Pit & Fissure Sealing Techniques

Pit & Fissure Sealing Techniques Preclinical Operative Dentistry Practical Dr Jamal N Naim

Review of occlusal morphology • Fossa • Central Fossa • Triangular Fossa • Pit • Sulcus • Grooves • Developmental Groove • Supplemental Groove • Fissure

Review of occlusal morphology A Fossa is an irregular depression or concavity. Central fossae are on the occlusal surface of molars. They are formed by the converging of ridges terminating at a central point in the bottom of the depression, where there is a junction of grooves. Triangular fossae are found on molars and premolars on the occlusal surfaces mesial or distal to marginal ridges. Central Fossa Triangular Fossa

Review of occlusal morphology A sulcus is a long depression or valley in the surface of a tooth between ridges and cusps, the inclines of which meet at an angle. A sulcus has developmental groove at the junction of its inclines. A developmental groove is a shallow groove or line between the primary parts of the crown or root. A supplemental groove, less distinct, is also a shallow linear depression on the surface of a tooth, but it is supplemental to a developmental groove and does not mark the junction of primary parts. Developmental groove Developmental groove

Review of occlusal morphology Pits are small pinpoint depressions located at the junction of developmental grooves or terminals of those grooves. Central pit is a term used to describe a landmark in the central fossa of molars where the developmental grooves join. Pit Central Pit

Fissure Types IK U I V

Fissure caries • Plaque retention • Mechanical plaque removal is difficult • Depth of fissure is in close proximity to the DEJ

Early caries in fissure confined to enamel only [Incipient Caries]

Early caries in fissure enamel spread [Incipient Caries]

Caries in fissure Spread to DEJ and involves dentine

Caries in fissure Dentine involvement note: no cavitation

Even a single toothbrush bristle is too large to enter and clean pits and fissures. Dental sealants are a noninvasive technique that preserves the tooth structure and at the same time prevents dental decay.

Fissure sealant Definition: A low viscosity material which is flowedinto pretreated pit or fissure on (occlusal, buccal, palatal surfaces) which fills the pits/fissures. • The Material polymerizes into a hard material. • Sealants are used as: • preventive treatment (before caries occur) and • therapeutic treatment.

Fissure sealant • Fissure sealants act as a physical barrier between the sealed area of the tooth and the bacteria in the oral cavity • Eliminate the environment conducive to s. mutans. • Make pit/fissures easier to clean by tooth brushing and mastication • Some sealants release fluorides A dental sealant is successful only if it firmly adheres to the enamel surface, and protects the pits and fissures from the oral environment.

Indications for fissure sealing Patients at risk of pit or fissure caries: • Newly erupted teeth (less than 4 years), useful for selected patients through the caries-active period, ages 6 to 15 years • Incipient caries in fissures with no radiographic evidence of caries on the proximal surface • Undergoing orthodontics • Xerostomia • Scheduled to undergo head and neck radiotherapy

Indications for fissure sealing Sealants should be used as part of a preventive program that includes: • the use of fluorides, • dietary considerations, • plaque control, and • regular dental examinations.

Contra-indications for fissure sealing • Shallow, self cleansing pits/fissures • Adult patient with no caries risk • Patient with low or negligible caries risk (eg. no new lesions or past restorations) • Tooth has radiographic evidence of proximal caries • Occlusal caries has progressed into the dentine. • Partially erupted teeth in which all pits/fissures not exposed to oral cavity. • If can not obtain excellent moisture control (for composite resin) • Uncooperative child/patient

Types of sealant materials • Classification by polymerisation: • Self-curing/auto-polymerized sealants (base and catalyst) • Photo-polymerized • Classification by contents: • Composite resin (CR) –bonding per micro-retention- • Filled (reduces occlusal wear) • unfilled • Glass ionomer (GI) –chemical bonding- • Fluoride-releasing

Types of sealant materials • Classification by colour: • Clear • Tinted • opaque

Steps by fissure sealing Clear Dry Clean Etch Dry Seal Check Care

Equipment • Explorer • Mouth mirror • Tweezers • Cotton roll/rubber dam • Polishing paste & brush • Etching gel • Sealant applicator • Sealant kit • Articulating-paper & holder • Fluoride gel • low speed handpiece • Protective eye wear • Light curing unit • Finishing burs

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Bite wing x-ray & with probe

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Polish with pumice or fluoride free paste and rinse with water Clean the grooves and fissures with an explorer

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care • rubber dam or • with cotton roll, dri-angles to the stenson's duct and saliva ejector

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care with cotton roll, dri-angles to the stenson's duct and saliva ejector

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Or also best with rubber dam

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Dry the site with compressed air that is free of moisture or oil

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Apply etchant gel (37% phosphoric acid) for 30-60 seconds If the etch is liquid, use a brush

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Rinse for 10 to 15 seconds (by gel up to 45 sec.), then dry with compressed air for 10 sec. If isolation with cotton, replace cotton roll before drying.

Steps by fissure sealing Clear Dry Clean Etch Dry Seal Check Care Etched enamel is necessary to produce micro-pores for the micro-retention of the sealant with enamel. Don’t rub etched areas to avoid damaging of the micro-retention

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Apply liquid sealant over fissures and pits. Allow it to flow in all etched areas

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Apply light cure tip to each portion Place the tip 2mm from sealant Light cure as manufacturer information (20 -30 sec)

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Two liquids are mixed together and applied over fissures. Polymerization is chemical

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Evaluate the sealant with an explorer for hard smooth sealant and for retention. Imperfections should be corrected.

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Check occlusion with articulating paper to detect high spot. Remove excess sealant with a finishing bur and polish with a rubber if necessary. Floss treated teeth and scale away residual sealant

Steps by fissure sealing Clear Clean Isolate Dry Etch Dry Seal Check Care Apply topical fluoride Evaluate sealant every 6 months (recall)

Pit & Fissure Sealing Techniques