fissure sealant an preventive resin restoration Flashcards
what is fissure sealant
a material places in the pits a fissures of teeth in order to prevent development of dental caries
what is a resin restoration
restoration of a carious lesion into dentine where the lesion is limited to areas of the tooth not bearing occlusal loads
what is dental caries
Dental caries is a disease caused by an ecological shift in the composition and activity of the bacterial biofilm when exposed over time to fermentable carbohydrates, leading to a break in the balance between demineralisation and remineralisation
as tooth brush bristles can’t access the fissure system what results
icro-organisms remain within the fissure system undisturbed. The tooth is most susceptible to plaque stagnation during eruption - 12 -18 months
Carious lesions are preventable by averting onset, and managable by implementing interventions, which may halt progression from early stage of the disease to cavitation, characterised by enamel demineralisation to frank cavitation
what is issues form a primary prevention perspective
From a primary prevention perspective, anatomic grooves or pits and fissures on occlusal surfaces of permanent molars trap food debris and promote the presence of bacterial boil, thereby increasing the risk of developing carious lesions.
Effectively penetrating and sealing these surfaces with a dental material - for example - a pit and fissure sealant - can prevent lesions and is part of a comprehensive caries management approach
what is the secondary prevention
sealants can inhibit the progression of non cavitated carious lesions
- part of comprehensive cares management approach
what percentage does pits and fissures account for
12.5%
what percentage of carious lesions are in the pits and fissures
66%
why do we use fissure sealant
- highly effective at preventing dental caries
- caries reduction 60%
- retention rate of 52% up to 4 years
- reduce incidence of occlusal carious lesions in permeant molars by 76% after 2-3 years of follow up
- for a population with caries prevalence;ence of 30%, 207 carious lesions would be prevented out of 100 sealant applications
what is the benefits of fluoride varnish
73% reduction in the incidence of occlusal carious lesions in permanent molars after 2-3 years
who is selected for fissure sealants
- all children at high risk of dental caries
- susceptible sites of permeant teeth
- could include palatal pits on upper lateral incisors
- good practice to FS 2nd primary molars
why are the patients factors and tooth factors on when FS should be used
Patient factors
- caries In primary teeth
- caries in other permanent molars
- patients with underlying medical physical or emotional problems
- risk factors (diet)
Tooth factors
- depth of fissures
- hypomineralisation
- hypoplasia
- inaccessible for cleaning
describe different placement techniques
Placement techniques vary based on sealant type and the manufacturer or brand
JADA 2016 - when assessing retention, GI sealants may have 5 times greater risk of experiencing loss of retention from the tooth compared with resin-based sealants after 2-3 years
The guideline panel suggests that clinicians take into account the likelihood of experience of lack of retention when choosing the type of sealant material most appropriate for a specific patient and clinical scenario
For example, in situations where dry isolation is difficult [eg partially erupted tooth], then a material that is more hydrophilic e.g. GI would be preferable to a hydrophobic resin-based sealant
On the other hand if the tooth can be isolated to ensure dry site, then resin-based sealant may be preferable
How are fissure sealants placed
- clean the pits and fissures
- Isolate the tooth - moisture control
- Ethc ,wash + dry
- Apply bonding agent, cure
- Apply sealant, cure
- Evaluate
what is step 1 of placing fissure sealant
Pre treatment cleaning
- tooth preparation with pumice and rotary results in good clinical retention rates, dry brushing achieves similar results
Do FS with rubber dam - needs LA
what is step 2 of placing FS
Moisture control
- rubber damn but only if restoration care is being undertaken in that quadrant
we would not place a rubber damn (which requires LA0 just to apply a fissure sealant)
- Most commonly we use cotton wool rolls, dry tips and good aspiration
what is step 3 placing FS
etch wash dry
20s
usually 35-37.5% phosphoric acid
if moisture contamination - re-etch
Taste
Need frosty appearance
what is step 4 placing FS
Bonding agent
Use of a bonding agent under a resin sealant aids bond strength
The use of a bonding agent under sealant on wet contaminated surfaces yields bond strengths equivalent to the bond strength obtained when sealant is bonded directly to clean etched enamel without contamination
Use of a bonding agent tends to increase the time and cost of the sealant application but in case where maintaining a dry surface is difficult or there there are areas of hypomineralization on the surface it has many advantages
what is step 5 of FS application
SEALANT APPLICATION
What is step 6 of FS application
EVALUATE
- no air bubbles or overhangs
If you have applied a very thin layer you should not need to use articulating paper – there should be no change in occlusion
when are FS failure rates high
- placed on newly erupted teeth
- placed in mouths with high previous caries experience
monitoring the integrity of sealants is vital - inform parents of the need to monitor
why do we use resin restorations?
when a ‘ stone dfissure’ is actually caries into dentine
- picked up on bitewing radiographs
- any cavitation identified in enamel surface
what doe we use to diagnose a resin restoration
bitewings / radiographs
dry teeth,goodlight
How do we give resin restorations
Caries into dentine
Give LA
Feel pain and sensitivity once burs get into dentine and clean ADJ
If close o pulp then give LA
Give children LA or tell adults they may feel sensitivity
LA- can put on rubber dam painlessly
Remove caries
Etch tooth
Seal non cavitated caries free pits and fissures
Place composite directly into cavity
Finished fissure sealant
how would you monitor FS/ resin restoration
- recall interval based on caries risk
- clinical + radiographie
- bitewings
- High risk children - BWs every 6 months
- Low risk - BWs every 12 months
- Repair/replace FS as required
what special investigation is required prior to undertaking a PRR
bitewing radiograph
how long do you etch for prior to washing and drying the tooth
20 seconds
