48

49. Troubleshooting sealant placement :
If sealant debonds upon immediate evaluation:
1. Debris remains on the fissure
Cleaning,re etching and apply material
2 .Saliva contaminated the enamel
Re etched ,dry and resealant
3. The tooth wasnot completely dry after the rinsing step
49

50. 50